Medicina

16 pages, 711 KiB

Open AccessArticle

Bariatric Surgery: Late Outcomes in Patients Who Reduced Comorbidities at Early Follow-Up

by Rebeca Rocha de Almeida, Felipe J. Aidar, Márcia Ferreira Cândido de Souza, Victor Batista Oliveira, Joselina Luzia Menezes Oliveira, Leonardo Baumworcel, Larissa Monteiro Costa Pereira, Larissa Marina Santana Mendonça de Oliveira, Jamille Oliveira Costa, Raysa Manuelle Santos Rocha, José Augusto Soares Barreto-Filho, Eduardo Borba Neves, Alfonso López Díaz-de-Durana, José Rodrigo Santos Silva, Marcos Antonio Almeida-Santos and Antônio Carlos Sobral Sousa

Medicina 2021, 57(9), 995; https://doi.org/10.3390/medicina57090995 - 21 Sep 2021

Cited by 2 | Viewed by 2316

Abstract

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with [...] Read more.

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20–29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 (p < 0.003), dyslipidemia (p < 0.000), and SAH (p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities). Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users. Full article

(This article belongs to the Special Issue Obesity and Bariatric Surgery: Challenges, Trends and Perspectives in Perioperative Practice)

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7 pages, 827 KiB

Open AccessArticle

Aging of the Nigrostriatal Tract in the Human Brain: A Diffusion Tensor Imaging Study

by Jeong-Pyo Seo and Dong-Kyun Koo

Medicina 2021, 57(9), 994; https://doi.org/10.3390/medicina57090994 - 20 Sep 2021

Cited by 3 | Viewed by 1876

Abstract

Background and Objectives: The loss of dopamine neurons in the nigrostriatal tract (NST) is one of the main pathological features of Parkinson’s disease (PD), and degeneration of the NST leads to the motor symptoms observed in PD, which include hypokinesia, tremors, rigidity, [...] Read more.

Background and Objectives: The loss of dopamine neurons in the nigrostriatal tract (NST) is one of the main pathological features of Parkinson’s disease (PD), and degeneration of the NST leads to the motor symptoms observed in PD, which include hypokinesia, tremors, rigidity, and postural imbalance. In this study, we used diffusion tensor tractography (DTT) to investigate the aging of the NST in normal human subjects to elucidate human brain structures. Materials and Methods: Fifty-nine healthy subjects were recruited for this study and allocated to three groups, that is, a 20 to ≤39 year old group (the young group), a 40 to ≤59 year old group (the middle-aged group), and a ≥60 year old group (the old group). DTT scanning was performed, and NSTs were reconstructed using the probabilistic tractography method. NSTs were defined by selecting fibers passing through seed and target regions of interest placed on the substantia nigra and the striatum. Results: A significant negative correlation was observed between age and fractional anisotropy and tract volume (TV) of the NST. Mean TV values of the NST were significantly lower in the old group than in the young and middle-aged groups (p < 0.05). The TV values of the NST were significantly reduced with age for men and women (p < 0.05). Conclusion: We found that aging of the NST began in the 3rd decile and progressed steadily throughout life until old age, when it exhibited significant degeneration. We suspect these results are related to the correlation between the incidence of PD and age. Full article

(This article belongs to the Section Neurology)

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10 pages, 290 KiB

Open AccessArticle

Perceived Positive and Negative Life Changes in Testicular Cancer Survivors

by Sigrun Vehling, Karin Oechsle, Michael Hartmann, Carsten Bokemeyer and Anja Mehnert-Theuerkauf

Medicina 2021, 57(9), 993; https://doi.org/10.3390/medicina57090993 - 20 Sep 2021

Cited by 5 | Viewed by 1817

Abstract

Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: [...] Read more.

Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized outpatient treatment facilities were approached at follow-up visits or via mail. We assessed a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4) by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range: 0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic status was associated with more positive changes (β = 0.25, 95% CI 0.08 to 0.42); no other association with demographic and disease-related predictors emerged. While positive life changes were not associated with depression (β = −0.05, 95% CI −0.17 to 0.07) and anxiety (β = 0.00, 95% CI −0.13 to 0.13), more negative life changes were significantly associated with higher depression (β = 0.15, 95% CI −0.03 to 0.27) and anxiety (β = 0.23, 95% CI 0.11 to 0.36). There was no significant interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive life changes after testicular cancer are common, a significant number of survivors perceive negative changes in life domains that have been primarily investigated in terms of personal growth. Early identification of and psychosocial support for patients who perceive predominantly negative changes may contribute to prevention of prolonged symptoms of anxiety and depression. Full article

(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)

4 pages, 584 KiB

Open AccessCase Report

Giant Pulmonary Artery Thrombotic Material, Due to Chronic Thromboembolic Pulmonary Hypertension, Mimics Pulmonary Artery Sarcoma

by Helen Triantafyllidi, Dimitrios Iordanidis, Aikaterini Mpahara, Maria Mademli, Dionyssia Birmpa, Stylianos Argentos, Dimitrios Benas, Paraskevi Trivilou, Konstantinos Anagnostopoulos and Eckhard Mayer

Medicina 2021, 57(9), 992; https://doi.org/10.3390/medicina57090992 - 20 Sep 2021

Cited by 1 | Viewed by 1858

Abstract

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery [...] Read more.

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Pulmonary Hypertension)

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7 pages, 3244 KiB

Open AccessArticle

The Development of Large Radicular Cysts in Endodontically Versus Non-Endodontically Treated Maxillary Teeth

by Ruth Schvartzman Cohen, Tomer Goldberger, Ina Merzlak, Igor Tsesis, Gavriel Chaushu, Gal Avishai and Eyal Rosen

Medicina 2021, 57(9), 991; https://doi.org/10.3390/medicina57090991 - 20 Sep 2021

Cited by 3 | Viewed by 2532

Abstract

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect [...] Read more.

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012–2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms. Full article

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11 pages, 1215 KiB

Open AccessArticle

Orthopedic Surgeons’ Views of Hyaluronic Acid Formulations in the Management of Knee Osteoarthritis: A Questionnaire-Based Cross-Sectional Study

by Shahd Alnasser, Fatima AlHussain, Hassan Asiri, Abdullah Almutairi, Hisham Alsanawi, Anas AR Altamimi, Yousif A. Asiri, Omar A. Almohammed and Yazed AlRuthia

Medicina 2021, 57(9), 990; https://doi.org/10.3390/medicina57090990 - 19 Sep 2021

Cited by 4 | Viewed by 5081

Abstract

Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies [...] Read more.

Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies with significant limitations in their designs have indicated positive outcomes among OA patients treated with HA; however, their results were inconclusive. Thus, we aimed to explore the therapeutic value of different HA products in alleviating knee OA pain and improving patients’ physical function from the orthopedic surgeons’ perspective. Materials and Methods: This was a questionnaire-based cross-sectional study in which practicing orthopedic surgeons in two countries (e.g., Saudi Arabia and Jordan) were invited to participate. The 10-item, newly developed questionnaire inquired about the respondents’ sociodemographic characteristics (e.g., age, gender, country, years of experience), and their opinions regarding the efficacy of HA products in the management of OA (e.g., efficacy in improving mobility and alleviating pain). Results: Out of the 200 orthopedic surgeons who were invited to participate, 122 (61%) filled out the questionnaire. Most of the respondents were from Saudi Arabia (58%), aged 35 to 55 years (68%), had at least 10 years of experience (69%), and male (98%). About 80% of the respondents reported prescribing HA, such as Hyalgan^®, Orthovisc^®, Hyalubrix^®, and Crespine Gel^®. About 66% of the respondents believed that HA was moderately to highly effective in managing knee OA, and 34% believed that HA was either ineffective or mildly effective. Pain at the site of injection (44.3%) and rash or local skin reactions (22.1%) were the most commonly reported adverse events. Conclusions: The variations in the formulation of different HA brands (e.g., molecular weight and cross-linking) did not seem to offer any therapeutic advantage. HA might have value in the management of knee OA; however, its value is highly uncertain and necessitates more well-designed studies to further examine its therapeutic value. Full article

(This article belongs to the Section Pharmacology)

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6 pages, 234 KiB

Open AccessArticle

Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach

by Juraj Timkovic, Jiri Stransky, Petr Handlos, Jaroslav Janosek, Hana Tomaskova and Jan Stembirek

Medicina 2021, 57(9), 989; https://doi.org/10.3390/medicina57090989 - 19 Sep 2021

Viewed by 1782

Abstract

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil [...] Read more.

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, “finger test”) has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the “finger test” were compared with those derived from a complex examination by orthoptic tests (considered “true” value in patients with OFBF). Results: “Finger test” detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients. Full article

(This article belongs to the Section Ophthalmology)

13 pages, 926 KiB

Open AccessArticle

Long-Term Outcomes of Perinatal Hypoxia and Asphyxia at an Early School Age

by Renata Dzikienė, Saulius Lukoševičius, Jūratė Laurynaitienė, Vitalija Marmienė, Irena Nedzelskienė, Rasa Tamelienė, Inesa Rimdeikienė and Aušrelė Kudrevičienė

Medicina 2021, 57(9), 988; https://doi.org/10.3390/medicina57090988 - 18 Sep 2021

Cited by 2 | Viewed by 2501

Abstract

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: [...] Read more.

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level. Full article

(This article belongs to the Section Pediatrics)

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5 pages, 5139 KiB

Open AccessCase Report

A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab

by Yung-Hao Liu, Meng-Han Chou, En Meng and Chien-Chang Kao

Medicina 2021, 57(9), 987; https://doi.org/10.3390/medicina57090987 - 18 Sep 2021

Cited by 1 | Viewed by 2001

Abstract

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is [...] Read more.

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. Case presentation: A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. Conclusion: Immunotherapy has been reported to show significant remission in mUC, but mostly in solid organs or bone. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy. Full article

(This article belongs to the Section Oncology)

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8 pages, 1092 KiB

Open AccessArticle

Direct-Acting Antiviral Use for Genotype 1b Hepatitis C Patients with Associated Hematological Disorders from Romania

by Iosif Marincu, Felix Bratosin, Manuela Curescu, Oana Suciu, Mirela Turaiche, Bianca Cerbu and Iulia Vidican

Medicina 2021, 57(9), 986; https://doi.org/10.3390/medicina57090986 - 18 Sep 2021

Cited by 2 | Viewed by 1564

Abstract

Background and objectives: this study assessed variations in the blood parameters of patients with hematological disorders infected with HCV throughout a 12-week interferon-free treatment regimen. Materials and methods: We followed a total of 344 patients suffering from chronic hepatitis C, infected with [...] Read more.

Background and objectives: this study assessed variations in the blood parameters of patients with hematological disorders infected with HCV throughout a 12-week interferon-free treatment regimen. Materials and methods: We followed a total of 344 patients suffering from chronic hepatitis C, infected with the 1b genotype and concomitant hematological disorders, who benefited from the direct-acting antiviral (DAA) therapy in our clinic. Seven of the most routinely checked blood parameters were analyzed, namely, hemoglobin, leucocyte count, neutrophils, erythrocyte count, platelet count, ALT, and total bilirubin level. In total, 129 patients received a treatment scheme comprising ombitasvir, paritaprevir, ritonavir, and dasabuvir, while the 215 other patients received a sofosbuvir and ledipasvir regimen. Results: Patients enrolled in the study showed remarkably increased ALT levels in the first four weeks of DAA treatment, normalizing to levels below 40 U/L by the end of regimen. There were no other blood parameters that worsened throughout the 12-week regimen to levels below our laboratory’s normal range. After 12 weeks of DAA therapy, 309 patients (90%) achieved SVR. Conclusions: Our findings are consistent in evaluating the efficacy and tolerability of direct-acting antivirals for 1b genotype HCV infected patients with associated hematological malignancies under remission, and other hematological disturbances, that were previously unsuccessfully treated with a pegylated interferon regimen. Thus, paving a pathway for government-funded programs being implemented in this direction. Full article

(This article belongs to the Special Issue Infections and Infectious Diseases: Epidemiology, Mechanisms of Infection and Treatment Options)

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9 pages, 3468 KiB

Open AccessArticle

Launay’s External Carotid Vein

by Mihaela Daniela Manta, Adelina Maria Jianu, Mugurel Constantin Rusu and Şerban Arghir Popescu

Medicina 2021, 57(9), 985; https://doi.org/10.3390/medicina57090985 - 18 Sep 2021

Cited by 3 | Viewed by 4950

Abstract

Background and Objectives: Launay’s external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA). We aimed to establish the incidence and morphology of the ECV. Materials and Methods: [...] Read more.

Background and Objectives: Launay’s external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA). We aimed to establish the incidence and morphology of the ECV. Materials and Methods: One hundred computed tomography angiograms were investigated, and ECVs were documented anatomically, when found. Results: Launay’s vein was found in 3/200 sides (1.5%) in a male and two female cases. In two of these cases, the ECV was a replaced variant of the anterior division of the retromandibular vein (RMV), and the facial vein (FV) ended in the external jugular vein. In the third case with the ECV, the RMV was absent and the common FV that resulted from that ECV and the FV drained into the internal jugular vein. The ECV could also appear as an accessory RMV, not just as a replaced one. Additional variants were found, such as fenestration of the external jugular vein (EJV), the extracondylar vein draining the deep temporal veins and an arterial occipitoauricular trunk. Conclusions: Surgical dissections of the ECA in the retromandibular space should carefully observe an ECV to avoid unwanted haemorrhagic events. Approaches of the neck of the mandible should also carefully distinguish the consistent extracondylar veins. Full article

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

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8 pages, 2986 KiB

Open AccessCase Report

Superior Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Drainage—Minimally Invasive Approach—Case Report

by Horațiu Moldovan, Andra-Mădălina Sibișan, Robert Țigănașu, Bogdan-Ștefan Popescu, Gabriel Vasile, Daniela Gheorghiță, Ondin Zaharia, Victor Sebastian Costache, Andrada Guță and Adrian Molnar

Medicina 2021, 57(9), 984; https://doi.org/10.3390/medicina57090984 - 18 Sep 2021

Cited by 2 | Viewed by 2223

Abstract

The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus [...] Read more.

The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus atrial septal defects (SV-ASD), defined as a communication in the posterior part of the interatrial septum, account for about 5 to 10% of atrial septal defects. Approximately 90% of SV-ASDs are associated with partial anomalous pulmonary venous drainage (PAPVD). The minimally invasive approach has gained ground in the treatment of ASDs, especially those of the ostium secundum type. The sinus venosus type is a relatively uncommon form of ASD, which, when associated with a PAPVD, is considered a complex cardiac malformation, and is usually treated in a classical manner, through median sternotomy. We describe the case of a 45-year-old woman diagnosed in adolescence with SV-ASD with PAPVD, who successfully underwent minimally invasive repair with fresh autologous pericardial patch reconstruction through an anterolateral mini-thoracotomy incision. The patient presented with shortness of breath and fatigue after heavy exertions, episodes of paroxysmal nocturnal dyspnea, palpitations during effort and at rest, and had a history of syncope dating from 17 years previously. Echocardiography revealed an SV-ASD with PAPVD in the right atrium and the intraoperative examination discovered that both right pulmonary veins were draining into the superior vena cava. Full article

(This article belongs to the Special Issue Novel Echocardiography Techniques for the Diagnosis and Monitoring of Treatment in Cardiovascular Disease)

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13 pages, 997 KiB

Open AccessArticle

Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study

by Daigo Ochiai, Yushi Abe, Rie Yamazaki, Tomoe Uemura, Ayako Toriumi, Hiroko Matsuhashi, Yuya Tanaka, Satoru Ikenoue, Yoshifumi Kasuga, Ryuji Tanosaki and Mamoru Tanaka

Medicina 2021, 57(9), 983; https://doi.org/10.3390/medicina57090983 - 18 Sep 2021

Cited by 6 | Viewed by 3425

Abstract

Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP [...] Read more.

Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. Materials and Methods: We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. Results: MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage. Full article

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

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8 pages, 781 KiB

Open AccessArticle

Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients

by Daniel Popp, Maximilian Kerschbaum, Daniel Mahr, Claudius Thiedemann, Antonio Ernstberger, Isabel Wiesinger, Wolf Bäumler, Volker Alt and Andreas Schicho

Medicina 2021, 57(9), 982; https://doi.org/10.3390/medicina57090982 - 18 Sep 2021

Cited by 3 | Viewed by 1808

Abstract

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort [...] Read more.

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort study was to find such cases and to describe their characteristics in order to be able to give possible recommendations for MRI application in acute trauma situations. Materials and Methods: In the study period from 2015–2019, an evaluation of the imaging performed on polytrauma patients was carried out. The specific diagnostic and therapeutic criteria of the MRI group were further defined. Results: In total, 580 patients with an ISS ≥16 (injury severity score) were included in the study. Of these 580 patients, 568 patients received a CT scan and 12 patients an MRI scan as part of the initial diagnostic. Altogether, 66.67% of the MRIs took place outside of regular service hours. The main findings for MRI indications were neurological abnormalities with a focus on myelon injuries. Further MRI examinations were performed to rule out vascular injuries. All in all, 58.3% of the MRIs performed resulted in modified therapeutic strategies afterward. Conclusions: MRI in the context of acute diagnostic of a severely injured patient will likely remain reserved for special indications in the future. However, maximum care hospitals with a high flow of severely injured patients should provide 24/7 MR imaging to ensure the best possible care, especially in neurological and blunt vascular injuries. Full article

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

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9 pages, 1198 KiB

Open AccessCommunication

Production of a Soluble Recombinant Antibody Fragment against MMP9 Using Escherichia coli

by Chang-Hun Yeom and Hee-Jin Jeong

Medicina 2021, 57(9), 981; https://doi.org/10.3390/medicina57090981 - 18 Sep 2021

Cited by 1 | Viewed by 1930

Abstract

Matrix metalloproteinase 9 (MMP9) is involved in several aspects of the pathology of cancer, including invasion, metastasis, and angiogenesis. In this study, we expressed a recombinant scFv-type anti-MMP9 antibody in soluble form using Escherichia coli, purified it, and confirmed its antigen-binding ability. [...] Read more.

Matrix metalloproteinase 9 (MMP9) is involved in several aspects of the pathology of cancer, including invasion, metastasis, and angiogenesis. In this study, we expressed a recombinant scFv-type anti-MMP9 antibody in soluble form using Escherichia coli, purified it, and confirmed its antigen-binding ability. The convenient, rapid, inexpressive system used in this study for producing recombinant antibody fragments needs only five days, and thus can be used for the efficient production of scFv against MMP9, which can be used in a range of applications and industrial fields, including diagnosis and treatment of inflammatory and cancer-related diseases. Full article

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11 pages, 6288 KiB

Open AccessArticle

Self-Assessment of Mobility of People over 65 Years of Age

by Pascal Martin, Alexander Martin Keppler, Paolo Alberton, Carl Neuerburg, Michael Drey, Wolfgang Böcker, Christian Kammerlander and Maximilian Michael Saller

Medicina 2021, 57(9), 980; https://doi.org/10.3390/medicina57090980 - 17 Sep 2021

Cited by 7 | Viewed by 2213

Abstract

Background and Objectives: Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their [...] Read more.

Background and Objectives: Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. Materials and Methods: 222 participants over 65 years of age and one external, closely-related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants’ mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank-sum test and assumed with a p-value of ≤ 0.05. Results: Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes. Conclusions: Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls. Full article

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11 pages, 1882 KiB

Open AccessArticle

EEG-Based Evidence of Mirror Neuron Activity from App-Mediated Stroke Patient Observation

by Jin-Cheol Kim and Hyun-Min Lee

Medicina 2021, 57(9), 979; https://doi.org/10.3390/medicina57090979 - 17 Sep 2021

Cited by 8 | Viewed by 2767

Abstract

Background and Objectives: The mirror neuron system in the sensorimotor region of the cerebral cortex is equally activated during both action observation and execution. Action observation training mimics the functioning of the mirror neuron system, requiring patients to watch and imitate the [...] Read more.

Background and Objectives: The mirror neuron system in the sensorimotor region of the cerebral cortex is equally activated during both action observation and execution. Action observation training mimics the functioning of the mirror neuron system, requiring patients to watch and imitate the actions necessary to perform activities of daily living. StrokeCare is a user-friendly application based on the principles of action observation training, designed to assist people recovering from stroke. Therefore, when observing the daily life behavior provided in the StrokeCare app, whether the MNS is activated and mu inhibition appears. Materials and Methods: We performed electroencephalography (EEG) on 24 patients with chronic stroke (infarction: 11, hemorrhage: 13) during tasks closely related to daily activities, such as dressing, undressing, and walking. The StrokeCare app provided action videos for patients to watch. Landscape imagery observation facilitated comparison among tasks. We analyzed the mu rhythm from the C3, CZ, and C4 regions and calculated the mean log ratios for comparison of mu suppression values. Results: The EEG mu power log ratios were significantly suppressed during action observation in dressing, undressing, walking, and landscape conditions, in decreasing order. However, there were no significant activity differences in the C3, C4 and CZ regions. The dressing task showed maximum suppression after a color spectrum was used to map the relative power values of the mu rhythm for each task. Conclusions: These findings reveal that the human mirror neuron system was more strongly activated during observation of actions closely related to daily life activities than landscape images. Full article

(This article belongs to the Section Translational Medicine)

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11 pages, 757 KiB

Open AccessArticle

Epidemiological Surveillance of Eye Disease and People Awareness in the Abruzzo Region, Italy

by Leonardo Mastropasqua, Rossella D’Aloisio, Alessandra Mastrocola, Fabiana Perna, Luca Cerino, Loredana Cerbara, Filippo Cruciani and Lisa Toto

Medicina 2021, 57(9), 978; https://doi.org/10.3390/medicina57090978 - 17 Sep 2021

Cited by 2 | Viewed by 2043

Abstract

Background and Objectives: Vision impairments and related blindness are major public health problems. The prevalence of eye disease and barriers to optimal care markedly vary among different geographic areas. In the Abruzzo region (central Italy), an epidemiological surveillance on the state of [...] Read more.

Background and Objectives: Vision impairments and related blindness are major public health problems. The prevalence of eye disease and barriers to optimal care markedly vary among different geographic areas. In the Abruzzo region (central Italy), an epidemiological surveillance on the state of ocular health in the population aged over 50 years was performed in 2019. Materials and Methods: Participants were sampled to be representative of the region’s inhabitants. Data were collected through a telephone interview and an eye examination. Prevalence of cataract, glaucoma, retinopathy, and maculopathy was assessed. The Cohen’s kappa (k) was used to measure the agreement between the presence of eye disease and awareness of the disease by the participants. Results: Overall, 983 people with a mean age of 66.0 ± 9.5 years were included in the study. The prevalence of cataracts, glaucoma, maculopathy, and retinopathy was 52.6%, 5.3%, 5.6%, and 29.1%, respectively. Among the total of the affected people, those aware of their condition were 21.8% (k = 0.12, slight agreement) for cataract, 65.4% (k = 0.78, substantial agreement) for glaucoma, 7.1% (k = 0.10, slight agreement) for maculopathy, and 0% for retinopathy (k = −0.004, agreement lower than that expected by chance). Refractive defects were corrected in the vast majority of participants. Conclusion: In the Abruzzo region, about two thirds of citizens aged 50 years or over suffer from cataract, glaucoma, retinopathy, or maculopathy, which are recognized as leading causes of blindness. Many people with eye disease do not know they have it. These data can be used by clinicians and policymakers to undertake clinical, political, and social actions. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 703 KiB

Open AccessEditor’s ChoiceReview

The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review

by Sławomir M. Januszek, Anna Faryniak-Zuzak, Edyta Barnaś, Tomasz Łoziński, Tomasz Góra, Natalia Siwiec, Paweł Szczerba, Rafał Januszek and Tomasz Kluz

Medicina 2021, 57(9), 977; https://doi.org/10.3390/medicina57090977 - 17 Sep 2021

Cited by 54 | Viewed by 11132

Abstract

Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to [...] Read more.

Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to conduct a systematic review concerning the approach of pregnant women towards vaccination against COVID-19, with particular regard to determinants of vaccination acceptance. Materials and Methods: Articles were reviewed in which the aim was to evaluate—via a survey or questionnaire—the acceptance and decision to undergo vaccination against COVID-19. The articles were subjected to review according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Results: In various studies, the percentage of pregnant women accepting the COVID-19 vaccine was between 29.7% and 77.4%. The strongest factors co-existing with the acceptance of the COVID-19 vaccination in pregnancy were trust in the importance and effectiveness of the vaccine, explicit communication about the safety of COVID-19 vaccines for pregnant women, acceptance of other vaccinations such as those for influenza, belief in the importance of vaccines/mass vaccination in one’s own country, anxiety about COVID-19, trust in public health agencies/health science, as well as compliance to mask guidelines. The remaining factors were older age, higher education, and socioeconomic status. Conclusions: This review allowed us to show that geographic factors (Asian, South American countries) and pandemic factors (different threats and risks from infection) significantly influence the acceptance of vaccines. The most significant factors affecting acceptance are those related to public awareness of the risk of infection, vaccine safety, and the way in which reliable information about the need and safety of vaccines is provided. Professional and reliable patient information by obstetricians and qualified medical personnel would significantly increase the level of confidence in vaccination against COVID-19. Full article

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16 pages, 1755 KiB

Open AccessReview

The Efficacy of Re-Warm-Up Practices during Half-Time: A Systematic Review

by Daniel González-Devesa, Alejandro Vaquera, David Suárez-Iglesias and Carlos Ayán-Pérez

Medicina 2021, 57(9), 976; https://doi.org/10.3390/medicina57090976 - 17 Sep 2021

Cited by 8 | Viewed by 3408

Abstract

Background and Objectives: The passive nature of rest breaks in sport could reduce athletes’ performance and even increase their risk of injury. Re-warm-up activities could help avoid these problems, but there is a lack of research on their efficacy. This systematic review [...] Read more.

Background and Objectives: The passive nature of rest breaks in sport could reduce athletes’ performance and even increase their risk of injury. Re-warm-up activities could help avoid these problems, but there is a lack of research on their efficacy. This systematic review aimed at analyzing the results of those randomized controlled trials (RCTs) that provided information on the effects of re-warm-up strategies. Materials and Methods: Four electronic databases (Web of Science, Scopus, PubMed, and SPORTDiscus) were searched from their inception to January 2021, for RCTs on the effects of re-warm-up activities on sports performance. Interventions had to be implemented just after an exercise period or sports competition. Studies that proposed activities that were difficult to replicate in the sport context or performed in a hot environment were excluded. Data were synthesized following PRISMA guidelines, while the risk of bias was assessed following the recommendations of the Cochrane Collaboration. Results: A total of 14 studies (178 participants) reporting data on acute or short-term effects were analyzed. The main outcomes were grouped into four broad areas: physiological measures, conditional abilities, perceptual skills, and sport efficiency measures. The results obtained indicated that passive rest decreases physiological function in athletes, while re-warm-up activities could help to improve athletes’ conditional abilities and sporting efficiency, despite showing higher fatigue levels in comparison with passive rest. The re-warm-up exercise showed to be more effective than passive rest to improve match activities and passing ability. Conclusions: Performing re-warm-up activities is a valuable strategy to avoid reducing sports performance during prolonged breaks. However, given that the methodological quality of the studies was not high, these relationships need to be further explored in official or simulated competitions. Full article

(This article belongs to the Special Issue Sports Injuries Epidemiology and Prevention)

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4 pages, 2045 KiB

Open AccessCase Report

Concomitant Prostate Cancer and Hodgkin Lymphoma: A Differential Diagnosis Guided by a Combined 68Ga-PSMA-11 and 18F-FDG PET/CT Approach

by Alberto Miceli, Mattia Riondato, Francesca D’Amico, Maria Isabella Donegani, Nataniele Piol, Marco Mora, Bruno Spina, Silvia Morbelli and Matteo Bauckneht

Medicina 2021, 57(9), 975; https://doi.org/10.3390/medicina57090975 - 17 Sep 2021

Cited by 2 | Viewed by 2506

Abstract

Here we report the case of concomitant favorable-risk prostate cancer and Hodgkin Lymphoma in a 38-year old male. 68Ga-Prostate Specific Membrane Antigen-11 Positron Emission Tomography/Computed Tomography (68Ga-PSMA-11 PET/CT) was performed for staging purposes, showing the focal PSMA prostatic uptake as well as the [...] Read more.

Here we report the case of concomitant favorable-risk prostate cancer and Hodgkin Lymphoma in a 38-year old male. 68Ga-Prostate Specific Membrane Antigen-11 Positron Emission Tomography/Computed Tomography (68Ga-PSMA-11 PET/CT) was performed for staging purposes, showing the focal PSMA prostatic uptake as well as the presence of enlarged low-PSMA expressing mediastinal lymphadenopathies, thus raising the suspicion of another malignancy. A subsequent 18F-Fluorodeoxyglucose (18F-FDG) PET/CT demonstrated a high FDG-avidity by mediastinal lymphadenopathies as opposed to the low prostate cancer FDG uptake. Of note, both tumor entities were clearly detected by the two scans. However, different ranges in terms of Maximum Standardized Uptake Value (SUVmax) uptake allowed the discrimination between the two tumor entities. At the subsequent mediastinal lymph nodal biopsy, the coexistence of Hodgkin lymphoma was documented. The present case suggests that even if specific for prostate cancer, 68Ga-PSMA-11 PET/CT may raise the suspicion of other concurrent malignancies thanks to its non-receptor bounding mechanism. Further, it shows that in certain cases, the combination of 18F-FDG and 68Ga-PSMA PET/CT imaging may non-invasively guide the clinical management, optimizing the diagnostic process and the subsequent therapeutic interventions. Full article

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

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11 pages, 318 KiB

Open AccessArticle

ABCA1 rs1883025 and CYP4F2 rs2108622 Gene Polymorphism Association with Age-Related Macular Degeneration and Anti-VEGF Treatment

by Ruta Mockute, Alvita Vilkeviciute, Vilma Jurate Balciuniene, Reda Zemaitiene and Rasa Liutkeviciene

Medicina 2021, 57(9), 974; https://doi.org/10.3390/medicina57090974 - 16 Sep 2021

Cited by 3 | Viewed by 2117

Abstract

Background and Objectives: The age-related macular degeneration (AMD) pathophysiology is multifactorial, as it consists of interactions between aging, genetic, and environmental factors. We aimed to determine a relationship between AMD and the genes controlling lipid metabolism, and to assess its association with [...] Read more.

Background and Objectives: The age-related macular degeneration (AMD) pathophysiology is multifactorial, as it consists of interactions between aging, genetic, and environmental factors. We aimed to determine a relationship between AMD and the genes controlling lipid metabolism, and to assess its association with treatment results. The purpose was to find the ABCA1 rs1883025 and CYP4F2 rs2108622 gene polymorphisms in patients with exudative AMD (eAMD) treated with anti-VEGF. Materials and Methods: The study enroled 104 patients with eAMD and 201 healthy persons in a control group. The genotyping of rs1883025 and rs2108622 was performed using the RT-PCR method. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before anti-VEGF therapy, then at three and six months during the therapy, using optical coherence tomography (OCT). The patients were grouped to responders and non-responders according to the changes in BCVA and CRT. Results: The T allele at rs1883025 was more frequent in non-responder eAMD patients compared to responder eAMD patients (41.7% vs. 21.1%; p = 0.009). The analysis of rs2108622 gene polymorphism did not reveal any differences in the distribution of C/C, C/T, and T/T genotypes between the eAMD group and the control group (56.35%, 39.78%, and 3.87% in the eAMD group and 53.33%, 39.05% and 7.62% in the control group, respectively, p = 0.286). The comparison of CRT and BCVA between the rs2108622 genotypes revealed statistically significant differences: CRT was thicker for the CC carriers than for those with CT and TT genotypes (p = 0.030). Conclusion: The rs1883025 T allele was found to play a more significant role in non-responder eAMD patients compared to responder eAMD patients. The rs2108622 genotypes revealed statistically significant differences: CRT was thicker for the CC carriers than for those with CT and TT genotypes. Full article

(This article belongs to the Special Issue Novel Therapies for Retinal Diseases)

5 pages, 253 KiB

Open AccessEditor’s ChoiceArticle

Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children

by Adrian Vlad, Viorel Serban, Romulus Timar, Alexandra Sima, Veronica Botea, Oana Albai, Bogdan Timar and Mihaela Vlad

Medicina 2021, 57(9), 973; https://doi.org/10.3390/medicina57090973 - 16 Sep 2021

Cited by 42 | Viewed by 5329

Abstract

Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of [...] Read more.

Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of the β-cells, as well, and thus lead to an increase in the incidence of type 1 diabetes. Material and Methods: The Romanian National Organization for the Protection of Children and Adolescents with Diabetes (ONROCAD) has collected information regarding new cases of type 1 diabetes in children aged 0 to 14 years from all over the country since 1996 and has computed the incidence of type 1 diabetes in this age group. Results: We observed a marked increase in the incidence of type 1 diabetes in the first year of the COVID-19 pandemic, with 16.9%, from 11.4/100,000 in 2019 to 13.3/100,000 in 2020, much higher compared to previous years (mean yearly increase was 5.1% in the period 1996–2015 and 0.8% in the interval 2015–2019). The proportion of newly diagnosed cases was significantly higher in the second half of 2020 compared to the second half of the previous years (57.8 vs. 51%, p < 0.0001). Conclusions: All these aspects suggest the role that SARS-CoV-2 could have in triggering pancreatic autoimmunity. To confirm this, however, collecting information from larger populations from different geographical regions, monitoring the incidence curves over a period of several years, and gathering background information on COVID-19 and/or data on COVID-19 specific antibodies are needed. Full article

14 pages, 859 KiB

Open AccessSystematic Review

The Influence of Serum Uric Acid Level on Non-Motor Symptoms Occurrence and Severity in Patients with Idiopathic Parkinson’s Disease and Atypical Parkinsonisms—A Systematic Review

by Anna Grażyńska, Klaudia Adamczewska, Sofija Antoniuk, Martyna Bień, Mateusz Toś, Jakub Kufel, Weronika Urbaś and Joanna Siuda

Medicina 2021, 57(9), 972; https://doi.org/10.3390/medicina57090972 - 16 Sep 2021

Cited by 6 | Viewed by 2840

Abstract

Background and Objectives: A growing number of studies correlated higher levels of serum uric acid (UA) with both: lower risk of Parkinson’s Disease (PD) occurrence and slower progression of the disease. Similar conclusions were made where studies correlated UA with atypical Parkinsonisms [...] Read more.

Background and Objectives: A growing number of studies correlated higher levels of serum uric acid (UA) with both: lower risk of Parkinson’s Disease (PD) occurrence and slower progression of the disease. Similar conclusions were made where studies correlated UA with atypical Parkinsonisms (AP) progression. A few researchers have studied the issue of the influence of serum UA on the occurrence of non-motor symptoms (NMS) in PD and AP. Our systematic review is the first review completely dedicated to this matter. Materials and Methods: A comprehensive evaluation of the literature was performed to review the relationship between UA and NMS in PD and AP. The systematic review was conducted according to PRISMA Statement guidelines. The following databases were searched starting in April 2021: MEDLINE via PubMed, Embase, and Scopus. During the research, the following filters were used: >2010, articles in English, concerning humans. The study was not registered and received no external funding. Results: Seven articles meeting all inclusion criteria were included in this study. Collectively, data on 1104 patients were analyzed. A correlation between serum UA concentration and a few NMS types has been provided by the analyzed studies. In four papers, sleep disorders and fatigue were related to UA for both advanced and early PD. Other commonly appearing NMS domains were Attention/memory (4 studies), Depression/anxiety (3 studies), Cardiovascular (3 studies), Gastrointestinal (1 study), Perceptual (1 study), and Miscellaneous (1 study). For AP, no significant correlation between UA and worsening of NMS has been found. Conclusions: Based on the analyzed studies, a correlation between serum UA level and the occurrence and worsening of NMS in PD and APs cannot be definitively determined. Large-scale studies with a more diverse patient population and with more accurate methods of NMS assessment in Parkinsonism are needed. Full article

(This article belongs to the Section Neurology)

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9 pages, 2324 KiB

Open AccessCase Report

Intracranial Hemorrhage in a Patient with TAFRO Syndrome Treated with Cyclosporine A and Rituximab

by Yuina Akagi, Takashi Kato, Yusuke Yamashita, Hiroki Hosoi, Shogo Murata, Shuto Yamamoto, Kenji Warigaya, Taisei Nakao, Shinichi Murata, Takashi Sonoki and Shinobu Tamura

Medicina 2021, 57(9), 971; https://doi.org/10.3390/medicina57090971 - 16 Sep 2021

Cited by 2 | Viewed by 2020

Abstract

TAFRO syndrome, a rare subtype of idiopathic multicentric Castleman disease, manifests as thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thrombotic microangiopathy, including renal dysfunction, is frequently associated with this syndrome. TAFRO syndrome can be life threatening and show rapid progression, and the diagnosis [...] Read more.

TAFRO syndrome, a rare subtype of idiopathic multicentric Castleman disease, manifests as thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thrombotic microangiopathy, including renal dysfunction, is frequently associated with this syndrome. TAFRO syndrome can be life threatening and show rapid progression, and the diagnosis and management of this disorder remain challenging. A 48-year-old woman was diagnosed with TAFRO syndrome complicated by thrombotic microangiopathy based on the clinical and histopathological findings. After receiving high-dose steroids, her thrombocytopenia and anasarca did not improve. The patient subsequently received a combination of cyclosporine A and rituximab as second-line therapy, which resulted in a significant gradual improvement in the clinical symptoms. Meanwhile, her platelet count increased to more than 40 × 10⁹/L; however, she developed intracranial hemorrhage. Following surgical evacuation, the patient recovered with an achievement of sustained remission. Based on these findings, attention should be paid to life-threatening bleeding associated with local thrombotic microangiopathy even when intensive treatment is administered for TAFRO syndrome. Full article

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10 pages, 303 KiB

Open AccessArticle

Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia

by Lubova Renemane, Anda Kivite-Urtane and Elmars Rancans

Medicina 2021, 57(9), 970; https://doi.org/10.3390/medicina57090970 - 16 Sep 2021

Cited by 2 | Viewed by 1634

Abstract

Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical [...] Read more.

Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014–2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34–45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15–26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides. Full article

(This article belongs to the Section Psychiatry)

5 pages, 248 KiB

Open AccessCase Report

Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm

by Antonios Koutras, Zacharias Fasoulakis, Michail Diakosavvas, Athanasios Syllaios, Athanasios Pagkalos, Athina A. Samara, Georgios Tsatsaris, Thomas Ntounis, Marianna Theodora, Michael Sindos and Emmanuel N. Kontomanolis

Medicina 2021, 57(9), 969; https://doi.org/10.3390/medicina57090969 - 15 Sep 2021

Cited by 3 | Viewed by 2213

Abstract

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with [...] Read more.

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks’ pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility. Full article

(This article belongs to the Section Obstetrics and Gynecology)

12 pages, 327 KiB

Open AccessArticle

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

by Güzin Çakmak, Sencer Ganidağlı, Eyyüp Murat Efendioğlu, Ercüment Öztürk and Zeynel Abidin Öztürk

Medicina 2021, 57(9), 968; https://doi.org/10.3390/medicina57090968 - 15 Sep 2021

Cited by 8 | Viewed by 2676

Abstract

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially [...] Read more.

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject. Full article

(This article belongs to the Section Endocrinology)

8 pages, 1109 KiB

Open AccessArticle

Prognostic Factors in Lung Adenocarcinoma with Bone Metastasis Treated with EGFR-TKIs

by Tzu-Hsuan Chiu, Chun-Yu Lin, Meng-Heng Hsieh, Shu-Min Lin and Yueh-Fu Fang

Medicina 2021, 57(9), 967; https://doi.org/10.3390/medicina57090967 - 15 Sep 2021

Cited by 3 | Viewed by 1660

Abstract

Background and Objectives: Patients who have advanced lung cancer and bone metastasis (BM) often suffer from skeletal-related events (SREs) that lead to poor quality of life and poor prognosis. Our study aimed to investigate the prognostic factors in patients with BM from epidermal [...] Read more.

Background and Objectives: Patients who have advanced lung cancer and bone metastasis (BM) often suffer from skeletal-related events (SREs) that lead to poor quality of life and poor prognosis. Our study aimed to investigate the prognostic factors in patients with BM from epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma. Materials and Methods: This retrospective study included 77 lung adenocarcinoma patients with synchronous BM. These patients had first-line EGFR tyrosine kinase inhibitors (EGFR-TKIs) between January 2017 and December 2019. Among them, 42 patients were treated with 120 mg of subcutaneous denosumab monthly. We investigated their baseline characteristics, cancer management, SREs, progression-free survival (PFS), and overall survival (OS). Results: The PFS in the patients treated with or without denosumab were 10.1 vs. 12.5 months (p = 0.971). The median OS was 26.9 vs. 29.5 months (p = 0.967) in no denosumab and denosumab groups, respectively. Univariate analyses showed benefit of afatinib in PFS and good performance status in OS. Conclusion: Those patients that took afatinib as first-line EGFR-TKIs had significantly longer PFS than those treated with other TKIs. Denosumab had no prognostic effect on PFS or OS. Full article

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10 pages, 2800 KiB

Open AccessArticle

Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome

by Adrian Kastler, Daniel-Ange Barbé, Guillaume Alemann, Georges Hadjidekov, Francois H. Cornelis and Bruno Kastler

Medicina 2021, 57(9), 966; https://doi.org/10.3390/medicina57090966 - 15 Sep 2021

Cited by 4 | Viewed by 2013

Abstract

Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients [...] Read more.

Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology. Full article

(This article belongs to the Collection Interventional Oncology)

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Medicina, Volume 57, Issue 9 (September 2021) – 139 articles

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