Medicina

3 pages, 240 KiB

Open AccessCommunication

The “Undetermined Significance” of ¹⁸F-FDG PET/CT or PET/MRI in Patients with Monoclonal Gammopathy of Undetermined Significance (MGUS)

by Giorgio Treglia, Francesco Bertagna and Domenico Albano

Medicina 2021, 57(8), 856; https://doi.org/10.3390/medicina57080856 - 23 Aug 2021

Cited by 2 | Viewed by 1976

Abstract

Monoclonal gammopathy of undetermined significance (MGUS) is a highly prevalent condition with the possible risk of progression to multiple myeloma (MM) or a lymphoproliferative neoplasm in a small percentage of patients. Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) or positron [...] Read more.

Monoclonal gammopathy of undetermined significance (MGUS) is a highly prevalent condition with the possible risk of progression to multiple myeloma (MM) or a lymphoproliferative neoplasm in a small percentage of patients. Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) or positron emission tomography/magnetic resonance imaging (PET/MRI) are imaging methods increasingly used in patients with MM. The aim of this communication is to underline that, taking into account current evidence-based data, compared to MM the role of ¹⁸F-FDG PET/CT or PET/MRI in MGUS is still undetermined and more studies should be performed before suggesting ¹⁸F-FDG PET/CT or PET/MRI for evaluation of MM progression in patients with MGUS. Full article

(This article belongs to the Special Issue 2-[18F]-FDG PET/CT in Oncology: New Evidences and Future Perspectives)

11 pages, 3741 KiB

Open AccessArticle

A Novel Procedure for the Management of Severe Hyphema after Glaucoma Filtering Surgery: Air–Blood Exchange under a Slit-Lamp Biomicroscopy

by I-Hung Lin, Lung-Chi Lee, Ke-Hao Huang, Chang-Min Liang, Yi-Hao Chen and Da-Wen Lu

Medicina 2021, 57(8), 855; https://doi.org/10.3390/medicina57080855 - 22 Aug 2021

Viewed by 4417

Abstract

Background and Objectives: This study introduces a novel office-based procedure involving air–blood exchange under a slit-lamp microscope for treatment of severe hyphema after filtering surgery. Materials and Methods: This retrospective study enrolled 17 patients (17 eyes) with a diagnosis of primary [...] Read more.

Background and Objectives: This study introduces a novel office-based procedure involving air–blood exchange under a slit-lamp microscope for treatment of severe hyphema after filtering surgery. Materials and Methods: This retrospective study enrolled 17 patients (17 eyes) with a diagnosis of primary open-angle glaucoma with severe hyphema (≥4-mm height) after filtering surgery. All patients were treated with air–blood exchange under a slit-lamp using room air (12 patients) or 12% perfluoropropane (C3F8; five patients). Results: The procedures were successful in all 17 patients; they exhibited clear visual axes without complications during follow-up. In the room air group, the mean visual acuity (VA) and hyphema height significantly improved from 1.70 ± 1.07 LogMAR and 5.75 ± 1.14 mm before the procedure to 0.67 ± 0.18 LogMAR and 2.83 ± 0.54 mm after the procedure (p = 0.004; p < 0.001). In the C3F8 group, the mean VA showed a trend, though not significant, for improvement from 1.70 ± 1.10 LogMAR to 0.70 ± 0.19 LogMAR (p = 0.08); the mean hyphema height showed a trend for improvement from 5.40 ± 0.96 mm to 3.30 ± 0.45 mm. Compared with the C3F8 group, the room air group showed the same efficacy with a shorter VA recovery time. Conclusions: “Air–blood exchange under a slit-lamp using room air” is a convenient, rapid, inexpensive, and effective treatment option for severe hyphema after filtering surgery, and may reduce the risk of failure of filtering surgery. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

13 pages, 322 KiB

Open AccessArticle

Long-Term Outcome after Liver Transplantation for Progressive Familial Intrahepatic Cholestasis

by Safak Gül-Klein, Robert Öllinger, Moritz Schmelzle, Johann Pratschke and Wenzel Schöning

Medicina 2021, 57(8), 854; https://doi.org/10.3390/medicina57080854 - 22 Aug 2021

Cited by 5 | Viewed by 1992

Abstract

Background and Objectives: Progressive familial intrahepatic cholestasis (PFIC) is a rare autosomal recessive inherited disease divided into five types (PFIC 1-5). Characteristic for all types is early disease onset, which may result clinically in portal hypertension, fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and extrahepatic [...] Read more.

Background and Objectives: Progressive familial intrahepatic cholestasis (PFIC) is a rare autosomal recessive inherited disease divided into five types (PFIC 1-5). Characteristic for all types is early disease onset, which may result clinically in portal hypertension, fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and extrahepatic manifestations. Liver transplantation (LT) is the only successful treatment approach. Our aim is to present the good long-term outcomes after liver transplantation for PFIC1, focusing on liver function as well as the occurrence of extrahepatic manifestation after liver transplantation. Materials and Methods: A total of seven pediatric patients with PFIC1 underwent liver transplantation between January 1999 and September 2019 at the Department of Surgery, Charité Campus Virchow Klinikum and Charité Campus Mitte of Charité-Universitätsmedizin Berlin. Long-term follow-up data were collected on all patients, specifically considering liver function and extrahepatic manifestations. Results: Seven (3.2%) recipients were found from a cohort of 219 pediatric patients. Two of the seven patients had multilocular HCC in cirrhosis. Disease recurrence or graft loss did not occur in any patient. Two patients (male, siblings) had persistently elevated liver parameters but showed excellent liver function. Patient and graft survival during long-term follow-up was 100%, and no severe extrahepatic manifestations requiring hospitalization or surgery occurred. We noted a low complication rate during long-term follow-up and excellent patient outcome. Conclusions: PFIC1 long-term follow-up after LT shows promising results for this rare disease. In particular, the clinical relevance of extrahepatic manifestations seems acceptable, and graft function seems to be barely affected. Further multicenter studies are needed to analyze the clinically inhomogeneous presentation and to better understand the courses after LT. Full article

(This article belongs to the Special Issue Liver Transplantation Today: Where We Are Now and Where We Are Going)

9 pages, 288 KiB

Open AccessArticle

The Experience of Healthy Pregnancy in High Parity Women: A Phenomenological Study in North Jordan

by Ghadeer Alzboon and Gülşen Vural

Medicina 2021, 57(8), 853; https://doi.org/10.3390/medicina57080853 - 22 Aug 2021

Cited by 1 | Viewed by 1929

Abstract

Background and Objectives: High parity women are more likely to have poor quality of life during pregnancy than low parity women. Thus, the aim of this study was to explore the lived experience of healthy pregnancy among high parity women in North [...] Read more.

Background and Objectives: High parity women are more likely to have poor quality of life during pregnancy than low parity women. Thus, the aim of this study was to explore the lived experience of healthy pregnancy among high parity women in North Jordan. Materials and Methods: A descriptive phenomenological design was employed in this study to complement previously published quantitative results. Fourteen pregnant women, who had four children or more, were recruited purposely according to inclusion criteria from Irbid city in North Jordan. Data were collected using face-to-face, semi-structured interviews. Colaizzi’s method was employed to analyze the verbatim data. Results: There were three main themes which emerged from participants significant statements: they had new discomforts, antenatal care and follow-up, and social issues. Each extracted theme was linked to some factors (subthemes), which had a positive or negative impact on the quality of life of high parity women during pregnancy. High parity women who experienced multiple stressors had a poor quality of life. Conclusions: Experiencing new discomforts, less or no antenatal care, and a lack of social support negatively affected the quality of life among high parity women. Antenatal interventions should be designed based on high parity women’s perceptions of their health and wellbeing in order to improve their quality of life and ultimately prevent maternal morbidity and mortality. Further quantitative studies are needed to explore the impact of previous mentioned factors on maternal quality of life and outcomes. Full article

(This article belongs to the Special Issue Diagnosis, Prevention and Treatment for Diseases Specific to Women)

4 pages, 272 KiB

Open AccessArticle

Performance of Antigen-Based Testing as Frontline Diagnosis of Symptomatic COVID-19

by Efrén Murillo-Zamora, Xóchitl Trujillo, Miguel Huerta, Mónica Ríos-Silva and Oliver Mendoza-Cano

Medicina 2021, 57(8), 852; https://doi.org/10.3390/medicina57080852 - 21 Aug 2021

Cited by 3 | Viewed by 2652

Abstract

Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted [...] Read more.

Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted in Mexico and data from 15,408 suspected (all of them symptomatic) cases of COVID-19 were analyzed. The results of antigen-based tests were compared with those obtained by molecular (polymerase chain reaction-based) assays. Results: The antigen-based tests showed sensitivity below 50% and high specificity in all the analyzed age groups. The highest Youden index (J) was observed among adults aged 25–44 years old (45.5, 95% CI 43.7–47.3). Conclusions: We documented the poor performance of serologic techniques as frontline diagnosis of symptomatic COVID-19 and inaccurate results may impact negatively on pandemic progression. Full article

(This article belongs to the Special Issue Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic)

7 pages, 3032 KiB

Open AccessCase Report

Tubulocystic Renal Cell Carcinoma Is Not an Indolent Tumor: A Case Report of Recurrences in the Retroperitoneum and Contralateral Kidney

by Tae-Soo Choi, Dong-Gi Lee, Kyu-Yeoun Won and Gyeong-Eun Min

Medicina 2021, 57(8), 851; https://doi.org/10.3390/medicina57080851 - 21 Aug 2021

Cited by 1 | Viewed by 2015

Abstract

Tubulocystic renal cell carcinoma (RCC) is a rare subtype of RCC that was recently included in the 2016 World Health Organization classification of tumors of the kidney. Most of these tumors exhibit indolent behavior with low metastatic potential. However, here we report a [...] Read more.

Tubulocystic renal cell carcinoma (RCC) is a rare subtype of RCC that was recently included in the 2016 World Health Organization classification of tumors of the kidney. Most of these tumors exhibit indolent behavior with low metastatic potential. However, here we report a case of recurrent tubulocystic RCC with aggressive features in the retroperitoneum and contralateral kidney treated with targeted agents and radiofrequency ablation. Full article

(This article belongs to the Section Surgery)

► Show Figures

Figure 1

6 pages, 12974 KiB

Open AccessCase Report

A Potentially Misleading Hepatocellular Carcinoma

by Ottavia De Simoni, Andrea Barina, Mario Gruppo, Antonio Scapinello, Vasileios Mourmouras, Pierluigi Pilati and Boris Franzato

Medicina 2021, 57(8), 850; https://doi.org/10.3390/medicina57080850 - 20 Aug 2021

Cited by 1 | Viewed by 2167

Abstract

Hepatocellular carcinoma (HCC) typically presents in patients with a chronic liver disease and rarely develops in healthy liver, especially within an accessory liver lobe. We present a case of a healthy 64-years-old woman who showed a serum alpha-fetoprotein (AFP) value of 226.3 µg/mL [...] Read more.

Hepatocellular carcinoma (HCC) typically presents in patients with a chronic liver disease and rarely develops in healthy liver, especially within an accessory liver lobe. We present a case of a healthy 64-years-old woman who showed a serum alpha-fetoprotein (AFP) value of 226.3 µg/mL during a screening blood test. Past medical history was negative for chronic liver disease or cirrhosis. Intraoperative finding was an ovaloid mass connected with the second hepatic segment by a thin pedicle of hepatic tissue. Lesion was safely resected by laparoscopic approach. Histopathology analysis showed a trabecular hepatocellular carcinoma. After a 6-month follow up, there was no evidence of recurrent disease. This case report showed how serum AFP remains a highly sensitive marker, although the presentation of HCC was unusual. To our knowledge, this is the second case reported in the literature. Full article

(This article belongs to the Section Surgery)

► Show Figures

Figure 1

5 pages, 2934 KiB

Open AccessCase Report

Complete Response in Metastatic Hepatocellular Carcinoma with Cardiac and Lung Involvement via Multimodality Treatment

by Kun-Feng Tsai, Jerry C. H. Tsai, Ming-Feng Li, Jimmy W. H. Tan, Chu-Kuang Chou, Huei-Lung Liang and Shan-Ho Chan

Medicina 2021, 57(8), 849; https://doi.org/10.3390/medicina57080849 - 20 Aug 2021

Cited by 1 | Viewed by 1917

Abstract

Background: Until recently, advanced HCC patients with major vessel and cardiac involvement have had an extremely poor prognosis without satisfactory treatment. Case presentation: A 63-year-old Taiwanese male presented with metastatic HCC with RA and IVC thrombi, as well as pulmonary metastases [...] Read more.

Background: Until recently, advanced HCC patients with major vessel and cardiac involvement have had an extremely poor prognosis without satisfactory treatment. Case presentation: A 63-year-old Taiwanese male presented with metastatic HCC with RA and IVC thrombi, as well as pulmonary metastases that were successfully treated by multimodal management, encompassed by surgical thrombectomy, concurrent systemic sorafenib and locoregional therapies, and immunotherapy. The patient has achieved a complete response over the past 33 months. Conclusions: Through this case report, which shows a successful outcome via multimodal management, a more aggressive approach should be considered when a patient is expected to tolerate the risks and side effects of various treatments. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

► Show Figures

Figure 1

9 pages, 17921 KiB

Open AccessArticle

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents—Preliminary Report and Step-by-Step Technique Showcase

by Jakub Bargiel, Michał Gontarz, Krzysztof Gąsiorowski, Tomasz Marecik, Paweł Szczurowski, Jan Zapała and Grażyna Wyszyńska-Pawelec

Medicina 2021, 57(8), 848; https://doi.org/10.3390/medicina57080848 - 20 Aug 2021

Cited by 6 | Viewed by 11940

Abstract

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects [...] Read more.

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon. Full article

(This article belongs to the Special Issue Oral Surgery–Minimizing Postoperative Morbidity)

► Show Figures

Figure 1

8 pages, 965 KiB

Open AccessArticle

An Insight into Deficient Mismatch Repair Colorectal Cancer Screening in a Romanian Population—A Bi-Institutional Pilot Study

by Cristina Lungulescu, Vlad Mihai Croitoru, Simona Ruxandra Volovat, Irina Mihaela Cazacu, Adina Turcu-Stiolica, Dan Ionut Gheonea, Daniel Sur and Cristian Virgil Lungulescu

Medicina 2021, 57(8), 847; https://doi.org/10.3390/medicina57080847 - 20 Aug 2021

Cited by 3 | Viewed by 2677

Abstract

Background and Objectives: Colorectal cancer (CRC) can be classified as mismatch-repair-deficient (dMMR) with high levels of microsatellite instability (MSI-H), or mismatch-repair-proficient (pMMR) and microsatellite stable (MSS). Approximately 15% of patients have microsatellite instability (MSI). MSI-H tumors are associated with a high mutation [...] Read more.

Background and Objectives: Colorectal cancer (CRC) can be classified as mismatch-repair-deficient (dMMR) with high levels of microsatellite instability (MSI-H), or mismatch-repair-proficient (pMMR) and microsatellite stable (MSS). Approximately 15% of patients have microsatellite instability (MSI). MSI-H tumors are associated with a high mutation burden. Monoclonal antibodies that block immune checkpoints can induce long-term durable responses in some patients. Pembrolizumab is the first checkpoint inhibitor approved in the EU to treat dMMR–MSI-H metastatic CRC. Materials and Methods: Our study assesses the regional variability of MSI-H colorectal cancer tumors in Romania. Formalin-fixed, paraffin-embedded (FFPE) tissue blocks containing tumor samples from 90 patients diagnosed with colorectal cancer were collected from two tertiary referral Oncology Centers from Romania. Tissues were examined for the expression loss of MMR proteins (MLH1, PMS2, MSH2, MSH6) using immunohistochemistry or MSI status using polymerase chain reaction (PCR), respectively. Results: MSI-H was detected in 19 (21.1%) patients. MSI-H was located more in ascending colon (36.8% vs. 9.9%, p-value = 0.0039) and less in sigmoid (5.3% vs. 33.8%, p-value = 0.0136) than MSS patients. Most patients were stage II for MSI-H (42.1%) as well as for MSS (56.3%), with significant more G1 (40.9% vs. 15.8%, p-value = 0.0427) for MSS patients. Gender, N stage, and M stage were identified as significant prognostic factors in multivariate analysis. MSI status was not a statistically significant predictor neither in univariate analysis nor multivariate analysis. Conclusion: Considering the efficacy of PD-1 inhibitor in metastatic CRC with MSI-H or dMMR, and its recent approval in EU, it is increasingly important to understand the prevalence across tumor stage, histology, and demographics, since our study displayed higher regional MSI-H prevalence (21%) compared to the literature. Full article

(This article belongs to the Special Issue Therapeutic Landscapes in Colorectal Carcinoma)

► Show Figures

Figure 1

10 pages, 1090 KiB

Open AccessArticle

Effect of Patient Clinical Variables in Osteoporosis Classification Using Hip X-rays in Deep Learning Analysis

by Norio Yamamoto, Shintaro Sukegawa, Kazutaka Yamashita, Masaki Manabe, Keisuke Nakano, Kiyofumi Takabatake, Hotaka Kawai, Toshifumi Ozaki, Keisuke Kawasaki, Hitoshi Nagatsuka, Yoshihiko Furuki and Takashi Yorifuji

Medicina 2021, 57(8), 846; https://doi.org/10.3390/medicina57080846 - 20 Aug 2021

Cited by 11 | Viewed by 3608

Abstract

Background and Objectives: A few deep learning studies have reported that combining image features with patient variables enhanced identification accuracy compared with image-only models. However, previous studies have not statistically reported the additional effect of patient variables on the image-only models. This [...] Read more.

Background and Objectives: A few deep learning studies have reported that combining image features with patient variables enhanced identification accuracy compared with image-only models. However, previous studies have not statistically reported the additional effect of patient variables on the image-only models. This study aimed to statistically evaluate the osteoporosis identification ability of deep learning by combining hip radiographs with patient variables. Materials andMethods: We collected a dataset containing 1699 images from patients who underwent skeletal-bone-mineral density measurements and hip radiography at a general hospital from 2014 to 2021. Osteoporosis was assessed from hip radiographs using convolutional neural network (CNN) models (ResNet18, 34, 50, 101, and 152). We also investigated ensemble models with patient clinical variables added to each CNN. Accuracy, precision, recall, specificity, F1 score, and area under the curve (AUC) were calculated as performance metrics. Furthermore, we statistically compared the accuracy of the image-only model with that of an ensemble model that included images plus patient factors, including effect size for each performance metric. Results: All metrics were improved in the ResNet34 ensemble model compared with the image-only model. The AUC score in the ensemble model was significantly improved compared with the image-only model (difference 0.004; 95% CI 0.002–0.0007; p = 0.0004, effect size: 0.871). Conclusions: This study revealed the additional effect of patient variables in identification of osteoporosis using deep CNNs with hip radiographs. Our results provided evidence that the patient variables had additive synergistic effects on the image in osteoporosis identification. Full article

(This article belongs to the Special Issue Imaging in Personalized Medicine: Detection, Diagnosis, and Therapy of Disease)

► Show Figures

Figure 1

10 pages, 550 KiB

Open AccessCase Report

Effects of High Intensity Plank Exercise on Physical Fitness and Immunocyte Function in a Middle-Aged Man: A Case Report

by Sang-Kyun Park, Ki-Soo Lee, Seung-Jae Heo and Yong-Seok Jee

Medicina 2021, 57(8), 845; https://doi.org/10.3390/medicina57080845 - 20 Aug 2021

Cited by 7 | Viewed by 3437

Abstract

Background and Objectives: Although the plank exercise is difficult to perform for untrained people, it does not require money, special equipment, or much space. However, it is not known how plank exercises affect physical fitness and immunocyte function. This study analyzed the [...] Read more.

Background and Objectives: Although the plank exercise is difficult to perform for untrained people, it does not require money, special equipment, or much space. However, it is not known how plank exercises affect physical fitness and immunocyte function. This study analyzed the changes in physical fitness and immune cells of a middle-aged man after performing 4 weeks of elbow plank exercise. Materials and Methods: Elbow plank exercise was performed for approximately 20 min (resting time, around 10 min) a day, 5 days a week for 4 weeks. The intensity was checked daily with ratings of perceived exertion (RPE). When the participant reached an intensity of RPE 15, RPE 16, and RPE 17 of the RPE 20 scale, 1 min of rest was given before repeating the process. Results: Compared with the pre-values, (1) all the physical fitness factors (muscle strength, muscle endurance, flexibility, and cardiopulmonary fitness) were increased after 4 weeks; (2) body weight, skeletal muscle mass, and the basal metabolic rate were increased, whereas body fat mass and fat percentage were decreased; and (3) although the variables of complete blood count were changed positively, some were not. Specifically, CD3, CD8, and CD56 were increased, whereas CD4, CD4/CD8, and cytotoxicity were decreased. These results show that elbow plank exercise can improve all factors of physical fitness and improve some of the immunocyte functions of a middle-aged man. Conclusions: This study confirmed that, although the elbow plank exercise of vigorous intensity for 4 weeks improved physical fitness, it was not effective in improving some immunocyte functions. Therefore, the exercise intensity of plank exercises for improving immunocyte functions should be reconsidered. Full article

(This article belongs to the Special Issue Exercise-Induced Changes in Immunology)

► Show Figures

Figure 1

5 pages, 266 KiB

Open AccessArticle

The Angiotensin Converting Enzyme Deletion/Deletion Genotype Is a Risk Factor for Severe COVID-19: Implication and Utility for Patients Admitted to Emergency Department

by Anna Annunziata, Antonietta Coppola, Valentina Di Spirito, Rosa Cauteruccio, Antonella Marotta, Pierpaolo Di Micco and Giuseppe Fiorentino

Medicina 2021, 57(8), 844; https://doi.org/10.3390/medicina57080844 - 20 Aug 2021

Cited by 10 | Viewed by 2136

Abstract

Background and objective: Insertion/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion/deletion(D/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and/or traditional thrombophilic [...] Read more.

Background and objective: Insertion/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion/deletion(D/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and/or traditional thrombophilic alterations and increases the risk of venous thromboembolism in subjects in whom a thrombogenic condition occurs. Thrombosis seems to play a role very early in the disease caused by SARS-CoV-2, in particular in those with severe COVID-19 pneumonia. The counterbalance between angiotensin-converting enzyme (ACE) and ACE2 activities in COVID-19 disease may play a crucial role in the thrombo-inflammatory process. We hypothesised that a genetic predisposition could condition the severity and complications of SARS-CoV-2 infection. Materials and methods: We conducted a spontaneous, single centre observational study in the Sub-Intensive Care Unit of A.O.R.N. Ospedali dei Colli, Cotugno Hospital, Naples (Italy). In this study, we performed genetic screening for ACE D/D genotype and other thrombophilic mutations in 20 patients affected by ARDS related to COVID-19 pneumonia, compared to 19 age- and sex-matched healthy controls. Results: All tested patients had multiple polymorphisms and, in particular, a significantly higher prevalence of ACE D/D polymorphism in severe COVID-19 patients Conclusion: We found that the majority of patients who tested positive for ACE D-D genotype and who were not associated with other risk factors for VTE showed an evolution to ARDS. This finding could have a predicting role in the selection of patients more prone to developing severe COVID-19 during clinical observation in emergency department. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

15 pages, 1611 KiB

Open AccessReview

Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management

by Christopher N. Nguyen and Soo-Jung Kim

Medicina 2021, 57(8), 843; https://doi.org/10.3390/medicina57080843 - 20 Aug 2021

Cited by 14 | Viewed by 7760

Abstract

Dermatitis herpetiformis (DH), Duhring disease, is caused by gluten sensitivity and affects 11.2 to 75.3 per 100,000 people in the United States and Europe with an incidence of 0.4 to 3.5 per 100,000 people per year. DH is characterized by a symmetrical blistering [...] Read more.

Dermatitis herpetiformis (DH), Duhring disease, is caused by gluten sensitivity and affects 11.2 to 75.3 per 100,000 people in the United States and Europe with an incidence of 0.4 to 3.5 per 100,000 people per year. DH is characterized by a symmetrical blistering rash on the extensor surfaces with severe pruritus. The diagnosis continues to be made primarily by pathognomonic findings on histopathology, especially direct immunofluorescence (DIF). Recently, anti-epidermal transglutaminase (TG3) antibodies have shown to be a primary diagnostic serology, while anti-tissue transglutaminase (TG2) and other autoantibodies may be used to support the diagnosis and for disease monitoring. Newly diagnosed patients with DH should be screened and assessed for associated diseases and complications. A gluten-free diet (GFD) and dapsone are still mainstays of treatment, but other medications may be necessary for recalcitrant cases. Well-controlled DH patients, managed by a dermatologist, a gastroenterologist, and a dietician, have an excellent prognosis. Our review comprehensively details the current diagnostic methods, as well as methods used to monitor its disease course. We also describe both the traditional and novel management options reported in the literature. Full article

(This article belongs to the Special Issue Updates to the Diagnosis and Medical Management of Vesiculobullous Disorders)

► Show Figures

Figure 1

14 pages, 1319 KiB

Open AccessArticle

The Prospect of Lactoferrin Use as Adjunctive Agent in Management of SARS-CoV-2 Patients: A Randomized Pilot Study

by Fahad Dhafer Algahtani, Mohamed Tharwat Elabbasy, Mai A. Samak, Adeniyi A. Adeboye, Rafeek A. Yusuf and Mohamed E. Ghoniem

Medicina 2021, 57(8), 842; https://doi.org/10.3390/medicina57080842 - 19 Aug 2021

Cited by 16 | Viewed by 5102

Abstract

Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently [...] Read more.

Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently no widely approved treatment for SARS-CoV-2 (COVID-19). Strict adherence to infection prevention and control procedures, as well as vaccines, can, however, prevent the spread of SARS-CoV-2. This study aimed to evaluate the efficacy of lactoferrin treatment in improving clinical symptoms and laboratory indices among individuals with mild to moderate coronavirus disease-19 (COVID-19). Materials and Method: A randomized, prospective, interventional pilot study conducted between 8 July and 18 September 2020 used a hospital-based sample of 54 laboratory-confirmed participants with mild to moderate symptoms of COVID-19. Randomization into a control and two treatment groups ensured all groups received the approved Egyptian COVID-19 management protocol; only treatment group participants received lactoferrin at different doses for seven days. Clinical symptoms and laboratory indices were assessed on Days 0, 2 and 7 after starting treatments. Mean values with standard deviation and one-way analysis of variance with least significant difference of demographic and laboratory data between control and treatment groups were calculated. Results: Our study showed no statistically significant difference among studied groups regarding recovery of symptoms or laboratory improvement. Conclusions: Further research into therapeutic properties particularly related to dosage, duration and follow-up after treatment with lactoferrin in individuals with COVID-19 is required. Full article

(This article belongs to the Special Issue Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic)

► Show Figures

Figure 1

13 pages, 352 KiB

Open AccessArticle

Assessing the Opinion of Mothers about School-Based Sexual Education in Romania, the Country with the Highest Rate of Teenage Pregnancy in Europe

by Magdalena Iorga, Lavinia-Maria Pop, Nicoleta Gimiga, Luminița Păduraru and Smaranda Diaconescu

Medicina 2021, 57(8), 841; https://doi.org/10.3390/medicina57080841 - 19 Aug 2021

Cited by 4 | Viewed by 4219

Abstract

Background and Objectives: Without mandatory school-based education, Romania is a leading European country in teen pregnancy. This survey aimed at assessing the level of knowledge and the opinions about sexual education and sexual-related issues among mothers of female teenagers aged 13–18 years old. [...] Read more.

Background and Objectives: Without mandatory school-based education, Romania is a leading European country in teen pregnancy. This survey aimed at assessing the level of knowledge and the opinions about sexual education and sexual-related issues among mothers of female teenagers aged 13–18 years old. Material and Methods: The survey was conducted between 2015 and 2017 and had four parts, collecting data about sociodemographic variables, the level of knowledge about sexuality, sexually transmitted diseases, and contraception. The respondents were mothers of female teenagers hospitalized in a tertiary pediatric clinic. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 25 (Inc., Chicago, IL, USA). Results: One hundred and thirty-five mothers (42.46 ± 6.81 years old) were included in the research. Most of them were from rural areas, had graduated secondary school, were Christian-orthodox, married, and with a stable job. More than half of the mothers (61.42%) declared that they personally knew adolescents that were already mothers. In great proportion, mothers proved good knowledge about sexual education, contraception, and STDs. They considered that the minimum age for becoming married, in general, is about M = 18.62 ± 2.09 years old but in the case of their daughters, mothers appreciated that the best age would be 23.56 ± 9.37. Mothers considered that they had good communication with their daughters (M = 4.28 ± 0.99) and two-thirds sustained that they had discussed with them about sexual activity, pregnancy, sexually transmitted diseases, and contraception. In case of unwanted pregnancy of their daughters, one-third of the mothers (38.50%) would advise their girls to continue the pregnancy and 7.40% mentioned the termination of pregnancy. Two-thirds of them (74.10%) agreed to school-based sexual education. In the order of preferred sources for sexual education, mothers mentioned parents (85.90%), teachers (33.30%), and family doctors (24.40%). Comparative results regarding their own sex life and that of their daughters are presented. Conclusions: School-based programs should meet parental beliefs about sexuality and sexual education. School, as a creator of values and models, should find the golden ratio to better shape the personal, familial, and social needs for the healthy sexual behavior of the new generation. Full article

(This article belongs to the Special Issue Humanistic Approaches to Medical Practice)

15 pages, 5580 KiB

Open AccessArticle

Association between Cone-Beam Computed Tomography and Histological and Immunohistochemical Features in Periapical Lesions Correlated with Thickened Maxillary Sinus Mucosa

by Alexandra Dumitrescu, Maria-Alexandra Martu, Alexandru Nemtoi, Ana Sirghe, Liliana Chelaru, Diana Tatarciuc, Ana-Maria Dumitrescu and Danisia Haba

Medicina 2021, 57(8), 840; https://doi.org/10.3390/medicina57080840 - 19 Aug 2021

Cited by 11 | Viewed by 3306

Abstract

Background and Objectives: Odontogenic sinusitis is a frequently underestimated pathology with fewer symptoms in patients with periapical lesions, periodontal disease, or iatrogenic foreign bodies in the maxillary sinus. The aim of our study was to determine the correlation between maxillary sinusitis and [...] Read more.

Background and Objectives: Odontogenic sinusitis is a frequently underestimated pathology with fewer symptoms in patients with periapical lesions, periodontal disease, or iatrogenic foreign bodies in the maxillary sinus. The aim of our study was to determine the correlation between maxillary sinusitis and periapical lesions using cone-beam computed tomography (CBCT) imaging and histological and immunohistochemical investigations. Materials and Methods: A total of 1450 initial patients diagnosed with maxillary sinusitis in the Ear-Nose-Throat (ENT) Department, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania, were treated with anti-inflammatory drugs. Of these, 629 still had unresolved symptomatology and were later referred to the Dental Medicine departments for further investigations. Only 50 subjects with periapical lesions in the premolar/molar maxillary area were included in the present study. All the periapical lesions were observed on CBCT and classified using the Periapical Status Index (PSI) and the mean maxillary sinus mucosa thicknesses (MSMT). The enrolled patients underwent surgical procedures with the excision of periapical lesions. The excised samples were submitted to the histological and immunohistochemical investigations. Results: The 50 patients presented periapical lesions of their maxillary teeth in 328 dental units. There was a higher prevalence of periapical lesions in men than in women (chi-square test). We observed a significant difference between the mean MSMT of individuals with periapical lesions compared to those without (p < 0.01). Mean MSMT was 1.23 mm for teeth without periapical lesions and 3.95 mm for teeth with periapical lesions. The histopathological study identified 50% cases with periapical granulomas, 10% cases with periapical granulomas with cystic potential, and 40% cases as periapical cysts. Immunohistochemical stainings showed that CD4+ helper and CD8+ cytotoxic T lymphocytes, along with CD20+ B lymphocytes and CD68+ macrophages, were diffusely distributed in all periapical cysts and in some periapical granulomas, but CD79α+ plasma cells characterized especially periapical granulomas. Conclusions: The current study observed a significant correlation between CBCT maxillary mucosa thickness and type of periapical lesion. Chronic inflammatory lympho-histiocytic infiltrate predominates in periapical lesions, supporting the idea that lesion progression is determined by a humoral-type (CD20+ and CD79α+ B lymphocytes) but also by a cellular-type (CD4+ and CD8+ T lymphocyte population) immune mechanism. Full article

(This article belongs to the Collection New Concepts for Dental Treatments and Evaluations)

► Show Figures

Figure 1

27 pages, 3816 KiB

Open AccessReview

Mechanisms and Impact of Biofilms and Targeting of Biofilms Using Bioactive Compounds—A Review

by Antony V. Samrot, Amira Abubakar Mohamed, Etel Faradjeva, Lee Si Jie, Chin Hooi Sze, Akasha Arif, Tan Chuan Sean, Emmanuel Norbert Michael, Chua Yeok Mun, Ng Xiao Qi, Pooi Ling Mok and Suresh S. Kumar

Medicina 2021, 57(8), 839; https://doi.org/10.3390/medicina57080839 - 18 Aug 2021

Cited by 36 | Viewed by 4529

Abstract

Biofilms comprising aggregates of microorganisms or multicellular communities have been a major issue as they cause resistance against antimicrobial agents and biofouling. To date, numerous biofilm-forming microorganisms have been identified, which have been shown to result in major effects including biofouling and biofilm-related [...] Read more.

Biofilms comprising aggregates of microorganisms or multicellular communities have been a major issue as they cause resistance against antimicrobial agents and biofouling. To date, numerous biofilm-forming microorganisms have been identified, which have been shown to result in major effects including biofouling and biofilm-related infections. Quorum sensing (which describes the cell communication within biofilms) plays a vital role in the regulation of biofilm formation and its virulence. As such, elucidating the various mechanisms responsible for biofilm resistance (including quorum sensing) will assist in developing strategies to inhibit and control the formation of biofilms in nature. Employing biological control measures (such as the use of bioactive compounds) in targeting biofilms is of great interest since they naturally possess antimicrobial activity among other favorable attributes and can also possibly act as potent antibiofilm agents. As an effort to re-establish the current notion and understanding of biofilms, the present review discuss the stages involved in biofilm formation, the factors contributing to its development, the effects of biofilms in various industries, and the use of various bioactive compounds and their strategies in biofilm inhibition. Full article

► Show Figures

Figure 1

15 pages, 357 KiB

Open AccessArticle

Development and Validation of the Mood Instability Questionnaire-Trait (MIQ-T)

by Joohyun Yoon, Tae Hyon Ha, Sunghee Oh, Yun Seong Park, Hyun A. Ryoo, Hyeon-A Yu, Seok Joo Hong, Nayoung Cho, Chan Woo Lee, Yoonjeong Jang, Wonyun Lee, Ye Rim Kim, Kwang Ho Park, Jiung Park, Ji Yoon Park and Woojae Myung

Medicina 2021, 57(8), 838; https://doi.org/10.3390/medicina57080838 - 18 Aug 2021

Cited by 1 | Viewed by 2647

Abstract

Background and objectives: Mood instability (MI) is a stable trait associated with psychiatric disorders, yet there is a lack of tools to measure MI. The purpose of this study was to develop and validate the Mood Instability Questionnaire-Trait (MIQ-T) to evaluate MI [...] Read more.

Background and objectives: Mood instability (MI) is a stable trait associated with psychiatric disorders, yet there is a lack of tools to measure MI. The purpose of this study was to develop and validate the Mood Instability Questionnaire-Trait (MIQ-T) to evaluate MI in mood disorder patients. Material and methods: Items were taken from various established questionnaires to create an initial list of MIQ-T questions. Data from 309 psychiatric patients (n = 309; 62 major depressive disorder, 58 bipolar I disorder, and 189 bipolar II disorder) were gathered from their medical records and were utilized in an exploratory factor analysis to clarify the underlying components of MI. Then, anonymous survey data from 288 individuals from the general population were included in the analysis as a comparison group. Associations between MIQ-T and other previously validated clinical instruments for mood disorders were examined to test external validity. Results: The exploratory factor analysis demonstrated that the five-factor structure (Lability, Upward Tendency, Downward Tendency, Childhood Instability, and Seasonality) of 59 items was the most appropriate with clear, cohesive features. MIQ-T exhibited high internal consistency (α = 0.96) and moderate to strong correlations with other previously validated clinical instruments, which were consistent with theoretical predictions, providing evidence of criterion validity. Short forms were also created to address the high internal consistency value, which can indicate redundancy, and to increase the approachability of the measure. We found that the patients with bipolar II disorder had higher MIQ-T scores than the patients with bipolar I disorder or major depressive disorder and the comparison group. Conclusion: Together, these findings validate the newly developed MIQ-T as an instrument of mood instability. MIQ-T can be a potential research tool for mood disorder. Full article

(This article belongs to the Section Psychiatry)

12 pages, 2007 KiB

Open AccessArticle

Low KIBRA Expression Is Associated with Poor Prognosis in Patients with Triple-Negative Breast Cancer

by So-Woon Kim, Jinah Chu, Sung-Im Do and Kiyong Na

Medicina 2021, 57(8), 837; https://doi.org/10.3390/medicina57080837 - 18 Aug 2021

Cited by 3 | Viewed by 2041

Abstract

Background and Objectives: Kidney and brain protein (KIBRA) is a protein encoded by the WW and C2 domain containing 1 (WWC1) gene and is involved in the Hippo signaling pathway. Recent studies have revealed the prognostic value of KIBRA expression; [...] Read more.

Background and Objectives: Kidney and brain protein (KIBRA) is a protein encoded by the WW and C2 domain containing 1 (WWC1) gene and is involved in the Hippo signaling pathway. Recent studies have revealed the prognostic value of KIBRA expression; however, its role in breast cancer remains unclear. The aim of this study was to examine KIBRA expression in relation to the clinical and pathological characteristics of patients with breast cancer and to disease outcomes. Materials and Methods: We analyzed the expression of KIBRA and its correlation with event-free survival (EFS) outcomes in resected samples from 486 patients with breast cancer. Results: KIBRA expression was significantly different among the molecular subgroups (low KIBRA expression: luminal A, 46.7% versus 50.0%, p = 0.641; luminal B, 32.7% versus 71.7%, p < 0.001; human epidermal growth factor receptor 2 (HER2)-enriched, 64.9% versus 45.5%. p = 0.001; triple-negative, 73.6% versus 43.8%, p < 0.001). Low KIBRA expression was also associated with high nuclear grade (60.4% versus 37.8%, p < 0.001), high histologic grade (58.7% versus 37.0%, p < 0.001), and estrogen receptor (ER) negativity (54.2% versus 23.6%, p < 0.001). Low KIBRA expression was significantly associated with poor EFS (p = 0.041; hazard ratio (HR) 1.658; 95% confidence interval (CI), 1.015–2.709). Low KIBRA expression was an independent indicator of poor prognosis (p = 0.001; HR = 3.952; 95% CI = 1.542–10.133) in triple-negative breast cancer (TNBC). Conclusion: Low KIBRA expression was associated with higher histological grade, ER negativity and poor EFS of breast cancer. In particular, our data highlight KIBRA expression status as a potential prognostic marker for TNBC. Full article

(This article belongs to the Special Issue Progress in Breast Cancer Diagnosis and Treatment)

► Show Figures

Figure 1

10 pages, 2043 KiB

Open AccessArticle

Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience

by In-Chul Nam, Hye-Jin Baek, Kyeong-Hwa Ryu, Jin-Il Moon, Eun Cho, Hyo-Jung An, Seokho Yoon and Jiyeon Baik

Medicina 2021, 57(8), 836; https://doi.org/10.3390/medicina57080836 - 18 Aug 2021

Cited by 4 | Viewed by 2164

Abstract

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the [...] Read more.

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words “parotid gland” or “PG”. Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm–2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management. Full article

► Show Figures

Figure 1

12 pages, 2764 KiB

Open AccessArticle

Reduced External Iliac Venous Blood Flow Rate Is Associated with Asymptomatic Compression of the Common Iliac Veins

by Yuan-Hsi Tseng, Chien-Wei Chen, Min-Yi Wong, Teng-Yao Yang, Yu-Hui Lin, Bor-Shyh Lin and Yao-Kuang Huang

Medicina 2021, 57(8), 835; https://doi.org/10.3390/medicina57080835 - 18 Aug 2021

Cited by 2 | Viewed by 2677

Abstract

Background and Objectives: Compression of the common iliac veins (CIV) is not always associated with lower extremity symptoms. This study analyzed this issue from the perspective of patient venous blood flow changes using quantitative flow magnetic resonance imaging. Materials and Methods: After we [...] Read more.

Background and Objectives: Compression of the common iliac veins (CIV) is not always associated with lower extremity symptoms. This study analyzed this issue from the perspective of patient venous blood flow changes using quantitative flow magnetic resonance imaging. Materials and Methods: After we excluded patients with active deep vein thrombosis, the mean flux (MF) and mean velocity (MV) of the popliteal vein, femoral vein, and external iliac vein (EIV) were compared between the left and right sides. Results: Overall, 26 of the patients had unilateral CIV compression, of which 16 patients had symptoms. No significant differences were noted in the MF or MV of the veins between the two sides. However, for the 10 patients without symptoms, the EIV MF of the compression side was significantly lower than the EIV MF of the non-compression side (p = 0.04). The receiver operating characteristic curve and chi-squared analyses showed that when the percentage difference of EIV MF between the compression and non-compression sides was ≤−18.5%, the relative risk of associated lower extremity symptoms was 0.44 (p = 0.016). Conclusions: If a person has compression of the CIV, a decrease in EIV blood flow rate on the compression side reduces the rate of symptom occurrence. Full article

(This article belongs to the Topic Human Anatomy and Pathophysiology)

► Show Figures

Figure 1

9 pages, 289 KiB

Open AccessArticle

Early Post-Transplant Leptin Concentration Changes in Kidney Transplant Recipients

by Diana Sukackiene, Agne Laucyte-Cibulskiene, Ignas Badaras, Laurynas Rimsevicius, Valdas Banys, Dalius Vitkus and Marius Miglinas

Medicina 2021, 57(8), 834; https://doi.org/10.3390/medicina57080834 - 17 Aug 2021

Cited by 1 | Viewed by 2089

Abstract

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, [...] Read more.

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, and influences growth, energy, and bone metabolism. There has been great interest in the role of this hormone in chronic kidney disease-related protein energy wasting; thus, a positive leptin correlation with body mass index and fat mass was confirmed. This study was designed to determine the association of pre and post-kidney transplant leptin concentration with nutritional status and body composition. Materials and Methods: We studied 65 kidney transplant recipients. Nutritional status was evaluated before kidney transplantation and 6 months later using three different malnutrition screening tools (Subjective Global Assessment Scale (SGA), Malnutrition Inflammation Score (MIS), and Geriatric Nutritional Risk Index (GNRI)), anthropometric measurements, and body composition (bioelectrical impedance analysis (BIA)). Demographic profile, serum leptin levels, and other biochemical nutritional markers were collected. Statistical analysis was performed with R software. Results: Median age of the studied patients was 45 years, 42% were females, and 12% had diabetes. Leptin change was associated with body weight (p < 0.001), waist circumference (p < 0.001), fat mass (p < 0.001) and body fat percentage (p < 0.001), decrease in parathyroid hormone (PTH) (p < 0.001) transferrin (p < 0.001), diabetes mellitus (p = 0.010), and residual renal function (p = 0.039), but not dependent on dialysis vintage, estimated glomerular filtration rate (eGFR), or delayed graft function at any time during the study. After adjustment for age and sex, body mass index (BMI) (p < 0.001), fat mass (p < 0.001), and body fat percentage (p < 0.001) were independent variables significantly associated with post-transplant leptin change. Lower leptin values were found both before and after kidney transplantation in the SGA B group. GNRI as a nutritional status tool was strongly positively related to changes in leptin within the 6-month follow-up period. Conclusions: Kidney transplant recipients experience change in leptin concentration mainly due to an increase in fat mass and loss of muscle mass. GNRI score as compared to SGA or MIS score identifies patients in whom leptin concentration is increasing alongside an accumulation of fat and decreasing muscle mass. Leptin concentration evaluation in combination with BIA, handgrip strength measurement, and GNRI assessment are tools of importance in defining nutrition status in the early post-kidney transplant period. Full article

22 pages, 870 KiB

Open AccessReview

Cardiovascular Disease Complicating COVID-19 in the Elderly

by Christopher Dayaramani, Joshua De Leon and Allison B. Reiss

Medicina 2021, 57(8), 833; https://doi.org/10.3390/medicina57080833 - 17 Aug 2021

Cited by 9 | Viewed by 5548

Abstract

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in [...] Read more.

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Graphical abstract

10 pages, 4469 KiB

Open AccessArticle

Morphometry of the Entire Internal Carotid Artery on CT Angiography

by Radu Andrei Baz, Cristian Scheau, Cosmin Niscoveanu and Petru Bordei

Medicina 2021, 57(8), 832; https://doi.org/10.3390/medicina57080832 - 17 Aug 2021

Cited by 14 | Viewed by 8497

Abstract

Background and Objectives: Knowledge of the internal carotid artery’s (ICA) morphometric features is influential in outlining surgical and minimally invasive procedures in the neurovascular field. Many studies have shown divisive numbers regarding the ICA’s caliber, with the measuring point of the artery [...] Read more.

Background and Objectives: Knowledge of the internal carotid artery’s (ICA) morphometric features is influential in outlining surgical and minimally invasive procedures in the neurovascular field. Many studies have shown divisive numbers regarding the ICA’s caliber, with the measuring point of the artery sometimes differing. This study presents ICA dimensions based on computed tomography angiography in each of its seven segments as per Bouthillier’s classification, correlating vascular dimensions with anthropometric parameters. Materials and Methods: A thorough CT angiography analysis was performed on 70 patients with internal carotid vessels unaffected by atherosclerotic disease. The extracranial part of the ICA was measured in four locations—carotid bulb, post-bulbar dilation, at its cervical midpoint, and below its entrance into the carotid foramen. Single landmarks were used for measurements in the intracranial segments. ICA length was assessed in the neck region and also in the cranial cavity. Craniometric measurements were performed on sagittal and coronal CT reconstructions. Patient height was taken into consideration. Results: The largest ICA portion is near its origin in the carotid sinus area (7.59 ± 1.00 mm), with a steep decline in caliber following its extracranial course. Distal ICA presented values somewhat similar to its proximal intracranial segment diameters (4.67 ± 0.47 mm). Dimensions of the ICA in the intracranial segments start from a value of 4.53 ± 0.47 mm and decrease by approximately 40% when reaching the origin of the middle cerebral artery (2.71 ± 0.37 mm), showing a marked decrease in caliber after the emergence of the most critical collateral artery, the ophthalmic branch. The length of the ICA varies between genders, with the male ICA being about 10 mm longer in total length than female ICA; this difference is also correlated with patient height and skull dimensions. Conclusions: Both intra- and extracranial ICA have variable dimensions and length related to gender and anthropometric parameters, with no significant differences obtained concerning side or age. Full article

(This article belongs to the Special Issue Topographic Anatomy of the Human Body)

► Show Figures

Figure 1

12 pages, 1286 KiB

Open AccessArticle

Latvian Primary Care Management of Children with Acute Infections: Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment

by Zane Likopa, Anda Kivite-Urtane and Jana Pavare

Medicina 2021, 57(8), 831; https://doi.org/10.3390/medicina57080831 - 17 Aug 2021

Cited by 1 | Viewed by 1535

Abstract

Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to [...] Read more.

Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing. Full article

(This article belongs to the Section Pediatrics)

► Show Figures

Figure 1

11 pages, 4912 KiB

Open AccessArticle

Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm

by Wei-Che Lin, Yi-Fan Tai, Meng-Hsiang Chen, Sheng-Dean Luo, Faye Huang, Wei-Chih Chen, Pi-Ling Chiang, Hsiu-Ling Chen, Mei-Hsiu Chen and Jung-Hwan Baek

Medicina 2021, 57(8), 830; https://doi.org/10.3390/medicina57080830 - 17 Aug 2021

Cited by 5 | Viewed by 2437

Abstract

Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues [...] Read more.

Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm³), midterm follow-up (5.1 ± 3.8 cm³, p = 0.020), and final follow-up (3.6 ± 1.4 cm³, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions. Full article

(This article belongs to the Collection Interventional Oncology)

► Show Figures

Figure 1

7 pages, 2786 KiB

Open AccessCase Report

Secondary Amenorrhea and Infertility Due to an Inhibin B Producing Granulosa Cell Tumor of the Ovary. A Rare Case Report and Literature Review

by Corina Gică, Ruxandra-Gabriela Cigăran, Radu Botezatu, Anca Maria Panaitescu, Brîndușa Cimpoca, Gheorghe Peltecu and Nicolae Gică

Medicina 2021, 57(8), 829; https://doi.org/10.3390/medicina57080829 - 17 Aug 2021

Cited by 7 | Viewed by 3268

Abstract

Granulosa cell tumor of the ovary (GCT) is a rare ovarian tumor with nonspecific symptoms. Studies reported that GCT are usually secreting estrogens and inhibins, especially inhibin B. It is considered that, in premenopausal women, irregular menses or secondary amenorrhea may be an [...] Read more.

Granulosa cell tumor of the ovary (GCT) is a rare ovarian tumor with nonspecific symptoms. Studies reported that GCT are usually secreting estrogens and inhibins, especially inhibin B. It is considered that, in premenopausal women, irregular menses or secondary amenorrhea may be an early symptom of GCT and, in postmenopausal women, the most common manifestation is vaginal bleeding. Additionally, endometrial abnormalities can be associated due to estrogenic secretion. At reproductive age, high levels of inhibin, lead to low levels of FSH and secondary amenorrhea causing infertility. At times, increased levels of LH in women with GCT are observed and the pathogenesis is still unclear. Therefore, inhibin B level can differentiate GCT from other causes of secondary amenorrhea. We report the case of a 26-year-old nulliparous, women who presented in our clinic with secondary infertility lasting longer than 2 years, secondary amenorrhea, polycystic ovarian syndrome, and suspicion of right ovarian endometrioma on CT scan. The ultrasound examination revealed that the right ovary was transformed in an anechoic mass with increased peripheral vascularity having a volume of 10 cm³. This patient had high serum levels of inhibin B and LH but normal levels of FSH and estradiol. The preliminary diagnosis of granulosa cell tumor of the ovary was made. After counseling, the informed consent for treatment was obtained and the patient agreed to undergo surgery. An uneventful laparoscopy was performed with right oophorectomy and multiple peritoneal sampling. The histological diagnosis confirmed adult GCT limited to right ovary, with negative peritoneal biopsies (FIGO IA). After surgery the patient recovered fully and had normal menstrual cycles with normal serum levels of hormones. Two months later she conceived spontaneously and had an uneventful pregnancy. In conclusion, for cases with secondary amenorrhea, the evaluation of inhibin B level is essential. Elevated inhibin B level may be a sign for the presence of an unsuspected tumor. With early diagnosis and treatment, the prognosis is generally good and the fertility may be preserved, especially in young patients with GCT. Full article

(This article belongs to the Special Issue High-Risk Pregnancy)

► Show Figures

Figure 1

6 pages, 282 KiB

Open AccessReview

Erythema Multiforme and COVID-19: What Do We Know?

by Luigi Bennardo, Steven Paul Nisticò, Stefano Dastoli, Eugenio Provenzano, Maddalena Napolitano, Martina Silvestri, Maria Passante and Cataldo Patruno

Medicina 2021, 57(8), 828; https://doi.org/10.3390/medicina57080828 - 16 Aug 2021

Cited by 24 | Viewed by 5212

Abstract

Background: Erythema multiforme (EM) is an acute cutaneous eruption often associated with infections and more rarely with drugs. This review aimed to evaluate the association between erythema multiforme and coronavirus disease 2019 (COVID-19). Methods: A systematic search of PubMed/MEDLINE, Scimago Scopus, [...] Read more.

Background: Erythema multiforme (EM) is an acute cutaneous eruption often associated with infections and more rarely with drugs. This review aimed to evaluate the association between erythema multiforme and coronavirus disease 2019 (COVID-19). Methods: A systematic search of PubMed/MEDLINE, Scimago Scopus, and ISI/Web of Science was performed. Original articles, case series, or case reports were evaluated and selected. Results: Fourteen articles were selected, describing a total of 70 patients. EM is a cutaneous eruption rarely occurring in COVID-19 and is, in most cases, associated with a hypersensitivity reaction to the virus. In these cases, EM seems to affect patients younger than 30 years or older than 55 years. Infrequently, some drugs used in the management of COVID-19 may induce EM, especially hydroxychloroquine. The three groups of patients seem to have different clinical characteristics and courses. Conclusions: From these data, it is possible to preliminarily propose that EM or EM-like eruptions linked to COVID-19 might be divided into three types: the virus-related juvenile type (affecting patients <30-year-old), the virus-related older type (affecting patients >55 years), and the drug-induced type. The occurrence of a skin rash does not seem to be related to the severity and clinical course of COVID-19. Full article

(This article belongs to the Section Dermatology)

8 pages, 295 KiB

Open AccessArticle

TACI Mutations in Primary Antibody Deficiencies: A Nationwide Study in Greece

by Ioannis Kakkas, Gerasimina Tsinti, Fani Kalala, Evangelia Farmaki, Alexandra Kourakli, Androniki Kapousouzi, Maria Dimou, Vassiliki Kalaitzidou, Eirini Sevdali, Athanasia-Marina Peristeri, Georgia Tsiouma, Peristera Patiou, Eleni Papadimitriou, Theodoros P. Vassilakopoulos, Panayiotis Panayiotidis, Anna Kioumi, Argiris Symeonidis and Matthaios Speletas

Medicina 2021, 57(8), 827; https://doi.org/10.3390/medicina57080827 - 16 Aug 2021

Cited by 6 | Viewed by 2092

Abstract

Background and objectives: Monoallelic (heterozygous) or biallelic (homozygous or compound heterozygous) TACI mutations have been reported as the most common genetic defects in patients with common variable immunodeficiency (CVID), which is the most common clinically significant primary immunodeficiency in humans. The aim [...] Read more.

Background and objectives: Monoallelic (heterozygous) or biallelic (homozygous or compound heterozygous) TACI mutations have been reported as the most common genetic defects in patients with common variable immunodeficiency (CVID), which is the most common clinically significant primary immunodeficiency in humans. The aim of our study was to evaluate the prevalence and any correlations of TACI defects in Greek patients with primary antibody deficiencies. Materials and Methods: 117 patients (male/female: 53/64) with CVID (110) and a combined IgA and IgG subclass deficiency (7) with a CVID-like clinical phenotype were enrolled in the study. Genomic DNA was extracted from peripheral blood and the molecular analysis of the TACI gene was performed by PCR (Polymerase Chain Reaction) and sequencing of all 5 exons, including exon–intron boundaries. Results: Seventeen patients (14.5%) displayed TACI defects, four (23.5%) carried combined heterozygous mutations and 13 (76.5%) carried single heterozygous mutations. The most frequently detected mutation was C104R (58.8%), followed by I87N (23.5%) and A181E (11.8%), while R20C, C62Y, P151L, K188M and E236X mutations were present in only one patient each. Patients with TACI defects were more frequently male (p = 0.011) and displayed a benign lymphoproliferation (splenomegaly and lymph node enlargement, p = 0.047 and p = 0.002, respectively), had a history of tonsillectomy (p = 0.015) and adenoidectomy (p = 0.031) and more frequently exhibited autoimmune cytopenias (p = 0.046). Conclusions: Considering that accumulating evidence suggests several CVID patients have a complex rather than a monogenic inheritance, our data further support the notion that TACI mutations, particularly as monoallelic defects, should be primarily considered as susceptibility co-factors and/or modifiers of primary antibody deficiencies. Full article

(This article belongs to the Section Hematology and Immunology)

Journal Menu

Journal Browser

Medicina, Volume 57, Issue 8 (August 2021) – 123 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI