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Medicina, Volume 59, Issue 5 (May 2023) – 185 articles

Cover Story (view full-size image): Chronic neck pain and lower back pain is a common problem worldwide, with a high lifetime prevalence; it is not only a personal burden, but also a social and financial one.
In this pilot study, we assessed the effect of weekly electrotherapy on the sensation of pain and also on the range of spinal motion in patients with chronic back pain and lower back pain. Our results suggest that weekly electrotherapy has a favourable effect on lumbar mobility, whereas the sensation of pain remained unchanged. View this paper
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8 pages, 1244 KiB  
Case Report
Drug-Induced Thrombocytopenia Due to Nintedanib during Treatment of Idiopathic Pulmonary Fibrosis
by Igor Dumic, Antonios Charokopos, Angadabir Parmar, Christopher R. Grant, Ronin Joshua S. Cosiquien, Marilia Dagnon da Silva and Emilia Petcu
Medicina 2023, 59(5), 999; https://doi.org/10.3390/medicina59050999 - 22 May 2023
Cited by 2 | Viewed by 1597
Abstract
Nintedanib is a tyrosine kinase inhibitor that was approved for the treatment of patients with idiopathic pulmonary fibrosis in 2014. The most common side effect of Nintedanib is diarrhea, and thrombocytopenia is a rare side effect of Nintedanib. The exact mechanism is unknown, [...] Read more.
Nintedanib is a tyrosine kinase inhibitor that was approved for the treatment of patients with idiopathic pulmonary fibrosis in 2014. The most common side effect of Nintedanib is diarrhea, and thrombocytopenia is a rare side effect of Nintedanib. The exact mechanism is unknown, and the literature lacks case reports of this phenomenon. Here, we report the case of a patient who developed thrombocytopenia 12 weeks after starting treatment with Nintedanib. The patient underwent an extensive work up for infectious, hematological, autoimmune, and neoplastic diseases. The patient’s thrombocytopenia resolved following cessation of Nintedanib. This case is significant as it reports a rare side effect that might have detrimental consequences if not recognized and treated timely. Additionally, the onset of thrombocytopenia was delayed, 3 months after the initiation of Nintedanib. We also highlight the various literature regarding drug-induced thrombocytopenia and explore the necessary work-up needed to exclude other potential diagnoses. We hope to advocate for multidisciplinary teams to be aware of patients with pulmonary fibrosis on Nintedanib so that this adverse effect can be recognized promptly. Full article
(This article belongs to the Special Issue Clinical Update and Treatment of Idiopathic Pulmonary Fibrosis)
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10 pages, 649 KiB  
Article
Aetiopathogenesis of Rotator Cuff Tear in Patients Younger than 50 Years: Medical Conditions Play a Relevant Role
by Stefano Gumina, Lorenzo Mezzaqui, Rossana Aimino, Marco Rionero, Alessandra Spagnoli, Vincenzo Campagna and Vittorio Candela
Medicina 2023, 59(5), 998; https://doi.org/10.3390/medicina59050998 - 22 May 2023
Viewed by 1278
Abstract
Background and Objectives: Studies on rotator cuff tears (RCT) in patients younger than 50 years have focused on the post-operative outcomes. Little is known about cuff tear etiopathogenesis, although it is a common belief that most tears are due to trauma. We have [...] Read more.
Background and Objectives: Studies on rotator cuff tears (RCT) in patients younger than 50 years have focused on the post-operative outcomes. Little is known about cuff tear etiopathogenesis, although it is a common belief that most tears are due to trauma. We have retrospectively verified the prevalence of medical conditions, whose role in tendon degeneration development have been widely demonstrated, in a group of patients younger than 50 years with postero-superior RCT. Materials and Methods: 64 patients [44M-20F; mean age (SD): 46.90 (2.80)] were enrolled. Personal data, BMI, smoking habit, diseases (diabetes, arterial hypertension, hypercholesterolaemia, thyroid diseases, and chronic obstructive pulmonary disease) were registered. The possible triggering cause and the affected side and tear dimensions were recorded, and statistical analysis was then performed. Results: 75% of patients had one or more diseases and/or a smoking habit for more than 10 years. In the remaining 25%, only four patients referred had had a traumatic event, while in the other eight patients, both medical condition and trauma were registered. The presence of two or more diseases did not affect RCT size. Conclusions: In our series, three quarters of patients with RCT had a smoking habit or medical conditions predisposing them to a tendon tear; therefore, the role of trauma in RCT onset in patients younger than 50 years is markedly resized. It is plausible that in the remaining 25%, RCT may be due to trauma or to genetic or acquired degeneration. Level of Evidence: IV Full article
(This article belongs to the Section Surgery)
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12 pages, 649 KiB  
Article
Leptin and the rs2167270 Polymorphism Are Associated with Glycemic Control in Type Two Diabetes Mellitus Patients on Metformin Therapy
by Mahmoud A. Alfaqih, Mukhallad Aljanabi, Ebaa Ababneh, Mariam Khanfar, Mohammad Alqudah and Mai Sater
Medicina 2023, 59(5), 997; https://doi.org/10.3390/medicina59050997 - 22 May 2023
Viewed by 1570
Abstract
Background and Objectives: Type two diabetes mellitus (T2DM) is a chronic disease with debilitating complications and high mortality. Evidence indicates that good glycemic control delays disease progression and is hence a target of disease management protocols. Nonetheless, some patients cannot maintain glycemic [...] Read more.
Background and Objectives: Type two diabetes mellitus (T2DM) is a chronic disease with debilitating complications and high mortality. Evidence indicates that good glycemic control delays disease progression and is hence a target of disease management protocols. Nonetheless, some patients cannot maintain glycemic control. This study aimed to investigate the association between serum leptin levels and several SNPs of the LEP gene with the lack of glycemic control in T2DM patients on metformin therapy. Materials and Methods: In a hospital-based case-control study, 170 patients with poor glycemic control and 170 patients with good glycemic control were recruited. Serum leptin was measured. Patients were genotyped for three SNPs in the LEP gene (rs7799039, rs2167270, and rs791620). Results: Serum leptin was significantly lower in T2DM patients with poor glycemic control (p < 0.05). In multivariate analysis, serum leptin levels significantly lowered the risk of having poor glycemic control (OR = 0.985; CI: 0.976–0.994; p = 0.002); moreover, the GA genotype of rs2167270 was protective against poor glycemic control compared to the GG genotype (OR = 0.417; CI: 0.245–0.712; p = 0.001). Conclusions: Higher serum leptin and the GA genotype of the rs2167270 SNP of the LEP gene were associated with good glycemic control in T2DM patients on metformin therapy. Further studies with a larger sample size from multiple institutions are required to validate the findings. Full article
(This article belongs to the Section Genetics and Molecular Medicine)
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20 pages, 4337 KiB  
Article
Chronic Periodontal Infection and Not Iatrogenic Interference Is the Trigger of Medication-Related Osteonecrosis of the Jaw: Insights from a Large Animal Study (PerioBRONJ Pig Model)
by Matthias Troeltzsch, Stephan Zeiter, Daniel Arens, Dirk Nehrbass, Florian A. Probst, Paris Liokatis, Michael Ehrenfeld and Sven Otto
Medicina 2023, 59(5), 1000; https://doi.org/10.3390/medicina59051000 - 22 May 2023
Cited by 3 | Viewed by 1684
Abstract
Background and Objectives: Antiresorptive drugs are widely used in osteology and oncology. An important adverse effect of these drugs is medication-induced osteonecrosis of the jaw (MRONJ). There is scientific uncertainty about the underlying pathomechanism of MRONJ. A promising theory suspects infectious stimuli [...] Read more.
Background and Objectives: Antiresorptive drugs are widely used in osteology and oncology. An important adverse effect of these drugs is medication-induced osteonecrosis of the jaw (MRONJ). There is scientific uncertainty about the underlying pathomechanism of MRONJ. A promising theory suspects infectious stimuli and local acidification with adverse effects on osteoclastic activity as crucial steps of MRONJ etiology. Clinical evidence showing a direct association between MRONJ and oral infections, such as periodontitis, without preceding surgical interventions is limited. Large animal models investigating the relationship between periodontitis and MRONJ have not been implemented. It is unclear whether the presence of infectious processes without surgical manipulation can trigger MRONJ. The following research question was formulated: is there a link between chronic oral infectious processes (periodontitis) and the occurrence of MRONJ in the absence of oral surgical procedures? Materials and Methods: A minipig large animal model for bisphosphonate-related ONJ (BRONJ) using 16 Göttingen minipigs divided into 2 groups (intervention/control) was designed and implemented. The intervention group included animals receiving i.v. bisphosphonates (zoledronate, n = 8, 0.05 mg/kg/week: ZOL group). The control group received no antiresorptive drug (n = 8: NON-ZOL group). Periodontitis lesions were induced by established procedures after 3 months of pretreatment (for the maxilla: the creation of an artificial gingival crevice and placement of a periodontal silk suture; for the mandible: the placement of a periodontal silk suture only). The outcomes were evaluated clinically and radiologically for 3 months postoperatively. After euthanasia a detailed histological evaluation was performed. Results: Periodontitis lesions could be induced successfully in all animals (both ZOL and NON-ZOL animals). MRONJ lesions of various stages developed around all periodontitis induction sites in the ZOL animals. The presence of MRONJ and periodontitis was proven clinically, radiologically and histologically. Conclusions: The results of this study provide further evidence that the infectious processes without prior dentoalveolar surgical interventions can trigger MRONJ. Therefore, iatrogenic disruption of the oral mucosa cannot be the decisive step in the pathogenesis of MRONJ. Full article
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12 pages, 1865 KiB  
Article
HSPB6 Is Depleted in Colon Cancer Patients and Its Expression Is Induced by 5-aza-2′-Deoxycytidine In Vitro
by Bader O. Almutairi, Mikhlid H. Almutairi, Abdulwahed F. Alrefaei, Saad Alkahtani and Saud Alarifi
Medicina 2023, 59(5), 996; https://doi.org/10.3390/medicina59050996 - 21 May 2023
Cited by 2 | Viewed by 1566
Abstract
Background and Objectives: Colon cancer (CC) is the second most common cancer in Saudi Arabia, and the number of new cases is expected to increase by 40% by 2040. Sixty percent of patients with CC are diagnosed in the late stage, causing a [...] Read more.
Background and Objectives: Colon cancer (CC) is the second most common cancer in Saudi Arabia, and the number of new cases is expected to increase by 40% by 2040. Sixty percent of patients with CC are diagnosed in the late stage, causing a reduced survival rate. Thus, identifying a new biomarker could contribute to diagnosing CC in the early stages, leading to delivering better therapy and increasing the survival rate. Materials and Methods: HSPB6 expression was investigated in extracted RNA taken from 10 patients with CC and their adjacent normal tissues, as well as in DMH-induced CC and a colon treated with saline taken from a male Wistar rat. Additionally, the DNA of the LoVo and Caco-2 cell lines was collected, and bisulfite was converted to measure the DNA methylation level. This was followed by applying 5-aza-2′-deoxycytidine (AZA) to the LoVo and Caco-2 cell lines for 72 h to see the effect of DNA methylation on HSPB6 expression. Finally, the GeneMANIA database was used to find the interacted genes at transcriptional and translational levels with HSPB6. Results: We found that the expression of HSPB6 was downregulated in 10 CC tissues compared to their adjacent normal colon tissues, as well as in the in vivo study, where its expression was lower in the colon treated with the DMH agent compared to the colon treated with saline. This suggests the possible role of HSPB6 in tumor progression. Moreover, HSPB6 was methylated in two CC cell lines (LoVo and Caco-2), and demethylation with AZA elevated its expression, implying a mechanistic association between DNA methylation and HSPB6 expression. Conclusions: Our findings indicate that HSPB6 is adversely expressed with tumor progression, and its expression may be controlled by DNA methylation. Thus, HSPB6 could be a good biomarker employed in the CC diagnostic process. Full article
(This article belongs to the Special Issue Development and Metastasis of Colorectal Cancer)
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10 pages, 2803 KiB  
Case Report
Multiple Rare Primary Malignancies: A Mixed Squamous Neuroendocrine Adenocarcinoma of the Cervix, Metastasized Carcinosarcoma and Extramammary Vulvar Paget’s Disease Case Report
by Linas Andreika, Karolina Vankevičienė, Marija Plioplytė, Monika Bitinaitytė and Vilius Rudaitis
Medicina 2023, 59(5), 995; https://doi.org/10.3390/medicina59050995 - 21 May 2023
Cited by 1 | Viewed by 1595
Abstract
The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a [...] Read more.
The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a 45-year-old female who was diagnosed with cervical mixed squamous neuroendocrine adenocarcinoma, metastasized carcinosarcoma and extramammary vulvar Paget’s disease. The patient was first diagnosed with a microinvasive squamous cervical carcinoma in situ. After a few months, the amputation of a small residual tumor and histological evaluation revealed an IA1-stage poorly differentiated (G3) mixed squamous and neuroendocrine cervical adenocarcinoma. After two years, the disease had progressed and biopsies from altered sites were taken. Histological diagnosis from an ulcerated vulvar region revealed extramammary vulvar Paget’s disease. A biopsy from vagina polyp revealed an earlier diagnosed mixed squamous and neuroendocrine cervical adenocarcinoma. However, histological diagnosis from an inguinal lymph node biopsy was unexpected and revealed carcinosarcoma. It indicated either the development of another primary malignancy, or an unusual spread of metastasis. Clinical presentation as well as diagnostic and treatment challenges are discussed in this case report. This case report shows that multiple primary malignancy cases are difficult to manage both for clinicians and the patient because the therapeutic options can become limited. This complex case was managed by a multidisciplinary team. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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13 pages, 3070 KiB  
Article
The Role of ROR1 in Chemoresistance and EMT in Endometrial Cancer Cells
by Kyung-Jun Lee, Nam-Hyeok Kim, Hyeong Su Kim, Youngmi Kim, Jae-Jun Lee, Jung Han Kim, Hye-Yon Cho, Soo Young Jeong and Sung Taek Park
Medicina 2023, 59(5), 994; https://doi.org/10.3390/medicina59050994 - 21 May 2023
Cited by 2 | Viewed by 1982
Abstract
Background and Objectives: Receptor tyrosine kinase-like orphan receptor type 1 (ROR1) plays a critical role in embryogenesis and is overexpressed in many malignant cells. These characteristics allow ROR1 to be a potential new target for cancer treatment. The aim of this study [...] Read more.
Background and Objectives: Receptor tyrosine kinase-like orphan receptor type 1 (ROR1) plays a critical role in embryogenesis and is overexpressed in many malignant cells. These characteristics allow ROR1 to be a potential new target for cancer treatment. The aim of this study was to investigate the role of ROR1 through in vitro experiments in endometrial cancer cell lines. Materials and Methods: ROR1 expression was identified in endometrial cancer cell lines using Western blot and RT-qPCR. The effects of ROR1 on cell proliferation, invasion, migration, and epithelial-mesenchymal transition (EMT) markers were analyzed in two endometrial cancer cell lines (HEC-1 and SNU-539) using either ROR1 silencing or overexpression. Additionally, chemoresistance was examined by identifying MDR1 expression and IC50 level of paclitaxel. Results: The ROR1 protein and mRNA were highly expressed in SNU-539 and HEC-1 cells. High ROR1 expression resulted in a significant increase in cell proliferation, migration, and invasion. It also resulted in a change of EMT markers expression, a decrease in E-cadherin expression, and an increase in Snail expression. Moreover, cells with ROR1 overexpression had a higher IC50 of paclitaxel and significantly increased MDR1 expression. Conclusions: These in vitro experiments showed that ROR1 is responsible for EMT and chemoresistance in endometrial cancer cell lines. Targeting ROR1 can inhibit cancer metastasis and may be a potential treatment method for patients with endometrial cancer who exhibit chemoresistance. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Gynecological Diseases)
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14 pages, 3560 KiB  
Case Report
Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings
by Kajetan Latka, Waldemar Kolodziej, Kornel Pawlak, Tomasz Sobolewski, Rafal Rajski, Jacek Chowaniec, Tomasz Olbrycht, Masato Tanaka and Dariusz Latka
Medicina 2023, 59(5), 993; https://doi.org/10.3390/medicina59050993 - 21 May 2023
Cited by 4 | Viewed by 2129
Abstract
Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, [...] Read more.
Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient’s condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end. Full article
(This article belongs to the Special Issue Recent Advances in Endoscopic Spine Surgery)
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15 pages, 483 KiB  
Systematic Review
Diagnosis of Liver Fibrosis Using Artificial Intelligence: A Systematic Review
by Stefan Lucian Popa, Abdulrahman Ismaiel, Ludovico Abenavoli, Alexandru Marius Padureanu, Miruna Oana Dita, Roxana Bolchis, Mihai Alexandru Munteanu, Vlad Dumitru Brata, Cristina Pop, Andrei Bosneag, Dinu Iuliu Dumitrascu, Maria Barsan and Liliana David
Medicina 2023, 59(5), 992; https://doi.org/10.3390/medicina59050992 - 21 May 2023
Cited by 2 | Viewed by 2372
Abstract
Background and Objectives: The development of liver fibrosis as a consequence of continuous inflammation represents a turning point in the evolution of chronic liver diseases. The recent developments of artificial intelligence (AI) applications show a high potential for improving the accuracy of [...] Read more.
Background and Objectives: The development of liver fibrosis as a consequence of continuous inflammation represents a turning point in the evolution of chronic liver diseases. The recent developments of artificial intelligence (AI) applications show a high potential for improving the accuracy of diagnosis, involving large sets of clinical data. For this reason, the aim of this systematic review is to provide a comprehensive overview of current AI applications and analyze the accuracy of these systems to perform an automated diagnosis of liver fibrosis. Materials and Methods: We searched PubMed, Cochrane Library, EMBASE, and WILEY databases using predefined keywords. Articles were screened for relevant publications about AI applications capable of diagnosing liver fibrosis. Exclusion criteria were animal studies, case reports, abstracts, letters to the editor, conference presentations, pediatric studies, studies written in languages other than English, and editorials. Results: Our search identified a total of 24 articles analyzing the automated imagistic diagnosis of liver fibrosis, out of which six studies analyze liver ultrasound images, seven studies analyze computer tomography images, five studies analyze magnetic resonance images, and six studies analyze liver biopsies. The studies included in our systematic review showed that AI-assisted non-invasive techniques performed as accurately as human experts in detecting and staging liver fibrosis. Nevertheless, the findings of these studies need to be confirmed through clinical trials to be implemented into clinical practice. Conclusions: The current systematic review provides a comprehensive analysis of the performance of AI systems in diagnosing liver fibrosis. Automatic diagnosis, staging, and risk stratification for liver fibrosis is currently possible considering the accuracy of the AI systems, which can overcome the limitations of non-invasive diagnosis methods. Full article
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8 pages, 2668 KiB  
Case Report
Renal Sarcoidosis-like Reaction Induced by PD-1 Inhibitor Treatment in Non-Small Cell Lung Cancer: A Case Report and Literature Review
by Sang-Don Park, Mee-Seon Kim, Man-Hoon Han, Yong-Jin Kim, Hee-Yeon Jung, Ji-Young Choi, Jang-Hee Cho, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim and Jeong-Hoon Lim
Medicina 2023, 59(5), 991; https://doi.org/10.3390/medicina59050991 - 21 May 2023
Cited by 1 | Viewed by 1725
Abstract
Monoclonal antibodies directed against immune checkpoint proteins have been widely used to treat various cancers and have resulted in favorable clinical outcomes. Despite these beneficial properties, immune checkpoint inhibitors (ICIs) can induce side effects called immune-related adverse events, including sarcoidosis-like reactions (SLR) across [...] Read more.
Monoclonal antibodies directed against immune checkpoint proteins have been widely used to treat various cancers and have resulted in favorable clinical outcomes. Despite these beneficial properties, immune checkpoint inhibitors (ICIs) can induce side effects called immune-related adverse events, including sarcoidosis-like reactions (SLR) across multiple organs. Here, we report a case of renal SLR after ICI treatment, and we review the related literature. A 66-year-old Korean patient with non-small cell lung cancer was referred to the nephrology clinic for renal failure after the 14th pembrolizumab treatment dose. A renal biopsy revealed multiple epithelioid cell granulomas, with several lymphoid aggregates in the renal interstitium and a moderate degree of inflammatory cell infiltration in the tubulointerstitium. A moderate dose of steroid therapy was initiated, and the serum creatinine level partially recovered after four weeks of treatment. Judicious monitoring of renal SLR is, therefore, required during ICI therapy, and a timely diagnosis by renal biopsy and appropriate treatment are important. Full article
(This article belongs to the Section Urology & Nephrology)
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9 pages, 277 KiB  
Article
Incidence and Risk Factors of Postoperative Febrile Morbidity among Patients Undergoing Myomectomy
by Korrakot Wattanasiri, Worashorn Lattiwongsakorn, Rung-aroon Sreshthaputra and Theera Tongsong
Medicina 2023, 59(5), 990; https://doi.org/10.3390/medicina59050990 - 20 May 2023
Cited by 2 | Viewed by 1194
Abstract
Background and Objectives: To identify the incidence, causes, and independent predictors of postoperative febrile morbidity among patients undergoing myomectomy. Material and methods: Medical records of patients who had undergone myomectomy at Chiang Mai University Hospital between January 2017 and June 2022 were comprehensively [...] Read more.
Background and Objectives: To identify the incidence, causes, and independent predictors of postoperative febrile morbidity among patients undergoing myomectomy. Material and methods: Medical records of patients who had undergone myomectomy at Chiang Mai University Hospital between January 2017 and June 2022 were comprehensively reviewed. The clinical variables, including age, body mass index, previous surgery, leiomyoma size and number, the International Federation of Gynecology and Obstetrics (FIGO) fibroid type, preoperative and postoperative anemia, type of surgery, operative time, estimated blood loss, and intraoperative antiadhesive use, were analyzed as a predictive factor of postoperative febrile morbidity. Results: During the study period, 249 consecutive women were reviewed. The mean age was 35.6 years. The majority of women had FIGO fibroid type 3–5 (58.2%) and type 6–8 (34.2%). Febrile morbidity was noted in 88 women (35.34%). Of them, 17.39% had a urinary tract infection and 4.34% had a surgical site infection, whereas the causes in the majority of cases (78.26%) could not be identified. The significant independent risk factors for febrile morbidity were abdominal myomectomy (adjusted odds ratio: aOR, 6.34; 95% CI, 2.07–19.48), overweight women (aOR, 2.25; 95% CI, 1.18–4.28), operation time of more than 180 min (aOR, 3.37; 95% CI, 1.64–6.92), and postoperative anemia (aOR, 2.71; 95% CI, 1.30–5.63). Conclusions: Approximately one-third of women undergoing myomectomy experienced febrile morbidity. The cause could not be identified in most cases. The independent risk factors included abdominal myomectomy, overweight, prolonged operation time, and postoperative anemia. Of them, abdominal myomectomy was the most significant risk factor. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Gynecological Diseases)
12 pages, 520 KiB  
Article
Medication Adherence and Its Associated Factors among Patients with Type 2 Diabetes Mellitus Attending Primary Health Centers of Eastern Province, Saudi Arabia
by Aseel Awad Alsaidan, Sultan Fahad Alotaibi, Ashokkumar Thirunavukkarasu, Bashayer Farhan ALruwaili, Rami Hamdan Alharbi, Maha M. Arnous, Omar Awad Alsaidan, Abdulbaqi Sulaiman Alduraywish and Yasir Abdulrahman Alwushayh
Medicina 2023, 59(5), 989; https://doi.org/10.3390/medicina59050989 - 20 May 2023
Cited by 1 | Viewed by 1704
Abstract
Medication adherence by patients with diabetes is critical, as it plays a crucial role in individuals’ long-term health and well-being. We evaluated the medication adherence, illness perception, diabetes knowledge, and associated factors among patients with type 2 diabetes mellitus (T2DM) attending primary health [...] Read more.
Medication adherence by patients with diabetes is critical, as it plays a crucial role in individuals’ long-term health and well-being. We evaluated the medication adherence, illness perception, diabetes knowledge, and associated factors among patients with type 2 diabetes mellitus (T2DM) attending primary health centers (PHCs) in the eastern province of the Kingdom of Saudi Arabia (KSA) using a validated Arabic version of a data collection form. In order to identify the variables that are associated with medication adherence, we applied a logistic regression analysis. Furthermore, we performed the Spearman test to find the correlation between medication adherence, illness perception, and diabetes knowledge. Of the 390 studied patients, 21.5% had low medication adherence, and it was significantly associated with gender (adjusted OR (AOR) = 1.89, 95% CI = 1.27–2.73, p = 0.003) and duration of diabetes (AOR = 0.83, 95% CI = 0.67–0.95, p = 0.017). Furthermore, we found a significant positive correlation between medication adherence and illness perception (rho = 0.217, p = 0.007) and knowledge of diabetes and medication adherence (rho = 0.425, p < 0.001). We recommend improving T2DM patients’ knowledge about the importance of adherence to their medication regimen in several health education sessions at the PHCs. In addition, we recommend mixed-method medication adherence assessment surveys in different parts of the KSA. Full article
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19 pages, 7700 KiB  
Article
Higher Expression Levels of SSX1 and SSX2 in Patients with Colon Cancer: Regulated In Vitro by the Inhibition of Methylation and Histone Deacetylation
by Turki M. Alrubie, Abdullah M. Alamri, Bader O. Almutairi, Abdulwahed F. Alrefaei, Maha M. Arafah, Mohammad Alanazi, Abdelhabib Semlali and Mikhlid H. Almutairi
Medicina 2023, 59(5), 988; https://doi.org/10.3390/medicina59050988 - 20 May 2023
Viewed by 1416
Abstract
Background and Objectives: Colon cancer (CC) has a high mortality rate and is often diagnosed at an advanced stage in Saudi Arabia. Thus, the identification and characterization of potential new cancer-specific biomarkers are imperative for improving the diagnosis of CC by detecting [...] Read more.
Background and Objectives: Colon cancer (CC) has a high mortality rate and is often diagnosed at an advanced stage in Saudi Arabia. Thus, the identification and characterization of potential new cancer-specific biomarkers are imperative for improving the diagnosis of CC by detecting it at an early stage. Cancer-testis (CT) genes have been identified as potential biomarkers for the early diagnosis of various cancers. Among the CT genes are those belonging to the SSX family. In order to assess the usefulness of SSX family genes as cancer biomarkers for the detection of early-stage CC, the goal of this research was to validate the expressions of these genes in patients with CC and in matched patients with normal colons (NCs). Materials and Methods: RT-PCR assays were used to analyze the SSX1, SSX2, and SSX3 family gene expression levels in 30 neighboring NC and CC tissue samples from male Saudi patients. Epigenetic alterations were also tested in vitro using qRT-PCR analysis to determine whether reduced DNA methyltransferase or histone deacetylation could stimulate SSX gene expression via 5-aza-2′-deoxycytidine and trichostatin treatments, respectively. Results: The RT-PCR results showed SSX1 and SSX2 gene expression in 10% and 20% of the CC tissue specimens, respectively, but not in any of the NC tissue specimens. However, no SSX3 expression was detected in any of the examined CC or NC tissue samples. In addition, the qRT-PCR results showed significantly higher SSX1 and SSX2 expression levels in the CC tissue samples than in the NC tissue samples. The 5-aza-2′-deoxycytidine and trichostatin treatments significantly induced the mRNA expression levels of the SSX1, SSX2, and SSX3 genes in the CC cells in vitro. Conclusions: These findings suggest that SSX1 and SSX2 are potentially suitable candidate biomarkers for CC. Their expressions can be regulated via hypomethylating and histone deacetylase treatments, subsequently providing a potential therapeutic target for CC. Full article
(This article belongs to the Section Genetics and Molecular Medicine)
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7 pages, 1425 KiB  
Case Report
Harnessing the Power of PAOO and Invisalign: An Interdisciplinary Approach to Orthodontic Care
by Kayvon Javid, Rafael Coutinho Mello-Machado, Pietro Montemezzi, Rodrigo dos Santos Pereira, Adam Lowenstein and Carlos Fernando Mourão
Medicina 2023, 59(5), 987; https://doi.org/10.3390/medicina59050987 - 20 May 2023
Viewed by 2311
Abstract
The present article explores the benefits of combining periodontally accelerated osteogenic orthodontics (PAOO) with Invisalign for optimal orthodontic treatment outcomes. PAOO is an interdisciplinary dental technique that minimizes complications and accelerates tooth movement while enhancing various orthodontic treatments. In conjunction with Invisalign, PAOO [...] Read more.
The present article explores the benefits of combining periodontally accelerated osteogenic orthodontics (PAOO) with Invisalign for optimal orthodontic treatment outcomes. PAOO is an interdisciplinary dental technique that minimizes complications and accelerates tooth movement while enhancing various orthodontic treatments. In conjunction with Invisalign, PAOO provides a discreet and comfortable solution for patients seeking to improve their smile. The study presents two challenging cases successfully treated using this combined approach, emphasizing the technique’s potential to reduce treatment times and improve orthodontic outcomes. The interdisciplinary approach of PAOO ensures long-term success and stability by preserving periodontal structures and addressing potential bony defects. By incorporating bone grafting materials, PAOO helps prevent common concerns in traditional orthodontic treatments, such as bony defects and gingival recession. Furthermore, the combination with Invisalign offers a more aesthetically pleasing and comfortable treatment experience, allowing patients to maintain their self-esteem and confidence throughout the treatment. Despite the potential advantages, dental professionals must manage patient expectations and address potential complications to ensure the best possible results. Overall, the integration of PAOO and Invisalign demonstrates a viable alternative for patients who do not want to proceed with orthognathic surgery, enhancing patient satisfaction and overall treatment outcomes. Full article
(This article belongs to the Special Issue Outcome of Minimally Invasive Techniques in Dentistry)
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11 pages, 4349 KiB  
Case Report
Reconstruction of High-Grade Trochlea Dysplasia in a Young Female with Recurrent Patella Dislocation: A Case Report
by Chih-Hsuan Wu, Kuo-Yao Hsu, You-Hung Cheng, Cheng-Pang Yang, Huan Sheu, Shih-Sheng Chang, Chao-Yu Chen and Chih-Hao Chiu
Medicina 2023, 59(5), 986; https://doi.org/10.3390/medicina59050986 - 19 May 2023
Viewed by 2727
Abstract
The patellofemoral joint involves a combination of bony structures and soft tissues to maintain stability. Patella instability is a disabling condition, and the cause is multifactorial. The main risk factors include patella alta, trochlea dysplasia, excessive tibial tuberosity to trochlea grove (TT–TG) distance, [...] Read more.
The patellofemoral joint involves a combination of bony structures and soft tissues to maintain stability. Patella instability is a disabling condition, and the cause is multifactorial. The main risk factors include patella alta, trochlea dysplasia, excessive tibial tuberosity to trochlea grove (TT–TG) distance, and excessive lateral patella tilt. In this case report, we highlight the thinking process of diagnosis and method for selecting the optimal treatment in accordance with the guidelines by Dejour et al. when we are presented with a patient with patella instability. A 20-year-old Asian woman without underlying medical conditions, presented with recurrent (>3 episodes) right patella dislocation for 7 years. Investigations revealed a type D trochlea dysplasia, increased TT–TG distance, and excessive lateral tilt angle. She underwent trochlea sulcus deepening, sulcus lateralization and lateral facet elevation, lateral retinacular release, and medial quadriceps tendon–femoral ligament (MQTFL) reconstruction. Due to the complexity behind the anatomy and biomechanics of patella instability, an easy-to-follow treatment algorithm is essential for the treating surgeon to provide effective and efficient treatment. MQTFL reconstruction is recommended for recurrent patella dislocation due to satisfactory clinical and patient reported outcomes and a reduced risk of iatrogenic patella fracture. Controversies for surgical indication in lateral retinacular release, and whether the sulcus angle is an accurate parameter for diagnosis of trochlea dysplasia, remain, and further research is required. Full article
(This article belongs to the Section Surgery)
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12 pages, 623 KiB  
Systematic Review
Remission of Type 2 Diabetes Mellitus (T2DM) after Sleeve Gastrectomy (SG), One-Anastomosis Gastric Bypass (OAGB), and Roux-en-Y Gastric Bypass (RYGB): A Systematic Review
by Vignesh Balasubaramaniam and Sjaak Pouwels
Medicina 2023, 59(5), 985; https://doi.org/10.3390/medicina59050985 - 19 May 2023
Cited by 5 | Viewed by 1976
Abstract
Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM [...] Read more.
Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM (type 2 diabetes mellitus). There are limited data that directly compare these three procedures. This study aims to compare the short-term and long-term remission of T2DM after RYGB, SG, and OAGB. Materials and Methods: Three databases (Embase, PubMed, and Cochrane) were searched for randomised controlled trials, prospective studies, and retrospective studies that compared the effects of RYGB, SG, and OAGB on T2DM remission. Studies published between 2001 and 2022 were analysed. Only patients with T2DM and who had primary bariatric surgery were included. Results: After applying the inclusion and exclusion criteria, seven articles were included in the review. It was found that all three procedures had comparable T2DM remission. RYGB was noted to have the highest complication rate when compared to SG and OAGB. Importantly, it was noted that other predictive factors such as age, duration of diabetes, baseline HbA1c, BMI, and use of antidiabetic medication play a crucial role in T2DM remission. Conclusions: This systematic literature review confirms the existing data that all three bariatric surgeries induce remission of T2DM. Increasing in popularity, OAGB had comparable outcomes to RYGB and SG in inducing T2DM remission. In addition to the choice of bariatric surgery, there are other independent predictive factors that have an impact on T2DM remission. Further studies with larger sample sizes, longer follow-up periods, and studies that control confounding factors are required in this field. Full article
(This article belongs to the Special Issue Combining Gastroenterology and Surgery: New Treatment Insights)
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3 pages, 234 KiB  
Editorial
Editorial for the Special Issue “Acute and Chronic Pancreatitis, Pancreatic Malignancies”
by Antanas Gulbinas, Povilas Ignatavicius and Zilvinas Dambrauskas
Medicina 2023, 59(5), 984; https://doi.org/10.3390/medicina59050984 - 19 May 2023
Cited by 2 | Viewed by 1098
Abstract
Pancreatic diseases, especially acute pancreatitis and pancreatic cancer, are associated with high rates of complications, difficult treatment that may not always be effective, and high mortality in complex cases [...] Full article
(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)
11 pages, 2329 KiB  
Article
Alleviation of Hepatic Steatosis by Alpha-Defensin Is Associated with Enhanced Lipolysis
by Emad Maraga, Rifaat Safadi, Johnny Amer, Abd Al-roof Higazi and Rami Abu Fanne
Medicina 2023, 59(5), 983; https://doi.org/10.3390/medicina59050983 - 19 May 2023
Cited by 2 | Viewed by 1468
Abstract
Background and Objectives: The neutrophilic peptide, alpha-defensin, is considered an evolving risk factor intimately linked with lipid mobilization. It was previously linked to augmented liver fibrosis. Here, we assess a potential association between alpha-defensin and fatty liver. Materials and Methods: A [...] Read more.
Background and Objectives: The neutrophilic peptide, alpha-defensin, is considered an evolving risk factor intimately linked with lipid mobilization. It was previously linked to augmented liver fibrosis. Here, we assess a potential association between alpha-defensin and fatty liver. Materials and Methods: A cohort of transgenic C57BL/6JDef+/+ male mice that overexpress the human neutrophil-derived alpha-defensin in their polymorphonuclear neutrophils (PMNs) were assessed for liver steatosis and fibrosis development. Wild type (C57BL/6JDef.Wt) and transgenic (C57BL/6JDef+/+) mice were maintained on a standard rodent chow diet for 8.5 months. At the termination of the experiment, systemic metabolic indices and hepatic immunological cell profiling were assessed. Results: The Def+/+ transgenic mice exhibited lower body and liver weights, lower serum fasting glucose and cholesterol, and significantly lower liver fat content. These results were associated with impaired liver lymphocytes count and function (lower CD8, NK cells, and killing marker CD107a). The metabolic cage demonstrated dominant fat utilization with a comparable food intake in the Def+/+ mice. Conclusions: Chronic physiological expression of alpha-defensin induces favorable blood metabolic profile, increased systemic lipolysis, and decreased hepatic fat accumulation. Further studies are needed to characterize the defensin net liver effect. Full article
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16 pages, 3416 KiB  
Article
Combined Treatment of Persistent Diabetic Macular Edema with Aflibercept and Triamcinolone Acetonide in Pseudophakic Eyes
by Nenad Petrovic, Dusan Todorovic, Tatjana Sarenac Vulovic, Suncica Sreckovic, Fatima Zivic and Dijana Risimic
Medicina 2023, 59(5), 982; https://doi.org/10.3390/medicina59050982 - 19 May 2023
Cited by 1 | Viewed by 1323
Abstract
Background and Objectives: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular [...] Read more.
Background and Objectives: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular endothelial growth factor therapy could improve therapeutic outcomes for pseudophakic eyes with persistent diabetic macular edema. Materials and Methods: twenty-four pseudophakic eyes with refractory diabetic macular edema, that had appeared despite three previously administered intravitreal injections of aflibercept, were divided into two groups (twelve eyes in each group). The first group continued to have aflibercept administered according to a fixed dosing regimen (once in two months). Triamcinolone acetonide 10 mg/0.1 mL (administered once per four months) was included for the second group, i.e., their treatment continued with a combination of aflibercept + triamcinolone acetonide. Results: The reduction in central macular thickness was higher in the eyes treated with combined therapy (aflibercept + triamcinolone acetonide) compared with the use of aflibercept alone during the entire 12-month follow-up period (3rd month p = 0.019; 6th month p = 0.023; 9th month p = 0.027; 12th month p = 0.031). As was evident from the p-values, the differences were statistically significant. No statistically significant difference was recorded for visual acuity: 3rd month p = 0.423; 6th month p = 0.392; 9th month p = 0.413; 12th month p = 0.418. Conclusions: Combined anti-vascular endothelial growth factor and steroid therapy leads to a better anatomical outcome of persistent diabetic macular edema in pseudophakic eyes, but does not lead to a more significant improvement in visual acuity than continuous anti-VEGF therapy alone. Full article
(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)
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8 pages, 491 KiB  
Case Report
Local Anesthetic Systemic Toxicity Following Inadvertent Intravenous Levobupivacaine Infusion in Infants: A Case Report
by Justina Jermolajevaite, Ilona Razlevice, Vaidotas Gurskis, Dovile Evalda Grinkeviciute, Laura Lukosiene and Andrius Macas
Medicina 2023, 59(5), 981; https://doi.org/10.3390/medicina59050981 - 19 May 2023
Viewed by 1880
Abstract
Background and objectives: Local anesthetic systemic toxicity (LAST) in children is extremely rare, occurring at an estimated rate of 0.76 cases per 10,000 procedures. However, among reported cases of LAST in the pediatric population, infants and neonates represent approximately 54% of reported LAST [...] Read more.
Background and objectives: Local anesthetic systemic toxicity (LAST) in children is extremely rare, occurring at an estimated rate of 0.76 cases per 10,000 procedures. However, among reported cases of LAST in the pediatric population, infants and neonates represent approximately 54% of reported LAST cases. We aim to present and discuss the clinical case of LAST with full clinical recovery due to accidental levobupivacaine intravenous infusion in a healthy 1.5-month-old patient, resulting in cardiac arrest necessitating resuscitation. Case presentation: A 4-kilogram, 1.5-month-old female infant, ASA I, presented to the hospital for elective herniorrhaphy surgery. Combined anesthesia was planned, involving general endotracheal and caudal anesthesia. After anesthesia induction, cardiovascular collapse was noticed, resulting in bradycardia and later cardiac arrest with EMD (Electromechanical Dissociation). It was noticed that during induction, levobupivacaine was accidentally infused intravenously. A local anesthetic was prepared for caudal anesthesia. LET (lipid emulsion therapy) was started immediately. Cardiopulmonary resuscitation was carried out according to the EMD algorithm, which lasted 12 min until spontaneous circulation was confirmed and the patient was transferred to the ICU. In ICU, the girl was extubated the second day, and the third day she was transferred to the regular pediatric unit. Finally, the patient was discharged home after a total of five days of hospitalization with full clinical recovery. A four-week follow-up has revealed that the patient recovered without any neurological or cardiac sequelae. Conclusions: The clinical presentation of LAST in children usually begins with cardiovascular symptoms because pediatric patients are already under general anesthesia when anesthetics are being used, as was the case in our case. Treatment and management of LAST involve cessation of local anesthetic infusion, stabilization of the airway, breathing, and hemodynamics, as well as lipid emulsion therapy. Early recognition of LAST as well as immediate CPR if needed and targeted treatment for LAST can lead to good outcomes. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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14 pages, 5053 KiB  
Article
Ameliorative Potential of Donepezil with or without Prednisolone in Bleomycin-Induced Pulmonary Fibrosis in Rats: Involvement of the Anti-Inflammatory, Antioxidant, and the Antifibrotic Pathways
by Shery Mina, Dina M. Elfeky, Ahmed M. Kabel and Sabeha E. Hedya
Medicina 2023, 59(5), 980; https://doi.org/10.3390/medicina59050980 - 19 May 2023
Viewed by 1524
Abstract
Background and Objectives: Bleomycin-induced pulmonary fibrosis is one of the serious complications that may limit the use of bleomycin in cancer therapy. To date, there is no effective remedy for the amelioration of this condition. Donepezil, an anti-Alzheimer’s medication, has recently been proven [...] Read more.
Background and Objectives: Bleomycin-induced pulmonary fibrosis is one of the serious complications that may limit the use of bleomycin in cancer therapy. To date, there is no effective remedy for the amelioration of this condition. Donepezil, an anti-Alzheimer’s medication, has recently been proven to exhibit potent anti-inflammatory, antioxidant, and antifibrotic effects. To the best of our knowledge, this study represents the first study designed to investigate the prophylactic effects of donepezil, either alone or in combination with the classic anti-inflammatory drug prednisolone, in bleomycin-induced pulmonary fibrosis. Methods: This study was carried out on fifty rats, which were divided into five equal groups: control (Saline) group; bleomycin group; bleomycin + prednisolone group; bleomycin + donepezil group; and bleomycin + prednisolone + donepezil group. At the end of the experiments, bronchoalveolar lavage was performed to evaluate the total and differential leucocytic counts. The right lung was processed to assess the oxidative stress markers, proinflammatory cytokines, NLRP3 inflammasome, and transforming growth factor–beta1. The left lung was subjected to histopathological and immunohistochemical examination. Results: The administration of donepezil and/or prednisolone induced a significant amelioration of oxidative stress, inflammation, and fibrosis. In addition, these animals showed a significant amelioration of the histopathological changes of fibrosis, together with a significant decline in nuclear factor kappa B (p65) immunoexpression, compared to the group treated with bleomycin alone. However, the rats treated with the donepezil/prednisolone combination showed non-significant effects on the aforementioned parameters compared to the group treated with prednisolone alone. Conclusions: Donepezil may emerge as a promising drug that shows significant prophylactic effects against bleomycin-induced pulmonary fibrosis. Full article
(This article belongs to the Section Pharmacology)
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8 pages, 277 KiB  
Article
Wide Awake Local Anesthesia No Tourniquet Surgery of Carpal Tunnel Syndrome: Patients’ Experience and Recall Bias in a Day-Care Setting
by Saulius Knystautas, Kęstutis Braziulis, Ernest Zacharevskij, Karolis Varkalys, Violeta Šimatonienė and Loreta Pilipaitytė
Medicina 2023, 59(5), 979; https://doi.org/10.3390/medicina59050979 - 19 May 2023
Cited by 1 | Viewed by 1340
Abstract
Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient [...] Read more.
Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient experiences in a wide variety of hand disorder-related cases. The aim of our study is to evaluate patient satisfaction regarding open surgical treatment for CTS using the WALANT technique. Material and Methods: we enrolled 82 patients with CTS without medical record of surgical treatment for CTS. For WALANT, a hand surgeon used a combination of 1:200,000 epinephrine, 1% lidocaine, and 1 mL 8.4% sodium bicarbonate solution without tourniquet application and sedating the patient. All patients were treated in a day-care setting. For assessment of patient experience, Lalonde’s questionnaire was adapted. Participants completed survey twice: one month and six months after the surgical treatment was performed. Results: the median pre-operative pain score for all patients was 4 (range 0–8) after one month and 3 (range 1–8) after six months. The median intraoperative pain score for all patients was 1 (range 0–8) after one month and 1 (range 1–7) after six months. The median post-operative pain score for all patients was 3 (range 0–9) after one month and 1 (range 0–8) after six months. More than half (61% after one month and 73% after six months) of the patients responded by stating that their real experience of WALANT was better than their initial expectations. An absolute majority of patients (95% after one month and 90% after six months) would recommend WALANT treatment to their relatives. Conclusions: overall, patient satisfaction with treatment for CTS using WALANT is high. Furthermore, complications related to the performed treatment and persistent post-operative pain could be associated with more reliable patient recall of this healthcare intervention. A longer period of time between intervention and assessment of patient experience could possibly be a reason for recall bias. Full article
(This article belongs to the Section Surgery)
11 pages, 667 KiB  
Hypothesis
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Comorbidities: Linked by Vascular Pathomechanisms and Vasoactive Mediators?
by Klaus J. Wirth and Matthias Löhn
Medicina 2023, 59(5), 978; https://doi.org/10.3390/medicina59050978 - 18 May 2023
Cited by 6 | Viewed by 6767
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often associated with various other syndromes or conditions including mast cell activation (MCA), dysmenorrhea and endometriosis, postural tachycardia (POTS) and small fiber neuropathy (SFN). The causes of these syndromes and the reason for their frequent association are [...] Read more.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often associated with various other syndromes or conditions including mast cell activation (MCA), dysmenorrhea and endometriosis, postural tachycardia (POTS) and small fiber neuropathy (SFN). The causes of these syndromes and the reason for their frequent association are not yet fully understood. We previously published a comprehensive hypothesis of the ME/CFS pathophysiology that explains the majority of symptoms, findings and chronicity of the disease. We wondered whether some of the identified key pathomechanisms in ME/CFS are also operative in MCA, endometriosis and dysmenorrhea, POTS, decreased cerebral blood flow and SFN, and possibly may provide clues on their causes and frequent co-occurrence. Our analysis indeed provides strong arguments in favor of this assumption, and we conclude that the main pathomechanisms responsible for this association are excessive generation and spillover into the systemic circulation of inflammatory and vasoactive tissue mediators, dysfunctional β2AdR, and the mutual triggering of symptomatology and disease initiation. Overall, vascular dysfunction appears to be a strong common denominator in these linkages. Full article
(This article belongs to the Special Issue Advances in ME/CFS Research and Clinical Care)
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14 pages, 1576 KiB  
Article
Differences between Very Highly Sensitized Kidney Transplant Recipients as Identified by Machine Learning Consensus Clustering
by Charat Thongprayoon, Jing Miao, Caroline C. Jadlowiec, Shennen A. Mao, Michael A. Mao, Pradeep Vaitla, Napat Leeaphorn, Wisit Kaewput, Pattharawin Pattharanitima, Supawit Tangpanithandee, Pajaree Krisanapan, Pitchaphon Nissaisorakarn, Matthew Cooper and Wisit Cheungpasitporn
Medicina 2023, 59(5), 977; https://doi.org/10.3390/medicina59050977 - 18 May 2023
Cited by 2 | Viewed by 1662
Abstract
Background and Objectives: The aim of our study was to categorize very highly sensitized kidney transplant recipients with pre-transplant panel reactive antibody (PRA) ≥ 98% using an unsupervised machine learning approach as clinical outcomes for this population are inferior, despite receiving increased [...] Read more.
Background and Objectives: The aim of our study was to categorize very highly sensitized kidney transplant recipients with pre-transplant panel reactive antibody (PRA) ≥ 98% using an unsupervised machine learning approach as clinical outcomes for this population are inferior, despite receiving increased allocation priority. Identifying subgroups with higher risks for inferior outcomes is essential to guide individualized management strategies for these vulnerable recipients. Materials and Methods: To achieve this, we analyzed the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database from 2010 to 2019 and performed consensus cluster analysis based on the recipient-, donor-, and transplant-related characteristics in 7458 kidney transplant patients with pre-transplant PRA ≥ 98%. The key characteristics of each cluster were identified by calculating the standardized mean difference. The post-transplant outcomes were compared between the assigned clusters. Results: We identified two distinct clusters and compared the post-transplant outcomes among the assigned clusters of very highly sensitized kidney transplant patients. Cluster 1 patients were younger (median age 45 years), male predominant, and more likely to have previously undergone a kidney transplant, but had less diabetic kidney disease. Cluster 2 recipients were older (median 54 years), female predominant, and more likely to be undergoing a first-time transplant. While patient survival was comparable between the two clusters, cluster 1 had lower death-censored graft survival and higher acute rejection compared to cluster 2. Conclusions: The unsupervised machine learning approach categorized very highly sensitized kidney transplant patients into two clinically distinct clusters with differing post-transplant outcomes. A better understanding of these clinically distinct subgroups may assist the transplant community in developing individualized care strategies and improving the outcomes for very highly sensitized kidney transplant patients. Full article
(This article belongs to the Special Issue Clinical Studies, Big Data, and Artificial Intelligence in Medicine)
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10 pages, 1752 KiB  
Article
Longitudinal Assessment of Multimorbidity Medication Patterns among Smokers in the COPDGene Cohort
by Yisha Li, Sarah J. Schmiege, Heather Anderson, Nicole E. Richmond, Kendra A. Young, John E. Hokanson, Stephen I. Rennard, Tessa L. Crume, Erin Austin, Katherine A. Pratte, Rebecca Conway and Gregory L. Kinney
Medicina 2023, 59(5), 976; https://doi.org/10.3390/medicina59050976 - 18 May 2023
Viewed by 1375
Abstract
Background and objectives: Chronic obstructive pulmonary disease (COPD) is usually comorbid with other chronic diseases. We aimed to assess the multimorbidity medication patterns and explore if the patterns are similar for phase 1 (P1) and 5-year follow-up phase 2 (P2) in the [...] Read more.
Background and objectives: Chronic obstructive pulmonary disease (COPD) is usually comorbid with other chronic diseases. We aimed to assess the multimorbidity medication patterns and explore if the patterns are similar for phase 1 (P1) and 5-year follow-up phase 2 (P2) in the COPDGene cohort. Materials and Methods: A total of 5564 out of 10,198 smokers from the COPDGene cohort who completed 2 visits, P1 and P2 visits, with complete medication use history were included in the study. We conducted latent class analysis (LCA) among the 27 categories of chronic disease medications, excluding COPD treatments and cancer medications at P1 and P2 separately. The best number of LCA classes was determined through both statistical fit and interpretation of the patterns. Results: We found four classes of medication patterns at both phases. LCA showed that both phases shared similar characteristics in their medication patterns: LC0: low medication; LC1: hypertension (HTN) or cardiovascular disease (CVD)+high cholesterol (Hychol) medication predominant; LC2: HTN/CVD+type 2 diabetes (T2D) +Hychol medication predominant; LC3: Hychol medication predominant. Conclusions: We found similar multimorbidity medication patterns among smokers at P1 and P2 in the COPDGene cohort, which provides an understanding of how multimorbidity medication clustered and how different chronic diseases combine in smokers. Full article
(This article belongs to the Section Epidemiology & Public Health)
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7 pages, 2152 KiB  
Case Report
Melanoma: BRAFi Rechallenge
by Christoforos S. Kosmidis, Konstantina Papadopoulou, Chrysi Maria Mystakidou, Evanthia Papadopoulou, Stylianos Mantalovas, Nikolaos Varsamis, Charilaos Koulouris, Vasiliki Theodorou, Konstantinos Papadopoulos, Christina Sevva, Petrina Miltiadous, Savvas Petanidis, Eleni Georgakoudi, Eleni Papadopoulou and Sofia Baka
Medicina 2023, 59(5), 975; https://doi.org/10.3390/medicina59050975 - 18 May 2023
Cited by 1 | Viewed by 1370
Abstract
Melanoma is the most aggressive type of skin cancer. Half of melanoma cases are characterized by the mutation BRAF V600. The case presented concerns a 41-year-old patient with locally advanced melanoma, being positive in mutation BRAF V600. The patient underwent surgery and received [...] Read more.
Melanoma is the most aggressive type of skin cancer. Half of melanoma cases are characterized by the mutation BRAF V600. The case presented concerns a 41-year-old patient with locally advanced melanoma, being positive in mutation BRAF V600. The patient underwent surgery and received additional targeted therapy as part of a clinical study. In subsequent disease progression, immunotherapy was used. When the disease progressed again while the patient was in a good performance status, targeted therapy was administered again, and a good response was noted, making the patient reach a statistically significant overall survival, exceeding four years. Targeted therapy has proven to be an important tool in the treatment of melanoma. The use of BRAFi targeted therapy does not exclude the option of readministration at subsequent disease progression (BRAFi rechallenge). Preclinical models suggest that the resistance mechanism of cancer cells to BRAFi therapy bends, as these cell clones lose their evolutionary advantage after stopping BRAFi. Cell clones sensitive to BRAFi may then outcompete, making the treatment effective again. Therapeutical dilemmas in the management of patients with locally advanced melanoma that progresses to metastatic cancer are discussed. Full article
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12 pages, 1132 KiB  
Article
Denture Adhesive Utilization and Associated Factors among Dental Practitioners in the Eastern Province, Saudi Arabia
by Mohammed M. Gad, Mayyasah O. Almusallam, Fadak H. Almarar, Haya O. Al khaldi, Alhanoof K. Aldossary, Wejdan M. Almutairi, Nawaf A. Alghamdi, Yasser S. Alssaialiy, Nawaf I. Alghamdi and Muhammad A. Nazir
Medicina 2023, 59(5), 974; https://doi.org/10.3390/medicina59050974 - 18 May 2023
Viewed by 1259
Abstract
Background: Denture adhesives (DAs) enhance denture retention and stability, thus improving functions of removable prostheses. However, the adverse effects of DAs on denture foundation area were also reported. The clinical use of DAs among dentists has not been investigated in Saudi Arabia. Therefore, [...] Read more.
Background: Denture adhesives (DAs) enhance denture retention and stability, thus improving functions of removable prostheses. However, the adverse effects of DAs on denture foundation area were also reported. The clinical use of DAs among dentists has not been investigated in Saudi Arabia. Therefore, this study aimed to evaluate utilization of DAs and associated factors among dental practitioners in Saudi Arabia. Methods: This cross-sectional study included dental professionals practicing in both public and private sectors in the Eastern Province of Saudi Arabia. A self-administered pilot tested questionnaire was distributed among participants. The questionnaire has questions related to demographic information, knowledge and awareness, and the utilization of DAs. Bivariate and multiple logistic regression analyses were performed. Results: The study included 279 participants with a response rate of 79.03%. The majority of participants (61.6%) were below 35 years of age, males (56.6%), general dentists (57.3%), and worked in the private sector (59.9%). Less than half of the participants (39.4%) used DAs in their dental practice, and 64.5% recommended using DAs when needed. The most reported complications of DAs included inflammation (58.40%), ulcers (35.10%), and whitish color (31.20%) of denture foundation area. A vast majority (83.90%) reported that DAs improve retention of the dentures. About 55.2% of the participants were taught about DAs in their undergraduate programs, 12.5% attended continuing education, and 21.5% updated their knowledge about DAs. Multiple logistic regression showed that those who attended continuing education activities (adjusted OR = 2.41, p = 0.036) and updated their knowledge about DAs (adjusted OR = 4.43, p = < 0.001) were significantly more likely to use DAs in their dental practice. Conclusion: A minority of dental practitioners used DAs in their practices. Attending continuing education programs and updating knowledge of DAs were significantly associated with DAs utilization. Full article
(This article belongs to the Section Dentistry)
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8 pages, 523 KiB  
Article
How Cultural Behaviors and Superstitions Associate the Willingness to Undergo Cataract Surgery in Taiwan: A Nationwide Survey
by Hsiao-Fan Tung, Yi-Ling Chen, Chiu-Liang Chen, Mei-Jih Gee, Chih-Hsin Muo and Shin-Lin Chiu
Medicina 2023, 59(5), 973; https://doi.org/10.3390/medicina59050973 - 18 May 2023
Cited by 1 | Viewed by 1291
Abstract
Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were [...] Read more.
Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were retrospectively retrieved from the national Longitudinal Health Insurance Database 2000 (LHID2000). From the national database, we enrolled patients that were diagnosed with cataracts and underwent cataract surgery from 2001 to 2010. All the patients were stratified according to their gender and living area. Gender was categorized as male or female, and the living area was classified as urban or rural. We compared the difference in the number of surgeries between stratified patient groups in each Chinese lunar month. Results: The number of cataract surgeries decreased significantly in the seventh and twelfth lunar months for both genders. There was a significant reduction in cataract surgeries in both the urban and rural groups during the seventh lunar month. Interestingly, only the seventh lunar month had an association with sex in different living areas, which meant that in the seventh month, there was a gender-specific difference in the surgical numbers. Conclusions: The Taiwanese population holds a belief that surgical procedures, including cataract surgery, during the lunar ghost month is inauspicious. Citizens tend to avoid elective surgery due to cultural practice, resulting in a decrease in surgical numbers during the period of the Chinese New Year. The authorities should consider these cultural behaviors when developing medical policies and allocating resources. Healthcare providers should be aware of these superstitions and take them into account when providing medical care and advice to patients. Full article
(This article belongs to the Section Ophthalmology)
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15 pages, 1730 KiB  
Systematic Review
Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review
by Andrea Scribante, Martina Ghizzoni, Matteo Pellegrini, Federica Pulicari and Francesco Spadari
Medicina 2023, 59(5), 972; https://doi.org/10.3390/medicina59050972 - 18 May 2023
Cited by 2 | Viewed by 1571
Abstract
Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this [...] Read more.
Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this research is to describe the main evidence from the last 10 years of clinical trials regarding the use of auxiliary devices such as autologous platelet concentrates (APCs) and laser, other than their effects against MRONJ disease onset or therapy. Advantages in the healing process and recurrence rates were also analyzed. Materials and Methods: A systematic search of the electronic databases of PubMed and Scopus was carried out. Data from the studies were analyzed, and the risk of bias was evaluated. Results: Nineteen studies between interventional studies, observational studies, and cohort studies have been considered in this review. Conclusions: Based on the studies included, the literature analysis shows that APCs could be a beneficial alternative in preventing and treating MRONJ. Laser technology, as a surgical tool or used on the antimicrobial photodynamic or photobiomodulation side, has been becoming increasingly popular in the last few years. The latest proposal concerning the combination of both auxiliary tools suggests interesting effects, but more studies should be conducted to evaluate eventual relapses and long-term consequences. Full article
(This article belongs to the Section Dentistry)
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Article
Mental Health of Primary and Secondary School Teachers in the Remote Mountain Areas
by Guoxiang Fang, Xiaofei Zhou, Yang Xin, Mei Li, Fang Li, Wenwen Zhang, Bo Li and Ying Wang
Medicina 2023, 59(5), 971; https://doi.org/10.3390/medicina59050971 - 17 May 2023
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Abstract
Background and objective: Teaching is widely recognized as a highly stressful profession. Job stress leads to emotional exhaustion, which in turn triggers teacher attrition. The cost is estimated as USD 2.2 billion annually for teacher dropouts. It is therefore important to understand [...] Read more.
Background and objective: Teaching is widely recognized as a highly stressful profession. Job stress leads to emotional exhaustion, which in turn triggers teacher attrition. The cost is estimated as USD 2.2 billion annually for teacher dropouts. It is therefore important to understand the mental state of teachers and the factors that may influence it in order to provide the appropriate early intervention. In the past, more attention has been paid to the mental status of teachers in economically developed cities, but less research has been conducted in remote cities. In this study, we selected primary and secondary school teachers in a typical area to assess their mental health, thereby contributing to the development of effective mental health education programs for teachers in primary and secondary schools. Materials and methods: In this study, 1102 teachers from a typical city in Ningxia Province, characterized by remote mountain areas, minority communities, and a low economic level, participated. The mental status of the teachers was assessed by a Symptom Checklist-90 (SCL-90). The effects of gender, age, level of education, place of work, and marital status on the total SCL-90 score were recorded and compared. The subscale scores of the SCL-90 and the differences among the respondents with various characteristics were analyzed. Results: In total, 1025 data were valid and used for statistical analysis. The effective rate of this study was 93.01%. The analysis showed that 25.17% of the subjects had possible mental problems. There were significant differences in age and marital status (p < 0.001). The score of teachers less than 30 years old was lower than that of other teachers (p = 0.001 vs. 30–39; p < 0.001 vs. 40–49; p < 0.001 vs. ≥50). The no-marriage teachers had the lowest score than the married group or others (p < 0.001 vs. married; p < 0.05 vs. others). Compared to the norm, teachers’ mental status was poor, especially in somatization (p < 0.001), obsessive-compulsive symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), hostility (p < 0.001), phobic anxiety (p < 0.001), and psychosis (p < 0.001). There were gender differences in obsessive-compulsive symptoms (p < 0.05) and depression (p < 0.05). Conclusions: These data indicate that the mental status of these teachers is not optimistic, and married female teachers aged 40–55 years need to be given more attention. Mental health examinations can be incorporated into daily physical examination items to facilitate the timely detection and early intervention of negative emotions. Full article
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