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Medicina
Volume 56
Issue 5
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Medicina, Volume 56, Issue 5 (May 2020) – 49 articles

Cover Story (view full-size image): Non-resorbable dense polytetrafluoroethylene (dPTFE) membranes are widely used for regeneration procedures. In this study, we examined the efficacy of the newly developed dPTFE membrane in the management of extraction socket healing. In group one, the sites were augmented with bovine xenograft and covered with membrane. The second group received immediate implant placement and the peri-implant gaps were grafted with bovine xenograft, which again was covered by membrane. The use of the newly developed dPTFE membrane consistently led to the preservation of hard tissue in the extraction sites. View this paper.
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10 pages, 1544 KiB  
Article
Sclerotherapy of Vascular Malformations in the Oral Cavity—Minimizing Postoperative Morbidity
by Itai Zeevi, Gavriel Chaushu, Michael Alterman and Liat Chaushu
Medicina 2020, 56(5), 254; https://doi.org/10.3390/medicina56050254 - 22 May 2020
Cited by 1 | Viewed by 2857
Abstract
Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. [...] Read more.
Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0–9. Calculated scores ranged 0–4. The patients were further divided into two groups with scores of 0–1 denoting minimal morbidity (MIN) and 2–4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity. Full article
(This article belongs to the Special Issue Oral Surgery–Minimizing Postoperative Morbidity)
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9 pages, 1699 KiB  
Article
The Diagnostic–Therapeutic Care Pathway in Psoriasis: Towards ISO 9001:2015 Certification
by Federica Veronese, Francesca Graziola, Edoardo Cammarata, Marco Andreassi, Vanessa Mazzoletti, Camilla Taglietti, Gaia Navarra, Paola Savoia and Rossana Tiberio
Medicina 2020, 56(5), 253; https://doi.org/10.3390/medicina56050253 - 22 May 2020
Cited by 3 | Viewed by 2156
Abstract
Background and objectives: Psoriasis (Pso) is a common skin condition characterized by a strong psychosocial impact, and is nowadays accepted as a systemic immune-mediated inflammatory disease. Diagnostic–Therapeutic Care Pathways (DTCPs) represent a predefined sequence of diagnostic, therapeutic, and assistance activities that integrate the [...] Read more.
Background and objectives: Psoriasis (Pso) is a common skin condition characterized by a strong psychosocial impact, and is nowadays accepted as a systemic immune-mediated inflammatory disease. Diagnostic–Therapeutic Care Pathways (DTCPs) represent a predefined sequence of diagnostic, therapeutic, and assistance activities that integrate the participation of several specialists to obtain, for each patient, the correct diagnosis and thus the most appropriate therapy. A DTCP was validated in our dermatology clinic (AOU Maggiore della Carità, Novara, Italy). The validation process included the detailed elaboration of a protocol of diagnosis, staging of care, therapies, and follow-up of the patient with Pso. The formalization and adaptation of our DTCP resulted in ISO 9001: 2015 certification in May 2019. Materials and methods: This process involved several stages, including analysis of context and the identification of (i) targets, (ii) indicators, and (iii) service providers. The evaluation was based on a cohort of over 200 patients affected by moderate to severe Pso, who were treated and followed-up at our institution from September 2017 to April 2019. Results: The ISO 9001:2015 quality certification process allowed us to identify our weaknesses, i.e., the long waiting times for the first visit and the reduced physician–patient ratio, but also our strengths, such as the commitment to clinical research, effective collaboration with other specialists, the efficient use of technological and human resources, and attention to ensuring patient follow-up. Conclusions: In qualifying for and achieving the ISO Quality Management System (QMS) certification we were heartened to realize that our basic methodology and approach were fit for purpose. The implementation of the ISO QMS helped us to reorganize our priorities by placing the patient at the center of the process and raising awareness that Pso is not just a skin disease. Full article
(This article belongs to the Special Issue New Perspectives in the Treatment of Skin Disease)
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10 pages, 600 KiB  
Article
Phacoemulsification Induced Changes of Choroidal Thickness in Eyes with Age-Related Macular Degeneration
by Gailė Gudauskienė, Ieva Povilaitytė, Eglė Šepetauskienė and Dalia Žaliūnienė
Medicina 2020, 56(5), 252; https://doi.org/10.3390/medicina56050252 - 22 May 2020
Cited by 1 | Viewed by 2005
Abstract
Background and Objectives: Patients with cataract and age-related macular degeneration (AMD) may safely undergo cataract phacoemulsification to enhance visual acuity. Although it has not been proven that cataract surgery can cause AMD progression, different phacoemulsification effects are observed not only on retinal [...] Read more.
Background and Objectives: Patients with cataract and age-related macular degeneration (AMD) may safely undergo cataract phacoemulsification to enhance visual acuity. Although it has not been proven that cataract surgery can cause AMD progression, different phacoemulsification effects are observed not only on retinal but also on choroidal tissues. The purpose of this study was to evaluate the effect of phacoemulsification on the choroidal thickness (CT) in eyes with and without AMD. Materials and Methods: In 32 eyes of 32 patients with senile cataract (No-AMD group) and in 32 eyes of 32 patients with cataract and dry AMD (AMD group), who had phacoemulsification without intraoperative complications and intraocular lens implantation, foveal retinal thickness (FRT) and CT were evaluated three times: at 1–2 post meridiem preoperatively, then 1 month and 3 months postoperatively, using 1050 nm swept source-optical coherence tomography (Topcon, Tokyo, Japan). Results: In both groups, a significant increase in FRT was observed after one month and a decrease after three months without reaching the baseline. One month after surgery, a sectorial CT increase was apparent in all sectors in both groups. A negative association between CT and age was disclosed in the No-AMD group almost for all regions at all time points. Furthermore, CT was significantly negatively associated with axial length (AL) in all sectors at all time points in the AMD group. Conclusion: Uneventful phacoemulsification may induce changes in the posterior eye segment. An increase in CT and FRT was observed in both groups one month after the surgery. However, three months after surgery, CT changes were different in both groups, while FRT decreased in both groups. CT changes negatively associated with age in the No-AMD group and with AL in the AMD eyes. These postoperative changes in the choroid and retina may not only lead to the late-onset pseudophakic cystoid macular edema but also to progression of AMD. Full article
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12 pages, 313 KiB  
Article
Role of a Brief Intensive Observation Area with a Dedicated Team of Doctors in the Management of Acute Heart Failure Patients: A Retrospective Observational Study
by Gabriele Savioli, Iride Francesca Ceresa, Federica Manzoni, Giovanni Ricevuti, Maria Antonietta Bressan and Enrico Oddone
Medicina 2020, 56(5), 251; https://doi.org/10.3390/medicina56050251 - 21 May 2020
Cited by 19 | Viewed by 2236
Abstract
Background and objectives: Acute heart failure (AHF) is one of the main causes of hospitalization in Western countries. Usually, patients cannot be admitted directly to the wards (access block) and stay in the emergency room. Holding units are clinical decision units, or [...] Read more.
Background and objectives: Acute heart failure (AHF) is one of the main causes of hospitalization in Western countries. Usually, patients cannot be admitted directly to the wards (access block) and stay in the emergency room. Holding units are clinical decision units, or observation units, within the ED that are able to alleviate access block and to contribute to a reduction in hospitalization. Observation units have also been shown to play a role in specific clinical conditions, like the acute exacerbation of heart failure. This study aimed to analyze the impact of a brief intensive observation (OBI) area on the management of acute heart failure (AHF) patients. The OBI is a holding unit dedicated to the stabilization of unstable patients with a team of dedicated physicians. Materials and Methods: We conducted a retrospective and single-centered observational study with retrospective collection of the data of all patients who presented to our emergency department with AHF during 2017. We evaluated and compared two cohorts of patients, those treated in the OBI and those who were not, in terms of the reduction in color codes at discharge, mortality rate within the emergency room (ER), hospitalization rate, rate of transfer to less intensive facilities, and readmission rate at 7, 14, and 30 days after discharge. Results: We enrolled 920 patients from 1st January to 31st December. Of these, 61% were transferred to the OBI for stabilization. No statistically significant difference between the OBI and non-OBI populations in terms of age and gender was observed. OBI patients had worse clinical conditions on arrival. The patients treated in the OBI had longer process times, which would be expected, to allow patient stabilization. The stabilization rate in the OBI was higher, since presumably OBI admission protected patients from “worse condition” at discharge. Conclusions: Data from our study show that a dedicated area of the ER, such as the OBI, has progressively allowed a change in the treatment path of the patient, where the aim is no longer to admit the patient for processing but to treat the patient first and then, if necessary, admit or refer. This has resulted in very good feedback on patient stabilization and has resulted in a better management of beds, reduced admission rates, and reduced use of high intensity care beds. Full article
(This article belongs to the Section Translational Medicine)
3 pages, 248 KiB  
Editorial
COVID-19 Pandemic and Telephone Triage before Attending Medical Office: Problem or Opportunity?
by Gabriele Cervino and Giacomo Oteri
Medicina 2020, 56(5), 250; https://doi.org/10.3390/medicina56050250 - 20 May 2020
Cited by 59 | Viewed by 4580
Abstract
During the COVID-19 emergency, the medical operating protocols have been largely modified for reducing any type of contamination risk, for working in a safe way and for making the patient feel in a safe environment. Telemedicine, smart phones and apps could represent important [...] Read more.
During the COVID-19 emergency, the medical operating protocols have been largely modified for reducing any type of contamination risk, for working in a safe way and for making the patient feel in a safe environment. Telemedicine, smart phones and apps could represent important devices for the community, in order to prevent virus trasmission and to perform quick diagnosis and management at medical offices. This manuscript could be useful for clinicians with regard to the current state of the effectiveness of the telephone triage in this COVID-19 epidemic period. Therefore, it could be an important starting point for future perspectives about telemedicine and virtual patient management. Full article
(This article belongs to the Special Issue Oral Health: Economic and Psychological–Behavioral Implications)
14 pages, 3402 KiB  
Article
Are Force Enhancement after Stretch and Muscle Fatigue Due to Effects of Elevated Inorganic Phosphate and Low Calcium on Cross Bridge Kinetics?
by Hans Degens and David A. Jones
Medicina 2020, 56(5), 249; https://doi.org/10.3390/medicina56050249 - 20 May 2020
Cited by 3 | Viewed by 2375
Abstract
Background and Objectives: Muscle fatigue is characterised by (1) loss of force, (2) decreased maximal shortening velocity and (3) a greater resistance to stretch that could be due to reduced intracellular Ca2+ and increased Pi, which alter cross bridge kinetics. Materials [...] Read more.
Background and Objectives: Muscle fatigue is characterised by (1) loss of force, (2) decreased maximal shortening velocity and (3) a greater resistance to stretch that could be due to reduced intracellular Ca2+ and increased Pi, which alter cross bridge kinetics. Materials and Methods: To investigate this, we used (1) 2,3-butanedione monoxime (BDM), believed to increase the proportion of attached but non-force-generating cross bridges; (2) Pi that increases the proportion of attached cross bridges, but with Pi still attached; and (3) reduced activating Ca2+. We used permeabilised rat soleus fibres, activated with pCa 4.5 at 15 °C. Results: The addition of 1 mM BDM or 15 mM Pi, or the lowering of the Ca2+ to pCa 5.5, all reduced the isometric force by around 50%. Stiffness decreased in proportion to isometric force when the fibres were activated at pCa 5.5, but was well maintained in the presence of Pi and BDM. Force enhancement after a stretch increased with the length of stretch and Pi, suggesting a role for titin. Maximum shortening velocity was reduced by about 50% in the presence of BDM and pCa 5.5, but was slightly increased by Pi. Neither decreasing Ca2+ nor increasing Pi alone mimicked the effects of fatigue on muscle contractile characteristics entirely. Only BDM elicited a decrease of force and slowing with maintained stiffness, similar to the situation in fatigued muscle. Conclusions: This suggests that in fatigue, there is an accumulation of attached but low-force cross bridges that cannot be the result of the combined action of reduced Ca2+ or increased Pi alone, but is probably due to a combination of factors that change during fatigue. Full article
(This article belongs to the Special Issue Exercise and Skeletal Muscle Physiology)
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11 pages, 2147 KiB  
Case Report
Pleomorphic Adenoma of External Auditory Canal: Case Report of First Endoscopic Resection and Literature Review
by Sven Beckmann, Matthias S. Dettmer, Marco D. Caversaccio, Roland Giger and Lukas Anschuetz
Medicina 2020, 56(5), 248; https://doi.org/10.3390/medicina56050248 - 20 May 2020
Cited by 7 | Viewed by 3611
Abstract
Ceruminous pleomorphic adenoma is a very rare, mostly benign tumor originating from the ceruminal glands in the external auditory canal. Histologically, it is a mixed tumor with epithelial and stromal parts of different proportions, and is recognized today by the World Health Organization [...] Read more.
Ceruminous pleomorphic adenoma is a very rare, mostly benign tumor originating from the ceruminal glands in the external auditory canal. Histologically, it is a mixed tumor with epithelial and stromal parts of different proportions, and is recognized today by the World Health Organization (WHO) as a ceruminous adenoma. Similar to the pleomorphic adenoma of salivary glands, recurrence or malignant degeneration with cellular atypia and metastasis can occur on rare occasions. Here, we describe an 87-year old female patient with a growing spherical mass in the right external auditory canal. After exclusive endoscopic tumor resection, a ceruminous pleomorphic adenoma was histologically diagnosed. Due to the absence of nuclear pleomorphism, no increased mitotic rate, no perineural invasion and no fusion transcripts of the MYB or MYBL1 gene loci, an adenoid cystic carcinoma could be excluded. The postoperative course was without any evidence of complications. A literature review identified 44 articles with 49 patients that were considered. Hearing loss and ear sensations were the most commonly reported symptoms. Most cases underwent an excision via an endaural or retroauricular approach. Recurrences were described in four patients, three of which had a malignant transformation. Full article
(This article belongs to the Section Oncology)
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14 pages, 354 KiB  
Article
Actual Nutrition and Dietary Supplementation in Lithuanian Elite Athletes
by Marius Baranauskas, Valerija Jablonskienė, Jonas Algis Abaravičius and Rimantas Stukas
Medicina 2020, 56(5), 247; https://doi.org/10.3390/medicina56050247 - 20 May 2020
Cited by 9 | Viewed by 4027
Abstract
Background and objectives: Health is partly determined by the state of one’s nutrition; it stimulates the body’s functional and metabolic adaptations to physical strain and helps one prevent sports injuries and get in shape in terms of body composition. This study aims to [...] Read more.
Background and objectives: Health is partly determined by the state of one’s nutrition; it stimulates the body’s functional and metabolic adaptations to physical strain and helps one prevent sports injuries and get in shape in terms of body composition. This study aims to investigate the actual nutrition and dietary supplements taken by elite Lithuanian athletes and to identify the relationship between the dietary intake, dietary supplementation and body composition of elite athletes. Materials and Methods: The research subjects were 76.7% of Lithuanian elite athletes (N = 247). The actual diet was investigated using the 24 h recall dietary survey method. Dietary supplementation was studied applying the questionnaire method. Measurements of body composition were performed using the BIA (bioelectrical impedance analysis) tetra-polar electrodes and measuring resistivity with 8–12 tangent electrodes at different frequencies of signal: 5, 50 and 250 kHz. Results: Results indicate that among the athletes, 62% use too few carbohydrates and 77% use too much fat. Although the 3.5% increase in lean body mass (95% CI: −0.107, 7.070) helps gain an increased protein intake with food (p = 0.057), 38% of athletes consume too little protein with food. The athletes mostly use carbohydrates (86%), vitamins (81%), protein supplements (70%), and multivitamins (62%). We did not determine the impact (p > 0.05) of individual or complex supplement use on the lean body mass (%) or fat mass (%) values of athletes. Conclusions: Athletes consume insufficient carbohydrates, vitamin D, calcium, polyunsaturated fatty acids, omega-3 and omega-6 fatty acids and too much fat, saturated fatty acids, cholesterol, and they use proteins irrationally. Sport nutritionists should also focus on the risk of malnutrition for female athletes. Nutritional supplements partially offset macronutrient and micronutrient deficiency. Nevertheless, the effect of food supplements on the body composition of athletes is too small compared to the normal diet. Athletes ought to prioritize the formation of eating habits and only then use supplements. Full article
(This article belongs to the Section Sports Medicine and Sports Traumatology)
14 pages, 2754 KiB  
Article
The Role of Laparoscopic Ultrasonography in the Evaluation of Suspected Choledocholithiasis. A Single-Center Experience
by Kristaps Atstupens, Maksims Mukans, Haralds Plaudis and Guntars Pupelis
Medicina 2020, 56(5), 246; https://doi.org/10.3390/medicina56050246 - 20 May 2020
Cited by 3 | Viewed by 2779
Abstract
Background and objectives: Opinions differ regarding the optimal diagnostic methods for patients with suspected choledocholithiasis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In [...] Read more.
Background and objectives: Opinions differ regarding the optimal diagnostic methods for patients with suspected choledocholithiasis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In all patients with suspected choledocholithiasis LUS was performed during laparoscopic cholecystectomy to evaluate biliary stones. According to availability, part of the patients had pre-operative MRCP. Data for diagnostic accuracy and main outcomes were collected prospectively and analyzed retrospectively; Results: Choledocholithiasis was detected in 178 of 297 patients by LUS (59.93%) and in 39 of 87 patients by MRCP (44.8%), p = 0.041. LUS yielded a sensitivity of 99.4%, a specificity of 94.3%, a positive predictive value of 96.1% and a negative predictive value of 99.1%. However, pre-operative MRCP had a sensitivity of 61.7%, a specificity of 92.3%, a positive predictive value of 94.9% and a negative predictive value of 51.1%. Moreover, of the 47 patients with no choledocholithiasis by MRCP, in 23 cases it was later detected by LUS (a false negative MRCP finding—38.3%), p < 0.001. Median duration of hospitalization was significantly shorter in patients evaluated without pre-operative MRCP—8 days (interquartile range – IQR 11–6) vs. 11 days (IQR 14–9), p = 0.001; Conclusions: LUS may reduce the role of pre-operative MRCP and can become a rational alternative to MRCP as a primary imaging technique for the detection of choledocholithiasis. Full article
(This article belongs to the Section Surgery)
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12 pages, 729 KiB  
Review
Relationship between Vitamin Deficiencies and Co-Occurring Symptoms in Autism Spectrum Disorder
by Madalina-Andreea Robea, Alina-Costina Luca and Alin Ciobica
Medicina 2020, 56(5), 245; https://doi.org/10.3390/medicina56050245 - 20 May 2020
Cited by 20 | Viewed by 6237
Abstract
Recently, connections have been made between feeding and eating problems and autism spectrum disorder (ASD) and between autism pathophysiology and diet issues. These could explain some of the mechanisms which have not yet been discovered or are not sufficiently characterized. Moreover, there is [...] Read more.
Recently, connections have been made between feeding and eating problems and autism spectrum disorder (ASD) and between autism pathophysiology and diet issues. These could explain some of the mechanisms which have not yet been discovered or are not sufficiently characterized. Moreover, there is an increased awareness for micronutrients in ASD due to the presence of gastrointestinal (GI) problems that can be related to feeding issues. For example, levels of vitamins B1, B6, B12, A and D are often reported to be low in ASD children. Thus, in the present mini review we focused on describing the impact of some vitamins deficiencies and their relevance in ASD patients. Full article
(This article belongs to the Special Issue Oxidative Stress as a Commune Factor for the Interplay between, Neuropsychiatric and Gastrointestinal Disorders)
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12 pages, 1074 KiB  
Article
Analysis of Multiple Risk Factors for Seronegative Rate of Anti-Tick-Borne Encephalitis Virus Immunization in Human Serum
by Marta Janik, Sylwia Płaczkowska, Mieczysław Woźniak and Iwona Bil-Lula
Medicina 2020, 56(5), 244; https://doi.org/10.3390/medicina56050244 - 20 May 2020
Cited by 3 | Viewed by 2191
Abstract
Background and objectives: Tick-borne encephalitis virus (TBEV) infections have been the cause of threatening outbreaks for many years. Apart from several physical and chemical methods to prevent tick bites, active vaccination of people highly exposed to infection is still the most important strategy [...] Read more.
Background and objectives: Tick-borne encephalitis virus (TBEV) infections have been the cause of threatening outbreaks for many years. Apart from several physical and chemical methods to prevent tick bites, active vaccination of people highly exposed to infection is still the most important strategy of prevention. However, in some subjects, the lack of or low response to TBEV antigens is observed. The aim of the current study was to assess the prevalence of seronegative rate for anti-TBEV antibodies and the risk factors for waning immunity. Materials and Methods: 2315 at least primary vaccinated subjects from the high risk group for TBEV infections participated in this study. A commercial enzyme-linked immunosorbent assay (ELISA) test was used for the assessment of anti-TBEV IgG serum level. Results: Data showed that 86.2% of subjects who underwent vaccination were positive for anti-TBEV antibodies within 5 years. As much as 13.8% of subjects that underwent primary or primary and booster vaccination were barely protected after vaccination. Women and subjects under 60 years underwent more effective protection but sex and older age was not a risk factor for being a subject of waning immunity. A logistic regression showed that both a longer time since the vaccination and a lower number of booster doses constantly increased the chance of lost anti-TBEV antibodies. Conclusions: This study demonstrates that the vaccination schedule should be reevaluated. The extension of the interval of booster immunization is risky and all subjects should be surrounded by care consisting of more frequent monitoring of serum antibodies by personalized schedule to adjust the frequency of subsequent doses of booster vaccination. Full article
(This article belongs to the Section Infectious Disease)
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10 pages, 298 KiB  
Article
Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison
by Cheng-Yen Chen, Yu-Fu Chen, Hong-Yaw Chen, Chen-Tsung Hung and Hon-Yi Shi
Medicina 2020, 56(5), 243; https://doi.org/10.3390/medicina56050243 - 19 May 2020
Cited by 15 | Viewed by 2271
Abstract
This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of [...] Read more.
This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of 10,534 hip fracture surgery patients during 1996–2010 were recruited in the study. Three datasets were used: a training dataset (n = 7374) was used for model development, a testing dataset (n = 1580) was used for internal validation, and a validation dataset (1580) was used for external validation. Global sensitivity analysis also was performed to evaluate the relative importances of input predictors in the ANN model. Mortality after hip fracture surgery was significantly associated with referral system, age, gender, urbanization of residence area, socioeconomic status, Charlson comorbidity index (CCI) score, intracapsular fracture, hospital volume, and surgeon volume (p < 0.05). For predicting mortality after hip fracture surgery, the ANN model had higher prediction accuracy and overall performance indices compared to the Cox model. Global sensitivity analysis of the ANN model showed that the referral to lower-level medical institutions was the most important variable affecting mortality, followed by surgeon volume, hospital volume, and CCI score. Compared with the Cox regression model, the ANN model was more accurate in predicting postoperative mortality after a hip fracture. The forecasting predictors associated with postoperative mortality identified in this study can also bae used to educate candidates for hip fracture surgery with respect to the course of recovery and health outcomes. Full article
(This article belongs to the Special Issue Artificial Intelligence Research in Healthcare)
10 pages, 1366 KiB  
Article
Inherited Risk Factors of Thromboembolic Events in Patients with Primary Nephrotic Syndrome
by Gener Ismail, Bogdan Obrișcă, Roxana Jurubiță, Andreea Andronesi, Bogdan Sorohan and Mihai Hârza
Medicina 2020, 56(5), 242; https://doi.org/10.3390/medicina56050242 - 19 May 2020
Cited by 9 | Viewed by 2393
Abstract
Background and objectives. Venous thromboembolic events (VTEs) are among the most important complications of nephrotic syndrome (NS). We conducted a study that aimed to determine the prevalence of inherited risk factors for VTE in NS and to identify which factors are independent predictors [...] Read more.
Background and objectives. Venous thromboembolic events (VTEs) are among the most important complications of nephrotic syndrome (NS). We conducted a study that aimed to determine the prevalence of inherited risk factors for VTE in NS and to identify which factors are independent predictors of VTE. Materials and Methods. Thirty-six consecutive patients with primary NS that underwent percutaneous kidney biopsy between January 2017 and December 2017 were enrolled in this retrospective, observational study. VTEs were the primary outcome. Baseline demographic and biochemical data were collected from medical records, and genetic testing was done for polymorphisms of Factor V, PAI, MTHFR, and prothrombin genes. Results. The incidence of VTE was 28%, and the median time to event was 3 months (IQR: 2–9). The prevalence of inherited risk factors was 14% for Factor V Leiden mutation, 5.6% for prothrombin G20210A, 44.5% for PAI, and 27.8% for each of the two polymorphisms of the MTHFR gene. On multivariate analysis, the presence of at least two mutations was independently associated with the risk of VTE (HR, 8.92; 95% confidence interval, CI: 1.001 to 79.58, p = 0,05). Conclusions. These findings suggest that genetic testing for inherited thrombophilia in NS could play an important role in detecting high-risk patients that warrant prophylactic anticoagulation. Full article
(This article belongs to the Special Issue Interdisciplinary Medicine)
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9 pages, 1631 KiB  
Article
The Aerodynamics and Energy Cost Assessment of an Able-Bodied Cyclist and Amputated Models by Computer Fluid Dynamics
by Pedro Forte, Daniel A. Marinho, Ricardo Silveira, Tiago M. Barbosa and Jorge E. Morais
Medicina 2020, 56(5), 241; https://doi.org/10.3390/medicina56050241 - 18 May 2020
Cited by 6 | Viewed by 2953
Abstract
Background and Objectives: The aim of this study was to assess and compare the drag and energy cost of three cyclists assessed by computational fluid dynamics (CFD) and analytical procedures. Materials and methods: A transradial (Tr) and transtibial (Tt) were compared to a [...] Read more.
Background and Objectives: The aim of this study was to assess and compare the drag and energy cost of three cyclists assessed by computational fluid dynamics (CFD) and analytical procedures. Materials and methods: A transradial (Tr) and transtibial (Tt) were compared to a full-body cyclist at different speeds. An elite male cyclist with 65 kg of mass and 1.72 m of height volunteered for this research with his competition cloths, helmet and bicycle with 5 kg of mass. A 3D model of the bicycle and cyclist in the upright position was obtained for numerical simulations. Upon that, two more models were created, simulating elbow and knee-disarticulated athletes. Numerical simulations by computational fluid dynamics and analytical procedures were computed to assess drag and energy cost, respectively. Results: One-Way ANOVA presented no significant differences between cyclists for drag (F = 0.041; p = 0.960; η2 = 0.002) and energy cost (F = 0.42; p = 0.908; η2 = 0.002). Linear regression presented a very high adjustment for absolute drag values between able-bodied and Tr (R2 = 1.000; Ra2 = 1.000; SEE = 0.200) and Tt (R2 = 1.00; Ra2 = 1.000; SEE = 0.160). The linear regression for energy cost presented a very high adjustment for absolute values between able-bodied and Tr (R2 = 1.000; Ra2 = 1.000; SEE = 0.570) and Tt (R2 = 1.00; Ra2 = 1.00; SEE = 0.778). Conclusions: This study suggests that drag and energy cost was lower in the able-bodied, followed by the Tr and Tt cyclists. Full article
(This article belongs to the Special Issue Environmental Physiology in Para Sports)
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10 pages, 814 KiB  
Review
Sepsis Associated Delirium
by Ben Atterton, Maria Carolina Paulino, Pedro Povoa and Ignacio Martin-Loeches
Medicina 2020, 56(5), 240; https://doi.org/10.3390/medicina56050240 - 18 May 2020
Cited by 34 | Viewed by 7545
Abstract
Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral [...] Read more.
Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient’s ability to wean from organ support. Full article
(This article belongs to the Special Issue Delirium in Critically Ill Patients)
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7 pages, 1028 KiB  
Article
Clinical Characteristics of Mitochondrial DNA Copy Number in Osteonecrosis of the Femoral Head
by Si-Wook Lee, Kyung-Jae Lee, Beom-Soo Kim, Hyuk-Jun Kwon and Jae-Ho Lee
Medicina 2020, 56(5), 239; https://doi.org/10.3390/medicina56050239 - 16 May 2020
Cited by 1 | Viewed by 1707
Abstract
Background and objectives: Alterations in mitochondrial DNA (mtDNA) have been observed and studied in various diseases. However, the clinical value of the mtDNA copy number (mtDNA-CN) alterations in osteonecrosis of the femoral head (ONFH) is poorly understood. In the present study, we [...] Read more.
Background and objectives: Alterations in mitochondrial DNA (mtDNA) have been observed and studied in various diseases. However, the clinical value of the mtDNA copy number (mtDNA-CN) alterations in osteonecrosis of the femoral head (ONFH) is poorly understood. In the present study, we investigated whether alterations in mtDNA-CNs are associated with clinicopathological parameters in ONFH. Materials and methods: MtDNA-CNs in the synovial tissue of 34 patients with ONFH and 123 control tissues (femoral neck fracture) were measured using quantitative real-time PCR. The present study then analyzed the correlation between the mtDNA-CN and the clinicopathological characteristics of ONFH and fracture patients. Results: The average mtDNA-CN (mean ± standard deviation) was 23.82 ± 22.37 and 25.04 ± 24.27 in ONFH and control tissues, respectively, and was not significantly different between the groups (p = 0.792). The mtDNA-CN was positively associated with age (27.7% vs. 45.9%, p = 0.018) and negatively associated with the erythrocyte sedimentation rate (ESR) (11.8% vs. 39.7%, p = 0.024) in all of the samples. The study also found further associations with age (22.2% vs. 68.8%, p = 0.014), gender (30.0% vs. 64.3%, p = 0.048), and ESR (0% vs. 57.7%, p = 0.043) in ONFH. Conclusions: in this study, we demonstrated that mtDNA-CN might be a significant marker for predicting clinical characteristics in ONFH. Full article
(This article belongs to the Section Translational Medicine)
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9 pages, 4156 KiB  
Article
Determination of Referential Rates for Optical Coherence Tomography and Optical Coherence Tomography Angiography Flow Deficits in the Macular Choriocapillaris in Ophthalmologically Healthy Children
by Viktorija Bakstytė, Liveta Šniurevičiūtė, Evelina Šimienė, Justina Skruodytė and Ingrida Janulevičienė
Medicina 2020, 56(5), 238; https://doi.org/10.3390/medicina56050238 - 16 May 2020
Cited by 4 | Viewed by 2158
Abstract
Background and Objectives: Despite the growing number of new research publications, normative references for children’s optical coherence tomography (OCT) parameters are still not completed. We chose to explore this topic because of the lack of normative parameters that is due to an [...] Read more.
Background and Objectives: Despite the growing number of new research publications, normative references for children’s optical coherence tomography (OCT) parameters are still not completed. We chose to explore this topic because of the lack of normative parameters that is due to an improvement in different technologies and instruments. Our aim was to determine referential rates of retinal nerve fiber layer (RNFL) thickness and flow deficits (FD%) in the macular choriocapillaris (CC) in normal eyes of ophthalmologically healthy children. Materials and Methods: Ophthalmologically healthy 8- to 14-year-old individuals participated (n = 75) in this study. OCT images were taken using an swept-source-OCT (SS-OCT) instrument (DRI-OCT Triton, Topcon, Tokyo, Japan). The early treatment diabetic retinopathy study (EDTRS) grid (6 × 6 mm) divided the RNFL into the thickness maps. The FD% values of the CC were calculated on the 3 × 3-mm scans in a 1-mm circle (C1), 1.5-mm rim (R1.5), and the entire 2.5-mm circle (C2.5), and on the 6 x 6-mm scans in a 1-mm circle (C1), 1.5-mm rim (R1.5), the entire 2.5-mm circle (C2.5), 2.5-mm rim (R2.5), and 5-mm circle (C5). Results: Both scan quantifications of FD% in the C1, C2.5, and R1.5 sectors were similar, but the 6 × 6-mm scan measurements were statistically significantly smaller than the 3 × 3-mm ones. Significant moderate correlations were found between axial length (AxL) and FD% in the 6 × 6-mm scans, namely C1 (r = −0.347, p = 0.002), C2.5 (r = −0.337, p = 0.003), R1.5 (r = −0.328, p = 0.004), R2.5 (r = −0.306, p = 0.008), and C5 (r = −0.314, p = 0.006). Conclusions: The thinnest RNFL layers were on the temporal and nasal sides. FD% values in the C1, C2.5, and R1.5 sectors were similar between the 3 × 3-mm and 6 × 6-mm scans. The negative moderate correlations between AxL and FD% were found in all C1, C2.5, C5, R1.5, and R2.5 sectors of the 6 × 6-mm scans. Further prospective studies are needed to determine more accurate normative references for children’s OCT parameters. Full article
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15 pages, 394 KiB  
Review
Herbal Preparations of Medical Cannabis: A Vademecum for Prescribing Doctors
by Pietro Brunetti, Simona Pichini, Roberta Pacifici, Francesco Paolo Busardò and Alessandro del Rio
Medicina 2020, 56(5), 237; https://doi.org/10.3390/medicina56050237 - 15 May 2020
Cited by 56 | Viewed by 5885
Abstract
Cannabis has been used for centuries for therapeutic purposes. In the last century, the plant was demonized due to its high abuse liability and supposedly insufficient health benefits. However, recent decriminalization policies and new scientific evidence have increased the interest in cannabis therapeutic [...] Read more.
Cannabis has been used for centuries for therapeutic purposes. In the last century, the plant was demonized due to its high abuse liability and supposedly insufficient health benefits. However, recent decriminalization policies and new scientific evidence have increased the interest in cannabis therapeutic potential of cannabis and paved the way for the release of marketing authorizations for cannabis-based products. Although several synthetic and standardized products are currently available on the market, patients’ preferences lean towards herbal preparations, because they are easy to handle and self-administer. A literature search was conducted on multidisciplinary research databases and international agencies or institutional websites. Despite the growing popularity of medical cannabis, little data is available on the chemical composition and preparation methods of medical cannabis extracts. The authors hereby report the most common cannabis preparations, presenting their medical indications, routes of administration and recommended dosages. A practical and helpful guide for prescribing doctors is provided, including suggested posology, titration strategies and cannabinoid amounts in herbal preparations obtained from different sources of medical cannabis. Full article
(This article belongs to the Special Issue Use of Medicinal Cannabis and Synthetic Cannabinoids)
10 pages, 915 KiB  
Article
Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients
by Charat Thongprayoon, Wisit Cheungpasitporn, Sorkko Thirunavukkarasu, Tananchai Petnak, Api Chewcharat, Tarun Bathini, Saraschandra Vallabhajosyula, Michael A. Mao and Stephen B. Erickson
Medicina 2020, 56(5), 236; https://doi.org/10.3390/medicina56050236 - 14 May 2020
Cited by 9 | Viewed by 2335
Abstract
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between [...] Read more.
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L. Full article
(This article belongs to the Special Issue Electrolyte, Acid–Base, and Mineral Metabolism Disorders: Pathophysiology, Outcomes, and Treatment)
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10 pages, 314 KiB  
Article
Could FeNO Predict Asthma in Patients with House Dust Mites Allergic Rhinitis?
by Ioana Adriana Muntean, Ioana Corina Bocsan, Stefan Vesa, Nicolae Miron, Irena Nedelea, Anca Dana Buzoianu and Diana Deleanu
Medicina 2020, 56(5), 235; https://doi.org/10.3390/medicina56050235 - 14 May 2020
Cited by 8 | Viewed by 2469
Abstract
Background and Objectives: The evolution of allergic rhinitis to asthma is a part of “atopic march”. The aim of this study was to analyze possible predictive markers for asthma occurrence in patients with allergic rhinitis to house dust mites (HDM). Materials and [...] Read more.
Background and Objectives: The evolution of allergic rhinitis to asthma is a part of “atopic march”. The aim of this study was to analyze possible predictive markers for asthma occurrence in patients with allergic rhinitis to house dust mites (HDM). Materials and Methods: Fifty-eight patients with persistent allergic rhinitis (PAR) were included. The clinical, biological evaluation and fractionated exhaled nitric oxide (FeNO) measurement were performed at enrolment. The patients were clinically evaluated after one year to determine asthma occurrence. Results: The severity of rhinitis symptoms, levels of total immunoglobulin E (IgE), ICAM-1, VCAM-1, E-selectin and IL-6, but not IL-8 and TNF-α were higher in patients with allergic rhinitis who developed asthma compared to non-asthmatics, but the differences were not significant to considered them as predictive factors for asthma occurrence. The risk of asthma was independently influenced by patients aged over 30 years ((OR-3.74; CI95% 0.86–16.31; p = 0.07), a duration of allergic rhinitis over 12 months ((OR-4.20; CI95% 0.88–20; p = 0.07) and a basal FeNO over 28 parts per billion (pbb) ((OR-18.68; CI95% 3.79–92.05; p < 0.001). Conclusion: Clinical and biological parameters may predict asthma occurrence in patients with persistent allergic rhinitis to HDM. Adult patients with a longer duration of rhinitis symptoms and a high level of FeNO have a greater risk to develop asthma. Full article
14 pages, 2763 KiB  
Article
Effects of Khat on Surface Roughness and Color of Feldspathic and Zirconia Porcelain Materials under Simulated Oral Cavity Conditions
by Mohammed M. Al Moaleem, Rashad AlSanosy, Nasser M. Al Ahmari, Mansoor Shariff, Abdulkhaliq A. Alshadidi, Hassan A. Alhazmi and Asaad Khalid
Medicina 2020, 56(5), 234; https://doi.org/10.3390/medicina56050234 - 13 May 2020
Cited by 10 | Viewed by 2716
Abstract
Background and Objectives: Khat chewing is considered as a daily habit that is practiced by more than five million people globally. The effect of khat chewing on the surface roughness and the color stability of natural teeth and the material used in [...] Read more.
Background and Objectives: Khat chewing is considered as a daily habit that is practiced by more than five million people globally. The effect of khat chewing on the surface roughness and the color stability of natural teeth and the material used in the fabrication of dental prosthesis remains unknown. This study was conducted to explore and compare the effect of khat homogenate (KH) on the surface roughness (Ra) and the average color changes (ΔE*) amongst natural teeth and selected shades from different porcelain types, namely, feldspathic metal ceramic (MC) VM13, computer-aided design/computer assisted manufacture (CAD/CAM) feldspathic (Vitablocs Mark II), and multilayer zirconia (Ceramill Zolid PS) porcelains. Materials and Methods: Seventy samples were prepared from natural teeth, feldspathic MC, CAD/CAM Vitablocs Mark II, and zirconia porcelain. The Ra values were measured using a profilometer and expressed in micrometers, whereas the ΔE* values were measured using VITA Easyshade® V spectrophotometer for all samples before and after frequent immersion and thermocycling in KH for 30 days. The surface topography was used to assess the materials surfaces (glazed or polished) after KH immersion by using a white light interferometry machine. Results: Results revealed that the Ra and the ΔE* values of the different types of tested porcelain were influenced by KH. The order of surface roughness values was glazed or polished MC > polished Zircon > polished Vitablocs Mark II > natural teeth. The lowest ΔE* values were recorded for glazed Vitablocs Mark II and MC, and the values could be arranged as polished zircon > natural teeth > glazed zircon > polished MC > polished Vitablocs Mark II. P values were significantly varied (<0.001) among all the tested groups, except the zircon group (>0.05) for both Ra and ΔE*. Conclusions: KH significantly affected both surface parameter and color of glazed or polished porcelain materials and natural teeth. Full article
(This article belongs to the Section Dentistry)
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12 pages, 507 KiB  
Editorial
Should Autism Spectrum Conditions Be Characterised in a More Positive Way in Our Modern World?
by Barry Wright, Penny Spikins and Hannah Pearson
Medicina 2020, 56(5), 233; https://doi.org/10.3390/medicina56050233 - 13 May 2020
Cited by 18 | Viewed by 7076
Abstract
In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over [...] Read more.
In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over the years has focused on comparisons between neuro-typical people and people with Autism Spectrum Conditions. These comparisons have tended to draw attention to ‘deficits’ in cognitive abilities and descriptions of behaviours that are characterised as unwanted. Not surprisingly, this is reflected in the classification systems from the World Health Organisation and the American Psychiatric Association. Public opinion about ASC may be influenced by presentations in the media of those with ASC who also have intellectual disability. Given that diagnostic systems are intended to help us better understand conditions in order to seek improved outcomes, we propose a more constructive approach to descriptions that uses more positive language, and balances descriptions of deficits with research finding of strengths and differences. We propose that this will be more helpful to individuals on the Autism Spectrum, both in terms of individual self-view, but also in terms of how society views Autism Spectrum Conditions more positively. Commentary has also been made on guidance that has been adjusted for people with ASC in relation to the current COVID-19 pandemic. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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23 pages, 613 KiB  
Review
Hypersensitivity Reactions to Monoclonal Antibodies in Children
by Francesca Mori, Francesca Saretta, Annamaria Bianchi, Giuseppe Crisafulli, Silvia Caimmi, Lucia Liotti, Paolo Bottau, Fabrizio Franceschini, Claudia Paglialunga, Giampaolo Ricci, Angelica Santoro and Carlo Caffarelli
Medicina 2020, 56(5), 232; https://doi.org/10.3390/medicina56050232 - 12 May 2020
Cited by 13 | Viewed by 3976
Abstract
Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can [...] Read more.
Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available. Full article
(This article belongs to the Special Issue Pediatric Allergy and Immunology)
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15 pages, 1180 KiB  
Article
Use of Glycated Hemoglobin (A1c) as a Biomarker for Vascular Risk in Type 2 Diabetes: Its Relationship with Matrix Metalloproteinases-2, -9 and the Metabolism of Collagen IV and Elastin
by Krasimir Kostov and Alexander Blazhev
Medicina 2020, 56(5), 231; https://doi.org/10.3390/medicina56050231 - 11 May 2020
Cited by 13 | Viewed by 3875
Abstract
Background and objectives: HbA1c measurements may be useful not only in optimizing glycemic control but also as a tool for managing overall vascular risk in patients with diabetes. In the present study, we investigate the clinical significance of HbA1c as a biomarker [...] Read more.
Background and objectives: HbA1c measurements may be useful not only in optimizing glycemic control but also as a tool for managing overall vascular risk in patients with diabetes. In the present study, we investigate the clinical significance of HbA1c as a biomarker for hyperglycemia-induced vascular damages in type 2 diabetes (T2D) based on the levels of matrix metalloproteinases-2, -9 (MMP-2, MMP-9), anti-collagen IV (ACIV), and anti-elastin (AE) antibodies (Abs) IgM, IgG, and IgA, and CIV-derived peptides (CIV-DP) reflecting collagen and elastin turnover in the vascular wall. The aim is to show the relationship of hyperglycemia with changes in the levels of vascular markers and the dynamics of this relationship at different degrees of glycemic control reported by HbA1c levels. Materials and Methods: To monitor elastin and collagen IV metabolism, we measured serum levels of these immunological markers in 59 patients with T2D and 20 healthy control subjects with an ELISA. Results: MMP-2, MMP-9, and the AEAbs IgA levels were significantly higher in diabetic patients than in control subjects, whereas those of the AEAbs IgM, ACIVAbs IgM, and CIV-DP were significantly lower. MMP-9 levels were significantly lower at HbA1c values >7.5%. Conclusions: A set of three tested markers (MMP-2, MMP-9, and AEAbs IgA) showed that vascular damages from preceding long-term hyperglycemia begin to dominate at HbA1c values ≥7.5%, which is the likely cut-point to predict increased vascular risk. Full article
(This article belongs to the Special Issue Interdisciplinary Medicine)
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11 pages, 315 KiB  
Article
Synchronous Multiple Breast Cancers—Do We Need to Reshape Staging?
by Minodora Onisâi, Adrian Dumitru, Iuliana Iordan, Cătălin Aliuș, Oana Teodor, Adrian Alexandru, Daniela Gheorghiță, Iulian Antoniac, Adriana Nica, Alexandra-Ana Mihăilescu and Sebastian Grădinaru
Medicina 2020, 56(5), 230; https://doi.org/10.3390/medicina56050230 - 11 May 2020
Cited by 6 | Viewed by 1904
Abstract
Background and Objectives: Current recommendations and treatment regimens in breast cancer are a reflection of its heterogeneity on multiple levels including histological subtypes, grading, molecular profiling, and numerous prognostic indices. Although based on extensive research, current guidelines are not explicit in the case [...] Read more.
Background and Objectives: Current recommendations and treatment regimens in breast cancer are a reflection of its heterogeneity on multiple levels including histological subtypes, grading, molecular profiling, and numerous prognostic indices. Although based on extensive research, current guidelines are not explicit in the case of surgical specimens showing various degrees of mismatch between different parts of the same tumor and even more so between multicentric lesions. Synchronous breast cancer is the ideal prototype for studying inter- and intra-tumoral heterogeneity, therefore we envisaged that a study on patients with multicentric and multifocal lesions could contribute to the reshaping of the staging, prognosis, and treatment of breast malignancies. Material and Methods: A prospective observational study was conducted between January 2013 and May 2017 on 235 patients diagnosed with breast cancer (BC) and surgically treated at Emergency University Hospital, Bucharest. Thirty-seven patients had multiple breast tumors and were eligible for assessment of the heterogeneity of their lesions. Results: 6 were multicentric and 31 multifocal. The number of foci varied from 2 to 11. We encountered numerous mismatches between the index and the secondary tumors, as follows: 3 cases (8.1%) with histopathological mismatch, 13 (35.1%) with different grades of differentiation, 11 (29.8%) with ER (Estrogen Receptors) status mismatch, 12 (32.4%) with PR (Progesterone Receptors) status mismatch, 8 (21.6%) with molecular phenotype mismatch, and 17 (45.9%) cases with variable Ki-67. After careful analysis of index and secondary tumors, apart from the mismatches reported above, we discovered that the secondary tumors were actually dominant in 5 cases (13.5%), and therefore at least those cases had to be reclassified/restaged, as the supplementary data commanded changes in the therapeutic decision. Conclusions: For synchronous breast tumors, the current Tumor-Node-Metastasis (TNM) staging system ignores not only the histopathological and immunohistochemical characteristics of the secondary foci, but also their size. When secondary lesions are more aggressive or their cumulative mass is significantly bigger than that of the index tumor, the treatment plan should be adapted accordingly. We believe that information obtained from examining secondary foci in synchronous breast cancer and assessment of the cumulative tumoral mass should be reflected in the final staging and definitive treatment. The clinical benefit of staging the patients based on the most aggressive tumor and the cumulative tumoral burden rather than according to the biggest single tumor, will avoid under-treatment in cases with multifocal/multicentric BC displaying intertumoral mismatch. Full article
9 pages, 276 KiB  
Article
Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured Abdominal Aortic Aneurysm Repair
by Sigitas Urbonavicius, Ingrid Luise Feuerhake, Reshaabi Srinanthalogen, Martinas Urbonavicius, Tomas Baltrunas, Nikolaj Fibiger Grøndal and Flemming Randsbæk
Medicina 2020, 56(5), 229; https://doi.org/10.3390/medicina56050229 - 11 May 2020
Cited by 2 | Viewed by 1916
Abstract
Background and Objectives: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective [...] Read more.
Background and Objectives: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective of this study was to evaluate the efficacy of routine flexible sigmoidoscopy in detecting CI after rAAA repair, and to identify potential hemodynamic, biochemical, and clinical variables that can predict the development of CI in the patients who underwent rAAA surgery. Materials and Methods: we retrospectively included all rAAA cases treated in Viborg hospital from 1 April 2014 until 31 August 2017, recorded the findings on flexible sigmoidoscopy, and the incidence of CI. We collected specific hemodynamic, biochemical, and clinical variables, measured pre- and perioperatively, and the first three postoperative days. The association between CI and possible predictors was analyzed in a logistic regression model. Results: a total of 80 patients underwent open rAAA repair during the study period. Flexible sigmoidoscopy was performed in 58 of 80 patients (73.5%) who survived at least 24 h after open rAAA surgery. Perioperative variables lowest arterial pH (p = 0.02) and types of operations—aortobifemoral bypass vs. straight graft (p = 0.04) showed statistically significant differences between CI groups. The analysis of the postoperative variables showed statistically significant difference in highest lactate on postoperative day 1 (p = 0.01), and lowest hemoglobin on postoperative day 2 (p = 0.04) comparing CI groups. Logistic regression model revealed that postoperative hemoglobin and lactate turned out to be independent risk factors for the development of CI (respectively OR = 0.44 (95% CI = 0.29–0.67) and OR = 1.91 (95% CI = 1.2–3.05)). Conclusions: flexible sigmoidoscopy can identify patients being at higher risk of mortality after open rAAA repair. The postoperative lactate and hemoglobin were found to be independent risk factors for the development of CI after open rAAA repair. Further larger studies are warranted to demonstrate these findings. Full article
(This article belongs to the Section Surgery)
8 pages, 311 KiB  
Article
Acute Effects of a Single Football Training or Match on Passive Hip Rotation Range of Motion in Semi-Professional Football Players: A Pilot Study
by Blanca De-la-Cruz-Torres, Vanesa Abuín-Porras, Maria Blanco-Morales, Mónica de-la-Cueva-Reguera, César Calvo-Lobo, Daniel López-López and Carlos Romero-Morales
Medicina 2020, 56(5), 228; https://doi.org/10.3390/medicina56050228 - 10 May 2020
Cited by 2 | Viewed by 2260
Abstract
Background and Objectives: The repetitive loading forces generated during football activities may induce alterations in the hip rotation range of motion (ROM) in players. The objective of this study was to evaluate the acute effects of a training and a match on [...] Read more.
Background and Objectives: The repetitive loading forces generated during football activities may induce alterations in the hip rotation range of motion (ROM) in players. The objective of this study was to evaluate the acute effects of a training and a match on bilateral passive hip rotation ROM in both lower limbs in soccer. Material and Methods: Twenty-eight male players were divided into two groups: 14 players (28 limbs) with normal bilateral hip rotation ROM (NH group) and 14 players (28 limbs) with restricted bilateral hip ROM (RH group). Passive bilateral hip rotation ROM was measured, by goniometer, before and after training or a match. Internal-rotation ROM (ROMIR), external-rotation ROM (ROMER), total ROM (ROMTOT) and relative internal rotation (ROMREL) were calculated. Results: The NH group did not show substantial changes in hip ROM after a training nor a match. After a training session, only the RH group exhibited a substantial increase in ROMIR, ROMER and ROMTOT. After a match, only the RH group exhibited a substantial increase in ROMER and ROMTOT and exhibited a substantial decrease in ROMREL. Comparing both groups, there were significant differences within ROM changes for ROMER and ROMTOT after training and for ROMER and ROMREL after a match. Conclusions: Despite the small sample size of the present study, the findings indicate that a single football activity leads to significant changes in hip rotation ROM in players with restricted bilateral hip external-rotation ROM. However, these changes did not reach reference cut-off scores. Full article
4 pages, 245 KiB  
Editorial
Stroke, Dementia, and Atrial Fibrillation: From Pathophysiologic Association to Pharmacological Implications
by Vincenzo Russo, Riccardo Vio and Riccardo Proietti
Medicina 2020, 56(5), 227; https://doi.org/10.3390/medicina56050227 - 10 May 2020
Cited by 5 | Viewed by 1826
Abstract
The impact of stroke and dementia on disability and death is a major contemporary health issue [...] Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
12 pages, 749 KiB  
Article
Reasons for Breastfeeding Cessation in the First Year after Childbirth in Lithuania: A Prospective Cohort Study
by Viktorija Zitkute, Vilija Snieckuviene, Jolita Zakareviciene, Aurelija Pestenyte, Vaidile Jakaite and Diana Ramasauskaite
Medicina 2020, 56(5), 226; https://doi.org/10.3390/medicina56050226 - 09 May 2020
Cited by 6 | Viewed by 2646
Abstract
Objectives: to identify the main reasons of breastfeeding cessation in Lithuania and if there is a link between the length of maternity leave and breastfeeding cessation. Methods: a prospective questionnaire study was conducted in a tertiary hospital from 2016 to 2017. The sample [...] Read more.
Objectives: to identify the main reasons of breastfeeding cessation in Lithuania and if there is a link between the length of maternity leave and breastfeeding cessation. Methods: a prospective questionnaire study was conducted in a tertiary hospital from 2016 to 2017. The sample size included 449 women. Results: a total of 41% (n = 123) of respondents weaned off by 6 months after birth, and 57.8% (n = 173) between 6 months and 1 year. During the first few days after delivery, mothers did not breastfeed their infants mainly due to shortage of milk (n = 10; 40%) or separation from their baby due to infant health problems (n = 12; 48%) (p < 0.0001). Mothers who did not breastfeed during the first days after birth more often did not start breastfeeding later at home (p = 0.001). Going back to work was not a significant factor in weaning off. Conclusions: breastfeeding initiation and practice during the first few days after birth has a significant impact on the further commitment for full breastfeeding. Additionally, a perceived lack of support and help from both doctors and midwives influences a woman’s decision to choose not to breastfeed. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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22 pages, 1356 KiB  
Review
Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis—Review of the Literature
by Marcin Derwich, Maria Mitus-Kenig and Elzbieta Pawlowska
Medicina 2020, 56(5), 225; https://doi.org/10.3390/medicina56050225 - 09 May 2020
Cited by 68 | Viewed by 8184
Abstract
Background and objectives: There is an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. [...] Read more.
Background and objectives: There is an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth. Full article
(This article belongs to the Section Dentistry)
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