Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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17 pages, 2318 KiB  
Article
Knowledge of Human Monkeypox and Its Relation to Conspiracy Beliefs among Students in Jordanian Health Schools: Filling the Knowledge Gap on Emerging Zoonotic Viruses
by Malik Sallam, Kholoud Al-Mahzoum, Latefa Ali Dardas, Ala’a B. Al-Tammemi, Laith Al-Majali, Hala Al-Naimat, Laila Jardaneh, Farah AlHadidi, Khaled Al-Salahat, Eyad Al-Ajlouni, Nadin Mohammad AlHadidi, Faris G. Bakri, Azmi Mahafzah and Harapan Harapan
Medicina 2022, 58(7), 924; https://doi.org/10.3390/medicina58070924 - 11 Jul 2022
Cited by 66 | Viewed by 7155
Abstract
Background and Objective: The recent multi-country outbreak of human monkeypox (HMPX) in non-endemic regions poses an emerging public health concern. University students in health schools/faculties represent a core knowledgeable group that can be helpful to study from a public health point of view. [...] Read more.
Background and Objective: The recent multi-country outbreak of human monkeypox (HMPX) in non-endemic regions poses an emerging public health concern. University students in health schools/faculties represent a core knowledgeable group that can be helpful to study from a public health point of view. As future healthcare workers, assessment of their knowledge and attitude towards emerging zoonotic viral infections can be helpful to assess their taught material and courses with potential improvement if gaps in knowledge were identified. Therefore, we aimed to evaluate the level of HMPX knowledge, conspiracy beliefs regarding emerging virus infections, as well as their associated determinants among university students studying Medicine, Nursing, Dentistry, Pharmacy, Medical Laboratory Sciences, and Rehabilitation in Jordanian health schools/faculties. In addition, we sought to evaluate the correlation between HMPX knowledge and the extent of holding conspiracy beliefs regarding emerging viral infection. Materials and Methods: A convenient sample of university students was obtained through an electronic survey distributed in late May 2022 using the chain-referral approach. Assessment of HMPX knowledge and general attitude towards emerging virus infections was based on survey items adopted from previously published literature. Results: The study sample comprised 615 students with a mean age of 20 years and a majority of females (432, 70.2%) and medical students (n = 351, 57.1%). Out of eleven monkeypox knowledge items, three were identified correctly by >70% of the respondents. Only 26.2% of the respondents (n = 161) knew that vaccination to prevent monkeypox is available. Age was significantly associated with better HMPX knowledge for a majority of items. Older age, females, and affiliation to non-medical schools/faculties were associated with harboring higher levels of conspiracy beliefs regarding emerging virus infections. Our data also indicate that lower levels of HMPX knowledge were associated with higher levels of conspiracy beliefs. Conclusion: The current study pointed to generally unsatisfactory levels of knowledge regarding the emerging HMPX among university students in Jordanian health schools/faculties. Conspiracy beliefs regarding emerging virus infections were widely prevalent, and its potential detrimental impact on health behavior should be evaluated in future studies. Full article
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16 pages, 931 KiB  
Review
Chronic Inflammation—A Link between Nonalcoholic Fatty Liver Disease (NAFLD) and Dysfunctional Adipose Tissue
by Maria Petrescu, Sonia Irina Vlaicu, Lorena Ciumărnean, Mircea Vasile Milaciu, Codruța Mărginean, Mira Florea, Ștefan Cristian Vesa and Monica Popa
Medicina 2022, 58(5), 641; https://doi.org/10.3390/medicina58050641 - 06 May 2022
Cited by 33 | Viewed by 4762
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a new challenge in modern medicine, due to its high prevalence in the world. The pathogenesis of NAFLD is a complex dysmetabolic process, following the “multiple-hit” hypothesis that involves hepatocytes excessive accumulation of triglycerides, insulin resistance (IR), [...] Read more.
Nonalcoholic fatty liver disease (NAFLD) is a new challenge in modern medicine, due to its high prevalence in the world. The pathogenesis of NAFLD is a complex dysmetabolic process, following the “multiple-hit” hypothesis that involves hepatocytes excessive accumulation of triglycerides, insulin resistance (IR), increased oxidative stress, chronic low-grade inflammatory response and lipotoxicity. In this review, we provide an overview of the interrelation of these processes, the link between systemic and local inflammation and the role of dysfunctional adipose tissue (AT) in the NAFLD development. Multiple extrahepatic triggers of the pathophysiological mechanisms of NAFLD are described: nutritional deficiency or malnutrition, unhealthy food intake, the dysfunction of the liver–gut axis, the involvement of the mesenteric adipose tissue, the role of adipokines such as adiponectin, of food intake hormone, the leptin and leptin resistance (LR) and adipose tissue’s hormone, the resistin. In addition, a wide range of intrahepatic players are involved: oxidative stress, fatty acid oxidation, endoplasmic reticulum stress, mitochondrial dysfunction, resident macrophages (Kupffer cells), neutrophils, dendritic cells (DCs), B and T lymphocytes contributing to the potential evolution of NAFLD to nonalcoholic steatohepatitis (NASH). This interdependent approach to complex dysmetabolic imbalance in NAFLD, integrating relevant studies, could contribute to a better clarification of pathogenesis and consequently the development of new personalized treatments, targeting de novo lipogenesis, chronic inflammation and fibrosis. Further studies are needed to focus not only on treatment, but also on prevention strategy in NAFLD. Full article
(This article belongs to the Special Issue Research Advances in Non-alcoholic Fatty Liver Disease)
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8 pages, 610 KiB  
Review
Dyspnea in Post-COVID Syndrome following Mild Acute COVID-19 Infections: Potential Causes and Consequences for a Therapeutic Approach
by Klaus J. Wirth and Carmen Scheibenbogen
Medicina 2022, 58(3), 419; https://doi.org/10.3390/medicina58030419 - 12 Mar 2022
Cited by 24 | Viewed by 8649
Abstract
Dyspnea, shortness of breath, and chest pain are frequent symptoms of post-COVID syndrome (PCS). These symptoms are unrelated to organ damage in most patients after mild acute COVID infection. Hyperventilation has been identified as a cause of exercise-induced dyspnea in PCS. Since there [...] Read more.
Dyspnea, shortness of breath, and chest pain are frequent symptoms of post-COVID syndrome (PCS). These symptoms are unrelated to organ damage in most patients after mild acute COVID infection. Hyperventilation has been identified as a cause of exercise-induced dyspnea in PCS. Since there is a broad overlap in symptomatology with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), causes for dyspnea and potential consequences can be deduced by a stringent application of assumptions made for ME/CFS in our recent review papers. One of the first stimuli of respiration in exercise is caused by metabolic feedback via skeletal muscle afferents. Hyperventilation in PCS, which occurs early on during exercise, can arise from a combined disturbance of a poor skeletal muscle energetic situation and autonomic dysfunction (overshooting respiratory response), both found in ME/CFS. The exaggerated respiratory response aggravating dyspnea does not only limit the ability to exercise but further impairs the muscular energetic situation: one of the buffering mechanisms to respiratory alkalosis is a proton shift from intracellular to extracellular space via the sodium–proton-exchanger subtype 1 (NHE1), thereby loading cells with sodium. This adds to two other sodium loading mechanisms already operative, namely glycolytic metabolism (intracellular acidosis) and impaired Na+/K+ATPase activity. High intracellular sodium has unfavorable effects on mitochondrial calcium and metabolism via sodium–calcium-exchangers (NCX). Mitochondrial calcium overload by high intracellular sodium reversing the transport mode of NCX to import calcium is a key driver for fatigue and chronification. Prevention of hyperventilation has a therapeutic potential by keeping intracellular sodium below the threshold where calcium overload occurs. Full article
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12 pages, 1466 KiB  
Review
Atherosclerosis Development and Progression: The Role of Atherogenic Small, Dense LDL
by Jelena Vekic, Aleksandra Zeljkovic, Arrigo F. G. Cicero, Andrej Janez, Anca Pantea Stoian, Alper Sonmez and Manfredi Rizzo
Medicina 2022, 58(2), 299; https://doi.org/10.3390/medicina58020299 - 16 Feb 2022
Cited by 39 | Viewed by 5513
Abstract
Atherosclerosis is responsible for large cardiovascular mortality in many countries globally. It has been shown over the last decades that the reduction of atherosclerotic progression is a critical factor for preventing future cardiovascular events. Low-density lipoproteins (LDL) have been successfully targeted, and their [...] Read more.
Atherosclerosis is responsible for large cardiovascular mortality in many countries globally. It has been shown over the last decades that the reduction of atherosclerotic progression is a critical factor for preventing future cardiovascular events. Low-density lipoproteins (LDL) have been successfully targeted, and their reduction is one of the key preventing measures in patients with atherosclerotic disease. LDL particles are pivotal for the formation and progression of atherosclerotic plaques; yet, they are quite heterogeneous, and smaller, denser LDL species are the most atherogenic. These particles have greater arterial entry and retention, higher susceptibility to oxidation, as well as reduced affinity for the LDL receptor. Increased proportion of small, dense LDL particles is an integral part of the atherogenic lipoprotein phenotype, the most common form of dyslipidemia associated with insulin resistance. Recent data suggest that both genetic and epigenetic factors might induce expression of this specific lipid pattern. In addition, a typical finding of increased small, dense LDL particles was confirmed in different categories of patients with elevated cardiovascular risk. Small, dense LDL is an independent risk factor for cardiovascular diseases, which emphasizes the clinical importance of both the quality and the quantity of LDL. An effective management of atherosclerotic disease should take into account the presence of small, dense LDL in order to prevent cardiovascular complications. Full article
(This article belongs to the Section Endocrinology)
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14 pages, 1517 KiB  
Review
Cytokine Storm in COVID-19: Immunopathogenesis and Therapy
by Christian Zanza, Tatsiana Romenskaya, Alice Chiara Manetti, Francesco Franceschi, Raffaele La Russa, Giuseppe Bertozzi, Aniello Maiese, Gabriele Savioli, Gianpietro Volonnino and Yaroslava Longhitano
Medicina 2022, 58(2), 144; https://doi.org/10.3390/medicina58020144 - 18 Jan 2022
Cited by 125 | Viewed by 10344
Abstract
A cytokine storm is a hyperinflammatory state secondary to the excessive production of cytokines by a deregulated immune system. It manifests clinically as an influenza-like syndrome, which can be complicated by multi-organ failure and coagulopathy, leading, in the most severe cases, even to [...] Read more.
A cytokine storm is a hyperinflammatory state secondary to the excessive production of cytokines by a deregulated immune system. It manifests clinically as an influenza-like syndrome, which can be complicated by multi-organ failure and coagulopathy, leading, in the most severe cases, even to death. The term cytokine storm was first used in 1993 to describe the graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. It was then reused to define the adverse syndromes secondary to the administration of immunostimulating agents, such as anti-CD28 antibodies or bioengineered immune cells, i.e., CAR T-cell therapy. Currently, the concept of cytokine storm has been better elucidated and extended to the pathogenesis of many other conditions, such as sepsis, autoinflammatory disease, primary and secondary hemophagocytic lymphohistiocytosis, and multicentric Castleman disease. Moreover, cytokine storm has recently emerged as a key aspect in the novel Coronavirus disease 2019, as affected patients show high levels of several key pro-inflammatory cytokines, such as IL-1, IL-2, IL-6, TNF-α, IFN-γ, IP-10, GM-CSF, MCP-1, and IL-10, some of which also correlate with disease severity. Therefore, since the onset of the pandemic, numerous agents have been tested in the effort to mitigate the cytokine storm in COVID-19 patients, some of which are effective in reducing mortality, especially in critically ill patients, and are now becoming standards of care, such as glucocorticoids or some cytokine inhibitors. However, the challenge is still far from being met, and other therapeutic strategies are being tested in the hope that we can eventually overcome the disease. Full article
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18 pages, 3484 KiB  
Article
Orthostatic Symptoms and Reductions in Cerebral Blood Flow in Long-Haul COVID-19 Patients: Similarities with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
by C. (Linda) M. C. van Campen, Peter C. Rowe and Frans C. Visser
Medicina 2022, 58(1), 28; https://doi.org/10.3390/medicina58010028 - 24 Dec 2021
Cited by 35 | Viewed by 14756
Abstract
Background and Objectives: Symptoms and hemodynamic findings during orthostatic stress have been reported in both long-haul COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but little work has directly compared patients from these two groups. To investigate the overlap in these clinical phenotypes, [...] Read more.
Background and Objectives: Symptoms and hemodynamic findings during orthostatic stress have been reported in both long-haul COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but little work has directly compared patients from these two groups. To investigate the overlap in these clinical phenotypes, we compared orthostatic symptoms in daily life and during head-up tilt, heart rate and blood pressure responses to tilt, and reductions in cerebral blood flow in response to orthostatic stress in long-haul COVID-19 patients, ME/CFS controls, and healthy controls. Materials and Methods: We compared 10 consecutive long-haul COVID-19 cases with 20 age- and gender-matched ME/CFS controls with postural tachycardia syndrome (POTS) during head-up tilt, 20 age- and gender-matched ME/CFS controls with a normal heart rate and blood pressure response to head-up tilt, and 10 age- and gender-matched healthy controls. Identical symptom questionnaires and tilt test procedures were used for all groups, including measurement of cerebral blood flow and cardiac index during the orthostatic stress. Results: There were no significant differences in ME/CFS symptom prevalence between the long-haul COVID-19 patients and the ME/CFS patients. All long-haul COVID-19 patients developed POTS during tilt. Cerebral blood flow and cardiac index were more significantly reduced in the three patient groups compared with the healthy controls. Cardiac index reduction was not different between the three patient groups. The cerebral blood flow reduction was larger in the long-haul COVID-19 patients compared with the ME/CFS patients with a normal heart rate and blood pressure response. Conclusions: The symptoms of long-haul COVID-19 are similar to those of ME/CFS patients, as is the response to tilt testing. Cerebral blood flow and cardiac index reductions during tilt were more severely impaired than in many patients with ME/CFS. The finding of early-onset orthostatic intolerance symptoms, and the high pre-illness physical activity level of the long-haul COVID-19 patients, makes it unlikely that POTS in this group is due to deconditioning. These data suggest that similar to SARS-CoV-1, SARS-CoV-2 infection acts as a trigger for the development of ME/CFS. Full article
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10 pages, 615 KiB  
Review
Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic
by Renata Solimini, Francesco Paolo Busardò, Filippo Gibelli, Ascanio Sirignano and Giovanna Ricci
Medicina 2021, 57(12), 1314; https://doi.org/10.3390/medicina57121314 - 30 Nov 2021
Cited by 46 | Viewed by 12078
Abstract
Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. [...] Read more.
Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested. Full article
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17 pages, 1098 KiB  
Review
Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes
by Alessandro de Sire, Nicola Marotta, Lorenzo Lippi, Dalila Scaturro, Giacomo Farì, Alfonso Liccardi, Lucrezia Moggio, Giulia Letizia Mauro, Antonio Ammendolia and Marco Invernizzi
Medicina 2021, 57(11), 1208; https://doi.org/10.3390/medicina57111208 - 05 Nov 2021
Cited by 26 | Viewed by 4934
Abstract
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is [...] Read more.
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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14 pages, 2262 KiB  
Article
Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis
by Oliver Dulic, Predrag Rasovic, Ivica Lalic, Vaso Kecojevic, Gordan Gavrilovic, Dzihan Abazovic, Dusan Maric, Mladen Miskulin and Marko Bumbasirevic
Medicina 2021, 57(11), 1193; https://doi.org/10.3390/medicina57111193 - 02 Nov 2021
Cited by 25 | Viewed by 8224
Abstract
Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare [...] Read more.
Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions. Full article
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7 pages, 1542 KiB  
Article
Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
by Juste Kaciulyte, Leonardo Garutti, Davide Spadoni, Jonathan Velazquez-Mujica, Luigi Losco, Pedro Ciudad, Marco Marcasciano, Federico Lo Torto, Donato Casella, Diego Ribuffo and Hung-Chi Chen
Medicina 2021, 57(11), 1175; https://doi.org/10.3390/medicina57111175 - 28 Oct 2021
Cited by 17 | Viewed by 6809
Abstract
Background and Objectives: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation [...] Read more.
Background and Objectives: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema—GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. Materials and Methods: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors’ department were selected. Only patients that were treated in the authors’ institution and presented a minimum follow-up of 3 months were admitted to the current study. Results: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months—11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. Conclusions: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients’ quality of life. Full article
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9 pages, 648 KiB  
Review
Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review
by Francesca Gimigliano, Giuseppina Resmini, Antimo Moretti, Milena Aulicino, Fiorinda Gargiulo, Alessandra Gimigliano, Sara Liguori, Marco Paoletta and Giovanni Iolascon
Medicina 2021, 57(10), 1118; https://doi.org/10.3390/medicina57101118 - 17 Oct 2021
Cited by 22 | Viewed by 5971
Abstract
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the [...] Read more.
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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24 pages, 1219 KiB  
Review
Diabetic Wound-Healing Science
by Jamie L. Burgess, W. Austin Wyant, Beatriz Abdo Abujamra, Robert S. Kirsner and Ivan Jozic
Medicina 2021, 57(10), 1072; https://doi.org/10.3390/medicina57101072 - 08 Oct 2021
Cited by 164 | Viewed by 31647
Abstract
Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, [...] Read more.
Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds. Full article
(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)
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7 pages, 4087 KiB  
Case Report
Acute Transverse Myelitis after COVID-19 Vaccination
by Yu-Ting Hsiao, Ming-Jen Tsai, Ying-Hao Chen and Chi-Feng Hsu
Medicina 2021, 57(10), 1010; https://doi.org/10.3390/medicina57101010 - 25 Sep 2021
Cited by 28 | Viewed by 10284
Abstract
The adverse effects of the COVID-19 vaccine have been discovered as the rapid application of the vaccines continues. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials. Transverse myelitis is a rare immune-mediated disease with spinal cord [...] Read more.
The adverse effects of the COVID-19 vaccine have been discovered as the rapid application of the vaccines continues. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials. Transverse myelitis is a rare immune-mediated disease with spinal cord neural injury, resulting in neurological deficits in the motor, sensory, and autonomic system. Vaccine-related transverse myelitis is even rarer. We present a case of acute transverse myelitis after vaccination against COVID-19 with the ChAdOx1 nCOV-19 vaccine (AZD1222), which was the first case reported in Taiwan. Although it rarely occurs, post-vaccination neurological complications should not be ignored. As the pandemic of SARS-CoV-2 continues to spread and concern about vaccination efficacy and safety rises, heterologous vaccination were implemented in health public policy in several countries. A literature review of several clinical trials shows promising effects of mix-and-match vaccination. Further study on different combinations of vaccines can be expected. Full article
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11 pages, 703 KiB  
Review
The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review
by Sławomir M. Januszek, Anna Faryniak-Zuzak, Edyta Barnaś, Tomasz Łoziński, Tomasz Góra, Natalia Siwiec, Paweł Szczerba, Rafał Januszek and Tomasz Kluz
Medicina 2021, 57(9), 977; https://doi.org/10.3390/medicina57090977 - 17 Sep 2021
Cited by 54 | Viewed by 11113
Abstract
Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to [...] Read more.
Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to conduct a systematic review concerning the approach of pregnant women towards vaccination against COVID-19, with particular regard to determinants of vaccination acceptance. Materials and Methods: Articles were reviewed in which the aim was to evaluate—via a survey or questionnaire—the acceptance and decision to undergo vaccination against COVID-19. The articles were subjected to review according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Results: In various studies, the percentage of pregnant women accepting the COVID-19 vaccine was between 29.7% and 77.4%. The strongest factors co-existing with the acceptance of the COVID-19 vaccination in pregnancy were trust in the importance and effectiveness of the vaccine, explicit communication about the safety of COVID-19 vaccines for pregnant women, acceptance of other vaccinations such as those for influenza, belief in the importance of vaccines/mass vaccination in one’s own country, anxiety about COVID-19, trust in public health agencies/health science, as well as compliance to mask guidelines. The remaining factors were older age, higher education, and socioeconomic status. Conclusions: This review allowed us to show that geographic factors (Asian, South American countries) and pandemic factors (different threats and risks from infection) significantly influence the acceptance of vaccines. The most significant factors affecting acceptance are those related to public awareness of the risk of infection, vaccine safety, and the way in which reliable information about the need and safety of vaccines is provided. Professional and reliable patient information by obstetricians and qualified medical personnel would significantly increase the level of confidence in vaccination against COVID-19. Full article
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5 pages, 253 KiB  
Article
Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children
by Adrian Vlad, Viorel Serban, Romulus Timar, Alexandra Sima, Veronica Botea, Oana Albai, Bogdan Timar and Mihaela Vlad
Medicina 2021, 57(9), 973; https://doi.org/10.3390/medicina57090973 - 16 Sep 2021
Cited by 42 | Viewed by 5307
Abstract
Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of [...] Read more.
Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of the β-cells, as well, and thus lead to an increase in the incidence of type 1 diabetes. Material and Methods: The Romanian National Organization for the Protection of Children and Adolescents with Diabetes (ONROCAD) has collected information regarding new cases of type 1 diabetes in children aged 0 to 14 years from all over the country since 1996 and has computed the incidence of type 1 diabetes in this age group. Results: We observed a marked increase in the incidence of type 1 diabetes in the first year of the COVID-19 pandemic, with 16.9%, from 11.4/100,000 in 2019 to 13.3/100,000 in 2020, much higher compared to previous years (mean yearly increase was 5.1% in the period 1996–2015 and 0.8% in the interval 2015–2019). The proportion of newly diagnosed cases was significantly higher in the second half of 2020 compared to the second half of the previous years (57.8 vs. 51%, p < 0.0001). Conclusions: All these aspects suggest the role that SARS-CoV-2 could have in triggering pancreatic autoimmunity. To confirm this, however, collecting information from larger populations from different geographical regions, monitoring the incidence curves over a period of several years, and gathering background information on COVID-19 and/or data on COVID-19 specific antibodies are needed. Full article
22 pages, 653 KiB  
Review
The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies
by Michela Amatruda, Guido Gembillo, Alfio Edoardo Giuffrida, Domenico Santoro and Giovanni Conti
Medicina 2021, 57(9), 868; https://doi.org/10.3390/medicina57090868 - 25 Aug 2021
Cited by 22 | Viewed by 4763
Abstract
Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset [...] Read more.
Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset T2DM are recorded in China (520 cases/100,000) and in the United States (212 cases/100,000), and the numbers are still increasing. T2DM young people present a strong hereditary component, often unmasked by social and environmental risk factors. These patients are affected by multiple coexisting risk factors, including obesity, hyperglycemia, dyslipidemia, insulin resistance, hypertension, and inflammation. Juvenile T2DM nephropathy occurs earlier in life compared to T1DM-related nephropathy in children or T2DM-related nephropathy in adult. Diabetic kidney disease (DKD) is T2DM major long term microvascular complication. This review summarizes the main mechanisms involved in the pathogenesis of the DKD in young population and the recent evolution of treatment, in order to reduce the risk of DKD progression. Full article
(This article belongs to the Special Issue Glomerulonephritis: Pathogenesis, Risk Factors, and Treatment)
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25 pages, 10351 KiB  
Review
A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities
by Miguel A. Ortega, Oscar Fraile-Martinez, Cielo García-Montero, Enrique Callejón-Peláez, Miguel A. Sáez, Miguel A. Álvarez-Mon, Natalio García-Honduvilla, Jorge Monserrat, Melchor Álvarez-Mon, Julia Bujan and María Luisa Canals
Medicina 2021, 57(9), 864; https://doi.org/10.3390/medicina57090864 - 24 Aug 2021
Cited by 80 | Viewed by 18127
Abstract
Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2–3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, [...] Read more.
Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2–3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, particularly in hypoxic regions, also exerting antimicrobial, immunomodulatory and angiogenic properties, among others. In this review, we will discuss in detail the physiological relevance of oxygen and the therapeutical basis of HBOT, collecting current indications and underlying mechanisms. Furthermore, potential areas of research will also be examined, including inflammatory and systemic maladies, COVID-19 and cancer. Finally, the adverse effects and contraindications associated with this therapy and future directions of research will be considered. Overall, we encourage further research in this field to extend the possible uses of this procedure. The inclusion of HBOT in future clinical research could be an additional support in the clinical management of multiple pathologies. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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9 pages, 482 KiB  
Article
Exploring Pregnancy Outcomes Associated with SARS-CoV-2 Infection
by Madalina Timircan, Felix Bratosin, Iulia Vidican, Oana Suciu, Livius Tirnea, Valentina Avram and Iosif Marincu
Medicina 2021, 57(8), 796; https://doi.org/10.3390/medicina57080796 - 01 Aug 2021
Cited by 28 | Viewed by 3503
Abstract
Background and Objectives: The ongoing pandemic proved to be a tremendous challenge to all economic layers, healthcare, and people safety. As more than one year elapsed since the beginning of the COVID-19 pandemic, a multitude of medical studies involving the SARS-CoV-2 virus [...] Read more.
Background and Objectives: The ongoing pandemic proved to be a tremendous challenge to all economic layers, healthcare, and people safety. As more than one year elapsed since the beginning of the COVID-19 pandemic, a multitude of medical studies involving the SARS-CoV-2 virus helped researchers and medical practitioners in understanding the effects it has on all sorts of patients until effective vaccines were finally developed and distributed for mass vaccination. Still, the SARS-CoV-2 and its new variants remain a potential threat towards all categories of patients, including a more delicate group represented by pregnant women. Thus, the current study aims to investigate the potential effects on obstetrical outcomes after a positive SARS-CoV-2 infection. Materials and Methods: This single-center prospective cohort study investigated the pregnancy outcomes in a total of 1039 eligible pregnant women between 30 August 2020 and 30 January 2021. Multiple patient characteristics and obstetrical outcomes were tested and analyzed in a multivariate regression model to establish potential risks determined by a COVID-19-positive pregnancy towards the mother and the newborn. Results: In the study sample, there were 938 pregnancies included without COVID-19 and 101 pregnant women identified with a positive COVID-19 infection. COVID-19 was significantly associated with a 2-fold increase in the risk of premature rupture of membranes and 1.5 times higher risk of preterm birth with emergency c-sections and lower APGAR scores. Also, significantly more newborns were given birth prematurely, with lower APGAR scores after the mothers were infected with SARS-CoV-2. Conclusions: A third-trimester infection with SARS-CoV-2 is a significant risk factor for preterm birth via an emergency cesarean section, a premature rupture of membranes, and a lower APGAR score in newborns, as compared with pregnancies where COVID-19 was not identified. Full article
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16 pages, 364 KiB  
Article
Psychosocial Impacts of the COVID-19 Quarantine: A Study of Gender Differences in 59 Countries
by Stephanie A. Kolakowsky-Hayner, Yelena Goldin, Kristine Kingsley, Elisabet Alzueta, Juan Carlos Arango-Lasprilla, Paul B. Perrin, Fiona C. Baker, Daniela Ramos-Usuga and Fofi Constantinidou
Medicina 2021, 57(8), 789; https://doi.org/10.3390/medicina57080789 - 31 Jul 2021
Cited by 47 | Viewed by 4619
Abstract
Background and Objectives: There is strong evidence in the literature that women experience psychological disorders at significantly higher rates than men. The higher rates of psychological disorders in women may partly be attributable to gender differences in response to stressors and coping [...] Read more.
Background and Objectives: There is strong evidence in the literature that women experience psychological disorders at significantly higher rates than men. The higher rates of psychological disorders in women may partly be attributable to gender differences in response to stressors and coping styles. The objective of this study was to contribute to the growing body of literature investigating gender differences in mental health outcomes and coping styles during the coronavirus disease 2019 pandemic in a large sample of individuals from 59 countries with variable demographic and socio-cultural characteristics. Materials and Methods: Survey data were collected from the general population following a snowball sampling method, and the survey was promoted through social media platforms and mailing lists. Participants included 6882 individuals from the general population from 59 countries around the world. A combination of both standardized and adapted measures was used to create a survey, originally in English and then translated to Spanish, Italian, French, German, and Turkish. Results: Compared with men, women presented with higher levels of trauma-related distress; had a harder time decompressing; were more depressed, anxious and stressed; showed decreased frustration tolerance and reported lower quality of sleep and an increased likelihood of taking sleep medication or other natural sleep remedies. Overall, women tended to be more vulnerable during the pandemic in developing symptoms consistent with various forms of mental disorders such as depression, anxiety and post-traumatic distress. However, they also were more likely than men to use a variety of adaptive coping strategies, including concentrating on doing something about the situation and getting emotional support from others. Conclusions: A high prevalence of mood symptoms was noted among women. In addition to meeting the physical health needs of the population, emphasis needs to be given to mental health and the prevention of psychiatric disorders, particularly in women. Full article
(This article belongs to the Section Infectious Disease)
10 pages, 2230 KiB  
Review
Bladder Cancer: Current Challenges and Future Directions
by Jakub Dobruch and Maciej Oszczudłowski
Medicina 2021, 57(8), 749; https://doi.org/10.3390/medicina57080749 - 24 Jul 2021
Cited by 127 | Viewed by 11158
Abstract
Bladder cancer (BCa) is the most common malignancy of the urinary tract and one of the most prevalent cancers worldwide. While the clinical approach to BCa has remained largely unchanged for many years, recent discoveries have paved the way to a new era [...] Read more.
Bladder cancer (BCa) is the most common malignancy of the urinary tract and one of the most prevalent cancers worldwide. While the clinical approach to BCa has remained largely unchanged for many years, recent discoveries have paved the way to a new era of diagnosis and management of the disease. BCa-specific mortality started to decrease in the regions with a wide range of activities leading to greater social awareness of the risk factors and the decline in carcinogenic exposure. The urologic community refines the role of transurethral surgery towards more rigorous and high-quality techniques. New agents have been approved for patients with BCG failure who faced radical cystectomy so far. Although radical removal of the bladder is the gold standard for muscle invasive cancer management, the extent and clinical value of lymphadenectomy is currently heavily challenged in randomized trials. Furthermore, alternatives to perioperative chemotherapy have arisen to increase the likelihood of complete treatment delivery and successful oncological outcomes. Finally, improvements in molecular biology and our understanding of tumorigenesis open the era of personalized medicine in bladder cancer. In the present review, the status and future directions in bladder cancer epidemiology, diagnosis and management are thoroughly discussed. Full article
(This article belongs to the Special Issue Bladder Cancer—Current Challenges and Future Perspectives)
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10 pages, 666 KiB  
Article
Safety and Tolerability of the BNT162b2 mRNA COVID-19 Vaccine in Dialyzed Patients. COViNEPH Project
by Karolina Polewska, Piotr Tylicki, Bogdan Biedunkiewicz, Angelika Rucińska, Aleksandra Szydłowska, Alicja Kubanek, Iwona Rosenberg, Sylwia Rodak, Waldemar Ślizień, Marcin Renke, Alicja Dębska-Ślizień and Leszek Tylicki
Medicina 2021, 57(7), 732; https://doi.org/10.3390/medicina57070732 - 19 Jul 2021
Cited by 26 | Viewed by 3907
Abstract
Background and Objectives: The Pfizer-BioNTech (BNT162b2) COVID-19 mRNA vaccine has demonstrated excellent efficacy and safety in phase 3 trials. However, no dialyzed patients were included, and therefore safety data for this patient group is lacking. The aim of the study was to [...] Read more.
Background and Objectives: The Pfizer-BioNTech (BNT162b2) COVID-19 mRNA vaccine has demonstrated excellent efficacy and safety in phase 3 trials. However, no dialyzed patients were included, and therefore safety data for this patient group is lacking. The aim of the study was to assess the safety and tolerances of vaccinations with BNT162b2 performed in chronically dialyzed patients. Materials and Methods: We performed a prospective cohort study including a group of 190 dialyzed patients (65% male) at median age 68.0 (55–74) years. 169 (89.0%) patients were treated with hemodialysis and 21 (11.0%) with peritoneal dialysis. The control group consisted of 160 people (61% male) without chronic kidney disease at median age 63 (range 53–77) years. Both groups were vaccinated with BNT162b2 with a 21-day interval between the first and the second dose. Solicited local and systemic reactogenicity, unsolicited adverse events and antipyretic and pain medication use were assessed with a standardized questionnaire. The toxicity grading scales were derived from the FDA Center for Biologics Evaluation and Research guidelines. Results: 59.8% (dose 1), 61.4% (dose 2) and 15.9% (dose 1), 29.4% (dose 2) dialyzed patients reported at least one local and one systemic reaction respectively within seven days after the vaccination. Many local and systemic solicited reactions were observed less frequently in dialyzed patients than in the age and sex matched control group and much less frequently than reported in the pivotal study. They were mostly mild to moderate, short-lived, and more frequently reported in younger individuals and women. No related unsolicited adverse events were observed. Conclusions: We have shown here that BNT162b2, an mRNA vaccine from Pfizer-BioNTech against SARS-COV-2 is safe and well-tolerated by dialyzed patients. The results can be useful for the nephrological community to resolve patients’ doubts and reduce their vaccine hesitancy. Full article
(This article belongs to the Section Urology & Nephrology)
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9 pages, 591 KiB  
Article
Short-Term Effects of a Conditioning Telerehabilitation Program in Confined Patients Affected by COVID-19 in the Acute Phase. A Pilot Randomized Controlled Trial
by Cleofas Rodriguez-Blanco, Juan Jose Gonzalez-Gerez, Carlos Bernal-Utrera, Ernesto Anarte-Lazo, Manuel Perez-Ale and Manuel Saavedra-Hernandez
Medicina 2021, 57(7), 684; https://doi.org/10.3390/medicina57070684 - 03 Jul 2021
Cited by 45 | Viewed by 4956
Abstract
Background and objectives: The COVID-19 pandemic has become a challenge for health systems and, specifically, to physical therapists obligated to adapt their job and stop face-to-face consultations. In this situation, therapeutic exercise has been implemented in different COVID-19 patients. This study evaluated [...] Read more.
Background and objectives: The COVID-19 pandemic has become a challenge for health systems and, specifically, to physical therapists obligated to adapt their job and stop face-to-face consultations. In this situation, therapeutic exercise has been implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel therapeutic exercise program through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Materials and Methods: A total of 40 subjects were randomized an experimental group, based on muscle conditioning, and in a control group, who did not perform physical activity. Thirty-six subjects, 18 in each group, completed the one-week intervention. We measured the six-minute walking test, multidimensional dyspnoea-12, thirty seconds sit-to-stand test, and Borg Scale. Results: Both groups were comparable at baseline. Statistically significant improvement between groups (p < 0.05) in favor of the experimental group was obtained. No differences between gender were found (p > 0.05). Ninety percent adherence was found in our program. Conclusion: A one-week telerehabilitation program based on muscle toning exercise is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage. Full article
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12 pages, 327 KiB  
Article
Acceptability of Healthcare Professionals to Get Vaccinated against COVID-19 Two Weeks before Initiation of National Vaccination
by Athanasia Pataka, Seraphim Kotoulas, Emilia Stefanidou, Ioanna Grigoriou, Asterios Tzinas, Ioanna Tsiouprou, Paul Zarogoulidis, Nikolaos Courcoutsakis and Paraskevi Argyropoulou
Medicina 2021, 57(6), 611; https://doi.org/10.3390/medicina57060611 - 12 Jun 2021
Cited by 16 | Viewed by 3094
Abstract
Background and Objectives The greatest challenge vaccines face is that of acceptance from the general population. Healthcare professionals’ (HCPs) recommendations have significant influence on general public vaccination behavior. The aim of this study was to assess the willingness of HCPs to get vaccinated [...] Read more.
Background and Objectives The greatest challenge vaccines face is that of acceptance from the general population. Healthcare professionals’ (HCPs) recommendations have significant influence on general public vaccination behavior. The aim of this study was to assess the willingness of HCPs to get vaccinated against COVID-19, two weeks before initiation of vaccinations. Materials and Methods: We conducted an anonymous online survey from 11–15 December 2020 among HCPs by emails delivered from the local medical and nursing stuff associations. Results: The 71.1% of 656 HCPs intended to accept vaccination, 5.9% did not and 23% were still undecided. The acceptance rate was higher in physicians (76.5%) and significantly lower in nurses (48.3%). Most of the responders who intended to accept vaccination were males (p = 0.01), physicians (p = 0.001), older (p = 0.02), married (p = 0.054) with children (p = 0.001), and had treated patients with COVID-19 (p < 0.001). In the multivariate logistic regression, the predictors of HCPs willingness to get vaccinated were parenthood (OR = 4.19, p = 0.003), being a physician (OR = 2.79, p = 0.04), and treating confirmed/suspected COVID-19 patients (OR = 2.87, p = 0.036). Conclusions: Low vaccination acceptance rate was found especially in nurses, and as this may have a negative impact in the vaccination compliance of the general public, interventional educational programs to enhance vaccination are crucial. Full article
(This article belongs to the Section Pulmonary)
9 pages, 449 KiB  
Article
Liver Impairment and Hematological Changes in Patients with Chronic Hepatitis C and COVID-19: A Retrospective Study after One Year of Pandemic
by Bianca Cerbu, Stelian Pantea, Felix Bratosin, Iulia Vidican, Mirela Turaiche, Stefan Frent, Ema Borsi and Iosif Marincu
Medicina 2021, 57(6), 597; https://doi.org/10.3390/medicina57060597 - 10 Jun 2021
Cited by 23 | Viewed by 4797
Abstract
Background and Objectives: The COVID-19 pandemic is an ongoing public health emergency. Patients with chronic diseases are at greater risk for complications and poor outcomes. The objective of this study was to investigate the liver function abnormalities and clinical outcomes in patients [...] Read more.
Background and Objectives: The COVID-19 pandemic is an ongoing public health emergency. Patients with chronic diseases are at greater risk for complications and poor outcomes. The objective of this study was to investigate the liver function abnormalities and clinical outcomes in patients with COVID-19 and chronic hepatitis C. Materials and Methods: This retrospective, single-center study was conducted on a cohort of 126 patients with a history of hepatitis C, confirmed with COVID-19 between 01 April 2020 and 30 December 2020. Several clinical outcomes were compared between patients with active and non-active HCV infection, and the risks of liver impairment and all-cause mortality in active HCV patients were analyzed using a multivariate logistic regression model. Results: Among 1057 patients under follow-up for chronic HCV infection, 126 (11.9%) were confirmed with COVID-19; of these, 95 (75.4%) were under treatment or achieved SVR, while in the other 31 (24.6%), we found active HCV replication. There was a significantly higher proportion of severe COVID-19 cases in the active HCV group as compared to the non-active HCV group (32.2 vs. 7.3%, p < 0.001). Multivariate analysis showed that age, sex, alanine aminotransferase, C-reactive protein, procalcitonin, and HCV viral load were significant independent risk factors for liver impairment and all-cause mortality. The length of stay in hospital and intensive care unit for COVID-19 was significantly higher in patients with active HCV infection (p-value < 0.001), and a higher proportion of these patients required mechanical ventilation. Conclusions: Active HCV infection is an independent risk factor for all-cause mortality in COVID-19 patients. Full article
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11 pages, 1870 KiB  
Review
Elevated Procalcitonin Is Positively Associated with the Severity of COVID-19: A Meta-Analysis Based on 10 Cohort Studies
by Yue Shen, Cheng Cheng, Xue Zheng, Yuefei Jin, Guangcai Duan, Mengshi Chen and Shuaiyin Chen
Medicina 2021, 57(6), 594; https://doi.org/10.3390/medicina57060594 - 09 Jun 2021
Cited by 24 | Viewed by 2922
Abstract
Background and Objectives: Procalcitonin (PCT) is positively associated with the severity of COVID-19 (including severe, critical, or fatal outcomes), but some of the confounding factors are not considered. The aim of this meta-analysis was to estimate the adjusted relationship between elevated procalcitonin [...] Read more.
Background and Objectives: Procalcitonin (PCT) is positively associated with the severity of COVID-19 (including severe, critical, or fatal outcomes), but some of the confounding factors are not considered. The aim of this meta-analysis was to estimate the adjusted relationship between elevated procalcitonin on admission and the severity of COVID-19. Materials and Methods: We searched 1805 articles from PubMed, Web of Science, and Embase databases up to 2 April 2021. The articles were selected which reported the adjusted relationship applying multivariate analysis between PCT and the severity of COVID-19. The pooled effect estimate was calculated by the random-effects model. Results: The meta-analysis included 10 cohort studies with a total of 7716 patients. Patients with elevated procalcitonin on admission were at a higher risk of severe and critical COVID-19 (pooled effect estimate: 1.77, 95% confidence interval (CI): 1.38–2.29; I2 = 85.6%, p < 0.001). Similar results were also observed in dead patients (pooled effect estimate: 1.77, 95% CI: 1.36–2.30). After adjusting for diabetes, the positive association between PCT and the severity of COVID-19 decreased. Subgroup analysis revealed heterogeneity between studies and sensitivity analysis showed that the results were robust. There was no evidence of publication bias by Egger’s test (p = 0.106). Conclusions: Higher procalcitonin is positively associated with the severity of COVID-19, which is a potential biomarker to evaluate the severity of COVID-19 and predict the prognosis. Full article
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14 pages, 1667 KiB  
Review
Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes
by João Miguel Santos, Joana F. Pereira, Andréa Marques, Diana B. Sequeira and Shimon Friedman
Medicina 2021, 57(6), 573; https://doi.org/10.3390/medicina57060573 - 03 Jun 2021
Cited by 44 | Viewed by 11253
Abstract
Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review [...] Read more.
Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities. Full article
(This article belongs to the Special Issue Outcome of Minimally Invasive Techniques in Dentistry)
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12 pages, 1576 KiB  
Article
Follow-Up Analysis of Pulmonary Function, Exercise Capacity, Radiological Changes, and Quality of Life Two Months after Recovery from SARS-CoV-2 Pneumonia
by Edita Strumiliene, Ingrida Zeleckiene, Rytis Bliudzius, Arturas Samuilis, Tadas Zvirblis, Birute Zablockiene, Arunas Strumila, Vygantas Gruslys, Laura Malinauskiene, Vytautas Kasiulevicius and Ligita Jancoriene
Medicina 2021, 57(6), 568; https://doi.org/10.3390/medicina57060568 - 03 Jun 2021
Cited by 20 | Viewed by 4250
Abstract
Background and objective: According to the World Health Organization (WHO), more than 100 million people have already recovered from SARS-CoV-2 infection. Therefore, it is imperative to understand the possible outcomes of COVID-19. The aim of our study was to evaluate pulmonary function, [...] Read more.
Background and objective: According to the World Health Organization (WHO), more than 100 million people have already recovered from SARS-CoV-2 infection. Therefore, it is imperative to understand the possible outcomes of COVID-19. The aim of our study was to evaluate pulmonary function, exercise capacity, residual radiological changes, and health-related quality of life (HRQoL) at follow-up in a cohort of SARS-CoV-2 pneumonia survivors. Materials and Methods: Patients with SARS-CoV-2 infection and radiologically confirmed lung injury, with no chronic lung disease prior to this infection, were included in the study. Patients’ evaluation 2 months after their discharge from hospital included spirometry (FVC, FEV1, FEV1/FVC), determination of lung volume (TLC, VC, RV) and diffusing capacity of lung for carbon monoxide (DLCO, adjusted for hemoglobin), 6-Minute Walk Test (6MWT), chest CT scan, and 36-Item Short Form General Health Survey (SF-36). Results: Fifty-one patients (25 men, 26 women) were included. The mean age was 56 years (SD-11,72). Eighteen patients (35.3%) had experienced moderate COVID-19, 21 (41.2%) severe COVID-19, and 12 (23.5%) were critically ill. The mean follow-up visit time after the discharge from hospital was 60 days (SD-17). Pulmonary function at follow-up was impaired in 24 (47.2%) patients. Reduced lung volume was observed in 15 (29.4%) patients, DLCO reduction in 15 (29.4%) patients, and only one patient displayed obstruction. Twelve patients out of 51 (12/51, 27.3%) showed reduced physical capacity in the 6 MWT, and 3/51 (9.1%) showed desaturation, with SO2 < 90%. Different levels of abnormality were found in 49/51 (96,1%) patients on follow-up chest CT; the median radiological score was 10.9 (SD ± 8.87, possible maximal score, 25). Ground-glass opacity was the most common radiological feature, found in 45 (88.2%) patients. The SF-36 scores demonstrated a reduction in health status across all domains, with the lowest scores for limitations in social activities because of physical problems, vitality, and general health. Conclusion: In the group of COVID-19 pneumonia survivors 2 months after hospital discharge, residual changes in the lungs on chest CT and in lung function and reduced physical and HRQoL status were found in a significant number of patients. To evaluate COVID-19 long-term consequences, a longer follow-up period is needed. Full article
(This article belongs to the Section Pulmonary)
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5 pages, 1870 KiB  
Case Report
Topical 5% Imiquimod Sequential to Surgery for HPV-Related Squamous Cell Carcinoma of the Lip
by Giovanni Pentangelo, Steven Paul Nisticò, Eugenio Provenzano, Giusy Ylenia Cisale and Luigi Bennardo
Medicina 2021, 57(6), 563; https://doi.org/10.3390/medicina57060563 - 02 Jun 2021
Cited by 30 | Viewed by 3133
Abstract
Background: Squamous cell carcinoma (SCC) is one of the most common neoplasms affecting the oral cavity and the face. Its more differentiated forms may be associated with human papilloma virus (HPV) infection. Case report: In this paper, we report the case of an [...] Read more.
Background: Squamous cell carcinoma (SCC) is one of the most common neoplasms affecting the oral cavity and the face. Its more differentiated forms may be associated with human papilloma virus (HPV) infection. Case report: In this paper, we report the case of an 86-year-old patient with a well-differentiated SCC of the lower lip associated with HPV treated with surgery with a non-complete histological resolution. Imiquimod 5% cream was applied on the surgical scar once a day for two weeks and then once a week. Two years after SCC removal, no relapse has occurred. Conclusions: Topical imiquimod may be a safe and effective treatment after surgery in SCC of the oral area to reduce the risk of relapses. Full article
(This article belongs to the Special Issue New Perspectives in the Treatment of Skin Disease)
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9 pages, 286 KiB  
Review
Effects of Rapid Weight Loss on Kidney Function in Combat Sport Athletes
by Nemanja Lakicevic, Antonio Paoli, Roberto Roklicer, Tatjana Trivic, Darinka Korovljev, Sergej M. Ostojic, Patrizia Proia, Antonino Bianco and Patrik Drid
Medicina 2021, 57(6), 551; https://doi.org/10.3390/medicina57060551 - 31 May 2021
Cited by 21 | Viewed by 6885
Abstract
Even though scientific literature shows numerous heath complications and performance decrements associated with rapid weight loss (RWL), its prevalence remains exceedingly high across various combat sports. The aim of this study was to thoroughly search the existing literature to explore the influence of [...] Read more.
Even though scientific literature shows numerous heath complications and performance decrements associated with rapid weight loss (RWL), its prevalence remains exceedingly high across various combat sports. The aim of this study was to thoroughly search the existing literature to explore the influence of RWL on kidney function in Olympic and non-Olympic combat sport athletes. PubMed and Web of Science were searched for the relevant studies. Only original articles published from 2005 onwards, written in English, that included healthy males and females who prompted ~5% weight loss within a week or less, were included in the study. Retrieved studies showed that creatinine, blood urea nitrogen and urine specific gravity values were significantly increased after RWL in the majority of the included studies. This observation indicates that RWL caused dehydration and subsequent acute kidney damage despite various degrees of weight lost during the RWL phase, which can lead to adverse events in other body systems. Alternative methods of weight reduction that prioritize athletes’ health should be considered. Full article
25 pages, 1253 KiB  
Opinion
European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE): Expert Consensus on the Diagnosis, Service Provision, and Care of People with ME/CFS in Europe
by Luis Nacul, François Jérôme Authier, Carmen Scheibenbogen, Lorenzo Lorusso, Ingrid Bergliot Helland, Jose Alegre Martin, Carmen Adella Sirbu, Anne Marit Mengshoel, Olli Polo, Uta Behrends, Henrik Nielsen, Patricia Grabowski, Slobodan Sekulic, Nuno Sepulveda, Fernando Estévez-López, Pawel Zalewski, Derek F. H. Pheby, Jesus Castro-Marrero, Giorgos K. Sakkas, Enrica Capelli, Ivan Brundsdlund, John Cullinan, Angelika Krumina, Jonas Bergquist, Modra Murovska, Ruud C. W. Vermuelen and Eliana M. Lacerdaadd Show full author list remove Hide full author list
Medicina 2021, 57(5), 510; https://doi.org/10.3390/medicina57050510 - 19 May 2021
Cited by 74 | Viewed by 22024
Abstract
Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action [...] Read more.
Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS. Full article
(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)
7 pages, 261 KiB  
Review
Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value
by Thomas F. Monaghan, Syed N. Rahman, Christina W. Agudelo, Alan J. Wein, Jason M. Lazar, Karel Everaert and Roger R. Dmochowski
Medicina 2021, 57(5), 503; https://doi.org/10.3390/medicina57050503 - 16 May 2021
Cited by 64 | Viewed by 9634
Abstract
Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion [...] Read more.
Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature. Full article
(This article belongs to the Section Epidemiology & Public Health)
12 pages, 258 KiB  
Review
Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ)
by Sven Otto, Suad Aljohani, Riham Fliefel, Sara Ecke, Oliver Ristow, Egon Burian, Matthias Troeltzsch, Christoph Pautke and Michael Ehrenfeld
Medicina 2021, 57(5), 463; https://doi.org/10.3390/medicina57050463 - 09 May 2021
Cited by 49 | Viewed by 4067
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. [...] Read more.
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis. Full article
(This article belongs to the Section Dentistry)
14 pages, 1049 KiB  
Review
Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy
by Neil D. Reeves, Giorgio Orlando and Steven J. Brown
Medicina 2021, 57(5), 457; https://doi.org/10.3390/medicina57050457 - 08 May 2021
Cited by 27 | Viewed by 11356
Abstract
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This [...] Read more.
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions. Full article
(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)
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17 pages, 670 KiB  
Review
The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature
by Roberta Angelico, Francesca Blasi, Tommaso Maria Manzia, Luca Toti, Giuseppe Tisone and Roberto Cacciola
Medicina 2021, 57(5), 435; https://doi.org/10.3390/medicina57050435 - 30 Apr 2021
Cited by 27 | Viewed by 3634
Abstract
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy [...] Read more.
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy may protect from the cytokine storm induced by SARS-CoV-2 infection or a temporary adjustment/withdrawal of IS therapy to restore the immune system may be necessary. We performed a systematic literature review to investigate the current management of IS therapy in KT recipients with COVID-1. Materials and Methods: Out of 71 articles published from 1 February 2020 until 30 October 2020, 554 KT recipients with SARS-CoV-2 infection were identified. Results: Modifications of IS therapy were based on the clinical conditions. For asymptomatic patients or those with mild COVID-19 symptoms, a “wait and see approach” was mostly used; a suspension of antimetabolites drugs (347/461, 75.27%) or mTOR inhibitors (38/48, 79.2%) was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, the most frequent attitude was their maintenance (243/502, 48.4%) or dose-reduction (99/502, 19.72%) in patients asymptomatic or with mild COVID-19 symptoms, while drug withdrawal was the preferred choice in severely symptomatic patients (160/450, 31.87%). A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Renal function remained stable in 422(76.17%) recipients, while 49(8.84%) patients experienced graft loss. Eight (1.44%) patients experienced a worsening of renal function. The overall mortality was 21.84%, and 53(9.56%) patients died with functioning grafts. Conclusion: A tailored approach to the patient has been the preferred strategy for the management of IS therapy in KT recipients, taking into account the clinical conditions of patients and the potential interactions between IS and antiviral drugs, in the attempt to balance the risks of COVID-19-related complications and those due to rejection or graft loss. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
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14 pages, 443 KiB  
Review
Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)—A Systemic Review and Comparison of Clinical Presentation and Symptomatology
by Timothy L. Wong and Danielle J. Weitzer
Medicina 2021, 57(5), 418; https://doi.org/10.3390/medicina57050418 - 26 Apr 2021
Cited by 203 | Viewed by 24641
Abstract
Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness—myalgic encephalomyelitis/chronic fatigue [...] Read more.
Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness—myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A review study comparing and contrasting ME/CFS with reported symptoms of long COVID may yield mutualistic insight into the characterization and management of both conditions. Materials and Methods: A systemic literature search was conducted in MEDLINE and PsycInfo through to 31 January 2021 for studies related to long COVID symptomatology. The literature search was conducted in accordance with PRISMA methodology. Results: Twenty-one studies were included in the qualitative analysis. Long COVID symptoms reported by the included studies were compared to a list of ME/CFS symptoms compiled from multiple case definitions. Twenty-five out of 29 known ME/CFS symptoms were reported by at least one selected long COVID study. Conclusions: Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME/CFS. The need for monitoring and treatment for patients post-COVID is evident. Advancements and standardization of long COVID research methodologies would improve the quality of future research, and may allow further investigations into the similarities and differences between long COVID and ME/CFS. Full article
(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)
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7 pages, 524 KiB  
Case Report
Herpes Simplex Keratitis in Patients with SARS-CoV-2 Infection: A Series of Five Cases
by Nora Majtanova, Petra Kriskova, Petra Keri, Zlatica Fellner, Juraj Majtan and Petr Kolar
Medicina 2021, 57(5), 412; https://doi.org/10.3390/medicina57050412 - 24 Apr 2021
Cited by 20 | Viewed by 3656
Abstract
Herpes simplex virus type 1 (HSV-1) is a leading cause of infectious blindness worldwide. Most of the initial infection cases manifest as acute epithelial keratitis. Reactivation of herpesviruses is common in critically ill patients, including patients with severe Coronavirus disease (COVID-19). However, the [...] Read more.
Herpes simplex virus type 1 (HSV-1) is a leading cause of infectious blindness worldwide. Most of the initial infection cases manifest as acute epithelial keratitis. Reactivation of herpesviruses is common in critically ill patients, including patients with severe Coronavirus disease (COVID-19). However, the data on COVID-19-related ocular infections is sparse, despite recent observations that more than 30% of COVID-19-infected patients had ocular manifestations. We report five cases of HSV-1 keratitis in COVID-19 patients. In total, five COVID-19 patients underwent ophthalmic examination, showing similar symptoms, including photophobia, tearing, decreased vision, eye redness, and pain. After initial assessment, tests of visual acuity and corneal sensitivity, a fluorescein staining test, and complete anterior and posterior segment examinations were performed. A diagnosis of HSV-1 keratitis was confirmed in all cases. Therapy was initiated using a local and systemic antiviral approach together with local antibiotic and mydriatic therapy. The complete reduction of keratitis symptoms and a clear cornea was achieved in all patients within 2 weeks. SARS-CoV-2 infection may be a risk factor for developing HSV-1 keratitis, or it may act as a potential activator of this ocular disease. Full article
(This article belongs to the Section Ophthalmology)
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10 pages, 359 KiB  
Opinion
Obese Animals as Models for Numerous Diseases: Advantages and Applications
by Abdelaziz Ghanemi, Mayumi Yoshioka and Jonny St-Amand
Medicina 2021, 57(5), 399; https://doi.org/10.3390/medicina57050399 - 21 Apr 2021
Cited by 13 | Viewed by 3123
Abstract
With the advances in obesity research, a variety of animal models have been developed to investigate obesity pathogenesis, development, therapies and complications. Such obese animals would not only allow us to explore obesity but would also represent models to study diseases and conditions [...] Read more.
With the advances in obesity research, a variety of animal models have been developed to investigate obesity pathogenesis, development, therapies and complications. Such obese animals would not only allow us to explore obesity but would also represent models to study diseases and conditions that develop with obesity or where obesity represents a risk factor. Indeed, obese subjects, as well as animal models of obesity, develop pathologies such as cardiovascular diseases, diabetes, inflammation and metabolic disorders. Therefore, obese animals would represent models for numerous diseases. Although those diseases can be induced in animals by chemicals or drugs without obesity development, having them developed as consequences of obesity has numerous advantages. These advantages include mimicking natural pathogenesis processes, using diversity in obesity models (diet, animal species) to study the related variabilities and exploring disease intensity and reversibility depending on obesity development and treatments. Importantly, therapeutic implications and pharmacological tests represent key advantages too. On the other hand, obesity prevalence is continuously increasing, and, therefore, the likelihood of having a patient suffering simultaneously from obesity and a particular disease is increasing. Thus, studying diverse diseases in obese animals (either induced naturally or developed) would allow researchers to build a library of data related to the patterns or specificities of obese patients within the context of pathologies. This may lead to a new branch of medicine specifically dedicated to the diseases and care of obese patients, similar to geriatric medicine, which focuses on the elderly population. Full article
(This article belongs to the Special Issue Muscles, Exercise, and Obesity)
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35 pages, 5879 KiB  
Review
Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome
by Mark I. Johnson
Medicina 2021, 57(4), 378; https://doi.org/10.3390/medicina57040378 - 14 Apr 2021
Cited by 24 | Viewed by 15664
Abstract
Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to ‘electrically rubbing [...] Read more.
Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to ‘electrically rubbing pain away’. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the ‘efficacy-impasse’. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a ‘run-in phase’ to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings. Full article
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8 pages, 5003 KiB  
Review
Skeletal Muscle Damage in COVID-19: A Call for Action
by Amira Mohammed Ali and Hiroshi Kunugi
Medicina 2021, 57(4), 372; https://doi.org/10.3390/medicina57040372 - 12 Apr 2021
Cited by 67 | Viewed by 8742
Abstract
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as [...] Read more.
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary. Full article
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5 pages, 14729 KiB  
Case Report
Primary Mucosal Melanoma Presenting with a Unilateral Nasal Obstruction of the Left Inferior Turbinate
by Nicola Lombardo, Marcello Della Corte, Corrado Pelaia, Giovanna Piazzetta, Nadia Lobello, Ester Del Duca, Luigi Bennardo and Steven Paul Nisticò
Medicina 2021, 57(4), 359; https://doi.org/10.3390/medicina57040359 - 08 Apr 2021
Cited by 27 | Viewed by 3029
Abstract
We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. [...] Read more.
We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the facial massif revealed turbinate hypertrophy and a polypoid phlogistic tissue isointense in T1 with an intermediate signal in T2 and Short-TI Inversion Recovery (STIR)-T2, occupying the middle meatus and the anterior upper and lower left meatus with partial obliteration of the ostium and the infundibulum of the maxillary sinus. The Positron emission tomography (PET) exam was negative for metastases. Conservatory surgery in the left anterior video rhinoscopy was performed, allowing a radical 4-cm tumor excision. Histology reported epithelioid cell melanoma, PanK−, CD45−, and PanMelanoma+. Adjuvant radiotherapy was suggested, even considering a complete resection as the result of surgery. No local or systemic relapse was noticed at the 2-month follow-up visit. Although mucosal melanoma is a rare and aggressive malignancy characterized by a poor prognosis, early diagnosis allows a more conservative approach, with little surgical difficulty and no aesthetic effect. Our case raises awareness of the importance of early intervention even in those cases where the clinic symptoms and diagnostic images show uncertain severity. Full article
(This article belongs to the Special Issue New Perspectives in the Treatment of Skin Disease)
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15 pages, 591 KiB  
Review
Management of Myositis-Associated Interstitial Lung Disease
by Tomoyuki Fujisawa
Medicina 2021, 57(4), 347; https://doi.org/10.3390/medicina57040347 - 03 Apr 2021
Cited by 38 | Viewed by 10372
Abstract
Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. [...] Read more.
Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. The management of PM-/DM-/CADM-associated ILD (PM/DM/CADM-ILD) requires careful evaluation of the disease severity and clinical subtype, including the ILD forms (acute/subacute or chronic), because of the substantial heterogeneity of their clinical courses. Recent studies have highlighted the importance of myositis-specific autoantibodies’ status, especially anti-melanoma differentiation-associated gene 5 (MDA5) and anti-aminoacyl tRNA synthetase (ARS) antibodies, in order to evaluate the clinical phenotypes and treatment of choice for PM/DM/CADM-ILD. Because the presence of the anti-MDA5 antibody is a strong predictor of a worse prognosis, combination treatment with glucocorticoids (GCs) and calcineurin inhibitors (CNIs; tacrolimus (TAC) or cyclosporin A (CsA)) is recommended for patients with anti-MDA5 antibody-positive DM/CADM-ILD. Rapidly progressive DM/CADM-ILD with the anti-MDA5 antibody is the most intractable condition, which requires immediate combined immunosuppressive therapy with GCs, CNIs, and intravenous cyclophosphamide. Additional salvage therapies (rituximab, tofacitinib, and plasma exchange) should be considered for patients with refractory ILD. Patients with anti-ARS antibody-positive ILD respond better to GC treatment, but with frequent recurrence; thus, GCs plus immunosuppressants (TAC, CsA, azathioprine, and mycophenolate mofetil) are often needed in order to achieve favorable long-term disease control. PM/DM/CADM-ILD management is still a therapeutic challenge for clinicians, as evidence-based guidelines do not exist to help with management decisions. A few prospective clinical trials have been recently reported regarding the treatment of PM/DM/CADM-ILD. Here, the current knowledge on the pharmacologic managements of PM/DM/CADM-ILD was mainly reviewed. Full article
(This article belongs to the Special Issue Myositis-Associated Interstitial Lung Disease)
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22 pages, 2459 KiB  
Review
Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)
by Francesco Sessa, Monica Salerno and Cristoforo Pomara
Medicina 2021, 57(4), 309; https://doi.org/10.3390/medicina57040309 - 25 Mar 2021
Cited by 21 | Viewed by 4066
Abstract
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east [...] Read more.
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome—Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality. Full article
(This article belongs to the Special Issue Update in Forensic Sciences)
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15 pages, 40176 KiB  
Case Report
COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection—The First Case Confirmed through Autopsy
by Ionuț Isaia Jeican, Patricia Inișca, Dan Gheban, Flaviu Tăbăran, Maria Aluaș, Veronica Trombitas, Victor Cristea, Carmen Crivii, Lia Monica Junie and Silviu Albu
Medicina 2021, 57(4), 302; https://doi.org/10.3390/medicina57040302 - 24 Mar 2021
Cited by 23 | Viewed by 4438
Abstract
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case [...] Read more.
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples. Full article
(This article belongs to the Section Infectious Disease)
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7 pages, 967 KiB  
Case Report
SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples
by Barbara Brogna, Carlo Brogna, Mauro Petrillo, Adriana Modestina Conte, Giulio Benincasa, Luigi Montano and Marina Piscopo
Medicina 2021, 57(3), 290; https://doi.org/10.3390/medicina57030290 - 20 Mar 2021
Cited by 31 | Viewed by 4677
Abstract
Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, [...] Read more.
Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, who resulted in being negative to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests performed on different oropharyngeal and nasopharyngeal swabs, despite serology having confirmed the presence of SARS-CoV-2 IgM. The patient underwent a chest computed tomography (CT) that showed typical imaging findings of COVID-19 pneumonia. The presence of viral SARS-CoV-2 was confirmed only by performing a SARS-CoV-2 RT-PCR test on stool. Performing of SARS-CoV-2 RT-PCR test on fecal samples can be a rapid and useful approach to confirm COVID-19 diagnosis in cases where there is an apparent discrepancy between COVID-19 clinical symptoms coupled with chest CT and SARS-CoV-2 RT-PCR tests’ results on samples from the upper respiratory tract. Full article
(This article belongs to the Section Infectious Disease)
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12 pages, 2271 KiB  
Review
Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature
by Giovanni Coloccia, Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Giuseppina Malcangi, Valentina Montenegro, Assunta Patano, Grazia Marinelli, Claudia Laudadio, Luisa Limongelli, Daniela Di Venere, Denisa Hazballa, Maria Teresa D’Oria, Ioana Roxana Bordea, Edit Xhajanka, Antonio Scarano, Felice Lorusso, Alessandra Laforgia, Francesco Inchingolo and Gianna Dipalma
Medicina 2021, 57(3), 288; https://doi.org/10.3390/medicina57030288 - 19 Mar 2021
Cited by 33 | Viewed by 7393
Abstract
Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander [...] Read more.
Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander approaches. Materials and Methods: The database used to perform the screening and determine the eligibility of the clinical papers was PubMed (Medline). Results: The database search included a total of 284 results, while 271 articles were excluded. A total of 14 articles were included for the qualitative assessment. Conclusions: The effectiveness of the present studies reported that skeletal expansion was a useful approach to increase the transverse changes for subjects with constricted maxillary arches. Full article
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12 pages, 2391 KiB  
Article
Protective Effect of Spirulina-Derived C-Phycocyanin against Ultraviolet B-Induced Damage in HaCaT Cells
by Young Ah Jang and Bo Ae Kim
Medicina 2021, 57(3), 273; https://doi.org/10.3390/medicina57030273 - 16 Mar 2021
Cited by 17 | Viewed by 3958
Abstract
Background and objectives: Reactive oxygen species (ROS) overwhelm the antioxidant defense system, induce oxidative stress, and increase matrix metalloproteinase (MMP) expression, resulting in skin aging. Thus, preventing ultraviolet B (UVB)-induced skin damage can attenuate skin aging. Spirulina (a biomass of cyanobacteria, also called [...] Read more.
Background and objectives: Reactive oxygen species (ROS) overwhelm the antioxidant defense system, induce oxidative stress, and increase matrix metalloproteinase (MMP) expression, resulting in skin aging. Thus, preventing ultraviolet B (UVB)-induced skin damage can attenuate skin aging. Spirulina (a biomass of cyanobacteria, also called blue-green algae) is comprised of prokaryotes, whereas microalgae are eukaryotes and are rich in phycocyanin, a powerful antioxidant. Materials and Methods: Here, we investigated the photoprotective effects of spirulina-derived C-phycocyanin (C-PC) against UVB radiation using keratinocytes (HaCaT cells). Results: UVB radiation increased MMP-1 and MMP-9 expression but decreased involucrin, filaggrin, and loricrin expression. C-PC showed no toxicity at concentrations of 5–80 μg/mL in terms of HaCaT cell viability. UVB-irradiated HaCaT cells had a 50.8% survival rate, which increased to 80.3% with C-PC treatment. MMP expression increased with UVB treatment, whereas MMP-1 and MMP-9 concentrations decreased with C-PC treatment. UVB reduced involucrin, filaggrin, and loricrin expression in HaCaT cells, but 80 μg/mL C-PC increased their expression by >25%. In the UVB radiation group, dichlorofluorescin diacetate fluorescence intensity in HaCaT cells increased by 81.6% compared with that in the control group, whereas ROS production was reduced by 51.2% and 55.1% upon treatment with 40 and 80 μg/mL C-PC, respectively. Conclusions: C-PC might reduce or prevent skin aging by reducing UVB irradiation-induced skin wrinkles and free radicals. Full article
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9 pages, 323 KiB  
Review
New-Onset Diabetes after Kidney Transplantation
by Claudio Ponticelli, Evaldo Favi and Mariano Ferraresso
Medicina 2021, 57(3), 250; https://doi.org/10.3390/medicina57030250 - 08 Mar 2021
Cited by 33 | Viewed by 4521
Abstract
New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, [...] Read more.
New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, whilst the modifiable factors include peri-operative stress, hepatitis C or cytomegalovirus infection, vitamin D deficiency, hypomagnesemia, and immunosuppressive medications such as glucocorticoids, calcineurin inhibitors (tacrolimus more than cyclosporine), and mTOR inhibitors. The most worrying complication of NODAT are major adverse cardiovascular events which represent a leading cause of morbidity and mortality in transplanted patients. However, NODAT may also result in progressive diabetic kidney disease and is frequently associated with microvascular complications, eventually determining blindness or amputation. Preventive measures for NODAT include a careful assessment of glucose tolerance before transplantation, loss of over-weight, lifestyle modification, reduced caloric intake, and physical exercise. Concomitant measures include aggressive control of systemic blood pressure and lipids levels to reduce the risk of cardiovascular events. Hypomagnesemia and low levels of vitamin D should be corrected. Immunosuppressive strategies limiting the use of diabetogenic drugs are encouraged. Many hypoglycemic drugs are available and may be used in combination with metformin in difficult cases. In patients requiring insulin treatment, the dose and type of insulin should be decided on an individual basis as insulin requirements depend on the patient’s diet, amount of exercise, and renal function. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
12 pages, 342 KiB  
Review
Antiviral and Immunomodulation Effects of Artemisia
by Suhas G. Kshirsagar and Rammohan V. Rao
Medicina 2021, 57(3), 217; https://doi.org/10.3390/medicina57030217 - 27 Feb 2021
Cited by 35 | Viewed by 6302
Abstract
Background and Objectives: Artemisia is one of the most widely distributed genera of the family Astraceae with more than 500 diverse species growing mainly in the temperate zones of Europe, Asia and North America. The plant is used in Chinese and Ayurvedic systems [...] Read more.
Background and Objectives: Artemisia is one of the most widely distributed genera of the family Astraceae with more than 500 diverse species growing mainly in the temperate zones of Europe, Asia and North America. The plant is used in Chinese and Ayurvedic systems of medicine for its antiviral, antifungal, antimicrobial, insecticidal, hepatoprotective and neuroprotective properties. Research based studies point to Artemisia’s role in addressing an entire gamut of physiological imbalances through a unique combination of pharmacological actions. Terpenoids, flavonoids, coumarins, caffeoylquinic acids, sterols and acetylenes are some of the major phytochemicals of the genus. Notable among the phytochemicals is artemisinin and its derivatives (ARTs) that represent a new class of recommended drugs due to the emergence of bacteria and parasites that are resistant to quinoline drugs. This manuscript aims to systematically review recent studies that have investigated artemisinin and its derivatives not only for their potent antiviral actions but also their utility against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and Methods: PubMed Central, Scopus and Google scholar databases of published articles were collected and abstracts were reviewed for relevance to the subject matter. Conclusions: The unprecedented impact that artemisinin had on public health and drug discovery research led the Nobel Committee to award the Nobel Prize in Physiology or Medicine in 2015 to the discoverers of artemisinin. Thus, it is clear that Artemisia’s importance in indigenous medicinal systems and drug discovery systems holds great potential for further investigation into its biological activities, especially its role in viral infection and inflammation. Full article
(This article belongs to the Special Issue The Future of Medicine: Frontiers in Integrative Health and Medicine)
11 pages, 1803 KiB  
Article
Perceptions of European ME/CFS Experts Concerning Knowledge and Understanding of ME/CFS among Primary Care Physicians in Europe: A Report from the European ME/CFS Research Network (EUROMENE)
by John Cullinan, Derek F. H. Pheby, Diana Araja, Uldis Berkis, Elenka Brenna, Jean-Dominique de Korwin, Lara Gitto, Dyfrig A. Hughes, Rachael M. Hunter, Dominic Trepel and Xia Wang-Steverding
Medicina 2021, 57(3), 208; https://doi.org/10.3390/medicina57030208 - 26 Feb 2021
Cited by 12 | Viewed by 4585
Abstract
Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as [...] Read more.
Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as to how this could be improved. Materials and Methods: A questionnaire was sent to all national representatives and members of the EUROMENE Core Group and Management Committee. Survey responses were collated and then summarized based on the numbers and percentages of respondents selecting each response option, while weighted average responses were calculated for questions with numerical value response options. Free text responses were analysed using thematic analysis. Results: Overall there were 23 responses to the survey from participants across 19 different European countries, with a 95% country-level response rate. Serious concerns were expressed about GPs’ knowledge and understanding of ME/CFS, and, it was felt, about 60% of patients with ME/CFS went undiagnosed as a result. The vast majority of GPs were perceived to lack confidence in either diagnosing or managing the condition. Disbelief, and misleading illness attributions, were perceived to be widespread, and the unavailability of specialist centres to which GPs could refer patients and seek advice and support was frequently commented upon. There was widespread support for more training on ME/CFS at both undergraduate and postgraduate levels. Conclusion: The results of this survey are consistent with the existing scientific literature. ME/CFS experts report that lack of knowledge and understanding of ME/CFS among GPs is a major cause of missed and delayed diagnoses, which renders problematic attempts to determine the incidence and prevalence of the disease, and to measure its economic impact. It also contributes to the burden of disease through mismanagement in its early stages. Full article
(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)
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9 pages, 285 KiB  
Article
Study on the Effects of Melatonin on Glycemic Control and Periodontal Parameters in Patients with Type II Diabetes Mellitus and Periodontal Disease
by Diana-Maria Anton, Maria-Alexandra Martu, Marius Maris, George-Alexandru Maftei, Irina-Georgeta Sufaru, Diana Tatarciuc, Ionut Luchian, Nicoleta Ioanid and Silvia Martu
Medicina 2021, 57(2), 140; https://doi.org/10.3390/medicina57020140 - 05 Feb 2021
Cited by 27 | Viewed by 3247
Abstract
Background and Objectives: There is evidence that melatonin could improve the periodontal status and also glycemic control of patients with diabetes mellitus. Therefore, the aim of this study was to assess the effects of scaling and root planing plus adjunctive systemic treatment [...] Read more.
Background and Objectives: There is evidence that melatonin could improve the periodontal status and also glycemic control of patients with diabetes mellitus. Therefore, the aim of this study was to assess the effects of scaling and root planing plus adjunctive systemic treatment with melatonin on periodontal parameters and glycemic control in patients with type 2 diabetes and chronic periodontitis. Materials and Methods: The study was conducted on 54 subjects with periodontitis and diabetes mellitus randomly assigned to the study group (n = 27, subjects with scaling and root planing + melatonin) or control group (n = 27, subjects with scaling and root planing + placebo). Periodontal parameters (probing depth—PD; clinical attachment loss—CAL; bleeding on probing—BOP; and hygiene level) and glycated hemoglobin (HbA1c) were assessed at baseline and 8 weeks after. Results: At baseline, there were no significant differences between groups, but at the second evaluation 8 weeks later the association of melatonin with the non-surgical periodontal therapy exerted statistically significant improvements, both in periodontal parameters, with a significant decrease in periodontal disease severity, and glycated hemoglobin when compared to the control subjects. Conclusions: In our study, combined non-surgical periodontal treatment and systemic treatment with melatonin provided additional improvements to severe periodontal condition and the glycemic control of patients with diabetes type 2 when compared to non-surgical periodontal treatment alone. Full article
(This article belongs to the Section Dentistry)
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