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Search Results (292)

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Keywords = remission period

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15 pages, 1476 KiB  
Article
Laboratory, Clinical, and Pathohistological Significance of the Outcomes of Patients with Membranous Nephropathy After 10 Year of Follow-Up
by Marko Baralić, Selena Gajić, Mihajlo Kostić, Milorad Stojadinović, Kristina Filić, Danka Bjelić, Vidna Karadžić-Ristanović, Ivana Mrđa, Jovana Gavrilović, Danica Ćujić, Aleksandar Sič, Stefan Janković, Ivan Putica, Sanja Stankovic, Dušan Vićentijević, Maja Životić, Sanja Radojević-Škodrić, Jelena Pavlović, Ana Bontić and Aleksandra Kezić
Life 2025, 15(8), 1221; https://doi.org/10.3390/life15081221 - 1 Aug 2025
Viewed by 365
Abstract
Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease [...] Read more.
Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney’s lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes (p < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD (p = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = −0.021, p = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, p = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease. Full article
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12 pages, 434 KiB  
Article
Gastroesophageal Reflux Disease 10 Years After Bariatric Surgery—Is It a Problem? A Multicenter Study (BARI-10-POL)
by Natalia Dowgiałło-Gornowicz, Monika Proczko-Stepaniak, Anna Kloczkowska, Paweł Jaworski and Piotr Major
J. Clin. Med. 2025, 14(15), 5405; https://doi.org/10.3390/jcm14155405 - 31 Jul 2025
Viewed by 245
Abstract
Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was [...] Read more.
Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was to evaluate the prevalence of GERD after MBS in a 10-year follow-up and analyze the endoscopic outcomes. Methods: This retrospective, multicenter study included 368 patients who underwent single bariatric procedure. The data came from five bariatric centers in Poland, part of the BARI-10-POL project. Data on symptoms of GERD, endoscopic findings, demographics, and surgical outcomes were collected for a 10-year follow-up period. Surgical procedures included SG, Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). Results: Of the 305 patients without symptoms of GERD, 12.3% developed de novo GERD postoperatively. There was no statistical significance regarding the new-onset symptoms and the type of MBS (p = 0.074) and the presence of symptoms of GERD and the type of MBS (p = 0.208). However, SG was associated with a significantly lower likelihood of GERD remission after MBS (p = 0.005). Endoscopic evaluation showed abnormal findings in asymptomatic patients in both preoperative (35.8%) and postoperative (14.1%) examinations (p < 0.001). Conclusions: GERD may be a common issue after MBS. One-quarter of patients after MBS may experience symptoms of GERD, regardless of the type of MBS. SG appears to be associated with a higher risk of persistent symptoms of GERD and a lower likelihood of GERD remission after MBS. Asymptomatic patients both before and after MBS may have abnormal findings in gastroscopy. Full article
(This article belongs to the Special Issue Clinical and Surgical Updates on Bariatric Surgery)
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14 pages, 1172 KiB  
Case Report
A Multimodal Approach to Managing Severe Psoriasis Vulgaris: A Case Report Leveraging Natural Therapies for Flare Control
by Ada Radu, Tunde Jurca, Andrei-Flavius Radu, Teodora Maria Bodog, Ruxandra Florina Bodog and Laura Endres
Life 2025, 15(8), 1186; https://doi.org/10.3390/life15081186 - 25 Jul 2025
Viewed by 349
Abstract
A psoriasis vulgaris flare is characterized by a rapid intensification of symptoms, which is often triggered by various factors that can worsen the condition. The risk factors for these exacerbations are numerous and include obesity, antihypertensive drugs, and psychological stress. Moreover, links have [...] Read more.
A psoriasis vulgaris flare is characterized by a rapid intensification of symptoms, which is often triggered by various factors that can worsen the condition. The risk factors for these exacerbations are numerous and include obesity, antihypertensive drugs, and psychological stress. Moreover, links have been documented between type II diabetes, hypertension, and psoriasis vulgaris. The present case report describes a 52-year-old female patient who presented at the clinic with disseminated erythematous-squamous plaques and patches covered by thick, white-pearly, easily detachable scales, along with stress, fatigue, anxiety, severe pruritus, irritability, insomnia, and decreased self-esteem. Her past medical regimen included various conventional topical options, including calcipotriol combined with betamethasone, clobetasol, betamethasone combined with salicylic acid, and betamethasone combined with gentamicin, yet the condition remained refractory, with periodic flare-ups. The integrated and personalized therapeutic approach aimed to target both the dermatological issues and the associated systemic and psychological factors contributing to the condition. The therapeutic strategy implemented in this case combined psychological counseling sessions, a very low-calorie ketogenic diet, oral supplementation with anti-inflammatory and antioxidant vitamins and minerals, topical treatments utilizing urea and Dead Sea-mineral-based formulations, and rosemary extract-based scalp care, without requiring additional conventional treatment. This comprehensive approach led to significant improvement, ultimately achieving complete remission of the patient’s psoriasis. The associated comorbidities were well controlled with the specified medication, without any further complications. Thus, the importance of alternative options was emphasized, particularly in the context of an incurable disease, along with the need for continued research to improve the ongoing therapeutic management of psoriasis vulgaris. Such approaches are essential to reducing the risk of flare-ups and to achieving better management of associated risk factors. Full article
(This article belongs to the Section Physiology and Pathology)
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13 pages, 3385 KiB  
Review
Efficacy of Dupilumab in a Young Woman with Refractory Cutaneous Lichen Planus: A Case-Based Review
by Cristina Guerriero, Luisa Boeti, Francesco Mastellone, Giulia Coscarella, Gennaro Marco Falco, Gerardo Palmisano, Helena Pelanda, Ketty Peris and Donato Rigante
Diseases 2025, 13(7), 225; https://doi.org/10.3390/diseases13070225 - 18 Jul 2025
Viewed by 449
Abstract
Background: Cutaneous lichen planus (CLP) is a chronic inflammatory T cell-mediated disease driven by a mixed Th1 and Th2 lymphocyte population, for which many of the currently available treatments have poor efficacy. Aim: The aim of this study was to indicate the clinical [...] Read more.
Background: Cutaneous lichen planus (CLP) is a chronic inflammatory T cell-mediated disease driven by a mixed Th1 and Th2 lymphocyte population, for which many of the currently available treatments have poor efficacy. Aim: The aim of this study was to indicate the clinical success of dupilumab administration after two years of treatment in a case of longstanding CLP and to perform a review of the medical literature related to the use of dupilumab in different dermatologic settings and in CLP. Case presentation: One 26-year-old woman with a previous history of atopic dermatitis had a long-lasting skin condition, referred to as a suspected lichen, which started when she was 7 years old. Her disease exhibited a relapsing–remitting course with severe bouts of pruritus over a very long period. The final histological diagnosis of CLP was confirmed at the age of 26. Starting dupilumab (injected subcutaneously at a dose of 600 mg followed by a maintenance dose of 300 mg every two weeks) resolved the skin scenery of this patient, who is currently in full remission. Conclusions: The remarkable recovery from CLP obtained via treatment with dupilumab in this single-patient case study emphasizes the potential therapeutic implications of targeting the Th2 pathway in this skin disorder. Full article
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16 pages, 679 KiB  
Article
Length of Washout Period After Remission Does Not Influence Relapse Risk in Patients with Acute Myeloid Leukemia Treated with Hypomethylating Agents Combined with Venetoclax
by Fanny Erika Palumbo, Andrea Duminuco, Laura Longo, Daniela Cristina Vitale, Cinzia Maugeri, Serena Brancati, Marina Silvia Parisi, Giuseppe Alberto Palumbo, Giovanni Luca Romano, Filippo Drago, Francesco Di Raimondo, Lucia Gozzo and Calogero Vetro
J. Clin. Med. 2025, 14(14), 5007; https://doi.org/10.3390/jcm14145007 - 15 Jul 2025
Viewed by 361
Abstract
Background/Objectives: The combination of venetoclax (VEN) and hypomethylating agents (HMA), such as azacitidine (AZA) or decitabine (DEC), has transformed the treatment landscape for acute myeloid leukemia (AML) in patients unfit for intensive chemotherapy. However, optimal management of neutropenia and the impact of post-remission [...] Read more.
Background/Objectives: The combination of venetoclax (VEN) and hypomethylating agents (HMA), such as azacitidine (AZA) or decitabine (DEC), has transformed the treatment landscape for acute myeloid leukemia (AML) in patients unfit for intensive chemotherapy. However, optimal management of neutropenia and the impact of post-remission treatment interruptions (washouts) remain unclear. This study aimed to evaluate the safety and efficacy of post-remission washouts and their effect on clinical outcomes. Methods: We conducted a retrospective single-center study of 44 AML patients treated with HMA/VEN between 2020 and 2021. Clinical, molecular, and treatment-related data were collected, including treatment duration, post-remission washout duration, response rates, disease-free survival (DFS), and overall survival (OS). Statistical analyses included Fisher’s exact test and univariate and multivariate Cox models. Results: Overall, 61% of patients responded to therapy, with significantly higher response rates among those potentially eligible for the VIALE-A trial (86% vs. 39%, p = 0.002). Neither treatment duration nor post-remission washout length was associated with DFS or OS. DFS was significantly longer in patients treated with AZA compared to DEC (p = 0.006). Median OS was 7.7 months, with longer OS observed in patients who did not meet VIALE-A trial eligibility criteria (p = 0.021). Achieving complete remission (CR) was associated with improved OS (14.5 months). Conclusions: Post-remission treatment interruptions (washouts) did not negatively impact DFS or OS, suggesting they may be a safe strategy to support hematologic recovery. However, the choice of HMA appears to influence response duration, with AZA outperforming DEC in maintaining disease control. Full article
(This article belongs to the Section Hematology)
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11 pages, 848 KiB  
Article
Efficacy of High-Dose Methylprednisolone in Inducing Remission in Pediatric Acute Severe Ulcerative Colitis: Retrospective Study
by Dominika Marszk, Aleksandra Treder, Agnieszka Szlagatys-Sidorkiewicz and Michał Brzeziński
J. Clin. Med. 2025, 14(14), 4938; https://doi.org/10.3390/jcm14144938 - 12 Jul 2025
Viewed by 420
Abstract
Background: Ulcerative colitis (UC) is increasing in incidence, including among pediatric populations. Treatment aims primarily to induce and maintain remission. For those inadequately responding to 5-aminosalicylic acid, remission may be induced via oral steroids or, in severe instances, intravenous methylprednisolone. This retrospective [...] Read more.
Background: Ulcerative colitis (UC) is increasing in incidence, including among pediatric populations. Treatment aims primarily to induce and maintain remission. For those inadequately responding to 5-aminosalicylic acid, remission may be induced via oral steroids or, in severe instances, intravenous methylprednisolone. This retrospective case series aims to evaluate the efficacy of high-dose intravenous methylprednisolone pulses (30 mg/kg, max 1 g per day for 3–5 days) in inducing remission in moderate and severe pediatric UC cases. Methods: From a cohort of pediatric patients (<18 years) hospitalized in 2018–2021 due to an acute flare of UC, those treated with high doses of methylprednisolone to induce remission were identified. The Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to determine the response to treatment, considering a 20-point reduction or a score below 10 as significant improvement and indicative of remission induction. Results: Disease activity was severe in most patients (12/15), with 3/15 having moderate but refractory disease. We observed a clinically significant response in 9/15 patients (60%) with a mean PUCAI decrease of 39.4 ± 14.7 points. The median duration to clinical remission was 4 (IQR 3–4) days. For the 6/15 non-responders to methylprednisolone pulses, treatment was escalated. Adverse effects were not observed during the treatment period. Conclusions: High-dose methylprednisolone may be a viable alternative for inducing remission in pediatric UC. However, the small sample size and retrospective design warrant further prospective studies to validate these findings. Full article
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15 pages, 463 KiB  
Article
Impaired Quality of Life in Croatian IBD Patients in the Era of Advanced Treatment Options
by Alen Bišćanin, Leon Palac, Zdravko Dorosulić, Dominik Kralj, Petra Ćaćić, Filip Babić, Doris Ogresta, Davor Hrabar and Vedran Tomašić
Healthcare 2025, 13(14), 1681; https://doi.org/10.3390/healthcare13141681 - 12 Jul 2025
Viewed by 317
Abstract
Background/Objectives: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder marked by relapsing episodes of gastrointestinal inflammation, potentially causing severe symptoms. These unpredictable acute episodes, paired with chronic disabilities, such as fatigue and malabsorption, and extensive pharmacological and surgical treatments, can severely impact [...] Read more.
Background/Objectives: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder marked by relapsing episodes of gastrointestinal inflammation, potentially causing severe symptoms. These unpredictable acute episodes, paired with chronic disabilities, such as fatigue and malabsorption, and extensive pharmacological and surgical treatments, can severely impact patients’ quality of life. This study aimed to assess which aspects of the patients’ lives IBD impacts, and how IBD patients perceive their disease. Methods: All IBD patients who had an appointment in our tertiary centre from 10 October 2022 to 21 February 2023, were invited to complete anonymous questionnaires. The questionnaires used were IBDQ-32, WPAI, and IBD Disk, all designed specifically to assess the IBD patients’ quality of life. Results: The questionnaires were completed by a total of 159 participants, 51% of whom were males, 47.9% who had UC, and 49.4% who had been or were currently treated with biologics. There was no statistically significant difference in the answers from patients with CD compared to UC, as well as those treated with conventional therapies compared to those with advanced options. Most of them considered their health to be good, but only a few (12.8%) claimed, with absolute certainty, that their health was at the level of healthy individuals, and only 13 (8.3%) claimed their health was excellent. A total of 95 (60.1%) participants expressed at least minor limitations when performing strenuous activities, but lighter forms of activities were not affected as much by the disease. A significant portion (48.7%) of the participants believed they were exposed to more stress than others, and their current pharmacological therapy was the cause of fear in 26.5%. A total of 119 (75.3%) participants believed that the disease affected their lives at least mildly during remission. Conclusions: Our study showed that IBD patients have diminished quality of life, not only in the periods of active disease but also during clinical remission. The decline in quality of life was not solely attributed to physical symptoms, as previously thought. Other factors, such as mental health issues, were found to impact quality of life as well. We firmly believe that restoring quality of life should be emphasised in guidelines as one of the most important therapeutic goals. Full article
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12 pages, 790 KiB  
Article
Bariatric Conversion Surgery Impact on LDL Cholesterol in Patients Previously Treated with Sleeve Gastrectomy
by David Benaiges, Max Calzada, Anna Casajoana, Belen Deza, Manuel Pera, Elisenda Climent, Juana A. Flores Le Roux, Marc Beisani, Miguel Olano, Karla A. Pérez-Vega, Juan Pedro-Botet and Albert Goday
J. Clin. Med. 2025, 14(14), 4901; https://doi.org/10.3390/jcm14144901 - 10 Jul 2025
Viewed by 342
Abstract
Background/Objectives: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, [...] Read more.
Background/Objectives: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, as the metabolic effects of such conversion procedures remain insufficiently understood. Methods: A retrospective analysis was conducted in a non-randomized prospective cohort of patients with severe obesity who were previously treated with SG and undergoing CBS. Changes in LDL cholesterol levels after SG were compared to those following CBS using repeated-measures ANOVA. Results: Twenty-eight patients were included (mean age 44.5 ± 7.2 years; 68% female; mean BMI 47.3 ± 7.2 kg/m2). Of these, 57% underwent Roux-en-Y gastric bypass (RYGB), and 43% underwent single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) as conversion procedures. The mean time between SG and CBS was 93.5 ± 45.3 months for RYGB and 31.0 ± 45.2 months for SADI-S. The change in LDL cholesterol pre- vs. post-SG was 3.3 mg/dL (95% CI: −13.6 to 20.1), whereas the change pre- vs. post-CBS was −25.7 mg/dL (95% CI: −37.5 to −13.9) (p < 0.001). Remission of high LDL-C was 18.8% after SG and 73.3% after CBS (p = 0.023). The cardiometabolic profile showed a marked improvement profile during the SG period, followed by maintenance of these improvements during the CBS period. Conclusions: CBS (with either RYGB or SADI-S) results in a reduction in LDL-C, in contrast to the initial surgery with SG. However, CBS does not appear to provide additional benefits over SG in terms of other cardiometabolic parameters. Full article
(This article belongs to the Special Issue Obesity Surgery—State of the Art)
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11 pages, 980 KiB  
Article
Trends in MitraClip Placements and Predictors of 90-Day Heart Failure Rehospitalization: A Nationwide Analysis
by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Seetharamaprasad Madala, Ruchi Bhuju, Carra Lyons, Simcha Weissman, Adam Atoot, Dominic Vacca and Budoor Alqinai
Med. Sci. 2025, 13(3), 81; https://doi.org/10.3390/medsci13030081 - 20 Jun 2025
Viewed by 489
Abstract
Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ [...] Read more.
Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016–2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76–79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1–3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82–4.23), pulmonary hypertension (OR 3.96, CI 1.49–5.55), and chronic lung disease (OR 1.91, CI 1.32–2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions. Full article
(This article belongs to the Section Cardiovascular Disease)
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16 pages, 3104 KiB  
Article
Outcomes of the Transsphenoidal Approach for ACTH-Secreting Pituitary Tumours and the Role of Postoperative ACTH in Predicting the Late Recurrence of Cushing’s Disease: A Retrospective Analysis of 50 Cases
by Athanasios Saratziotis, Maria Baldovin, Claudia Zanotti, Sara Munari, Luca Denaro, Jiannis Hajiioannou and Enzo Emanuelli
Healthcare 2025, 13(12), 1395; https://doi.org/10.3390/healthcare13121395 - 11 Jun 2025
Viewed by 642
Abstract
Background/Objectives: The endoscopic transsphenoidal approach constitutes an excellent technique for adrenocorticotropin hormone (ACTH)-producing pituitary tumours. It is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate re-operation. Methods: The authors retrospectively reviewed patients with Cushing’s disease who [...] Read more.
Background/Objectives: The endoscopic transsphenoidal approach constitutes an excellent technique for adrenocorticotropin hormone (ACTH)-producing pituitary tumours. It is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate re-operation. Methods: The authors retrospectively reviewed patients with Cushing’s disease who had undergone endoscopic transsphenoidal surgery between 2013 and 2023. All operations were performed by neurosurgeons and skull-base otolaryngologists. Surgical outcomes were evaluated in combination with prognostic factors such as cortisol and ACTH levels in terms of long-term remission and late recurrence rates of Cushing’s disease. Results: Fifty patients aged between 15 and 69 (average 37.8) years were evaluated, having undergone 50 operations. The median follow-up was 76.5 months (range: 23–122 months). Major complications with a transient CSF leak resulting from the surgical approach occurred in three patients. Two patients in the series experienced minor complications, developing a deep vein thrombosis, and thirteen patients developed transient diabetes insipidus. The initial remission rate was 84% (n = 42/50). Initial non-remission occurred in eight (8) patients (16%), with three macro- and five microadenomas. A total of 3 of the 42 patients with initial remission had a late recurrence after 50 months follow-up and required repeat transsphenoidal surgery. Seven patients (16.6%) who did not exhibit early postoperative cortisol reduction subsequently achieved remission. Male gender was the only factor that was significantly associated with lower remission rates in either short- or long-term follow-up (p = 0.003 and 0.038, respectively). An immediate postoperative ACTH nadir of ≤5 pg/mL was significantly related to long-term remission (p = 0.004). In our study, a significant correlation was confirmed between remission of the disease and 24 h urinary cortisol values, both early and late (p = 0.019), and serum cortisol <138 nmol/L. In this retrospective study from a single institution specialising in pituitary tumour management, the endoscopic transsphenoidal approach was shown to be both safe and effective. Additionally, we found that the risk of relapse in patients with Cushing’s disease persisting for more than 5 years after surgery is real but low. Moreover, failure to achieve an early postoperative cortisol reduction does not preclude a subsequent remission. Conclusions: Our findings demonstrate that ACTH, postoperative serum cortisol, and urinary free cortisol are valuable predictors of relapse over a five-year period and are closely correlated to each other. Full article
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14 pages, 792 KiB  
Article
Cryofibrinogenemia in PRECOVID-19 and COVID-19 Periods: Single University Study in Northern Spain
by María del Amparo Sánchez López, Carmen Lasa-Teja, Mónica Renuncio-García, Cristina Abraira-Meriel, Saray Simón-Coloret, Inmaculada Bertomeu-Genis, Adrián Martín-Gutiérrez, Carmen Secada-Gómez, Carmen González-Vela, Juan Irure-Ventura, Marcos López-Hoyos, Marcos A. González-López and Ricardo Blanco
Sci 2025, 7(2), 81; https://doi.org/10.3390/sci7020081 - 6 Jun 2025
Viewed by 350
Abstract
Cryofibrinogenemia (CF) may be secondary to COVID-19. To establish this relationship, in PRECOVID-19 and COVID-19 periods we assess: (a) frequency and clinical features in patients with CF; (b) study of CF syndrome. We study all cryofibrinogen tests performed in a single university hospital [...] Read more.
Cryofibrinogenemia (CF) may be secondary to COVID-19. To establish this relationship, in PRECOVID-19 and COVID-19 periods we assess: (a) frequency and clinical features in patients with CF; (b) study of CF syndrome. We study all cryofibrinogen tests performed in a single university hospital in Northern Spain, comparing two periods: PRECOVID-19 (July 2017–February 2020) and COVID-19 (March 2020–October 2022). CF syndrome was established with two positive cryofibrinogen tests plus compatible cutaneous manifestations and/or thrombotic events (TE). CF was found in 129/279 patients. In the COVID-19 period, they had more positive tests (50.2% vs. 28%; p = 0.0047), younger age (33 vs. 55 years, p = 0.054) and fewer cardiovascular (CV) risk factors (39.1% vs. 78.6%, p = 0.005). Cutaneous manifestations were the most frequent in both periods (81.4%), particularly purpuric macules (29.5%). Skin ulcers showed statistically significant differences, being more frequent in the PRECOVID-19 era (35.7% vs. 7.8%, p = 0.008). Thrombotic CV events were also observed (13.2%), particularly venous thromboembolisms (12.2%). Severe complications were more frequent in the PRECOVID-19 era, although this difference did not reach statistical significance (35.7% vs. 19.1%; p = 0.169). CF was secondary in 68/129 cases, mainly to SARS-CoV-2 (n = 45). CF syndrome was found in 27.9% of patients. After one year, most patients were clinically stable or in remission. Mild dermatological lesions were the most frequent manifestations, and most patients recovered. Full article
(This article belongs to the Section Biology Research and Life Sciences)
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12 pages, 682 KiB  
Article
Epidemiology, Clinical Features and Treatment of Neurosarcoidosis in Northern Spain
by Alba Herrero-Morant, Raúl Fernández-Ramón, Diana Prieto-Peña, José Luis Martín-Varillas, Santos Castañeda and Ricardo Blanco
Biomedicines 2025, 13(6), 1360; https://doi.org/10.3390/biomedicines13061360 - 1 Jun 2025
Viewed by 622
Abstract
Objectives: Neurosarcoidosis (NS) is a severe and infrequent complication of sarcoidosis. Available data on NS are variable. We aimed to characterize NS epidemiology, clinical and therapeutic characteristics in a well-defined cohort of NS patients. Methods: Observational population-based cohort study of 342 patients diagnosed [...] Read more.
Objectives: Neurosarcoidosis (NS) is a severe and infrequent complication of sarcoidosis. Available data on NS are variable. We aimed to characterize NS epidemiology, clinical and therapeutic characteristics in a well-defined cohort of NS patients. Methods: Observational population-based cohort study of 342 patients diagnosed with sarcoidosis in Northern Spain, between 1999 and 2019. Among them, those patients who fulfilled the Consortium Consensus Group diagnosis criteria for NS were included. The annual incidence between 1999 and 2019 was estimated by gender, age, and year of diagnosis. Additionally, a literature review was performed. Therapeutic efficacy was evaluated using the neurological-related extra-pulmonary physician organ severity tool (ePOST). Results: NS was diagnosed in 29 out of 342 patients with sarcoidosis (8.5%; 18 women/11 men) with a mean age of 42.3 ± 15.1 years. Most NS patients have associated systemic sarcoidosis (93.4%) mainly consisting of lung (n = 22; 75.9%), articular (n = 15; 51.7%) and/or ocular (n = 12; 40%) involvement. The annual incidence of NS during the study period was 1.1 per 1,000,000 people. There is a linear relationship with a weak decrease in age at diagnosis over time. NS was subdivided into chronic headache (n = 11; 36.7%), cranial neuropathy (n = 7; 24.1%), myelitis (n = 4; 13.8%), peripheral neuropathy (n = 3; 10.3%), cranial neuropathy with chronic headache (n = 3; 10.3%) and aseptic meningitis (n = 2; 6.9%). Twenty-five patients (86.2%) received oral glucocorticoids (mean ± SD maximum prednisone dose 49.6 ± 19.4 mg/day). In addition, conventional immunosuppressive drugs were administered to 17 (58.6%) patients and biological therapy to 12 (41.4%) patients. After 12 months of initiating biological therapy, 14 out of 17 patients (82.4%) achieved complete remission, defined as an ePOST score of 0. Severe allergic reaction was observed in only one patient who had received treatment with both Infliximab and Adalimumab. Conclusions: The epidemiological, clinical and treatment characteristics of NS in Northern Spain are similar to that of other countries. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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12 pages, 824 KiB  
Article
Evaluating Repetitive Transcranial Magnetic Stimulation for Refractory Chronic Cluster Headache Prevention: Insights from a Randomized Crossover Pilot Trial
by Leonardo Portocarrero-Sánchez, Cristian Rizea, Exuperio Díez-Tejedor, Moisés León-Ruiz and Javier Díaz-de-Terán
Brain Sci. 2025, 15(6), 554; https://doi.org/10.3390/brainsci15060554 - 23 May 2025
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Abstract
Background/Objectives: Cluster headache (CH) is a debilitating primary headache disorder characterized by severe unilateral pain attacks. Chronic CH (CCH) poses significant treatment challenges, especially in refractory cases. Neuromodulation, including repetitive transcranial magnetic stimulation (rTMS), offers a potential alternative; however, evidence for its [...] Read more.
Background/Objectives: Cluster headache (CH) is a debilitating primary headache disorder characterized by severe unilateral pain attacks. Chronic CH (CCH) poses significant treatment challenges, especially in refractory cases. Neuromodulation, including repetitive transcranial magnetic stimulation (rTMS), offers a potential alternative; however, evidence for its efficacy in CCH is lacking. Methods: A randomized, double-blind, placebo-controlled, crossover pilot study was conducted. Eligibility criteria included patients with refractory CCH (rCCH), who were then randomized to receive two treatment sequences: A, rTMS followed by sham stimulation, or B, sham followed by rTMS, separated by a one-month washout, with a follow-up period of 3 months. The primary endpoint was to analyze efficacy by assessing the change in the number of attacks per week (APW). Secondary endpoints included treatment tolerability and changes in intensity, duration, and use of rescue medication. The trial was registered with ClinicalTrials.gov (NCT06917144). Results: Eight patients were enrolled and randomized with a 50% probability of assignment to either treatment arm. Despite this, five patients were allocated to sequence A and three to sequence B. Three patients completed the entire study; five received treatment with rTMS and six with sham. The APW change during rTMS showed a change of (mean ± SD) +2.2 (10.8) attacks per week (p = 0.672). Two patients achieved complete remission during the rTMS phase, though symptoms returned by the washout period. In comparison with sham, the difference was also not statistically significant. No significant changes were observed in secondary endpoints. Side effects (two cases) were mild and transient. Conclusions: This pilot study suggests that rTMS may provide clinical benefits for rCCH in selected cases, though its effects seem transient. Adherence to treatment remains a critical challenge. Full article
(This article belongs to the Special Issue Neuromodulation for Pain Management: Evidence of Safety and Efficacy)
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12 pages, 641 KiB  
Article
Clinical Characteristics and Prognostic Factors in Patients with Gestational Trophoblastic Neoplasia: A Single-Center Study Comparing Ultra-High-Risk and Other Risk Groups
by Atita Ruengsaen, Sethawat Sethasathien, Charuwan Tantipalakorn, Kittipat Charoenkwan, Prapaporn Suprasert, Jatupol Srisomboon and Theera Tongsong
Cancers 2025, 17(10), 1655; https://doi.org/10.3390/cancers17101655 - 14 May 2025
Viewed by 599
Abstract
Objective: To evaluate treatment outcomes and prognostic factors in patients with ultra-high-risk gestational trophoblastic neoplasia (GTN) compared to those with low-risk and high-risk GTN. Methods: A retrospective review of medical records was conducted for GTN patients treated at Chiang Mai University [...] Read more.
Objective: To evaluate treatment outcomes and prognostic factors in patients with ultra-high-risk gestational trophoblastic neoplasia (GTN) compared to those with low-risk and high-risk GTN. Methods: A retrospective review of medical records was conducted for GTN patients treated at Chiang Mai University Hospital, Chiang Mai, Thailand, between January 1999 and December 2019. Overall and risk-specific survival rates were estimated using the Kaplan–Meier method, and prognostic factors were analyzed through univariate and multivariate analyses. Results: During the study period, 160 patients with GTN were identified, including 98 (61.2%) classified as low-risk, 31 (19.4%) as high-risk, and 31 (19.4%) as ultra-high-risk. One patient in the low-risk group and one in the high-risk group underwent hysterectomy without adjuvant chemotherapy due to spontaneous regression of serum β-hCG (human chorionic gonadotropin). Additionally, one patient with ultra-high-risk GTN died before receiving chemotherapy. Among the 97 low-risk GTN patients, 80 (82.5%) were treated with either single-agent methotrexate or actinomycin D. Among the 30 high-risk GTN patients, 20 (66.7%) received EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) as first-line chemotherapy, while 24 (80%) of the 30 ultra-high-risk GTN patients received EMA/CO as first-line treatment. Following first-line chemotherapy and/or salvage treatment, patients with ultra-high-risk GTN had significantly worse outcomes compared with those with low- and high-risk GTN, with remission rates of 63.3%, 96.9%, and 80.0%, respectively (p < 0.01). The five-year overall survival rate for patients with ultra-high-risk GTN was significantly lower than that for patients with low- and high-risk GTN (56% vs. 96% and 80%, respectively; p < 0.001). On multivariable analysis, significant prognostic factors included antecedent term pregnancy (hazard ratio [HR] = 11.50; 95% confidence interval [CI], 3.56–37.22; p < 0.01) and brain metastasis (HR = 4.61; 95% CI, 1.73–12.28; p < 0.01). Conclusions: Ultra-high-risk GTN accounts for only a small proportion of GTN cases but it is associated with poor survival rate and responsible for the majority of GTN-related deaths. Antecedent term pregnancy and brain metastasis were identified as significant prognostic factors. Full article
(This article belongs to the Special Issue Rare Gynecological Cancers)
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14 pages, 2440 KiB  
Article
The Dynamics of Seizures After Microsurgical Treatment of Brain AVMs in Patients with Symptomatic Epilepsy: A Single-Center Experience over 10 Years
by Yerbol Makhambetov, Aiman Maidan, Iroda Mammadinova, Karashash Menlibayeva, Baurzhan Kunakbayev, Serik Dyussembaev, Nurtay Nurakay, Nursultan Makhambetov, Aigul Almabayeva and Chingiz Nurimanov
Medicina 2025, 61(5), 856; https://doi.org/10.3390/medicina61050856 - 6 May 2025
Viewed by 542
Abstract
Background and Objectives: Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins, lacking a normal capillary network. Seizures are a common clinical manifestation in patients with brain AVMs, ranking as the second most frequent presentation. The objective of this study was [...] Read more.
Background and Objectives: Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins, lacking a normal capillary network. Seizures are a common clinical manifestation in patients with brain AVMs, ranking as the second most frequent presentation. The objective of this study was to evaluate the dynamics of seizure activity in patients with brain AVMs following surgical treatment. Materials and Methods: This study included 27 patients with brain AVMs who underwent microsurgical AVM resection for symptomatic epilepsy. All surgical interventions were performed at JSC “National Centre for Neurosurgery” between 2008 and 2020. Results: Over an average follow-up period of 98.07 ± 45.6 months, 82 patients with brain AVMs underwent open microsurgical resection at the National Centre for Neurosurgery. Among them, 27 patients presented with seizures and had complete follow-up information, qualifying them for inclusion in this study. The participants had a mean age of 32.59 ± 9.06 years, with 13 of them being women. The Spetzler–Martin grading system was used to classify the AVMs: 6 patients had grade 1, 13 had grade 2, 7 had grade 3, and 1 had grade 4. More than half of the patients experienced generalized seizures. Microsurgical removal of the AVMs resulted in seizure remission for all patients. Only one patient experienced postoperative hemorrhage during the follow-up period. Additionally, one patient developed acute postoperative anemia, which resolved with a favorable outcome. Conclusions: Microsurgical resection of brain AVMs, when performed with careful patient selection, leads to a significant reduction in seizure activity. It is a safe and effective treatment option for symptomatic epilepsy associated with brain AVMs. Full article
(This article belongs to the Special Issue Epilepsy, Seizures, and Sleep Disorders)
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