Search Results (85)

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2Is) have significantly improved the management of diabetes mellitus (DM). In the general population, these drugs have additional benefits, such as weight loss, improvement of liver steatosis, and a cardiorenal protective effect. However, data regarding the effects of GLP-1RAs or SGLT-2Is in the treatment of posttransplant diabetes mellitus (PTDM), obesity, and their potential cardiorenal protective effects in liver transplant (LT) recipients remain limited. PTDM increases the risk of developing graft steatosis, experiencing major cardiovascular events (MACEs), and developing chronic kidney disease and reduces long-term survival in LT recipients. The aim of this systematic review was to evaluate the efficacy and safety of GLP-1RAs and SGLT-2Is in the treatment of PTDM in LT recipients. Methods: Twelve retrospective studies (five specifically conducted in LT recipients and seven in mixed solid organ transplant cohorts, including LT recipients) that collectively enrolled 402 LT recipients treated with GLP-1RAs and/or SGLT-2Is for PTDM were selected. Results: GLP-1Ras and SGLT-2Is reduced serum glycated hemoglobin levels, body weight, and insulin requirements in LT recipients. Some studies reported benefits in reducing graft steatosis, improving renal function, and in reducing the occurrence of MACEs. Common adverse events included gastrointestinal symptoms, which rarely required treatment discontinuation. Conclusions: GLP-1RAs and SGLT-2Is represent promising treatment options for PTDM in LT recipients, offering metabolic benefits with manageable side effects. However, further prospective studies are needed to establish the long-term safety and efficacy, as well as the favorable impact on patient survival, of these drugs in LT recipients. Full article

Deep dehumidification is crucial for industrial applications requiring ultra-low humidity levels. Traditional cooling-based dehumidification struggles to achieve low dew points efficiently due to excessive energy consumption and frost formation risks. As an alternative, desiccant-based methods, particularly solid desiccant systems, offer improved performance with lower energy demands. This study experimentally investigates a fixed-bed dehumidification system utilizing a plate-fin heat exchanger filled with a silica gel/calcium chloride composite material. The performance evaluation focuses on the influence of ambient conditions and operating parameters, including air velocity and cooling fluid temperature. Among these, the most influential parameter was the velocity of air. For the tested heat exchanger, an optimum value in the range of 0.4–0.6 m/s was identified. Under optimal conditions, the tested HEX was able to reduce the dew point of air down to −2 °C, achieving a reduction in the humidity ratio up to 13 g/kg. The results indicate that air velocity significantly impacts also heat and mass transfer, with coefficients ranging from 80 to 140 W/(m² K) and 0.015 to 0.060 kg/(m² s), respectively. The findings highlight the potential of composite desiccant fixed-bed systems for efficient deep dehumidification, outperforming conventional lab-scale components in heat and mass transfer effectiveness. A comparison with other works in the literature indicated that up to 30% increased mass transfer coefficient was achieved and up to seven times higher heat transfer coefficient was measured. Full article

Background/Objectives: the aim of this study was to evaluate the safety and efficacy of percutaneous transhepatic lithotripsy using the SpyGlassDSTM cholangioscopy system for the treatment of difficult stones. Methods: Retrospectively, all patients treated with percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy system were analyzed. As primary outcome measures, the following data were assessed: the presence of a previous history of the hepatobiliary disease, location of stones, reasons for the choice of the procedure, previous balloon bilioplasty, type of pre-procedural imaging, procedural time, technical success, clinical success, and post-procedural complications (according to CIRSE classification). Clinical success was considered “primary” when achieved with a single treatment, and “secondary” if more than one treatment was required in the duration of follow-up. Results: 10 patients (6 males and 4 females, mean age = 64 years, SD = 22), all with cholangitis due to gallstones, underwent 11 PTL procedures using SpyGlassDSTM. Technical and clinical successes were achieved in all patients (100%). Primary success was observed in 4/10 (40%) patients, while the remaining 6/10 (60%) patients undergoing re-treatment, and all showed secondary success (100%). No periprocedural complications were observed. In 10/11 procedures (90%), no relevant adverse events were recorded within the first thirty days of follow-up. In 1/11 case (9%), mild complications (grade I according to CIRSE classification) were registered in the following days after the procedure (<30 days). Conclusions: in conclusion, the treatment of percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy of difficult stones has been demonstrated as efficient and safe treatment. Full article

Introduction: Respiratory syncytial virus (RSV) is the main etiological agent in pediatric lower respiratory tract infections. The limited availability of therapeutic options for severe clinical cases associated with RSV infection makes prophylactic interventions a priority for containment. The aim of the current study was to evaluate the epidemiology of RSV in the Piedmont population and the consequences of containment measures applied during the pandemic on viral circulation in the immediate and medium-term post-pandemic phase. Methods: This study considered all biological samples analyzed for RSV at the City of Health and Science of Turin collected from 1 January 2016 to 31 December 2023. Evaluation of the positivity rates of samples was performed and differences between pediatric and adult population swabs (nasopharyngeal, pharyngeal, nasal aspirates) and bronchoalveolar samples were reported. Results: This study analyzed 14,085 samples and highlighted a trend in Piedmont RSV infections characterized by a higher pediatric population involvement of 82% compared to the adult population at 17%. A higher number of URT infections (95%) compared to LRT infections (4.6%) was also identified. This study shows a peak in RSV cases from November to April between 2016 and 2020. Our data show no RSV positivity during the 2020/2021 winter season, a result most likely due to the influence of containment measures implemented during the COVID-19 pandemic. Conclusions: Our study provided an epidemiological panorama of RSV and its high prevalence in pediatrics and adults. Pediatrics had a higher prevalence, while adults presented a delayed trend of about one month compared to pediatrics. The effectiveness of infection control measures applied during the SARS-CoV-2 pandemic to limit viral infections were proved. Future studies may further investigate the impact of the SARS pandemic on RSV epidemiology considering patients at a higher risk of severe symptoms. Full article

Background: Medical anthropology is a subfield that examines the various factors influencing health, disease, illness, and sickness. Cardiovascular disease (CVD) encompasses a range of disorders affecting the heart, arteries, and veins. Patients with CVD face significant, unique health challenges, including functional decline, repeated hospitalizations, and psychological and social issues, which contribute to a global decline in health and escalate health system costs. Medical anthropologists have explored this extensive category of diseases in numerous ways, including cross-cultural studies that enhance our understanding of these conditions. Therefore, building on these preliminary insights, this article posed the following research question: How does medical anthropology enhance our understanding, prevention, and management of cardiovascular diseases through cultural, social, and behavioral lenses? Methods: This study examined the research question through a narrative literature review. Results: The literature analysis revealed connections between medical anthropology and specific CVDs: heart disease, hypertension, arterial disease, venous disease, and wound care. Conclusions: The findings from the literature analysis indicate what could be described as the cultural “blood ties” between medical anthropology and cardiovascular disease. In this manner, in the spirit of integration, inter-, and transdisciplinarity, it is increasingly necessary to incorporate mixed-method approaches drawing from both the anthropological and medical fields to better deliver tailored care. Full article

Background: Peripheral arterial disease (PAD) is a growing public health problem due to its high and increasing prevalence worldwide. PAD is responsible for several severe complications that affect the quality of life (QoL) of affected patients. Social determinants of health (SDHs) cover five areas: economic stability, education access, and quality, health care access and quality, neighborhood and built environment, and social and community context. This study aims to investigate SDHs-related outcomes to better understand their potential role in the lives of patients with PAD. Methods: A qualitative study has been conducted using semi-structured interviews to understand the role of SDHs in patients with PAD. Braun and Clarke’s method was used to guide the qualitative analysis of the data. Results: Twenty-seven patients were recruited to receive the interview, including twelve males (44.44%) and fifteen females (55.56%), with a mean age of 63.3 years old (a range of 50–87 years old). SDHs related to the five areas investigated significantly impacted PAD patient diagnosis and outcomes. Conclusions: Our findings suggest that physicians and vascular surgeons should consider SDHs impairments to recognize vulnerable patient populations and tailor treatment methods and follow-up protocols to their specific needs. Full article

Guanidinoacetic acid (GAA), a precursor of creatine, has a recognized effect on ruminant performance when used as a dietary supplement. However, its impact on reproductive response remains to be elucidated. Therefore, this study aimed to contribute initially to this area by supplementing the diets of ewes with a high dose of GAA, evaluating its effects on reproductive response. Twenty adult sheep had their estrus synchronized using an MPA sponge, eCG, and PGF2α. After estrus detection ewes were mated. For 10 days until mating, ewes were grouped in groups of baseline diet (BSD; n = 10) and GAA diet (GAAD; n = 10), which was the BSD with daily 0.9 g/kg DM of GAA. After the eCG + PGF2α dose, the GAAD group exhibited an increase in the peak diastolic and pulsatility of the ovarian artery, a reduction in the systolic/diastolic peaks ratio, and a larger intraovarian blood perfusion area. A greater depletion of follicles with <3 mm was observed in the GAAD group and a higher number of follicles ≥3 mm. No differences were observed between the diets respect to pregnancy, and twin rates. Thus, a high GAA supply before mating significantly alters ovarian vasculature and improves follicular growth in ewes but does not affect the pregnancy rate. Full article

Background/Objectives: Vitamin D (VD) has immunoregulatory properties, generating interest in its potential to influence therapeutic outcomes in inflammatory bowel disease (IBD), other than affecting the expression of genes encoding enzymes and transporters involved in drug metabolism and transport. This study investigated VD-related single nucleotide polymorphisms (SNPs) as predictors of clinical responses in patients with Crohn’s disease (CD) and ulcerative colitis (UC) treated with vedolizumab (VDZ) or ustekinumab (UST) after 3 (T3) and 12 months (T12), as well as the achievement of fecal calprotectin (FC) levels < 250 mg/kg, a marker of mucosal healing. Methods: In this prospective study, 103 patients (67 CD, 36 UC) were enrolled, 40 receiving VDZ and 63 receiving UST. SNPs in the genes CYP24A1, GC, CYP27B1, and VD receptor (VDR) were analyzed via polymerase chain reaction (PCR) and associated with clinical and laboratory outcomes. Results: UST therapy demonstrated a higher clinical response rate at T12 compared to VDZ (p = 0.03). A correlation was found between response at T3 and T12 (p = 0.0002). GC 1296 AC polymorphism negatively predicted response at T12, with 63.6% of non-responders carrying this genotype. CYP24A1 8620 AG was a negative predictor for achieving FC < 250 mg/kg (p = 0.045). CYP24A1 22776 CT and VDR Cdx2 GG increased the likelihood of presenting CD over UC (OR 3.40, p = 0.009 and OR 3.74, p = 0.047, respectively). Additionally, CYP27B1 −1260 GT and +2838 CT increased the likelihood of non-ileal CD (OR 3.13, p = 0.054; OR 7.02, p = 0.01). Conclusions: This study reveals associations between VD-SNPs, clinical response to VDZ and UST, and IBD phenotype and localization, supporting the development of personalized IBD treatment and warranting further validation. Full article

Anemia and mineral and bone disorder (MBD) are significant complications of chronic kidney disease (CKD). The erythropoietin (Epo) pathway plays a key role in both of these processes in CKD. Another molecule that plays an important role in CKD-MBD is fibroblast growth factor (FGF)-23, whose main role is to maintain serum phosphate levels in the normal range, acting via its co-receptor Klotho; however, its activity may also be related to anemia and inflammation. In this review, the regulation of Epo and FGF-23 and the molecular mechanisms of their action are outlined. Furthermore, the complex interaction between EPO and FGF-23 is discussed, as well as their association with other anemia-related factors and processes such as Klotho, vitamin D, and iron deficiency. Together, these may be part of a “kidney–bone marrow–bone axis” that promotes CKD-MBD. Full article

Background: The medical humanities (MH) are important in medical education, and one of the most relevant is medical anthropology. This discipline constitutes the bridge between the biomedical world and the human sciences because it can detect social, cultural, and psychological variables that can act as barriers to the provision of medical services in epidemic contexts, combining knowledge of pathologies in different cultures and epidemiology. Based on what has been reported so far, this article starts with a research question: what is the role of medical anthropology in medical education? Methods: A scoping review was established according to the PRISMAScR method to try to understand the role of this discipline in medical education. Results: In total, 22 articles were included, and the extracted data were organized into different themes: the reasons for teaching anthropology to medical students, methods used that are useful for medical students, teaching methods and techniques, and some problems regarding anthropology in medical education. Conclusions: The MH may support the decision-making of physicians, thus improving several physician skills to deliver the most appropriate care to patients. On the other hand, medical sciences may provide important feedback on medical anthropology to have an actual impact on curing and caring processes. Full article

Background: Diabetes mellitus (DM) is an ongoing and growing health problem worldwide, with a series of important complications such as diabetic foot that can significatively reduce the quality of life of affected patients. This study aims to explore the socio-cultural aspects of patients with diabetic foot, analyzing the following research question: “What are the socio-cultural aspects experienced by patients with diabetic foot?” Methods: A qualitative design using an ethnographic approach was applied to study the social and cultural aspects of Italian diabetic foot patients. Results: We included 20 key informants: 13 men and 7 women. Ages ranged from 54 to 71, with an average age of 61.2. The data analysis revealed five main themes: perceptions of diabetic foot, living with diabetic foot, impacts of culture and economic performance, barriers to health and diabetic foot, and home remedies and alternative medicine. Conclusions: This study provides a new perspective on the influence of cultural factors on the health of diabetic foot patients, showing various factors related to a lack of knowledge and training, fear, and acceptance of diabetic foot. This study also presents a new integrated model which will allow patients and practitioners to act on the various critical issues that emerged from our research. Full article

Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile. Full article

Electrophysiological aspects of cardiac amyloidosis (CA) are still poorly explored compared to other aspects of the disease. However, electrocardiogram (ECG) abnormalities play an important role in CA diagnosis and prognosis and the management of arrhythmias is a crucial part of CA treatment. Low voltages and a pseudonecrosis pattern with poor R-wave progression in precordial leads are especially common findings. These are useful for CA diagnosis and risk stratification, especially when combined with clinical or echocardiographic findings. Both ventricular and supraventricular arrhythmias are common in CA, especially in transthyretin amyloidosis (ATTR), and their prevalence is related to disease progression. Sustained and non-sustained ventricular tachycardias’ prognostic role is still debated, and, to date, there is a lack of specific indications for implantable cardiac defibrillator (ICD). On the other hand, atrial fibrillation (AF) is the most common supraventricular arrhythmia with a prevalence of up to 88% of ATTR patients. Anticoagulation should be considered irrespective of CHADsVA score. Furthermore, even if AF seems to not be an independent prognostic factor in CA, its treatment for symptom control is still crucial. Finally, conduction disturbances and bradyarrhythmias are also common, requiring pacemaker implantation in up to 40% of patients. Full article

Dietary changes expose consumers to risks from Anisakis larvae in seafood, leading to parasitic diseases and allergies. Anisakis is recognized by EFSA as a significant hazard, with potential oncogenic implications. Diagnostic advancements, like the Basophil Activation Test (BAT), enhance sensitivity and accuracy in identifying Anisakis sensitization, complementing traditional IgE tests. We conducted a cross-sectional study on patients with allergic symptoms from April 2021 to April 2023 at two outpatient clinics in western Sicily. Our goal was to assess the prevalence of Anisakis-related allergies and to identify risk profiles using specific Anisakis IgE and the BAT, especially in regions with high raw fish consumption. The study evaluated specific Anisakis IgE as a screening tool for Anisakis sensitization, using questionnaires, blood samples, and immuno-allergology analyses. Anisakis-specific IgE values were compared with the BAT results, with statistical analyses including Fisher’s exact test and logistic regression. The results showed an 18.5% seroprevalence of Anisakis IgE, while the BAT as a second-level test showed 4.63%, indicating the BAT’s superior specificity and accuracy. The study highlighted the importance of the BAT in diagnosing Anisakis sensitization, especially in cases of cross-reactivity with Ascaris and tropomyosin. The findings confirm the BAT’s exceptional specificity in identifying Anisakis sensitization and support using Anisakis-specific IgE for population-based risk profiling. The BAT can effectively serve as a confirmatory test. Full article

Carotid stenosis is characterized by the progressive narrowing of the carotid arteries due to the formation of atherosclerotic plaque, which can lead to stroke and death as major complications. Numerous biomarkers allow for its study and characterization, particularly those related to “omics” sciences. Through the most common research databases, we report representative studies about carotid stenosis biomarkers based on genomics, transcriptomics, proteomics, and metabolomics in a narrative review. To establish a priority among studies based on their internal validity, we used a quality assessment tool, the Scale for the Assessment of Narrative Review Articles (SANRA). Genes, transcriptomes, proteins, and metabolites can diagnose the disease, define plaque connotations, predict consequences after revascularization interventions, and associate carotid stenosis with other patient comorbidities. It also emerged that many aspects determining the patient’s psychological and social sphere are implicated in carotid disease. In conclusion, when taking the multidisciplinary approach that combines human sciences with biological sciences, it is possible to comprehensively define a patient’s health and thus improve their clinical management through precision medicine. Full article