Medicina

13 pages, 3441 KiB

Open AccessArticle

Specific Learning Disorders: Variation Analysis of 15 Candidate Genes in 9 Multiplex Families

by Francesco Calì, Francesco Domenico Di Blasi, Emanuela Avola, Mirella Vinci, Antonino Musumeci, Angelo Gloria, Donatella Greco, Daniela Rita Raciti, Alessandro Zagami, Biagio Rizzo, Santina Città, Concetta Federico, Luigi Vetri, Salvatore Saccone and Serafino Buono

Medicina 2023, 59(8), 1503; https://doi.org/10.3390/medicina59081503 - 21 Aug 2023

Cited by 1 | Viewed by 1488

Abstract

Background and Objectives: Specific Learning Disorder (SLD) is a complex neurobiological disorder characterized by a persistent difficult in reading (dyslexia), written expression (dysgraphia), and mathematics (dyscalculia). The hereditary and genetic component is one of the underlying causes of SLD, but the relationship [...] Read more.

Background and Objectives: Specific Learning Disorder (SLD) is a complex neurobiological disorder characterized by a persistent difficult in reading (dyslexia), written expression (dysgraphia), and mathematics (dyscalculia). The hereditary and genetic component is one of the underlying causes of SLD, but the relationship between genes and the environment should be considered. Several genetic studies were performed in different populations to identify causative genes. Materials and Methods: Here, we show the analysis of 9 multiplex families with at least 2 individuals diagnosed with SLD per family, with a total of 37 persons, 21 of whom are young subjects with SLD, by means of Next-Generation Sequencing (NGS) to identify possible causative mutations in a panel of 15 candidate genes: CCPG1, CYP19A1, DCDC2, DGKI, DIP2A, DYM, GCFC2, KIAA0319, MC5R, MRPL19, NEDD4L, PCNT, PRMT2, ROBO1, and S100B. Results: We detected, in eight families out nine, SNP variants in the DGKI, DIP2A, KIAA0319, and PCNT genes, even if in silico analysis did not show any causative effect on this behavioral condition. In all cases, the mutation was transmitted by one of the two parents, thus excluding the case of de novo mutation. Moreover, the parent carrying the allelic variant transmitted to the children, in six out of seven families, reports language difficulties. Conclusions: Although the present results cannot be considered conclusive due to the limited sample size, the identification of genetic variants in the above genes can provide input for further research on the same, as well as on other genes/mutations, to better understand the genetic basis of this disorder, and from this perspective, to better understand also the neuropsychological and social aspects connected to this disorder, which affects an increasing number of young people. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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Graphical abstract

47 pages, 1138 KiB

Open AccessSystematic Review

Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis

by Sonja Perkovic-Kepeci, Andja Cirkovic, Natasa Milic, Stefan Dugalic, Dejana Stanisavljevic, Milos Milincic, Konstantin Kostic, Nikola Milic, Jovana Todorovic, Ksenija Markovic, Natasa Aleksic Grozdic and Miroslava Gojnic Dugalic

Medicina 2023, 59(8), 1502; https://doi.org/10.3390/medicina59081502 - 21 Aug 2023

Cited by 1 | Viewed by 1578

Abstract

Background and Objectives: The aim of this study was to assess the differences in Doppler indices of the uterine (Ut), umbilical (UA), and middle cerebral artery (MCA) in diabetic versus non-diabetic pregnancies by conducting a comprehensive systematic review of the literature with [...] Read more.

Background and Objectives: The aim of this study was to assess the differences in Doppler indices of the uterine (Ut), umbilical (UA), and middle cerebral artery (MCA) in diabetic versus non-diabetic pregnancies by conducting a comprehensive systematic review of the literature with a meta-analysis. Materials and Methods: PubMed, Web of Science, and SCOPUS were searched for studies that measured the pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio index (S/D ratio) of the umbilical artery, middle cerebral artery, and uterine artery in diabetic versus non-diabetic pregnancies. Two reviewers independently evaluated the eligibility of studies, abstracted data, and performed quality assessments according to standardized protocols. The standardized mean difference (SMD) was used as a measure of effect size. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated by means of funnel plots. Results: A total of 62 publications were included in the qualitative and 43 in quantitative analysis. The UA-RI, UtA-PI, and UtA-S/D ratios were increased in diabetic compared with non-diabetic pregnancies. Subgroup analysis showed that levels of UtA-PI were significantly higher during the third, but not during the first trimester of pregnancy in diabetic versus non-diabetic pregnancies. No differences were found for the UA-PI, UA-S/D ratio, MCA-PI, MCA-RI, MCA-S/D ratio, or UtA-RI between diabetic and non-diabetic pregnancies. Conclusions: This meta-analysis revealed the presence of hemodynamic changes in uterine and umbilical arteries, but not in the middle cerebral artery in pregnancies complicated by diabetes. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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12 pages, 332 KiB

Open AccessArticle

Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic

by Haytham I. AlSaif, Zeyad A. Alhozaimi, Alhanouf S. Alrashed, Kholoud S. Alanazi, Mohammed G. Alshibani, Turky H. Almigbal, Saad M. Alsaad, Abdullah A. Alrasheed and Fahad D. Alosaimi

Medicina 2023, 59(8), 1501; https://doi.org/10.3390/medicina59081501 - 21 Aug 2023

Cited by 1 | Viewed by 1771

Abstract

Purpose: Smartphone addiction is prevalent among medical students, and there is a concern that the coronavirus disease 2019 (COVID-19) pandemic fueled a rise in smartphone addiction. Earlier studies suggest a link between excessive smartphone usage and negative outcomes such as depression, stress, and [...] Read more.

Purpose: Smartphone addiction is prevalent among medical students, and there is a concern that the coronavirus disease 2019 (COVID-19) pandemic fueled a rise in smartphone addiction. Earlier studies suggest a link between excessive smartphone usage and negative outcomes such as depression, stress, and reduced academic achievement. However, there is a dearth of both local studies in Saudi Arabia and studies conducted during the COVID-19 pandemic exploring the prevalence of smartphone addiction and its association with academic performance, depression, and perceived stress, which is the purpose of the current study. Methods: In 2021, a cross-sectional research project took place among medical students at King Saud University and the Vision Colleges located in Riyadh, Saudi Arabia. An online self-administered questionnaire consisting of demographic variables, grade point average (GPA), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Stress Scale-4 (PSS-4), and the Smartphone Addiction Scale—Short Version (SAS-SV) was deployed. Results: Three hundred and fifteen students participated. Around 47.9% of students reported smartphone addiction, and the mean SAS-SV score was 32.31 ± 12.01 points. Both PHQ-9 and PSS-4 scores showed a significant positive correlation with the SAS-SV score (r = 0.216, p < 0.001 and r = 247, p < 0.001, respectively), while GPA did not (r = −0.027, p = 0.639). An adjusted analysis showed that the PSS-4 score was positively associated with the SAS-SV score (odds ratio (OR) = 1.206, p < 0.001), while the PHQ-9 score was not (OR = 102, p = 0.285). Conclusions: Smartphone addiction is prevalent among medical students and associated with perceived stress. Additional research is required to gain a deeper comprehension of this issue and to assess the success of intervention initiatives aimed at encouraging healthy smartphone usage, particularly in times of crisis like the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Public Mental Health Crisis during SARS-CoV-2 Pandemic)

24 pages, 3763 KiB

Open AccessSystematic Review

The Prevalence of Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

by Eleni Karlafti, Dimitrios Tsavdaris, Evangelia Kotzakioulafi, Adonis A. Protopapas, Georgia Kaiafa, Smaro Netta, Christos Savopoulos, Antonios Michalopoulos and Daniel Paramythiotis

Medicina 2023, 59(8), 1500; https://doi.org/10.3390/medicina59081500 - 21 Aug 2023

Viewed by 1981

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many [...] Read more.

Introduction: Severe acute respiratory syndrome coronavirus 2 caused the coronavirus disease of 2019 (COVID-19), which rapidly became a pandemic, claiming millions of lives. Apart from the main manifestations of this infection concerning the respiratory tract, such as pneumonia, there are also many manifestations from the gastrointestinal tract. Of these, bleeding from the gastrointestinal tract is a significant complication quite dangerous for life. This bleeding is divided into upper and lower, and the primary pathophysiological mechanism is the entering of the virus into the host cells through the Angiotensin-converting enzyme 2 receptors. Also, other comorbidities and the medication of corticosteroids and anticoagulants are considered to favor the occurrence of gastrointestinal bleeding (GIB). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were searched in two different databases (Scopus and PubMed) from November 2019 until February 2023. All studies that reported GIB events among COVID-19 patients were included. Results: 33 studies were selected and reviewed to estimate the prevalence of GIB. A total of 134,905 patients with COVID-19 were included in these studies, and there were 1458 episodes of GIB. The prevalence of GIB, in these 33 studies, ranges from 0.47% to 19%. This range of prevalence is justified by the characteristics of the COVID-19 patients. These characteristics are the severity of COVID-19, anticoagulant and other drug treatments, the selection of only patients with gastrointestinal manifestations, etc. The pooled prevalence of gastrointestinal bleeding was estimated to be 3.05%, rising to 6.2% when only anticoagulant patients were included. Conclusions: GIB in COVID-19 patients is not a rare finding, and its appropriate and immediate treatment is necessary as it can be life-threatening. The most common clinical findings are melena and hematemesis, which characterize upper GIB. Treatment can be conservative; however, endoscopic management of bleeding with embolization is deemed necessary in some cases. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

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13 pages, 2038 KiB

Open AccessArticle

Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older

by Hsuan-Ching Lin, Ming-Jui Hung, Chao-Hung Wang, Tien-Hsing Chen, Wei-Siang Chen and Chi-Wen Cheng

Medicina 2023, 59(8), 1499; https://doi.org/10.3390/medicina59081499 - 21 Aug 2023

Viewed by 1050

Abstract

Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior [...] Read more.

Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m² (HR: 2.21, 95% CI: 1.06–4.61), estimated glomerular filtration rate <30 mL/min/1.73 m² (3.35, 1.77–6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02–3.43) and dyspnea as the major presenting symptom (1.90, 1.03–3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24–17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Full article

(This article belongs to the Section Cardiology)

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13 pages, 4434 KiB

Open AccessReview

Total Talar Prosthesis, Learning from Experience, Two Reports of Total Talar Prosthesis after Talar Extrusion and Literature Review

by Danilo Leonetti, Giorgio Carmelo Basile, Gabriele Giuca, Elena Corso, Domenico Fenga and Ilaria Sanzarello

Medicina 2023, 59(8), 1498; https://doi.org/10.3390/medicina59081498 - 21 Aug 2023

Cited by 1 | Viewed by 1160

Abstract

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a [...] Read more.

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a high-intensity trauma. Both cases subsequently required revision surgery due to degenerative changes of the tibial plafond (arthrodesis in the first case, conversion to a total ankle prosthesis in the latter). We report and analyze the literature concerning total talar replacement to discuss strategies that could help improve prosthesis survival and reduce the incidence of osteoarthritis. Full article

(This article belongs to the Special Issue Current Status and Future Directions of Bone Trauma Surgery)

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8 pages, 1694 KiB

Open AccessCase Report

Using Single Peroneal Longus Tendon Graft for Segmental Meniscus Transplantation and Revision Anterior Cruciate Ligament Combined Anterolateral Reconstruction

by Ling Yang, Chih-Hao Chiu, Kuo-Yao Hsu, Chieh-An Chuang, Alvin Chao-Yu Chen, Yi-Sheng Chan and Cheng-Pang Yang

Medicina 2023, 59(8), 1497; https://doi.org/10.3390/medicina59081497 - 21 Aug 2023

Viewed by 1159

Abstract

This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal [...] Read more.

This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency. Full article

(This article belongs to the Special Issue Advances in Orthopedics and Sports Medicine)

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11 pages, 1920 KiB

Open AccessArticle

Feasibility and Efficacy of the Newly Developed Robotic Hybrid Assistive Limb Shoulder Exercises in Patients with C5 Palsy during the Acute Postoperative Phase

by Shigeki Kubota, Hideki Kadone, Yukiyo Shimizu, Hiroki Watanabe, Masao Koda, Yoshiyuki Sankai and Masashi Yamazaki

Medicina 2023, 59(8), 1496; https://doi.org/10.3390/medicina59081496 - 21 Aug 2023

Cited by 1 | Viewed by 1119

Abstract

Background and Objectives: Although postoperative C5 palsy is a frequent complication of cervical spine surgery, no effective therapeutic rehabilitation approach has been established for postoperative C5 palsy. The purpose of this study was to find evidence confirming the effectiveness and feasibility of [...] Read more.

Background and Objectives: Although postoperative C5 palsy is a frequent complication of cervical spine surgery, no effective therapeutic rehabilitation approach has been established for postoperative C5 palsy. The purpose of this study was to find evidence confirming the effectiveness and feasibility of robotic Hybrid Assistive Limb (HAL) shoulder exercises for C5 palsy. Materials and Methods: In this before-after, uncontrolled case series clinical study, we performed a mean of 11.7 shoulder training sessions using a shoulder HAL immediately after the onset of C5 palsy in seven shoulders of six patients who developed postoperative C5 palsy and had difficulty raising their shoulder during the acute postoperative phase of cervical spine surgery. Shoulder HAL training was introduced as early as possible after evaluating the general condition of all inpatients who developed C5 palsy. Patients underwent shoulder abduction training using shoulder HAL on an inpatient and outpatient basis at 2-week or 1-month intervals. Adverse events associated with shoulder HAL training were investigated. The shoulder abduction angle and power without the shoulder HAL were evaluated before shoulder HAL usage, at every subsequent session, and upon completion of all sessions. Results: Severe adverse events due to shoulder HAL training were not reported. After completion of all shoulder HAL sessions, all patients showed improved shoulder elevation, while shoulder abduction angle and power improved over time. Conclusions: Shoulder elevation training with HAL in patients in the acute stage of postoperative C5 palsy has the potential to demonstrate improvement in shoulder joint function with a low risk of developing severe adverse events. Full article

(This article belongs to the Section Surgery)

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10 pages, 1730 KiB

Open AccessCase Report

Sarcoidosis-Associated Sensory Ganglionopathy and Harlequin Syndrome: A Case Report

by Ieva Navickaitė, Miglė Ališauskienė, Sandra Petrauskienė and Gintarė Žemgulytė

Medicina 2023, 59(8), 1495; https://doi.org/10.3390/medicina59081495 - 20 Aug 2023

Cited by 1 | Viewed by 1465

Abstract

Background and Objectives: Sensory ganglionopathy is a rare neurological disorder caused by degeneration of the neurons composing the dorsal root ganglia. It manifests as various sensory disturbances in the trunk, proximal limbs, face, or mouth in a patchy and asymmetrical pattern. Harlequin [...] Read more.

Background and Objectives: Sensory ganglionopathy is a rare neurological disorder caused by degeneration of the neurons composing the dorsal root ganglia. It manifests as various sensory disturbances in the trunk, proximal limbs, face, or mouth in a patchy and asymmetrical pattern. Harlequin syndrome is characterized by unilateral flushing and sweating of the face, neck, and upper chest, concurrent with contralateral anhidrosis. Here, we present and discuss a clinical case of sarcoidosis-associated ganglionopathy and Harlequin syndrome. Case presentation: A 31-year-old woman complained of burning pain in the right side of the upper chest and the feet. She also experienced episodes of intense flushing and sweating on the right side of her face, neck, and upper chest. Three years before these symptoms began, the patient was diagnosed with pulmonary sarcoidosis. On neurological examination, sensory disturbances were present. In the trunk, the patient reported pronounced hyperalgesia and allodynia in the upper part of the right chest and some patches on the right side of the upper back. In the extremities, hypoalgesia in the tips of the fingers and hyperalgesia in the feet were noted. An extensive diagnostic workup was performed to eliminate other possible causes of these disorders. A broad range of possible metabolic, immunological, and structural causes were ruled out. Thus, the final clinical diagnosis of sarcoidosis-induced sensory ganglionopathy, small-fiber neuropathy, and Harlequin syndrome was made. Initially, the patient was treated with pregabalin and amitriptyline, but the effect was inadequate for the ganglionopathy-induced pain. Therefore, therapeutic plasma exchange as an immune-modulating treatment was selected, leading to partial pain relief. Conclusions: This case report demonstrates the possible autoimmune origin of both sensory ganglionopathy and Harlequin syndrome. It suggests that an autoimmune etiology for these disorders should be considered and the diagnostic workup should include screening for the most common autoimmune conditions. Full article

(This article belongs to the Section Neurology)

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16 pages, 8968 KiB

Open AccessArticle

The Carotid–Hyoid Topography Is Variable

by Mihaela Daniela Manta, Mugurel Constantin Rusu, Sorin Hostiuc, Alexandra Diana Vrapciu, Bogdan Adrian Manta and Adelina Maria Jianu

Medicina 2023, 59(8), 1494; https://doi.org/10.3390/medicina59081494 - 19 Aug 2023

Cited by 5 | Viewed by 1318

Abstract

Background and Objectives: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case reports have provided evidence of the possibility of carotid artery location [...] Read more.

Background and Objectives: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case reports have provided evidence of the possibility of carotid artery location either lateral or medial to the greater hyoid horn, these reports have not established specific anatomic possibilities and prevalences. Materials and Methods: We retrospectively analysed a batch of 147 CT angiograms for 12 types of carotid–hyoid relationships and classified the bilateral combination possibilities of these types. Results: In 168/294 sides there were no carotid–hyoid relationships. Type I, external carotid artery (ECA) medial to the greater horn of the hyoid bone (GHHB), was observed in 0.34%; type II, internal carotid artery (ICA) medial to GHHB, in 0.34%; type III, ICA and ECA medial to GHHB, in 1.02%; type IV, common carotid artery (CCA) medial to GHHB, in 1.02%; type V, CB medial to GHHB, in 0.34%; type VI, ECA lateral to GHHB, in 20.41%; type VII, ICA lateral to GHHB, was not recorded; type VIII, ECA and ICA lateral to GHHB, in 3.74%; type IX, CCA lateral to GHHB, in 8.5%; type X, CB lateral to GHHB, in 6.46%; type XI, ECA lateral and ICA medial to GHHB, in 0.34%; and type XII, ICA lateral and ECA medial to GHHB, in 0.34%. Bilateral symmetry was found in 70.74% of cases, including the null types without carotid–hyoid relationships as well as types IV, VI, VIII, IX, and X. There was a highly significant association between the left and right variants of the carotid–hyoid relationship. Conclusions: Mechanical compression of the hyoid bone on the carotid arteries has various undesirable effects on the ICA and cerebral circulation. Underlying these are several variational anatomical patterns of carotid–hyoid relationships, which can be accurately documented on CT angiograms. A case-by-case anatomical study is better than assuming the carotid anatomy learned from textbooks. Full article

(This article belongs to the Topic Human Anatomy and Pathophysiology, 2nd Volume)

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11 pages, 307 KiB

Open AccessArticle

Promoting Self-Management and Independent Living of Older Individuals with Chronic Diseases through Technology: A Study of Self-Reported Needs, Priorities, and Preferences

by Argyroula Kalaitzaki, Michael Rovithis, Alexios Dimitropoulos, Sofia Koukouli, Manolis Linardakis, Elli Katsiri, Nikos Rikos, George Vasilopoulos, George Tsolas, Aikaterini Papachristou, Anastasia Dimitrantzou, Dimitrios Katsiris and Areti Stavropoulou

Medicina 2023, 59(8), 1493; https://doi.org/10.3390/medicina59081493 - 19 Aug 2023

Viewed by 1551

Abstract

Background and Objectives: Older patients’ needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of older patients with heart failure (HF), [...] Read more.

Background and Objectives: Older patients’ needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of older patients with heart failure (HF), diabetes mellitus type II (DM2), and chronic obstructive pulmonary disease (COPD) toward technology use to enhance self-management. Materials and Methods: A convenience sample of 473 participants over 60 s (60.5% females), diagnosed with HF (n= 156), DM2 (n = 164), or COPD (n = 153) was recruited. They were administered a questionnaire about the usefulness of technology in general and in specific areas of disease management. Results: Most participants (84.7%) admitted that technology is needed for better disease management. This was equally recognized across the three groups both for the overall and specific areas of disease management (in order of priority: “Information”, “Communication with Physicians and Caregivers”, and “Quality of Life and Wellbeing”). Sociodemographic differences were found. Cell phones and PCs were the devices of preference. The four common features prioritized by all three groups were related to ‘information about disease management’ (i.e., monitoring symptoms, reminders for medication intake, management and prevention of complications), whereas the fifth one was related to ‘communication with physicians and caregivers (i.e., in case of abnormal or critical signs). The top disease-specific feature was also monitoring systems (of respiratory rate or blood sugar or blood pressure, and oxygen), whereas other disease-specific features followed (i.e., maintaining normal weight for HF patients, adjusting insulin dose for DM2 patients, and training on breathing exercises for COPD patients). Conclusions: Older individuals in these three groups seem receptive to technology in disease management. mHealth tools, incorporating both common and disease-specific features and addressing different chronic patients, and also being personalized at the same time, could be cost-saving and useful adjuncts in routine clinical care to improve self-management. Full article

(This article belongs to the Section Epidemiology & Public Health)

14 pages, 3005 KiB

Open AccessArticle

Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis

by Hyunseok Jang, Soon Tak Jeong, Yun Chul Park and Wu Seong Kang

Medicina 2023, 59(8), 1492; https://doi.org/10.3390/medicina59081492 - 19 Aug 2023

Cited by 2 | Viewed by 936

Abstract

Background and Objectives: Angioembolization has emerged as an effective therapeutic approach for pelvic hemorrhages; however, its exact effect size concerning the level of embolized artery remains uncertain. Therefore, we conducted this systematic review and meta-analysis to investigate the effect size of embolization-related [...] Read more.

Background and Objectives: Angioembolization has emerged as an effective therapeutic approach for pelvic hemorrhages; however, its exact effect size concerning the level of embolized artery remains uncertain. Therefore, we conducted this systematic review and meta-analysis to investigate the effect size of embolization-related pelvic complications after nonselective angioembolization compared to that after selective angioembolization in patients with pelvic injury accompanying hemorrhage. Materials and Methods: Relevant articles were collected by searching the PubMed, EMBASE, and Cochrane databases until 24 June 2023. Meta-analyses were conducted using odds ratios (ORs) for binary outcomes. Quality assessment was conducted using the risk of bias tool in non-randomized studies of interventions. Results: Five studies examining 357 patients were included in the meta-analysis. Embolization-related pelvic complications did not significantly differ between patients with nonselective and selective angioembolization (OR 1.581, 95% confidence interval [CI] 0.592 to 4.225, I² = 0%). However, in-hospital mortality was more likely to be higher in the nonselective group (OR 2.232, 95% CI 1.014 to 4.913, I² = 0%) than in the selective group. In the quality assessment, two studies were found to have a moderate risk of bias, whereas two studies exhibited a serious risk of bias. Conclusions: Despite the favorable outcomes observed with nonselective angioembolization concerning embolization-related pelvic complications, determining the exact effect sizes was limited owing to the significant risk of bias and heterogeneity. Nonetheless, the low incidence of ischemic pelvic complications appears to be a promising result. Full article

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17 pages, 5362 KiB

Open AccessReview

When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy

by Catalin Alius, Dragos Serban, Dan Georgian Bratu, Laura Carina Tribus, Geta Vancea, Paul Lorin Stoica, Ion Motofei, Corneliu Tudor, Crenguta Serboiu, Daniel Ovidiu Costea, Bogdan Serban, Ana Maria Dascalu, Ciprian Tanasescu, Bogdan Geavlete and Bogdan Mihai Cristea

Medicina 2023, 59(8), 1491; https://doi.org/10.3390/medicina59081491 - 19 Aug 2023

Cited by 2 | Viewed by 2978

Abstract

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a [...] Read more.

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms ”difficult cholecystectomy”, ”bile duct injuries”, ”safe cholecystectomy”, and ”laparoscopy in acute cholecystitis”. The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies. Full article

(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)

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11 pages, 619 KiB

Open AccessArticle

Collagen-Based Ovule Therapy Reduces Inflammation and Improve Cervical Epithelialization in Patients with Fungal, Viral, and Bacterial Cervico-Vaginitis

by Nicoletta De Rosa, Fabrizia Santangelo, Celestino Todisco, Fabiana Dequerquis and Claudio Santangelo

Medicina 2023, 59(8), 1490; https://doi.org/10.3390/medicina59081490 - 18 Aug 2023

Viewed by 1459

Abstract

Background and Objectives: Vulvovaginal infections pose significant health challenges for women, necessitating effective treatment approaches. This retrospective observational study aimed at investigating the efficacy of collagen-based vaginal ovules therapy, specifically Plurigin Ovules, in restoring cervical epithelialization and reducing inflammation in mycotic, viral, [...] Read more.

Background and Objectives: Vulvovaginal infections pose significant health challenges for women, necessitating effective treatment approaches. This retrospective observational study aimed at investigating the efficacy of collagen-based vaginal ovules therapy, specifically Plurigin Ovules, in restoring cervical epithelialization and reducing inflammation in mycotic, viral, and bacterial cervico-vaginitis. Materials and Methods: A total of 398 women with cervico-vaginitis were included in the study, categorized into three groups: bacterial cervico-vaginitis (Group A), viral cervico-vaginitis (Group B), and fungal cervico-vaginitis (Group C). Participants received vaginal therapy with Plurigin Ovules for three months. Vaginal health parameters were assessed at baseline (T0) and after six months (T1) using various diagnostic tests and analyzed with appropriate statistical tests. Results: Significant improvement in cervico-vaginitis was observed in all three groups. At T1, 87.7% patients of Group A, 66.7% of Group B, and 71.5% of Group C achieved infection resolution (all p < 0.05). Positive colposcopy results decreased across all groups (p < 0.001). Positive vaginal swabs and altered vaginal pH decreased in group A and C (p < 0.001). Positive HPV tests decreased in Group B (p < 0.001). Positive Pap tests and clinical examinations decreased significantly across all groups (p < 0.001). The odds ratios were calculated to reveal the significant associations between these diagnostic outcomes. The therapy was well-tolerated, and no major adverse events were reported. Conclusion: Plurigin Ovules exhibited promising therapeutic outcomes in the three cervico-vaginitis conditions studied. Bacterial cervico-vaginitis showed the most significant improvement, followed by fungal and viral cervico-vaginitis. These findings emphasize the potential of Plurigin Ovules as an effective therapeutic option for cervico-vaginal inflammation and infection, highlighting its role in promoting re-epithelialization and reducing inflammatory processes in the cervix and vagina. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Gynecological Diseases)

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13 pages, 25172 KiB

Open AccessArticle

Multiple Flap Transfer for Multiple Local Recurrence of Soft Tissue Sarcoma

by Ryo Karakawa, Hidehiko Yoshimatsu, Yuma Fuse and Tomoyuki Yano

Medicina 2023, 59(8), 1489; https://doi.org/10.3390/medicina59081489 - 18 Aug 2023

Viewed by 1292

Abstract

Background and Objectives: Surgical management of local recurrence of soft tissue sarcomas (STS) is still challenging. In this article, we report on multiple flap reconstructions for multiple local recurrences of STS. Their feasibility will be validated by examining clinical cases. Materials and [...] Read more.

Background and Objectives: Surgical management of local recurrence of soft tissue sarcomas (STS) is still challenging. In this article, we report on multiple flap reconstructions for multiple local recurrences of STS. Their feasibility will be validated by examining clinical cases. Materials and Methods: Patients who underwent multiple flap reconstructions for multiple local recurrences of STS between April 1997 and October 2021 were included in this retrospective study. Patient demographics, tumor characteristics, surgical characteristics, and postoperative complications were examined. Results: Twenty operations of eight patients were identified. The location of the defects was the back in two, the buttock in two, the groin in two, and the lower extremities in two. The average total number of wide resections was 4.0 and the average total number of flap reconstructions was 2.5. The average follow-up period was 109.4 months. The average size of the defect was 102.4 cm² and the average flap size was 15.7 × 10.8 cm. The histological diagnoses were malignant fibrous histocytoma (MFH) in eight operations, osteosarcoma in two operations, myxoid liposarcoma in two operations, undifferentiated pleomorphic sarcoma (UPS) in six operations, and myxofibrosarcoma (MFS) in one operation. Of twelve subsequent operations, the resection of the previously transferred flap was performed in six operations (50%). The occurrence of take back, flap complications, and donor-site complications in the primary operation group was 25%, 25%, and 12.5%, respectively. The occurrence of take back, flap complications, and donor-site complications in the second and subsequent operation group was 0%, 0%, and 16.7%, respectively. Conclusions: Multiple operations including wide resections followed by flap reconstructions for multiple local recurrences are feasible. Reconstructive surgeons should choose the options of the flaps considering the future local recurrence for tumors with a high risk of recurrence. Full article

(This article belongs to the Special Issue Latest Trends in Reconstructive Microsurgery: From Modification to Innovation - Volume II)

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14 pages, 906 KiB

Open AccessArticle

Can Routine Laboratory Tests Be Suggestive in Determining Suspicions of Malignancy in the Case of Thyroid Nodules?

by Mervat Matei, Mihaela Maria Vlad, Ioana Golu, Cristina Ștefania Dumitru, Graziano De Scisciolo and Sergiu-Ciprian Matei

Medicina 2023, 59(8), 1488; https://doi.org/10.3390/medicina59081488 - 18 Aug 2023

Viewed by 1467

Abstract

Background and objectives: Thyroid nodules are a common finding in clinical practice and can be either benign or malignant. The aim of this study was to compare laboratory parameters between patients with malignant thyroid nodules and those with benign thyroid nodules. Materials and [...] Read more.

Background and objectives: Thyroid nodules are a common finding in clinical practice and can be either benign or malignant. The aim of this study was to compare laboratory parameters between patients with malignant thyroid nodules and those with benign thyroid nodules. Materials and methods: A total of 845 patients were included, with 251 in the study group (malignant thyroid nodules) and 594 in the control group (benign thyroid nodules). Results: Our results show that there were statistically significant differences in several laboratory parameters, including FT3, FT4, ESR, fibrinogen, WBC, and lymphocyte percentage, between the two patient groups (p < 0.05). Conclusions: These findings suggest that certain laboratory parameters may be useful in differentiating between benign and malignant thyroid nodules and could aid in the diagnosis and treatment of thyroid cancer. However, further diagnostic tests such as fine-needle aspiration biopsy and imaging studies are typically required for an accurate diagnosis. Routine laboratory tests prove most effective when combined with other diagnostic methods to identify thyroid cancer. Although not conclusive on their own, these tests significantly suggest and guide physicians to suspect malignancy in thyroid nodules. This affirmative answer to our question, “Can routine laboratory tests be suggestive in determining suspicions of malignancy in the case of thyroid nodules?” aligns with the results of our study. Full article

(This article belongs to the Topic Public Health and Healthcare in the Context of Big Data)

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8 pages, 424 KiB

Open AccessBrief Report

Antibody Kinetics after Three Doses of SARS-CoV-2 mRNA Vaccination in Patients with Inflammatory Bowel Disease

by Evangelos Tsipotis, Ankith Maremanda, Laura Bowles Zeiser, Caoilfhionn Connolly, Sowmya Sharma, Sharon Dudley-Brown, Sarah Frey, Mark Lazarev, Joanna M. Melia, Alyssa M. Parian, Dorry L. Segev, Brindusa Truta, Huimin Yu, William A. Werbel and Florin M. Selaru

Medicina 2023, 59(8), 1487; https://doi.org/10.3390/medicina59081487 - 18 Aug 2023

Viewed by 1243

Abstract

Background: The emergence of new SARS-CoV-2 variants calls for more data on SARS-CoV-2 mRNA vaccine response. Aims: We aimed to assess the response to a third mRNA vaccine dose against SARS-CoV-2 in inflammatory bowel disease (IBD) patients. Methods: This was a single-center, observational [...] Read more.

Background: The emergence of new SARS-CoV-2 variants calls for more data on SARS-CoV-2 mRNA vaccine response. Aims: We aimed to assess the response to a third mRNA vaccine dose against SARS-CoV-2 in inflammatory bowel disease (IBD) patients. Methods: This was a single-center, observational prospective study of IBD patients who received a third mRNA vaccine dose against SARS-CoV-2. Antibody titers were taken post-third-dose at one and three months using the Roche Elecsys anti-SARS-CoV-2-S enzyme immunoassay. Titers less than 0.8 units/mL were considered negative according to the manufactures. Titers between 0.8 units/mL and 250 units/mL were considered non-neutralizing. Titers greater than 250 units/mL were considered neutralizing. Results: Eighty-three patients were included, all of whom had detectable antibodies at 3 months post-third dose. A total of 89% showed neutralizing and 11% non-neutralizing titers. Participants with non-neutralizing titers were more likely to be on systemic corticosteroids (p = 0.04). Two participants seroconverted from negative to positive, whereas 86% with non-neutralizing titers boosted to neutralizing levels. Only one participant with neutralizing titers after a third dose had a decrease to a non-neutralizing level within 3 months. Conclusions: Our findings support the ongoing recommendations for additional doses in immunocompromised individuals. However, longitudinal studies with a greater-sized patient population are needed. Full article

(This article belongs to the Special Issue The Digestive System in the Era of COVID-19)

19 pages, 2167 KiB

Open AccessArticle

Quality of Life Predictors in a Group of Informal Caregivers during the COVID-19 Pandemic

by Ana Claudia Damian, Alexandra Ioana Mihăilescu, Cristina Anghele, Constantin Alexandru Ciobanu, Cristian Petrescu, Sorin Riga, Vlad Dionisie and Adela Magdalena Ciobanu

Medicina 2023, 59(8), 1486; https://doi.org/10.3390/medicina59081486 - 18 Aug 2023

Viewed by 1427

Abstract

Background and Objectives: The informal caregiver’s contribution to the wellbeing of dementia patients is critical since these individuals become dependent on others for all daily activities. Our goal was to investigate the dynamics of anxiety, depression, burnout, sleep, and their influence on [...] Read more.

Background and Objectives: The informal caregiver’s contribution to the wellbeing of dementia patients is critical since these individuals become dependent on others for all daily activities. Our goal was to investigate the dynamics of anxiety, depression, burnout, sleep, and their influence on quality of life over a 6-month period in the context of pandemic distress in a sample of informal caregivers of Alzheimer’s patients. Materials and Methods: For this prospective, longitudinal study, we conducted a 6-month telephonic survey between 2021 and 2022, administering a series of questionnaires at three timepoints (baseline, 3 months and 6 months) to a group of informal caregivers of patients suffering from dementia due to Alzheimer’s disease. Results: A total of 110 caregivers were included at baseline, out of which 96 continued to the second stage and 78 followed through to the last stage. The majority of the participants were female (most likely the patients’ daughters), around 55 years old, living in urban areas, married, with children, having a high school degree or a higher education degree, and working in jobs that required physical presence; in the best-case scenario, they were sharing their responsibilities with another two–three caregivers. More than half of the 110 participants (50.9%) reported mild to moderate anxiety at baseline, and 27.3% reported significant anxiety, with no changes between the three timepoints, F(2, 154) = 0.551, p = 0.57; 25% reported moderate–severe depression at the start, with no changes between the three timepoints, F(2, 154) = 2.738, p = 0.068; and many reported a decrease in quality of life, poor quality of sleep, and decreased fear of COVID infection. Cynicism, professional effectiveness, anxiety, depression, and sleep quality explained up to 87.8% of the variance in quality of life. Conclusions: Caregivers’ decreased quality of life during the pandemic was explained by their levels of burnout, anxiety, and depression throughout the 6-month period. Full article

(This article belongs to the Special Issue Management of Major Depressive Disorder)

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Graphical abstract

12 pages, 372 KiB

Open AccessReview

Vertigo Associated with Otosclerosis and Stapes Surgery—A Narrative Review

by Violeta Necula, Alma Aurelia Maniu, László-Péter Ujváry, Maximilian-George Dindelegan, Mara Tănase, Mihai Tănase and Cristina Maria Blebea

Medicina 2023, 59(8), 1485; https://doi.org/10.3390/medicina59081485 - 18 Aug 2023

Viewed by 2431

Abstract

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the [...] Read more.

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

15 pages, 1722 KiB

Open AccessArticle

The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules

by Giuseppina Orlando, Giuseppa Graceffa, Sergio Mazzola, Fabrizio Vassallo, Maria Pia Proclamà, Pierina Richiusa, Stefano Radellini, Nunzia Cinzia Paladino, Giuseppina Melfa and Gregorio Scerrino

Medicina 2023, 59(8), 1484; https://doi.org/10.3390/medicina59081484 - 17 Aug 2023

Cited by 2 | Viewed by 1124

Abstract

Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5–15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to [...] Read more.

Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5–15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, “taller than wide” shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93–0.98); sensitivity 0.70 IC95% (0.59–0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80–0.94); specificity 0.75 CI95% (0.72–0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice. Full article

(This article belongs to the Section Surgery)

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10 pages, 607 KiB

Open AccessSystematic Review

Clinical Research in Chronic Lymphocytic Leukemia in Pakistan; A Systematic Review

by Mohammad Ammad Ud Din, Moazzam Shahzad, Aqsa Ashraf, Hania Liaqat, Ali Jaan and Faiz Anwer

Medicina 2023, 59(8), 1483; https://doi.org/10.3390/medicina59081483 - 17 Aug 2023

Viewed by 1673

Abstract

Background: Significant advances have been made in the treatment of chronic lymphocytic leukemia (CLL) since the turn of the new millennium. However, most clinical trials were done in developed countries where minority ethnicities were underrepresented. Materials and Methods: To gauge the [...] Read more.

Background: Significant advances have been made in the treatment of chronic lymphocytic leukemia (CLL) since the turn of the new millennium. However, most clinical trials were done in developed countries where minority ethnicities were underrepresented. Materials and Methods: To gauge the quality of research in CLL being done in Pakistan, we conducted a comprehensive literature search using PubMed, Clinicaltrials.gov, and Google Scholar on 14 January 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Results: A total of 16 studies met the inclusion criteria. The most common study design was cross-sectional. Eight studies evaluated the clinicohematological profile of CLL patients and the effect of various cytogenic abnormalities through fluorescence in situ hybridization (FISH) technique on disease progression and prognosis. Five studies discussed the prevalence of abnormalities such as autoimmune cytopenias and other serum chemistry derangements. Only two studies evaluated treatment outcomes, among which one study reported a 2-year overall survival of 65% among patients with 17p deletion. None of the studies had patients on novel targeted agents. No pharmaceutical sponsored or funded clinical trials were found. Conclusions: Our review suggests that although small clinical studies continue to be performed across the country, multiple financial and logistical barriers need to be addressed for larger, more impactful clinical trials to be conducted that will help answer demographic-specific questions and decrease reliance on foreign studies. Full article

(This article belongs to the Section Oncology)

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12 pages, 1083 KiB

Open AccessSystematic Review

Are Whiplash-Associated Disorders and Temporomandibular Disorders in a Trauma Related Cause and Effect Relationship? A Review

by Nicola Montemurro, Irma Trilli, Ioana Roxana Bordea, Elisabetta Ferrara, Maurizio De Francesco, Francesca Caccamo, Giuseppina Malcangi and Biagio Rapone

Medicina 2023, 59(8), 1482; https://doi.org/10.3390/medicina59081482 - 17 Aug 2023

Cited by 1 | Viewed by 1318

Abstract

Background: Whiplash is associated with a wide variety of clinical manifestations, including headache, neck pain, cervical rigidity, shoulder and back pain, paresthesia, vertigo, and temporomandibular disorders (TMDs). Previous studies reported that TMDs are more common in individuals with chronic whiplash-associated disorders (WAD) [...] Read more.

Background: Whiplash is associated with a wide variety of clinical manifestations, including headache, neck pain, cervical rigidity, shoulder and back pain, paresthesia, vertigo, and temporomandibular disorders (TMDs). Previous studies reported that TMDs are more common in individuals with chronic whiplash-associated disorders (WAD) than in the general population; however, the pathophysiology and mechanism of this relationship are still not well understood. Methods: A PubMed and Ovid EMBASE review was performed to identify all studies addressing the trauma related cause and effect relationship between WAD and TMDs from January 2003 to March 2023. Results: After screening for eligibility and inclusion criteria, a total of 16 articles met the selection criteria. The various included studies discussed different aspects of the association between WDA and TMDs, including changes in the coordination and amplitude of jaw opening, the severity of the associated symptoms/signs in cases of WAD, the degree of fatigue and psychological stress, difficulty in feeding, cervical and myofascial pain, changes in the MRI signal at various muscle points, muscle tenderness, and quality of life. Conclusions: In this review, we summarized the clinical evidence of any trauma related cause and effect relationship between whiplash and TMDs. An accurate screening of the previous literature showed that, in conclusion, the relationship between whiplash and TMDs is still unclear. Full article

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9 pages, 747 KiB

Open AccessArticle

Association of Scapular Dyskinesis with Neck and Shoulder Function and Training Period in Brazilian Ju-Jitsu Athletes

by Ji Hyeon Jeong and Young Kyun Kim

Medicina 2023, 59(8), 1481; https://doi.org/10.3390/medicina59081481 - 17 Aug 2023

Cited by 1 | Viewed by 1302

Abstract

Background and Objectives: Neck and shoulder injuries are common in Brazilian ju-jitsu (BJJ) athletes, and scapular dyskinesis (SD) is associated with these injuries. This study aimed to investigate the prevalence of SD in BJJ athletes, their neck and shoulder function and strength, [...] Read more.

Background and Objectives: Neck and shoulder injuries are common in Brazilian ju-jitsu (BJJ) athletes, and scapular dyskinesis (SD) is associated with these injuries. This study aimed to investigate the prevalence of SD in BJJ athletes, their neck and shoulder function and strength, and the BJJ training period. Materials and Methods: Forty-eight BJJ athletes participated in the study. Years of experience with BJJ, belt, shoulder internal and external rotation strength, neck strength, neck disability index (NDI), and SD were measured. Results: Approximately 31 BJJ athletes (64.6%) showed SD, and the nondominant arm showed a more obvious SD (n = 22, 45.8%) than the dominant arm (n = 18, 37.5%). Those with over five years of BJJ training experience showed a significantly higher rate of SD (p = 0.006) than those with less than five years of experience. Shoulder isometric internal rotation strength was significantly weaker in the obvious SD group than in the normal SD group (p = 0.014). Neck isometric strength and NDI did not differ significantly between individuals with or without SD. Conclusions: SD was common among BJJ athletes, and more experienced BJJ athletes exhibited higher rates of SD. Shoulder rotational strength was weaker with SD. Further studies are necessary on the neck and shoulders of BJJ athletes with SD. Full article

(This article belongs to the Special Issue Advances in Orthopedics and Sports Medicine)

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13 pages, 1044 KiB

Open AccessArticle

Long-Term Retention Rate of Tofacitinib in Rheumatoid Arthritis: An Italian Multicenter Retrospective Cohort Study

by Marino Paroli, Andrea Becciolini, Elena Bravi, Romina Andracco, Valeria Nucera, Simone Parisi, Francesca Ometto, Federica Lumetti, Antonella Farina, Patrizia Del Medico, Matteo Colina, Alberto Lo Gullo, Viviana Ravagnani, Palma Scolieri, Maddalena Larosa, Marta Priora, Elisa Visalli, Olga Addimanda, Rosetta Vitetta, Alessandro Volpe, Alessandra Bezzi, Francesco Girelli, Aldo Biagio Molica Colella, Rosalba Caccavale, Eleonora Di Donato, Giuditta Adorni, Daniele Santilli, Gianluca Lucchini, Eugenio Arrigoni, Ilaria Platè, Natalia Mansueto, Aurora Ianniello, Enrico Fusaro, Maria Chiara Ditto, Vincenzo Bruzzese, Dario Camellino, Gerolamo Bianchi, Francesca Serale, Rosario Foti, Giorgio Amato, Francesco De Lucia, Ylenia Dal Bosco, Roberta Foti, Massimo Reta, Alessia Fiorenza, Guido Rovera, Antonio Marchetta, Maria Cristina Focherini, Fabio Mascella, Simone Bernardi, Gilda Sandri, Dilia Giuggioli, Carlo Salvarani, Veronica Franchina, Francesco Molica Colella, Giulio Ferrero and Alarico Ariani Show full author list Hide full author list

Medicina 2023, 59(8), 1480; https://doi.org/10.3390/medicina59081480 - 17 Aug 2023

Cited by 4 | Viewed by 1591

Abstract

Background: Tofacitinib (TOFA) was the first Janus kinase inhibitor (JAKi) to be approved for the treatment of rheumatoid arthritis (RA). However, data on the retention rate of TOFA therapy are still far from definitive. Objective: The goal of this study is [...] Read more.

Background: Tofacitinib (TOFA) was the first Janus kinase inhibitor (JAKi) to be approved for the treatment of rheumatoid arthritis (RA). However, data on the retention rate of TOFA therapy are still far from definitive. Objective: The goal of this study is to add new real-world data on the TOFA retention rate in a cohort of RA patients followed for a long period of time. Methods: A multicenter retrospective study of RA subjects treated with TOFA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was conducted in 23 Italian tertiary rheumatology centers. The study considered a treatment period of up to 48 months for all included patients. The TOFA retention rate was assessed with the Kaplan–Meier method. Hazard ratios (HRs) for TOFA discontinuation were obtained using Cox regression analysis. Results: We enrolled a total of 213 patients. Data analysis revealed that the TOFA retention rate was 86.5% (95% CI: 81.8–91.5%) at month 12, 78.8% (95% CI: 78.8–85.2%) at month 24, 63.8% (95% CI: 55.1–73.8%) at month 36, and 59.9% (95% CI: 55.1–73.8%) at month 48 after starting treatment. None of the factors analyzed, including the number of previous treatments received, disease activity or duration, presence of rheumatoid factor and/or anti-citrullinated protein antibody, and presence of comorbidities, were predictive of the TOFA retention rate. Safety data were comparable to those reported in the registration studies. Conclusions: TOFA demonstrated a long retention rate in RA in a real-world setting. This result, together with the safety data obtained, underscores that TOFA is a viable alternative for patients who have failed treatment with csDMARD and/or biologic DMARDs (bDMARDs). Further large, long-term observational studies are urgently needed to confirm these results. Full article

(This article belongs to the Special Issue Recent Advances in Rheumatoid Arthritis)

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12 pages, 4509 KiB

Open AccessArticle

The Course and Variation of the Facial Vein in the Face—Known and Unknown Facts: An Anatomical Study

by Martin Siwetz, Hannes Widni-Pajank, Niels Hammer, Ulrike Pilsl, Simon Bruneder, Andreas Wree and Veronica Antipova

Medicina 2023, 59(8), 1479; https://doi.org/10.3390/medicina59081479 - 17 Aug 2023

Viewed by 1875

Abstract

Background and Objectives: The facial vein is the main collector of venous blood from the face. It plays an important role in physiological as well as pathological context. However, to date, only limited data on the course and tributaries of the facial [...] Read more.

Background and Objectives: The facial vein is the main collector of venous blood from the face. It plays an important role in physiological as well as pathological context. However, to date, only limited data on the course and tributaries of the facial vein are present in contemporary literature. The aim of this study was to provide detail on the course and the tributaries of the facial vein. Materials and Methods: In 96 sides of 53 body donors, latex was injected into the facial vein. Dissection was carried out and the facial vein and its tributaries (angular vein, ophthalmic vein, nasal veins, labial veins, palpebral veins, buccal and masseteric veins) were assessed. Results: The facial vein presented a textbook-like course in all cases and crossed the margin of the mandible anterior to the masseter in 6.8% of cases, while being located deep to the zygomaticus major muscle in all cases and deep to the zygomaticus minor in 94.6% of cases. Conclusions: This work offers detailed information on the course of the facial vein in relation to neighboring structures, which shows a relatively consistent pattern, as well as on its tributaries, which show a high variability. Full article

(This article belongs to the Special Issue Variational Anatomy and Developmental Anomalies in Clinical Practice: Second Edition)

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12 pages, 323 KiB

Open AccessReview

Treatment of Fabry Nephropathy: A Literature Review

by Homare Shimohata, Marina Yamashita, Kota Yamada, Kouichi Hirayama and Masaki Kobayashi

Medicina 2023, 59(8), 1478; https://doi.org/10.3390/medicina59081478 - 17 Aug 2023

Cited by 4 | Viewed by 1567

Abstract

Fabry disease is an X-linked inherited lysosomal storage disorder with a deficiency of α-galactosidase A activity, which results in the intracellular accumulation of globotriaosylceramide (Gb3) and related glycosphingolipids in various organs. Fabry nephropathy is one of the major complications of Fabry disease, and [...] Read more.

Fabry disease is an X-linked inherited lysosomal storage disorder with a deficiency of α-galactosidase A activity, which results in the intracellular accumulation of globotriaosylceramide (Gb3) and related glycosphingolipids in various organs. Fabry nephropathy is one of the major complications of Fabry disease, and kidney damage is often related to cardiovascular disease and mortality. The treatment of Fabry nephropathy thus helps prolong life expectancy. Two treatment options for Fabry nephropathy and cardiopathy are now commercially available: enzyme replacement therapy (agalsidase α agalsidase β, and a biosimilar of agalsidase β) and pharmacological chaperone therapy (migalastat). In this review, we summarize the efficacy of these treatment options for Fabry nephropathy with respect to renal function, proteinuria, and renal pathological findings. We also describe the importance of adjunctive therapy for Fabry nephropathy. Full article

(This article belongs to the Special Issue Treatment of Refractory Glomerular Diseases: Challenges and Solutions)

13 pages, 5474 KiB

Open AccessCase Report

Type I Dentin Dysplasia: The Literature Review and Case Report of a Family Affected by Misrecognition and Late Diagnosis

by Alessandra Putrino, Martina Caputo, Angela Galeotti, Enrico Marinelli and Simona Zaami

Medicina 2023, 59(8), 1477; https://doi.org/10.3390/medicina59081477 - 17 Aug 2023

Cited by 3 | Viewed by 1989

Abstract

Background and Objectives: Type I dentin dysplasia (DD-I) is a rare genetic disorder with autosomal dominant or recessive inheritance at risk of late or long-misunderstood diagnosis because the teeth, compared to other degenerative dentin diseases, do not have coronal defects and/or alterations [...] Read more.

Background and Objectives: Type I dentin dysplasia (DD-I) is a rare genetic disorder with autosomal dominant or recessive inheritance at risk of late or long-misunderstood diagnosis because the teeth, compared to other degenerative dentin diseases, do not have coronal defects and/or alterations but only at the root level (absent, conical, pointed roots, and obliterated pulp canals). The first radiographic suspicion often occurs only in case of sudden mobility and/or abscesses of the permanent teeth. Genetic tests confirm the diagnosis. Case Presentation: This case report describes the oral and radiographic characteristics of two siblings, 12 and 10 years old, a male and a female, at an early age affected by DD-I, whose diagnosis was made for a first orthodontic visit. The father and the older child had already undergone dental and orthodontic treatments, respectively, without the disease being suspected by the dentist. Results: Genetic tests support the diagnosis of DD-I. Following the diagnosis, the patients began a process of close periodic checks every 3–4 months to monitor their situation. The male child lost upper lateral incisors, which were then replaced with a light nylon removable prosthesis. Conclusions: The ability to recognize the radiographic features characteristic of DD-I is very important to avoid prejudicial diagnostic delays and to be able to plan the long-term treatment of these patients better, especially when the pathology was primarily misrecognized in the family. Full article

(This article belongs to the Special Issue Medicine and Dentistry: New Methods and Clinical Approaches)

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7 pages, 291 KiB

Open AccessArticle

Cardiovascular Mortality in Ovarian Cancer Patients: An Analysis of Patient Characteristics Using the SEER Database

by Ismail Abdulrahman Al-Badawi, Osama Alomar, Saud Owaimer Alsehaimi, Mohammed Ziad Jamjoom, Nadia Ahmed Abdulmalik, Ibtihal Abdulaziz Bukhari, Abdullah Alyousef, Safa Alabdrabalamir, Saeed Baradwan, Ahmad Sayasneh, Saad M. S. Alqarni and Ahmed Abu-Zaid

Medicina 2023, 59(8), 1476; https://doi.org/10.3390/medicina59081476 - 17 Aug 2023

Viewed by 1444

Abstract

Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and [...] Read more.

Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and Methods: A retrospective cohort study was performed using the SEER database to analyze primary ovarian cancer cases from 2000 to 2019. Multivariable logistic regression analysis was employed to identify patient characteristics linked to cardiovascular mortality. Results: The cohort included 41,930 cases of patients who were alive, 54,829 cases of cancer-related deaths, 3003 cases of cardiovascular-related deaths, and 10,238 cases with other causes of death. Poorly differentiated cancer cells and distant metastasis were associated with a higher risk of cardiovascular mortality. Logistic regression analysis identified age, year of diagnosis, race, laterality, and staging as significant risk factors for cardiovascular cause of death. The risk of cardiovascular cause of death was lower in patients aged 31–60 and higher in those aged over 60 years old, and the risk also increased with a later year of diagnosis. Patients who were not white were at a higher risk of cardiovascular cause of death. Additionally, bilateral ovarian cancer and distant staging disease were linked to elevated risks of cardiovascular cause of death. Conclusion: Cardiovascular mortality is a significant concern in ovarian cancer patients, and several patient characteristics are associated with an increased risk. Our study suggests that targeted interventions to improve cardiovascular health in high-risk patients, such as those with comorbidities or an advanced stage at diagnosis, may improve survival in this population. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

10 pages, 1238 KiB

Open AccessArticle

Laryngopharyngeal Reflux Patient Changes during the COVID-19 Quarantine

by Alexandra Rodriguez, Younes Steffens, Christian Calvo-Henriquez, Miguel Mayo-Yáñez, Mihaela Horoi and Jerome R. Lechien

Medicina 2023, 59(8), 1475; https://doi.org/10.3390/medicina59081475 - 17 Aug 2023

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Abstract

Background and Objective: To examine the effects of the lockdown on diet adherence and stress levels in patients with laryngopharyngeal reflux (LPR). Materials and Methods: Patients with a positive LPR diagnosis at the hypopharyngeal-esophageal impedance-pH monitoring were treated from a pre- [...] Read more.

Background and Objective: To examine the effects of the lockdown on diet adherence and stress levels in patients with laryngopharyngeal reflux (LPR). Materials and Methods: Patients with a positive LPR diagnosis at the hypopharyngeal-esophageal impedance-pH monitoring were treated from a pre- to lockdown period with a 3-month high-protein, low-fat, alkaline, plant-based diet, with behavioral changes, and an association of pantoprazole (20 MG/d) and alginate (Gaviscon 3/d). The following patient-reported outcomes questionnaire and findings instrument were used: Reflux Symptom Score-12 (RSS-12) and Reflux Sign Assessment (RSA). At the posttreatment time, patients were invited to evaluate the impact of lockdown on diet adherence and stress management with a predefined grid of foods and beverages and the perceived stress scale (PSS), respectively. Results: Thirty-two patients completed the evaluations. RSS-12 and RSA significantly improved from baseline to 3-month posttreatment. Most patients experienced mild-to-severe stress levels at the end of the lockdown. The level of stress substantially increased in 11 patients (34%) due to the lockdown, while it did not change in 11 patients (44%). In 11 cases (34%), patients reported that the adherence to the anti-reflux diet was better than initially presumed thanks to the lockdown period, while 44% (N = 14) reported that the lockdown did not impact the adherence to a diet. PSS and RSS-12 were significantly correlated at the end of the pandemic (r_s = 0.681; p < 0.001). The increase in stress level was positively associated with the lack of adherence to diet (r_s = 0.367; p = 0.039). Conclusions: During the lockdown, the diet habits of LPR patients were improved in one-third and unchanged in 44% of cases. The stress level was increased in one-third of patients, which was associated with an increase in symptom scores. Full article

(This article belongs to the Special Issue Oral and Cervical Pathology during the COVID-19 Crisis)

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20 pages, 15714 KiB

Open AccessArticle

The mTOR Inhibitor Rapamycin Counteracts Follicle Activation Induced by Ovarian Cryopreservation in Murine Transplantation Models

by Jules Bindels, Marlyne Squatrito, Laëtitia Bernet, Michelle Nisolle, Laurie Henry and Carine Munaut

Medicina 2023, 59(8), 1474; https://doi.org/10.3390/medicina59081474 - 16 Aug 2023

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Abstract

Background and Objectives: Ovarian tissue cryopreservation followed by autotransplantation (OTCTP) is currently the only fertility preservation option for prepubertal patients. Once in remission, the autotransplantation of frozen/thawed tissue is performed when patients want to conceive. A major issue of the procedure is [...] Read more.

Background and Objectives: Ovarian tissue cryopreservation followed by autotransplantation (OTCTP) is currently the only fertility preservation option for prepubertal patients. Once in remission, the autotransplantation of frozen/thawed tissue is performed when patients want to conceive. A major issue of the procedure is follicular loss directly after grafting mainly due to follicle activation. To improve follicular survival during the OTCTP procedure, we inhibited the mTOR pathway involved in follicle activation using rapamycin, an mTOR inhibitor. Next, we compared two different in vivo models of transplantation: the recently described non-invasive heterotopic transplantation model between the skin layers of the ears, and the more conventional and invasive transplantation under the kidney capsule. Materials and Methods: To study the effects of adding rapamycin during cryopreservation, 4-week-old C57BL/6 mouse ovaries, either fresh, slow-frozen, or slow-frozen with rapamycin, were autotransplanted under the kidney capsule of mice and recovered three weeks later for immunohistochemical (IHC) analysis. To compare the ear with the kidney capsule transplantation model, fresh 4-week-old C57BL/6 mouse ovaries were autotransplanted to either site, followed by an injection of either LY294002, a PI3K inhibitor, vehicle control, or neither, and these were recovered three weeks later for IHC analysis. Results: Rapamycin counteracts cryopreservation-induced follicle proliferation, as well as AKT and mTOR pathway activation, in ovaries autotransplanted for three weeks under the kidney capsule of mice. Analyses of follicle proliferation, mTOR activation, and the effects of LY294002 treatment were similar in transplanted ovaries using either the ear or kidney capsule transplantation model. Conclusions: By adding rapamycin during the OTCTP procedure, we were able to transiently maintain primordial follicles in a quiescent state. This is a promising method for improving the longevity of the ovarian graft. Furthermore, both the ear and kidney capsule transplantation models were suitable for investigating follicle activation and proliferation and pharmacological strategies. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Human Reproduction and Infertility)

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Medicina, Volume 59, Issue 8 (August 2023) – 147 articles

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