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Medicines, Volume 9, Issue 12 (December 2022) – 6 articles

Cover Story (view full-size image): The figure describes the overall design of our retrospective cohort analysis. We have compared group medical visits with individual medical visits in a clinical setting. Patients attending group medical visits had an overall greater decrease in weight and blood pressure, when compared to patients attending individual medical visits. View this paper

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7 pages, 563 KiB

Open AccessArticle

Breast Reconstruction: Economic Impact Swiss Health Insurance System

by Jeanne Martin, Pietro G. di Summa, Wassim Raffoul and Nathalie Koch

Medicines 2022, 9(12), 64; https://doi.org/10.3390/medicines9120064 - 16 Dec 2022

Cited by 1 | Viewed by 1253

Abstract

Background: Considering present concerns about healthcare costs and the lack of evidence and published articles on breast reconstruction costs in Switzerland, we retrospectively investigated charges to the Swiss healthcare system for different breast reconstruction procedures at the Centre Hospitalier Universitaire Vaudois. Methods: We selected all hospitalized patients at the University Hospital who underwent a “total” delayed breast reconstruction from January 2012 to December 2015. Analysis included 72 women who underwent autologous or implant-based reconstructions. Three main breast reconstruction techniques were included: Deep Inferior Epigastric Perforator (n = 46) autologous flap reconstruction, Tissue Expander followed by Implant (n = 12) and pedicled Latissimus Dorsi (n = 12) flap with or without tissue expander and implant (n = 7). For all different groups, the global costs of reconstruction and total number of required operations were statistically compared. Results: Global costs for Deep Inferior Epigastric Perforator reconstruction were 29,728 ± 1892 CHF (avg ± Std. Error of Mean), while Tissue Expander reconstruction showed a significantly higher global cost, reaching an average of 44,313 ± 5553 CHF (avg ± Std. Error of Mean). LD showed a similar cost, compared to the Deep Inferior Epigastric Perforator reconstruction (29,813 ± 3637 CHF), increasing when including an implant (37,688 ± 4840 CHF). No significant differences in the number of interventions were detected. Conclusion: These data show that autologous breast reconstruction (DIEP) delivers the best cost ratio, with lower overall costs. Implant-based reconstructions showed a greater likelihood of complications and re-intervention, globally creating superior costs when compared to autologous reconstructions. Full article

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9 pages, 3133 KiB

Open AccessArticle

Post-Traumatic-Related Technical Errors in Orthopantomographic Imaging

by Oana Almășan, Raluca Ancuța Roman, Mihaela Hedeşiu, Simion Bran, Sara Roman, Bianca Petric and Cristian Dinu

Medicines 2022, 9(12), 63; https://doi.org/10.3390/medicines9120063 - 09 Dec 2022

Cited by 1 | Viewed by 1715

Abstract

Background: This study aimed at identifying errors encountered in orthopantomography (OPG) in post-traumatic patients caused by limitations in performing a correct technique. Methods: A retrospective observational study was performed. Diagnosis, exposure/processing mistakes, positioning-related errors, and bimaxillary immobilization were evaluated. Results: Thirty panoramic radiographs with mandible fractures were examined. Twelve error types were encountered: errors in exposure or processing, air radiolucency in the palatoglossal space, errors in the alignment of the Frankfort horizontal plane: head in flexion, with a joyful expression or head extended, with a somber appearance, errors towards the mid-sagittal plane (lateral head inclination, deviation, or rotation), errors caused by the non-use of the bite-block or inappropriate position on the device, errors caused by positioning outside the focal plane, artifacts/shadow images produced by post-operative metal plates, and bimaxillary immobilization errors. The number of errors per radiograph ranged from two to a maximum of five. The most dominant ones were inappropriate alignment in the focal plane and lateral rotation of the head in over 70% of cases. Lateral deviation and palatoglossal air were present in more than 50% of images. Conclusions: In trauma cases, technical difficulties in obtaining a proper OPG image are common and often insurmountable, limiting the diagnosis. Full article

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10 pages, 875 KiB

Open AccessArticle

Antimicrobial and Toxic Effects of Boswellia serrata Roxb. and Mentha piperita Linn. Essential Oils on Vaginal Inhabitants

by Mirjana A. Bogavac, Tamara M. Perić, Jovana Mišković and Maja Karaman

Medicines 2022, 9(12), 62; https://doi.org/10.3390/medicines9120062 - 09 Dec 2022

Cited by 3 | Viewed by 1518

Abstract

Commercial essential oils (EOs) of incense, Boswellia serrata Roxb, and mint, Mentha piperita L., were investigated against vaginal bacterial and Candida albicans isolates for antimicrobial potential and safety use. The antimicrobial activity of EOs was investigated through a double-dilution micro-plate assay. A brine shrimp assay was used for the determination of toxicity, while the determination of the chemical composition of EOs was carried out using GS–MS. Obtained minimal inhibitory (MIC) and minimal bactericidal concentration (MBC) point to the activity of mint essential oil (EO) against the multi-resistant P. aeruginosa isolate (MIC/MBC at 6.25 µL/mL), while MIC and MBC values for other isolates were reached at higher concentrations (25–50 µL/mL). According to the toxicity assay, the incense EO reached the LC₅₀ value at 3.07 µL/mL, while mint EO showed higher toxicity at lower concentrations (0.5 µL/mL) and the LC₅₀ could not be determined. The highest antimicrobial potential was obtained for incense against P. aeruginosa. Although the toxicity assay showed high toxicity of mint EO to the eggs of aquatic crustaceans Artemia salina, further testing of EO toxicity is proposed, for example on healthy cell-lines. According to the GC/MS spectrometry, the most represented components of mint EO were the oxygenated hydrocarbons L-menthone (20.86%) and menthol (31.86%), and they could be proposed for further antimicrobial and toxicity investigation. Full article

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8 pages, 5602 KiB

Open AccessCase Report

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report

by Khalid Hasan, Sreenivasulu Metikala and Madana Mohana R. Vallem

Medicines 2022, 9(12), 61; https://doi.org/10.3390/medicines9120061 - 02 Dec 2022

Viewed by 1319

Abstract

Diabetic Charcot arthropathy of the ankle, due to the presence of multiplanar deformities, and associated medical comorbidities, poses a challenge for treating physicians. The situation becomes more complicated when accompanied by ulceration and osteomyelitis, leaving limited salvage options. We present a case of advanced Charcot ankle arthropathy with osteomyelitis and ulcerated hindfoot. It was managed by talectomy and antibiotic-impregnated cement beads, followed by hindfoot arthrodesis using a retrograde intramedullary nail six weeks later. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at one-year postoperative follow-up. Full article

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7 pages, 1520 KiB

Open AccessArticle

Group Medical Visits for Addressing Weight and Blood Pressure in an Underserved Population

by Amit Algotar, Stephanie Trofymenko, Myra Muramoto, Amy Howerter and Randa Kutob

Medicines 2022, 9(12), 60; https://doi.org/10.3390/medicines9120060 - 01 Dec 2022

Viewed by 1294

Abstract

The effect of group medical visits (GMV) compared to individual medical visits (IMV), on weight and blood pressure in a large primary care practice serving a predominantly underserved population, was assessed. The records of 304 patients attending a weight-loss program were analyzed using mixed-effects regression models. Patients in GMV lost an average of 11.63 lbs, whereas patients in IMV lost an average of 3.99 lbs (p < 0.001). A total of 55% of patients lost ≥7% in GMV compared to 11% of patients in IMV (p ≤ 0.001). Individuals who lost >5% of their baseline weight had a higher reduction in overall blood pressure. For systolic and diastolic blood pressure, the differences between baseline and three months for GMV and IMV were −7.4 vs. 4.1 mm of Hg (p = 0.002) and −4.6 vs. 4.2 mm of Hg (p = 0.003), respectively. Results from this study demonstrate that GMV may be a potentially useful modality for addressing weight and blood pressure in an underserved population. Full article

(This article belongs to the Special Issue Perspective of Metabolism: Potential Therapeutic Targets of Metabolic Diseases such as Obesity-Associated Diabetes, Atherosclerosis and Fatty Liver)

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9 pages, 1184 KiB

Open AccessArticle

The Incidence and Risk Factors of Urinary Tract Infection in Patients with Type 2 Diabetes Mellitus Using SGLT2 Inhibitors: A Real-World Observational Study

by Suriyon Uitrakul, Krittika Aksonnam, Pimchanok Srivichai, Sorawit Wicheannarat and Supatcha Incomenoy

Medicines 2022, 9(12), 59; https://doi.org/10.3390/medicines9120059 - 22 Nov 2022

Cited by 12 | Viewed by 7138

Abstract

Background: The incidence and risk of urinary tract infection (UTI) in patients with type 2 diabetes mellitus (T2DM) who use sodium glucose co-transporter-2 (SGLT2) inhibitors are still controversial. Therefore, this study aimed to investigate the incidence and risk factors of using SGLT2 inhibitors, particularly in Thai patients. Methods: Electronic medication records of all patients, who started the treatment of T2DM between 1 January 2019 and 30 June 2021 at a tertiary hospital in Thailand, were reviewed. The patients were divided into SGLT2 inhibitor and non-SGLT2 inhibitor groups to compare the incidence of UTI. Results: The overall incidence rate of UTI was 33.49% in the SGLT2 inhibitor group and 11.72% in the non-SGLT2 inhibitor group. The incidence rates of UTI were not different between dapagliflozin and empagliflozin treatment (34.00% and 33.03%, respectively). Patients treated with SGLT2 inhibitors had a 3.70 higher risk of UTI compared with those treated with non-SGLT2 inhibitors (95%CI 2.60–5.29). Moreover, the significant risk factors for UTI found in this study were gender, age, and occupation. Conclusions: This study highlighted the high incidence of UTI in patients using dapagliflozin and empagliflozin compared with non-SGLT2 inhibitors. Additionally, patients of female gender and older age had a significantly higher risk of UTI when treated with SGLT2 inhibitors, whereas those with permanent jobs had a lower risk. Full article

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