Medicina

12 pages, 673 KiB

Open AccessArticle

Exploring Spiritual Needs and Loneliness Among Acutely Hospitalized Patients with Chronic Illnesses: An Observational Study Across Three Waves of the COVID-19 Epidemic in Taiwan

by Yu-Yin Kao, Shu-Wei Wang and Chen-Hsiang Lee

Medicina 2025, 61(4), 770; https://doi.org/10.3390/medicina61040770 - 21 Apr 2025

Abstract

Background and Objectives: Spirituality and loneliness are widely recognized as important aspects of holistic healthcare. This observational study was conducted among hospitalized patients with chronic illnesses in a medical ward during three waves of the epidemic in Taiwan, from April 2022 to [...] Read more.

Background and Objectives: Spirituality and loneliness are widely recognized as important aspects of holistic healthcare. This observational study was conducted among hospitalized patients with chronic illnesses in a medical ward during three waves of the epidemic in Taiwan, from April 2022 to March 2023, to examine changes in spiritual needs and loneliness. Materials and Methods: These waves were classified as the first wave (outbreak period, April 2022 to July 2022); second wave (mitigation period, August 2022 to November 2022); and third wave (December 2022 to March 2023). The Spiritual Needs Scale and Loneliness Scale were used to assess changes in spiritual needs and loneliness of the enrolled patients across the different waves of the epidemic. Results: We found that the spiritual needs of the enrolled patients were higher during the outbreak period (F = 9.847, p < 0.001) compared to the other periods. In addition, loneliness was higher during the conclusion period (F = 45.764, p < 0.001) compared to the other two periods. Age (r = 0.261, p < 0.001) and the Charlson comorbidity index (r = 0.193, p < 0.01) were significantly positively correlated with spiritual needs. Furthermore, the number of daily confirmed COVID-19 cases (r = −0.392, p < 0.001) was significantly negatively correlated with loneliness. Conclusions: Hospitalized patients with chronic illnesses experienced heightened spiritual needs during the COVID-19 outbreak, while loneliness increased as the epidemic waned. The study’s prospective observational design is a strength, but incorporating additional temporal measures between periods would have enhanced the findings. Full article

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

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9 pages, 769 KiB

Open AccessArticle

Potential Benefits of Flunarizine in Patients with Sudden Sensorineural Hearing Loss with Incomplete Recovery Following Conventional Steroid Treatment: A Retrospective Analysis

by Young-Soo Chang and Jeong Hwan Choi

Medicina 2025, 61(4), 769; https://doi.org/10.3390/medicina61040769 - 21 Apr 2025

Abstract

Objectives: This study assessed the potential benefits of supplemental flunarizine administration in patients with sudden sensorineural hearing loss (SSNHL) experiencing incomplete recovery with conventional steroid treatment. Methods: Thirty-nine SSNHL patients, unresponsive to conventional steroid therapy, received either oral ginkgo biloba (control [...] Read more.

Objectives: This study assessed the potential benefits of supplemental flunarizine administration in patients with sudden sensorineural hearing loss (SSNHL) experiencing incomplete recovery with conventional steroid treatment. Methods: Thirty-nine SSNHL patients, unresponsive to conventional steroid therapy, received either oral ginkgo biloba (control group, n = 24) or a combination of oral ginkgo biloba and flunarizine (treatment group, n = 15). Pure-tone average (PTA) evaluation at 0.5, 1, 2, and 4 kHz was conducted upon each patient’s visits. A change of ≥10 dB was considered ‘significant hearing gain’. Results: The treatment group showed a higher rate of hearing gain ≥10 dB (46.7%) compared to the control group (12.5%) (p = 0.03). Additional treatment with flunarizine was associated with greater improvement in hearing thresholds compared with ginkgo biloba alone (p = 0.004), suggesting a potential therapeutic benefit. Conclusion: This retrospective study suggests that flunarizine may provide additional benefit in patients with SSNHL experiencing incomplete recovery following conventional steroid treatment. These findings are preliminary and require validation in larger, controlled studies. Full article

(This article belongs to the Section Surgery)

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32 pages, 776 KiB

Open AccessReview

Hemodynamic Monitoring During Liver Transplantation for Patients on Perioperative Extracorporeal Membrane Oxygenation (ECMO) Support: A Narrative Review

by Stefano Tigano, Giulio Casolaro, Amedeo Bianchini, Enrico Bernardi, Cristiana Laici, Linda Ramahi, Giovanni Vitale and Antonio Siniscalchi

Medicina 2025, 61(4), 768; https://doi.org/10.3390/medicina61040768 - 21 Apr 2025

Abstract

Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is [...] Read more.

Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is made possible by donations made after circulatory death (DCD). Liver transplantation (LT) in such high-risk patients may be challenging and may require perioperative Extracorporeal Membrane Oxygenation (ECMO). There is a lack of evidence on the best hemodynamic monitoring techniques for patients undergoing ECMO support during the perioperative period of LT. This review aims to provide a comprehensive overview of the hemodynamic monitoring standards of patients supported by ECMO before, during, and after LT. Materials and Methods: Comprehensive research was conducted through the PubMed database, and 153 articles regarding patients who needed perioperative ECMO support were found. Among these, 18 articles were finally included in our analysis as the authors specified hemodynamic monitoring techniques and data. The articles included case reports, letters to the editor, and correspondence. Results: We identified 20 cases of patients supported by ECMO as a planned preoperative strategy (9 patients), as a rescue therapy during surgery (7 patients), and as a postoperative support (4 patients). Cardiac catheterism and echocardiography (transthoracic and transesophageal) were the authors’ most cited hemodynamic monitoring techniques. Conclusions: Data on hemodynamic monitoring methods used to manage patients supported by ECMO during the whole perioperative period of LT are poor and derived from descriptive low-quality studies. However, a multimodal approach that includes continuous monitoring of pulmonary pressures and echocardiography can increase diagnostic accuracy and improve the decision-making process to manage this complex patient population. Full article

(This article belongs to the Special Issue Extracorporeal Membrane Oxygenation (ECMO): New Insights and Future Directions)

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19 pages, 2521 KiB

Open AccessSystematic Review

Alterations in von Willebrand Factor Levels in Patients with Malaria: A Systematic Review and Meta-Analysis of Disease Severity

by Suriyan Sukati, Rujikorn Rattanatham, Frederick Ramirez Masangkay, Ching-Ping Tseng and Manas Kotepui

Medicina 2025, 61(4), 767; https://doi.org/10.3390/medicina61040767 - 21 Apr 2025

Abstract

Background and Objectives: Elevated von Willebrand factor (vWF) levels have been reported in malaria, but their relationship with disease severity remains unclear. This study aimed to compare vWF levels between Plasmodium-infected and uninfected individuals and assess changes in severe infections. Materials [...] Read more.

Background and Objectives: Elevated von Willebrand factor (vWF) levels have been reported in malaria, but their relationship with disease severity remains unclear. This study aimed to compare vWF levels between Plasmodium-infected and uninfected individuals and assess changes in severe infections. Materials and Methods: The systematic review was registered in PROSPERO (CRD42024558479). A comprehensive search across six databases identified studies reporting vWF levels in malaria. A meta-analysis was conducted using a random-effects model, with standardized mean difference (SMD) as the effect measure due to varying measurement units. Heterogeneity was assessed using the I² statistic. Results: Of 1647 identified records, 26 studies met the inclusion criteria. The meta-analysis showed significantly higher vWF levels in Plasmodium-infected individuals compared to uninfected controls (p < 0.001, SMD: 2.689 [95% CI 1.362; 4.017], I²: 98.1%, 12 studies, 3109 participants). However, no significant difference was found between severe and less severe cases (p = 0.051, SMD: 3.551 [95% CI −0.007; 7.109], I²: 99.3%, 8 studies, 1453 participants). Conclusions: vWF levels are significantly elevated in individuals with Plasmodium infections, indicating a potential role in malaria pathophysiology. Although levels tend to be higher in severe cases, current evidence is insufficient to support vWF as a reliable marker for disease severity. Further prospective and well-controlled studies are needed to validate its diagnostic and prognostic value in malaria management. Full article

(This article belongs to the Special Issue Infectious and Tropical Diseases: Symptoms, Diagnosis and Treatment)

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10 pages, 717 KiB

Open AccessArticle

Evaluation of the Electrocardiographic Tp-e, Tp-e/QT, and Tp-e/QTc Parameters in Patients with Non-Alcoholic Liver Disease

by Kader Eliz Sahin, Mesut Karatas, Sezgin Barutcu and Ibrahim Halil Inanc

Medicina 2025, 61(4), 766; https://doi.org/10.3390/medicina61040766 - 21 Apr 2025

Abstract

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease associated with significant morbidity, including cardiovascular complications. This study investigates the relationship between NAFLD and electrocardiographic parameters indicative of ventricular arrhythmia risk. Materials and Methods: We conducted a cross-sectional [...] Read more.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease associated with significant morbidity, including cardiovascular complications. This study investigates the relationship between NAFLD and electrocardiographic parameters indicative of ventricular arrhythmia risk. Materials and Methods: We conducted a cross-sectional study enrolling 136 patients with NAFLD and 136 healthy controls. Electrocardiographic parameters—Tp-e interval, QT and corrected QT (QTc) intervals, and Tp-e/QTc ratio—were measured and compared between groups. Results: Patients with NAFLD exhibited significantly higher Tp-e, QTc, Tp-e/QT ratio, and Tp-e/QTc ratio (p < 0.001, for all) than controls. Subgroup analysis showed progressive increases in Tp-e and Tp-e/QT ratio correlating with NAFLD severity (p < 0.001 and p = 0.001, respectively, for grade 1 vs. grade 2; p < 0.001 and p = 0.001, respectively, for grade 1 vs. grade 3). ROC analysis indicated that the Tp-e interval was a strong predictor for identifying grade 2 or more NAFLD (AUC 0.887, p < 0.001). Conclusions: Our findings highlight the association of NAFLD with prolonged electrocardiographic intervals that may predispose patients to ventricular arrhythmias. These parameters can serve as valuable markers for cardiac risk stratification in patients with NAFLD, suggesting the need for vigilant cardiac follow-up in this population. Full article

(This article belongs to the Special Issue An Update to the Epidemiology, Diagnostic Challenges, and Molecular Bases of Nonalcoholic Fatty Liver Disease)

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16 pages, 3745 KiB

Open AccessReview

The Role of MDCT Coronary Angiography in the Detection of Benign Varieties and Anomalies of Coronary Blood Vessels—A Narrative Review

by Ana Mladenovic Markovic, Ana Tomic, Miodrag Nisevic, Biljana Parapid, Nikola Boskovic, Marina Vitas, Miona Jevtovic and Sandra Grujicic

Medicina 2025, 61(4), 765; https://doi.org/10.3390/medicina61040765 - 21 Apr 2025

Abstract

Coronary arteries may vary in quantity, point of origin, or course. These variations fall under the category of anatomical variants/anomalies of the coronary arteries, representing congenital abnormalities of the coronary vascular system. Generally, they are benign, asymptomatic, and identified inadvertently during coronary angiography [...] Read more.

Coronary arteries may vary in quantity, point of origin, or course. These variations fall under the category of anatomical variants/anomalies of the coronary arteries, representing congenital abnormalities of the coronary vascular system. Generally, they are benign, asymptomatic, and identified inadvertently during coronary angiography conducted for alternative indications. However, in some cases, the anomaly’s characteristics or its interaction with surrounding structures may cause hemodynamic disturbances. These disturbances can lead to turbulent blood flow, which in turn poses an increased likelihood for the development of atherosclerosis and myocardial ischemia. If symptomatic, potential manifestations include chest pain, arrhythmias, syncope, myocardial infarction, and sudden cardiac death. Given the potential for life-threatening complications in certain cases, the early and accurate diagnosis of coronary artery anomalies is of paramount importance. The most common diagnostic procedures used for the evaluation of coronary vessels are coronary angiography and multi-detector row computed tomography (MDCT) coronary angiography. MDCT angiography is a non-invasive, dependable, safe, and sensitive method for the detailed visualization of coronary anatomy. It offers high-resolution imaging that enables precise assessment of congenital coronary variations, aiding in both clinical decision-making and long-term patient management. We conducted a narrative review to analyze and integrate the body of literature on coronary artery varieties and anomalies. Our objective was to provide a comprehensive, albeit non-exhaustive, overview of essential concepts and findings related to their definition, classification, and detection with MDCT angiography. By integrating current knowledge in MDCT imaging, we seek to contribute to a better understanding of the clinical implications of coronary artery variations and their role in cardiovascular health. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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14 pages, 1445 KiB

Open AccessSystematic Review

Use of Quadruple Therapy in the Management of Hypertension: A Systematic Review of Randomized Controlled Trials

by Khalid A. Alnemer

Medicina 2025, 61(4), 764; https://doi.org/10.3390/medicina61040764 - 21 Apr 2025

Abstract

Background and objectives: Hypertension remains a leading global cause of cardiovascular morbidity and mortality, with suboptimal blood pressure (BP) control despite available treatments. Monotherapy often fails to achieve target BP, necessitating combination therapies. Quadruple low-dose combination therapy (quadpill) has emerged as a potential [...] Read more.

Background and objectives: Hypertension remains a leading global cause of cardiovascular morbidity and mortality, with suboptimal blood pressure (BP) control despite available treatments. Monotherapy often fails to achieve target BP, necessitating combination therapies. Quadruple low-dose combination therapy (quadpill) has emerged as a potential strategy to enhance efficacy while minimizing side effects. This systematic review evaluates the effectiveness and safety of quadpill therapy compared to standard monotherapy and dual therapy. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus from inception till January 2025 for randomized controlled trials (RCTs) investigating quadruple therapy in hypertensive patients. Studies comparing quadpill therapy with monotherapy, dual therapy, or placebo were included. Data on BP reduction, achievement of target BP, and adverse events were extracted and analyzed. The Cochrane Risk of Bias tool (RoB-2) was used to assess study quality. Results: Five RCTs were included in the current systematic review. Quadpill therapy resulted in greater reductions in systolic BP (SBP and diastolic BP (DBP) compared to monotherapy and dual therapy across all time points. The proportion of patients achieving target BP (<140/90 mmHg) was significantly higher in the quadpill group. The safety profile was favorable, with adverse event rates comparable to those in monotherapy and dual therapy groups. Notable adverse effects included mild dizziness, edema, and biochemical alterations (elevated fasting glucose and uric acid levels), but these did not lead to significant treatment discontinuation. Conclusions: Quadruple low-dose combination therapy is a promising approach for improving BP control while maintaining a favorable safety profile. Early initiation of quadpill therapy could mitigate treatment inertia and improve long-term cardiovascular outcomes. Full article

(This article belongs to the Section Cardiology)

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20 pages, 3447 KiB

Open AccessArticle

Sternal Resections: An Attempt to Find the Ideal Reconstruction Method

by Emanuel Palade, Ioana-Medeea Titu, Lucian Fodor, Ion Mircea Ciorba, Ion Jentimir, Florin Teterea, Monica Mlesnite and Ioana Tichil

Medicina 2025, 61(4), 763; https://doi.org/10.3390/medicina61040763 - 21 Apr 2025

Abstract

Background and Objectives: Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus [...] Read more.

Background and Objectives: Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel “spider-web” technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. Materials and Methods: Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the “spider-web” technique–based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh–followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. Results: Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330–435 min). All patients were extubated postoperatively without the need for respiratory support. The “spider-web” construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD ± 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD ± 6.55 months), without long-term complications. Conclusions: The “spider-web” technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity. Full article

(This article belongs to the Section Surgery)

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15 pages, 982 KiB

Open AccessArticle

Evaluation of the Efficacy, Safety, and Adherence to Oral Drug Therapy in Patients with Relapsing–Remitting Multiple Sclerosis

by Paulius Sėdžius and Dalia Musneckienė

Medicina 2025, 61(4), 762; https://doi.org/10.3390/medicina61040762 - 21 Apr 2025

Abstract

Background and Objectives: Selecting appropriate disease-modifying drugs (DMDs) is crucial for optimizing treatment and slowing disease progression in multiple sclerosis (MS). Real-world studies assess drug efficacy and usage in routine clinical practice. Therefore, the goal of this study was to determine the efficacy [...] Read more.

Background and Objectives: Selecting appropriate disease-modifying drugs (DMDs) is crucial for optimizing treatment and slowing disease progression in multiple sclerosis (MS). Real-world studies assess drug efficacy and usage in routine clinical practice. Therefore, the goal of this study was to determine the efficacy and safety of oral drug therapy in patients with relapsing–remitting multiple sclerosis and the particularities of adherence to the therapy. Materials and Methods: A retrospective and prospective study was conducted at the Neurology Clinic of the Kaunas Clinics of the Lithuanian University of Health Sciences. The medical records of patients with relapsing–remitting multiple sclerosis (RRMS) were reviewed. The retrospective study included 286 patients, and the prospective study included 175 patients. Results: The study population included 131 patients on teriflunomide (TFN), 53 on dimethyl fumarate (DMF), 37 on fingolimod (FTY), and 65 on cladribine (CLAD). The overall absolute reduction in the ARR over 4 years of treatment was higher in the second-line (FTY and CLAD) group (−2.00) compared with the first-line (−0.99) group (TFN and DMF). The total EDSS scores of patients who received FTY and CLAD were higher in the second (3.09, p = 0.024), third (3.94, p = 0.015), and fourth (3.6, p = 0.002) years of treatment, compared with the patients of first-line therapy. MRI revealed that the number of contrast-enhancing and new lesions was lower among patients taking second-line drugs in the second year (4.7% and 18.6%, respectively). The worst adherence to the drug therapy due to forgetfulness was observed in the DMF group (30.8%). Lymphopenia was less frequent in the TFN group (93.1%) and more frequent in the FTY group (86.5%) (p < 0.001). Conclusions: Over four years, second-line patients had greater ARR reduction, fewer MRI lesions, and higher EDSS from year two. DMF showed the lowest adherence, mainly due to patient forgetfulness, while lymphopenia occurred most frequently with FTY. Full article

(This article belongs to the Section Neurology)

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17 pages, 273 KiB

Open AccessArticle

An Assessment of the Knowledge of Autism Spectrum Disorder Among Polish Primary Care Physicians

by Patryk Domarecki, Katarzyna Plata-Nazar and Kristin Sohl

Medicina 2025, 61(4), 761; https://doi.org/10.3390/medicina61040761 - 21 Apr 2025

Abstract

Background and Objectives: In light of the growing need to incorporate primary care physicians (PCPs) in the complex care system for autistic patients, this study aims to assess the level of physicians’ knowledge of the autism spectrum in Poland. Materials and Methods [...] Read more.

Background and Objectives: In light of the growing need to incorporate primary care physicians (PCPs) in the complex care system for autistic patients, this study aims to assess the level of physicians’ knowledge of the autism spectrum in Poland. Materials and Methods: After a literature review, an online survey consisting of 20 items assessing the knowledge of autism etiology, diagnosis criteria, and patient support was developed. Of 250 invitations, 166 physicians filled out the form (a 66.4% response rate). For the statistical analysis, the normal distribution was excluded for all data based on the Shapiro–Wilk test. The U-Mann–Whitney test was performed for two variables to verify the comparison of variables. The threshold of statistical significance was at the level of p = 0.05. Results: Correct responses regarding autism etiology, diagnosis, and support were 37.95%, 42.69%, and 70.05%, respectively. Female physicians presented a higher level of knowledge regarding all categories. The level of general knowledge is statistically higher in pediatricians than in general practitioners, and the knowledge of physicians in training is higher in contrast to specialists. The knowledge of physicians from small towns, as well as physicians with more clinical experience, was low. Conclusions: This study revealed an insufficient level of knowledge relating to autism spectrum disorder among primary care physicians, which is similar to the findings of other studies conducted in different regions of the world. The lack of knowledge is especially evident in the theoretical preparation of physicians regarding ASD. Full article

(This article belongs to the Section Neurology)

14 pages, 491 KiB

Open AccessArticle

Role of Salivary Biomarkers IL-1β and MMP-8 in Early Detection and Staging of Periodontal Disease

by Liliana Sachelarie, Corina Laura Stefanescu, Rodica Maria Murineanu, Mircea Grigorian, Agripina Zaharia, Ioana Scrobota and Loredana Liliana Hurjui

Medicina 2025, 61(4), 760; https://doi.org/10.3390/medicina61040760 - 20 Apr 2025

Abstract

Background: Periodontal disease is a chronic inflammatory condition affecting the supporting tissues of the teeth. Early diagnosis is crucial for preventing severe complications. This study investigates and compares the utility of two salivary biomarkers, interleukin-1 beta (IL-1β) and matrix metalloproteinase-8 (MMP-8), in [...] Read more.

Background: Periodontal disease is a chronic inflammatory condition affecting the supporting tissues of the teeth. Early diagnosis is crucial for preventing severe complications. This study investigates and compares the utility of two salivary biomarkers, interleukin-1 beta (IL-1β) and matrix metalloproteinase-8 (MMP-8), in the early detection and staging of periodontal disease. Methods: This study included 189 patients, all of whom were evaluated both clinically and biologically. Each participant provided unstimulated saliva samples, which were analyzed using ELISA methods to quantify IL-1β and MMP-8 levels. Clinical periodontal data, including probing depth (3.9 ± 0.6 mm), clinical attachment loss (3.4 ± 0.6 mm), and Plaque Index (2.35 ± 0.55), were collected for all subjects. Biomarker concentrations were then correlated with these clinical parameters and with disease severity, classified according to the 2018 EFP/AAP criteria. Results: IL-1β levels (210 ± 95 pg/mL) were strongly associated with early gingival inflammation, while MMP-8 levels (185 ± 140 ng/mL) correlated with periodontal tissue destruction (p < 0.01). MMP-8 showed a higher sensitivity for diagnosing advanced stages (p = 0.002), whereas IL-1β was more effective in detecting early inflammatory changes (p = 0.01). Logistic regression identified MMP-8 as a significant predictor of advanced disease (coefficient 0.85, p < 0.001) and IL-1β as an indicator of early inflammation (coefficient 0.25, p = 0.02). Conclusions: Both biomarkers are valuable tools for the diagnosis and staging of periodontal disease. MMP-8 is relevant for identifying advanced cases, while IL-1β supports early detection. Their combined use may enhance diagnostic accuracy and guide personalized periodontal care. Full article

(This article belongs to the Special Issue Recent Breakthroughs in the Diagnosis and Treatment of Oral Inflammatory Diseases)

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11 pages, 1659 KiB

Open AccessArticle

Chainsaw-Related Extremity Injuries

by Hüseyin Utku Özdeş, Emre Ergen, Muhammed Köroğlu, Mustafa Karakaplan, Ömer Acet, Fırat Al, İdris Çoban, Ferdi Özdemir, Oğuzhan Tok, Tahsin Sarıbas, Harun Köse, Şeyma Yaşar, Kadir Ertem and Okan Aslantürk

Medicina 2025, 61(4), 759; https://doi.org/10.3390/medicina61040759 - 20 Apr 2025

Abstract

Background: Chainsaw-related injuries vary from skin lacerations to amputation and may cause serious loss of work time in addition to temporary or permanent disability. Most studies in the literature have reported injuries to the lower or upper extremities separately. The aim of our [...] Read more.

Background: Chainsaw-related injuries vary from skin lacerations to amputation and may cause serious loss of work time in addition to temporary or permanent disability. Most studies in the literature have reported injuries to the lower or upper extremities separately. The aim of our study is to compare the loss of work time between upper- and lower-extremity chainsaw-related non-occupational injuries in rural areas. Methods: Chainsaw-related injuries that occurred in rural areas and were treated in our center between 2012 and 2022 were retrospectively reviewed. The patients’ demographics, the injured side and structures, the hand dominance of operators, lengths of hospital stays, the numbers of operations, complications, and loss of work time were recorded. Results: In total, 185 patients (181 males and four females) were enrolled in this study. The mean age was 45.5 years (range: 17–81). The mean follow-up time was 9.3 months (range: 6–24). The lower extremities were affected in 109 patients, while the upper extremities were affected in 76. The loss of work time was 60 and 75 days for lower- and upper-extremity injuries, respectively, and was statistically significantly higher for upper-extremity injuries (p < 0.001). The fracture rate was higher in the upper than the lower extremities, at 50% and 26.6%, respectively. Conclusions: Chainsaws may cause severe injuries in both the upper and lower extremities, and while the lower extremities were affected more frequently, upper-extremity injuries caused a greater loss of work time. Through the use of protective gear and simple precautions, chainsaw-related injuries and the associated loss of work time can be prevented. Full article

(This article belongs to the Section Orthopedics)

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2 pages, 185 KiB

Open AccessEditorial

Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases

by Ludovico Abenavoli and Marcello Candelli

Medicina 2025, 61(4), 758; https://doi.org/10.3390/medicina61040758 - 20 Apr 2025

Viewed by 66

Abstract

The Special Issue titled “Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases” is a collection of papers from our Editorial Board Members and researchers invited by them [...] Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)

21 pages, 1313 KiB

Open AccessArticle

Cognitive and Neuropsychiatric Effects of 40 Hz tACS Simultaneously with Cognitive Exercises for Dementia: A Randomized, Crossover, Double-Blind, Sham-Controlled Study

by Maria Anabel Uehara, Sumeet Kalia, Mari Garcia Campuzano, Mohammad Jafari-Jozani, Brian Lithgow and Zahra Moussavi

Medicina 2025, 61(4), 757; https://doi.org/10.3390/medicina61040757 - 19 Apr 2025

Viewed by 42

Abstract

Background and Objectives: Transcranial alternating current stimulation (tACS) at 40 Hz has shown potential to enhance cognitive function. However, research on its combination with cognitive exercises, particularly its long-term effects in a dementia population, remains limited. This study investigated the effects of [...] Read more.

Background and Objectives: Transcranial alternating current stimulation (tACS) at 40 Hz has shown potential to enhance cognitive function. However, research on its combination with cognitive exercises, particularly its long-term effects in a dementia population, remains limited. This study investigated the effects of 40 Hz tACS paired with simultaneous cognitive exercises on cognition, neuropsychiatric symptoms, and the depression status of individuals with dementia in a sham-controlled, double-blind crossover design. Materials and Methods: A total of 42 participants with dementia were randomized into two groups: (1) the R1S2 group received 40 Hz real tACS with cognitive exercises, followed by a ≥8-week washout period, and then sham tACS with cognitive exercises; (2) the S1R2 group received the reversed sequence. tACS was applied at 1.5 mA peak-to-peak with electrodes over the left dorsolateral prefrontal cortex and contralateral supraorbital area. Participants received two 30 min stimulation sessions per day, 5 days per week, for 4 consecutive weeks, paired with cognitive exercises using the MindTriggers app (2.9.1). The primary outcome was the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) and the secondary outcomes included the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Neuropsychiatric Inventory Questionnaire (NPI-Q). All outcome measures were assessed before and after each treatment block. Results: Real tACS paired with cognitive exercises significantly improved ADAS-Cog scores post-treatment compared to pre-treatment (p-value = 0.019), whereas sham tACS did not. Furthermore, real tACS produced significant long-term improvements approximately 2–3 months post-treatment in ADAS-Cog scores compared to sham (p-value = 0.048). Both real (p-value = 0.003) and sham (p-value = 0.015) tACS significantly reduced NPI-Q scores post-treatment. MADRS scores significantly improved (p-value = 0.007) post-treatment for real tACS but not sham. Conclusions: The 40 Hz tACS paired with cognitive exercises improves cognition, neuropsychiatric symptoms, and depression post-treatment in dementia, with sustained cognitive effects. The findings highlight its potential as a non-invasive therapeutic intervention for dementia. Full article

(This article belongs to the Special Issue Efficacy of Transcranial Electrical Current and Magnetic Stimulation Treatment Options for Alzheimer’s Disease)

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12 pages, 3566 KiB

Open AccessArticle

The Impact of Coagulation Biomarkers on Survival Outcomes in Adult Glioblastoma

by Rahmi Atıl Aksoy, Timur Koca, Yasemin Şengün, Ece Atak and Aylin Fidan Korcum

Medicina 2025, 61(4), 756; https://doi.org/10.3390/medicina61040756 - 19 Apr 2025

Viewed by 52

Abstract

Background and Objectives: Glioblastoma presents a significant challenge in oncology due to its aggressive nature and poor prognosis, despite advancements in treatment. This study aims to comprehensively evaluate the prognostic significance of coagulation biomarkers, including the novel albumin/D-dimer ratio, in adult glioblastoma [...] Read more.

Background and Objectives: Glioblastoma presents a significant challenge in oncology due to its aggressive nature and poor prognosis, despite advancements in treatment. This study aims to comprehensively evaluate the prognostic significance of coagulation biomarkers, including the novel albumin/D-dimer ratio, in adult glioblastoma patients. Material and Methods: This retrospective study included 74 adult glioblastoma patients who underwent Stupp protocol treatment. Blood samples were collected before radiotherapy to measure biomarkers, including prothrombin time (PT), activated partial thromboplastin time (aPTT), albumin, D-dimer, and the albumin/D-dimer ratio. The prognostic significance of these biomarkers for progression-free survival (PFS) and overall survival (OS) was assessed using both univariate and multivariate Cox regression analyses. Results: The median follow-up time was 12.2 months (range, 1–77.4 months). Univariate analysis revealed that ECOG performance status (p = 0.001), D-dimer (p = 0.03), and albumin (p = 0.001) were significant prognostic factors for PFS. Multivariate analysis identified albumin (p = 0.02) as an independent prognostic biomarker for PFS. For OS, univariate analysis showed that age (p = 0.004), ECOG performance status (p = 0.001), tumor volume (p = 0.007), extent of resection (p = 0.01), radiotherapy dose (p = 0.001), D-dimer (p = 0.02), albumin (p = 0.001), albumin/D-dimer ratio (p = 0.02), and PT (p = 0.002) were significant prognostic factors. Multivariate analysis revealed age (p = 0.04), extent of resection (p = 0.02), and PT (p = 0.04) as independent prognostic factors for OS. Conclusions: Our findings highlight the prognostic significance of coagulation biomarkers, particularly PT, D-dimer, albumin, and the albumin/D-dimer ratio, in glioblastoma. These biomarkers may serve as valuable tools for prognostic assessment and personalized treatment strategies, warranting further exploration in larger prospective studies. Full article

(This article belongs to the Special Issue Early Diagnosis and Management of Glioma)

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8 pages, 604 KiB

Open AccessBrief Report

Effect of NT-proBNP on Serum Calcium: A Longitudinal Analysis

by Maria Rita Stancanelli, Giuseppe Restivo, Thea Corriere, Carmela Cannarozzo, Maria Gabriella Ferrara, Rosario Salemi, Maria Eva Sberna, Angelo Iraci, Ada Restivo, Valeria Furia, Elisa Longhitano, Domenico Santoro and Vincenzo Calabrese

Medicina 2025, 61(4), 755; https://doi.org/10.3390/medicina61040755 - 19 Apr 2025

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Abstract

Background and Objectives: Brain natriuretic peptide (NT-proBNP) is a biomarker widely used in diagnosing and monitoring heart failure. Its impact on electrolyte homeostasis is known, particularly for sodium. However, its relationship with serum calcium remains unclear. This retrospective observational study aimed to [...] Read more.

Background and Objectives: Brain natriuretic peptide (NT-proBNP) is a biomarker widely used in diagnosing and monitoring heart failure. Its impact on electrolyte homeostasis is known, particularly for sodium. However, its relationship with serum calcium remains unclear. This retrospective observational study aimed to investigate the longitudinal association between NT-proBNP and serum calcium levels in a cohort of hospitalized patients with the goal of determining whether NT-proBNP could have a direct or indirect impact on calcium metabolism. Materials and Methods: We included 688 patients with 1022 repeated measurements of NT-proBNP and serum calcium collected during hospitalization from March 2022 to February 2025. Linear mixed models (LMMs) were employed to analyze longitudinal associations, adjusting for age, eGFR, estimated plasma volume status (ePVs), CRP, potassium, and albumin. Results: Baseline analysis revealed a negative correlation between NT-proBNP and serum calcium (r = −0.23, p < 0.001). Univariate LMM demonstrated a significant negative association (β = −1.3 × 10⁻⁵, p < 0.001), which remained significant in multivariate analysis (β = −6.9 × 10⁻⁶, p = 0.01), accounting for intrasubject variability. This suggests that as NT-proBNP increases, serum calcium levels decrease within individual patients, independent of confounders. This study’s findings indicate that NT-proBNP may influence calcium excretion, possibly through mechanisms involving the sodium–calcium exchanger (NCX) in renal tubules, similar to its effects on sodium homeostasis. Conclusions: This is the first study to evaluate the longitudinal impact of NT-proBNP on serum calcium, highlighting a potential clinical relevance in patients with cardiac dysfunction. Limitations include a retrospective design and a lack of urine calcium data. Further research is warranted to validate these findings and elucidate the underlying mechanisms. Full article

(This article belongs to the Section Urology & Nephrology)

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13 pages, 3362 KiB

Open AccessArticle

Delta and Theta Band Power Alterations During Face and Face Pareidolia Perception in Children with Autism Spectrum Disorder: An Electroencephalographic Analysis

by Gülsüm Akdeniz

Medicina 2025, 61(4), 754; https://doi.org/10.3390/medicina61040754 - 19 Apr 2025

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Abstract

Background and Objectives: Autism Spectrum Disorder (ASD) is characterized by a range of deficits across cognitive, sensory, motor, emotional, language, and social domains, which can significantly hinder daily functioning and social interactions. This study explores the differences in brain activity between children [...] Read more.

Background and Objectives: Autism Spectrum Disorder (ASD) is characterized by a range of deficits across cognitive, sensory, motor, emotional, language, and social domains, which can significantly hinder daily functioning and social interactions. This study explores the differences in brain activity between children with ASD and typically developing peers, focusing on their responses to face and face pareidolia stimuli. Materials and Methods: A group comprising ten typically developing children (four males, six females), aged between 6 and 16 years, alongside eleven children diagnosed with ASD (three males, eight females), whose ages ranged from 6 to 15 years, were engaged in the pilot study. We recorded brain electrical activity using electroencephalography (EEG) while participants viewed images of face and face pareidolia images. Following face and pareidolia stimulus presentation, delta and theta powers in the 0.5–4 Hz and 4–6 Hz frequency ranges and within the 140–190 ms time window were analyzed for both typically developing children and children with ASD. Results: The research result reveals that children with ASD show lower amplitude and delayed latency in their EEG responses, particularly in the theta and delta frequency bands, when processing images that evoke face pareidolia. Conclusions: The findings suggest that while children with ASD face challenges in recognizing faces, they may still possess some perceptual abilities that could be harnessed for therapeutic interventions. Moreover, this research highlights the potential of the face pareidolia paradigm to provide insights that could inform future strategies aimed at enhancing social attention and interaction skills in children with ASD. Despite the limitations of the current sample size, this study provides a valuable foundation for future investigations. Expanding the participant pool will be crucial for confirming and generalizing these findings. Full article

(This article belongs to the Section Psychiatry)

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13 pages, 1116 KiB

Open AccessArticle

Variability in Survival Outcomes Among Asian Ethnic Groups with Stage IV NSCLC

by Aria Bassiri, Yue-Lin Hu, Christina Boutros, Boxiang Jiang, Jillian Sinopoli, Leonidas Tapias Vargas, Philip A. Linden and Christopher W. Towe

Medicina 2025, 61(4), 753; https://doi.org/10.3390/medicina61040753 - 19 Apr 2025

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Abstract

Background and Objectives: Patients of Asian descent are often grouped together despite their diverse ethnicities and genetic backgrounds. Cancer outcomes result from a complex interplay of genetics, environment, and socioeconomic factors. This study aims to describe lung cancer survival outcome variations in [...] Read more.

Background and Objectives: Patients of Asian descent are often grouped together despite their diverse ethnicities and genetic backgrounds. Cancer outcomes result from a complex interplay of genetics, environment, and socioeconomic factors. This study aims to describe lung cancer survival outcome variations in Asian ethnic subgroups, hypothesizing that significant outcome differences exist between subgroups. Materials and Methods: A retrospective analysis of the 2020 National Cancer Database identified patients with stage IV non-small-cell lung cancer (NSCLC). Asian patients were subcategorized into nine groups: Chinese, Japanese, Korean, Asian Indian/Pakistani, Vietnamese, Pacific Islander, Filipino, Laotian/Hmong/Kampuchean/Thai, and Other Asian/Asian not otherwise specified (NOS). The primary outcome was overall survival, and the secondary outcome was utilization of palliative care. Kaplan–Meier analysis and multivariate Cox and logistic modeling were used to assess outcomes of interest. Results: A total of 23,747 Asian patients with stage IV NSCLC were identified. Demographic characteristics of the subgroups varied by age, sex, Charlson–Deyo Comorbidity Index, and utilization of palliative care. Relative to Chinese Asians, multivariate Cox analysis showed worse survival outcomes among patients categorized as Japanese, Korean, Pacific Islanders, Filipino, and Laotian/Hmong/Kampuchean/Thai. The rate of palliative care utilization also varied among Asian subgroups. Compared to Chinese patients, palliative care was more likely to be utilized by patients categorized as Japanese and Pacific Islander. Conclusions: Amongst Asian subgroups, variations in survival outcomes and palliative care utilization in stage IV NSCLC patients were observed. Surgeons should acknowledge these disparities and consider disaggregating Asian races in prognosis analysis to enhance understanding of race’s impact on outcomes. Recognizing these differences is crucial for guiding personalized treatment strategies, optimizing resource allocation, and informing health policy to ensure equitable cancer care for all Asian populations. Full article

(This article belongs to the Section Oncology)

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16 pages, 1579 KiB

Open AccessArticle

A Comparative Longitudinal Study Analyzing Vaginal Microbiota Differences Between Term and Preterm Pregnancies in Korean Women

by Gina Nam, Kyung A. Lee, Soo Jung Kim, Kwan Young Oh, Sunghee Lee, Hyun Chul Lee, So Yoon Kim and Mi Hye Park

Medicina 2025, 61(4), 752; https://doi.org/10.3390/medicina61040752 - 18 Apr 2025

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Abstract

Background and Objectives: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, remains a significant public health concern due to its association with neonatal morbidity and mortality. Although studies have suggested that microbial factors in vaginal microbiota (VMB) influence PTB, [...] Read more.

Background and Objectives: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, remains a significant public health concern due to its association with neonatal morbidity and mortality. Although studies have suggested that microbial factors in vaginal microbiota (VMB) influence PTB, longitudinal research on Korean women is limited. This study aimed to analyze VMB differences between term and preterm pregnancies in Korean women and their correlation with the cervical length (CL). Materials and Methods: A cohort of 60 pregnant Korean women (40 who had a term birth (TB) and 20 who had a PTB) was recruited. Vaginal samples were collected at five time points (first, second, and third trimester; 1–2 weeks postpartum; 1–2 months postpartum). Microbial DNA was extracted and analyzed using quantitative PCR targeting 12 bacterial species. The CL was measured in the second and third trimesters. Results: Lactobacillus crispatus was consistently dominant in the TB group, whereas PTB cases exhibited greater microbial diversity with elevated levels of Prevotella salivae and Ureaplasma species. The CL was significantly shorter in PTB cases, correlating with shifts in the VMB composition. Conclusions: A stable, Lactobacillus-dominant microbiome is protective in pregnancy, while increased diversity in PTB cases suggests microbial biomarkers for early risk prediction. Combining VMB profiling with CL measurement may enhance early, non-invasive PTB risk assessments. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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19 pages, 5849 KiB

Open AccessArticle

Folic Acid Mitigates Sertraline-Induced Liver Damage in Adult Female Albino Rats During Pregnancy and Postpartum: A Biochemical and Histological Study

by Ayman A. Refai, Mohammad I. Jumaa, Einas M. Yousef, Ala M. Aljehani, Rana Ahmed Alduraywish, Mohamed R. Elkabary, Safaa M. Hanafy, Hanan S. Seleem and Eman S. El-Roghy

Medicina 2025, 61(4), 751; https://doi.org/10.3390/medicina61040751 - 18 Apr 2025

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Abstract

Background and Objectives: Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is frequently prescribed during pregnancy to treat mood disorders. Studies indicate that chronic use of sertraline is associated with elevated liver enzymes, oxidative stress, and histological alterations in the liver. Folic [...] Read more.

Background and Objectives: Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is frequently prescribed during pregnancy to treat mood disorders. Studies indicate that chronic use of sertraline is associated with elevated liver enzymes, oxidative stress, and histological alterations in the liver. Folic acid, a recommended supplement currently used during the first trimester of pregnancy, has antioxidant and anti-inflammatory effects. Hence, folic acid might be a potential protective agent against sertraline-induced liver injury. The current study aimed to investigate the possible hepatotoxic effects of sertraline administration during pregnancy and early postpartum. In addition, we sought to evaluate the potential protective effects of folic acid supplementation in alleviating any sertraline-induced liver damage. Materials and Methods: Eighty pregnant albino rats were randomly divided into four groups: control, folic acid-treated, sertraline-treated, and folic acid–sertraline-treated. Each group was divided into rats euthanized immediately after giving birth (0 h) or 14 days postpartum. Biochemical, histological, and immunohistochemical evaluations of liver function and structure were conducted. Results: Administration of sertraline was associated with a significant increase in hepatic enzymes (ALT and AST) and disrupted lipid profile (elevated cholesterol, triglycerides, and LDL-c) compared to the control group. Increased apoptosis was evidenced by increased caspase 3 expression and histological alterations, including vacuolation and inflammatory infiltrates, in sertraline-treated rats. Folic acid supplementation effectively mitigated these effects by preserving liver architecture, normalizing biochemical markers (ALT, AST, and lipid profile changes), and reducing apoptotic activity (lower caspase 3 expression). Conclusions: Folic acid mitigated sertraline-induced hepatic damage in pregnant rats. This suggests the potential benefits of using folic acid during the whole duration of pregnancy in patients treated with sertraline. Full article

(This article belongs to the Topic Human Anatomy and Pathophysiology, 3rd Edition)

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8 pages, 253 KiB

Open AccessArticle

The Impact of Early Epidural Analgesia on the Course of Labor and Delivery

by Atene Simanauskaite, Gabriele Kavaliauskaite, Justina Kacerauskiene and Vilda Vilimiene

Medicina 2025, 61(4), 750; https://doi.org/10.3390/medicina61040750 - 18 Apr 2025

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Abstract

Background and Objectives: This study aimed to assess the impact of early epidural analgesia (EA) on the progression of labor and delivery outcomes among nulliparous women. Materials and Methods: A retrospective analysis was conducted utilizing data from the Birth Registry of [...] Read more.

Background and Objectives: This study aimed to assess the impact of early epidural analgesia (EA) on the progression of labor and delivery outcomes among nulliparous women. Materials and Methods: A retrospective analysis was conducted utilizing data from the Birth Registry of the Department of Obstetrics and Gynecology at LUHS. The dataset encompassed women who underwent childbirth between 1 January 2021 and 31 December 2021 and who received EA for labor pain management. A total of 89 women with low-risk deliveries and EA were included in the study. The cohort was divided into two groups: Group I—parturients who underwent early EA with cervical dilatation ≤3 cm—and Group II—parturients who underwent EA with cervical dilatation >3 cm but <7 cm. The results were processed using IBM SPSS. Results: Group I consisted of 25 (28.1%) women and Group II consisted of 64 (71.9%). The prevalence of obesity was higher in Group II (p = 0.021). Bishop score was statistically elevated in Group II (p = 0.018). Upon hospital admission, Group II exhibited greater cervical dilation (p = 0.001). The rate of cervical dilation was higher in Group II at 1.54 cm/h (p = 0.033). Episiotomy was more frequently performed in Group II (p = 0.014). The average durations of the first stage of labor (p = 0.045), the second stage of labor (p = 0.033), and the overall labor (p = 0.023) were prolonged in Group I. Conclusions: The cervical dilation up to 10 cm occurs at a swifter pace when EA is administered following cervical dilation exceeding 3 cm. Notable associations were observed between EA and the incidence of episiotomy as well as the duration of labor stages. Early EA exhibited no impact on neonatal outcomes. Full article

(This article belongs to the Section Obstetrics and Gynecology)

12 pages, 3749 KiB

Open AccessArticle

3D CT-Based Preoperative Planning and Intraoperative Navigation in Reverse Shoulder Arthroplasty: Early Clinical Outcomes

by Elisa Troiano, Azzurra Masini, Giovanni Battista Colasanti, Caterina Drago, Stefano Giannotti and Nicola Mondanelli

Medicina 2025, 61(4), 749; https://doi.org/10.3390/medicina61040749 - 18 Apr 2025

Viewed by 146

Abstract

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional [...] Read more.

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. Materials and Methods: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24–108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. Results: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. Conclusions: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself. Full article

(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)

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10 pages, 2846 KiB

Open AccessArticle

Tubeless Percutaneous Nephrolithotomy in the Barts ‘Flank-Free’ Modified Supine Position with 24-Hour Discharge: A Single-Center Experience

by Zoltán Kiss, Gyula Drabik, Mihály Murányi, Attila Nagy, Ioannis Kartalas Goumas and Tibor Flaskó

Medicina 2025, 61(4), 748; https://doi.org/10.3390/medicina61040748 - 18 Apr 2025

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Abstract

Background and Objectives: To evaluate the effectiveness and outcomes of supine percutaneous nephrolithotomy (PCNL) using the Barts ‘flank-free’ position and ultrasound-guided puncture, assessing the feasibility of the tubeless technique for discharge within 24 h. Materials and Methods: We conducted a retrospective analysis of [...] Read more.

Background and Objectives: To evaluate the effectiveness and outcomes of supine percutaneous nephrolithotomy (PCNL) using the Barts ‘flank-free’ position and ultrasound-guided puncture, assessing the feasibility of the tubeless technique for discharge within 24 h. Materials and Methods: We conducted a retrospective analysis of 208 patients across 220 renal units who underwent supine PCNL at a tertiary university hospital between May 2019 and December 2024. All procedures were performed by a single surgeon. Patient demographics, stone characteristics, and surgical outcomes were analyzed. The tubeless technique was applied in most cases, and outcomes were assessed in terms of operative time, complication rates, stone-free rates (SFRs), and length of hospital stay. Results: The mean operating time was 50.34 ± 30.80 min. Single-tract PCNL was performed in 94.55% of cases, with the tubeless technique used in 90% of patients. The overall complication rate was 9.55%, with no Clavien–Dindo grade IV–V complications observed. On the first postoperative day, 68.18% of patients were discharged, demonstrating 24 h discharge feasibility. SFR and complication rates aligned with existing literature. Conclusions: The Barts ‘flank-free’ position and ultrasound-guided puncture considerably improved surgical access and safety in supine PCNL. The tubeless technique facilitates faster recovery, making early discharge feasible, even with standard sheath sizes. Further research is warranted to validate these findings and optimize renal stone management outcomes. Full article

(This article belongs to the Section Urology & Nephrology)

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8 pages, 422 KiB

Open AccessArticle

An Important Biomarker in Patients with Bell’s Palsy: Serum Calprotectin

by Cihan Türker, Elif Emre, Süleyman Aydın, Mustafa Dalgıç and Deniz Baklacı

Medicina 2025, 61(4), 747; https://doi.org/10.3390/medicina61040747 - 18 Apr 2025

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Abstract

Background and Objectives: This study aimed to examine the relationship between serum calprotectin levels and facial paralysis in patients with Bell’s palsy and to determine its prognostic significance. Materials and Methods: This study included 40 patients diagnosed with Bell’s palsy and [...] Read more.

Background and Objectives: This study aimed to examine the relationship between serum calprotectin levels and facial paralysis in patients with Bell’s palsy and to determine its prognostic significance. Materials and Methods: This study included 40 patients diagnosed with Bell’s palsy and 20 healthy individuals as controls. The patients were categorized into three groups based on their response to treatment: complete response, partial response, and no response. Blood samples were taken before treatment and in the third month after treatment to measure C-reactive protein, white blood cell count, lymphocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, and calprotectin levels. Results: Serum calprotectin levels were found to be elevated in patients with BP compared to the healthy controls; however, no significant correlation was observed between calprotectin levels and disease prognosis. Conclusions: The findings suggest that Bell’s palsy patients have elevated serum calprotectin levels compared to healthy individuals, indicating the potential use of calprotectin as a biomarker in Bell’s palsy. However, no significant difference in calprotectin levels was observed between patients with varying degrees of treatment response, suggesting that calprotectin may be limited in predicting disease prognosis. Full article

(This article belongs to the Special Issue Update on Otorhinolaryngologic Diseases (2nd Edition))

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11 pages, 651 KiB

Open AccessArticle

The Role of Mid-Trimester BUN and Creatinine Assessment in Predicting Preeclampsia: Retrospective Case–Control Study

by Ebru Celik Kavak, Cigdem Akcabay, Meryem Demircan, Ibrahim Batmaz, Cengiz Sanli, Ahmet Senocak, Mesut Ali Haliscelik, Miray Onat, Batuhan Tepe and Salih Burcin Kavak

Medicina 2025, 61(4), 746; https://doi.org/10.3390/medicina61040746 - 18 Apr 2025

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Abstract

Background and Objectives: Preeclampsia (PE) is a major cause of adverse perinatal outcomes. Early diagnosis of pregnant women at risk of PE can facilitate disease prevention and management. However, the presence of different phenotypes of the disease complicates its prediction. In particular, the [...] Read more.

Background and Objectives: Preeclampsia (PE) is a major cause of adverse perinatal outcomes. Early diagnosis of pregnant women at risk of PE can facilitate disease prevention and management. However, the presence of different phenotypes of the disease complicates its prediction. In particular, the challenges in the early diagnosis of term PE cases necessitate research on PE prediction in the second and third trimesters. This study aims to examine the association between PE development and mid-trimester blood urea nitrogen (BUN), serum creatinine, and the BUN/creatinine ratio in pregnant women. Materials and Methods: This retrospective case–control study was conducted on women diagnosed with PE. Pregnant women who underwent routine biochemical blood tests between the 18th and 24th weeks of gestation and subsequently gave birth at our hospital between January 2022 and May 2023 were categorized into three groups. Accordingly, healthy women who had term deliveries were classified as Group 1 (150 cases), women diagnosed with PE were classified as Group 2 (58 cases), and those diagnosed with severe PE were classified as Group 3 (44 cases). Results: There were no significant differences in age, gravidity, parity, body mass index, or gestational week at blood sampling between the patient and control groups (p > 0.05). When comparing the mean blood urea nitrogen, serum creatinine, and BUN/creatinine ratios, a significant difference was observed between the control group and those who developed PE (p = 0.001, p < 0.001, and p = 0.031, respectively). Univariate analysis revealed a significant association between BUN levels and PE development (OR 1.083; 95% CI, 1.031–1.139; p = 0.002). A stronger association was observed between serum creatinine levels and PE development (OR 112.344; 95% CI, 11.649–1083.416; p < 0.001). However, no significant association was found between the BUN/creatinine ratio and PE in univariate analysis (OR 1.003; 95% CI, 0.979–1.028; p > 0.05). Mid-trimester BUN and serum creatinine levels were significantly higher in patients who developed PE and severe PE. The AUC value for the BUN parameter in predicting PE was 0.614 (AUC 0.614; 95% CI, 0.539–0.689; p = 0.002). A BUN cut-off value of 16.2 mg/dL predicted disease development with a sensitivity of 52.9% and a specificity of 74%. Similarly, the AUC value for the serum creatinine parameter in predicting PE was 0.644 (AUC 0.644; 95% CI, 0.574–0.751; p < 0.001). A serum creatinine cut-off value of 0.58 mg/dL was able to predict disease development with 37.2% sensitivity and 88% specificity. No significant AUC value was obtained for the BUN/creatinine ratio (p > 0.05). Conclusions: Our findings indicate that elevated BUN and serum creatinine levels measured during the mid-trimester (18–24 weeks) are associated with an increased risk of developing preeclampsia. Full article

(This article belongs to the Special Issue Recent Advances in Maternal–Fetal Medicine)

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11 pages, 288 KiB

Open AccessArticle

Correlation and Comparative Evaluation of MOCART and MOCART 2.0 for Assessing Cartilage Repair

by Felix Conrad Oettl, Louis Leuthard, Moritz Brunner, Vincent A. Stadelmann, Stefan Preiss, Michael Leunig, Gian M. Salzmann and Jakob Hax

Medicina 2025, 61(4), 745; https://doi.org/10.3390/medicina61040745 - 18 Apr 2025

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Abstract

Background and Objectives: Chondral and osteochondral lesions can lead to osteoarthritis if untreated, making accurate assessment of cartilage repair outcomes essential for optimizing treatment strategies. The objective of this study was to compare MOCART and MOCART 2.0 and to evaluate the clinical [...] Read more.

Background and Objectives: Chondral and osteochondral lesions can lead to osteoarthritis if untreated, making accurate assessment of cartilage repair outcomes essential for optimizing treatment strategies. The objective of this study was to compare MOCART and MOCART 2.0 and to evaluate the clinical utility of both across different surgical cartilage repair techniques and various time points. Material and Methods: This study included 111 patients (age: 35 ± 10, 35% female) who underwent cartilage repair surgery of the knee between September 2015 and March 2022. A total of 188 postoperative magnetic resonance images were evaluated using MOCART and MOCART 2.0. The correlations between both scores, as well as to the change in Patient-Reported Outcome Measures (PROMs), were determined. Results: MOCART 2.0 scores (66 ± 13) were significantly higher than MOCART scores (58 ± 13, p < 0.001). Positive correlation was observed between scoring systems (r = 0.837, p < 0.001). There was no significant correlation between MOCART or MOCART 2.0 scores and the change in PROMs. Noticeably, there was a statistically significant correlation between both MOCART and MOCART 2.0 in the AutoCart subgroup across multiple timepoints for the change in PROMs. Conclusions: Based on radiographic–clinical outcome discordance, clinicians should not rely solely on MOCART or MOCART 2.0 scores when evaluating cartilage repair success but instead prioritize patient-reported functional improvements while using imaging as a complementary assessment tool. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

14 pages, 5728 KiB

Open AccessArticle

A Collagen–Elastin Regenerative Dermal Matrix May Generate Unfavorable Results in Head and Neck Postburn Scar Reconstruction: A Case Series

by Bogdan Nitescu, Andrei Dumitrescu, Florin Radu Stanescu, Diana Cintacioiu, Gratiana Lates and Sorin Viorel Parasca

Medicina 2025, 61(4), 744; https://doi.org/10.3390/medicina61040744 - 17 Apr 2025

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Abstract

Background and Objectives: Dermal matrices have brought solutions for many problems, mainly in the treatment of burns and burn scar revisions. The objective of this study was to draw attention to the limits of a collagen–elastin dermal matrix (MatriDerm^®) in its [...] Read more.

Background and Objectives: Dermal matrices have brought solutions for many problems, mainly in the treatment of burns and burn scar revisions. The objective of this study was to draw attention to the limits of a collagen–elastin dermal matrix (MatriDerm^®) in its 1 mm variant for the treatment of burn scars on the face and neck. Materials and Methods: A case series of four patients (three women and one man) with burn scars of the face (one case) and of the neck (three cases) treated with collagen–elastin matrices is presented. In all cases, the excision or release of the scars was performed, and the defects were covered with MatriDerm^® and thin split-thickness skin grafts in the same operative time. Results: In all cases, the graft take was very good but was followed by the important contraction of the graft to such an extent that the results were found to be poor by both the surgeons and the patients. The surface of the new scar was irregular, and the elasticity was low. The article points out some probable causes and draws attention to the need for more objective studies regarding the use of this dermal matrix in burn scars of the head and neck. Conclusions: This collagen–elastin 1 mm dermal matrix should be used with caution for the surgical treatment of burn scars of the head and neck area, and its indication should be carefully weighted. Full article

(This article belongs to the Special Issue Recent Advances in Plastic and Reconstructive Surgery)

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11 pages, 610 KiB

Open AccessArticle

Predicted vs. Observed Prosthesis–Patient Mismatch After Surgical Aortic Valve Replacement

by Giorgia Cibin, Augusto D’Onofrio, Giulia Lorenzoni, Valentina Lombardi, Emma Bergonzoni, Assunta Fabozzo, Irene Cao, Andrea Francavilla, Chiara Tessari, Dario Gregori and Gino Gerosa

Medicina 2025, 61(4), 743; https://doi.org/10.3390/medicina61040743 - 17 Apr 2025

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Abstract

Background and Objectives: Prosthesis–patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is associated with worse clinical outcomes and worse valve durability. The aim of this retrospective single-center study was to evaluate the consistency between predicted PPM (PPMp) and measured PPM (PPMm) [...] Read more.

Background and Objectives: Prosthesis–patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is associated with worse clinical outcomes and worse valve durability. The aim of this retrospective single-center study was to evaluate the consistency between predicted PPM (PPMp) and measured PPM (PPMm) after SAVR with three different bioprostheses. Materials and Methods: We analyzed data of all consecutive patients who underwent surgical aortic valve replacement with Magna Ease, Intuity, and Inspiris Resilia bioprostheses (Edwards Lifesciences, Irvine, CA, USA) at our institution. PPM was defined if EOAi ≤ 0.85 cm²/m². PPMm was determined by institutional echo lab-measured EOAi on discharge-day echocardiogram. PPMp was assessed using reference values for each valve model and size indexed to BSA based on height, weight, prosthesis type, and size. For the overall population and for the three valve types we evaluated the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp. Furthermore, the consistency between PPMm and PPMp were evaluated according to prosthesis type, size, stent internal diameter (ID), and true ID. Results: A total of 1323 patients underwent SAVR; complete hemodynamic data were available for 872 patients, who represent the population of our study. Magna Ease, Intuity, and Inspiris Resilia were implanted in 446 (51.1%), 341 (39.1%), and 85 (9.7%) patients, respectively. In 635 out of 872 cases (72.8%), PPMp was consistent with PPMm (Magna Ease: 321/446, 72%; Inspiris Resilia: 58/85, 68.2%; Intuity: 256/341, 75%). Overall, the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp were 0.26, 0.83, 0.24, 0.84, and 0.73, respectively (Magna Ease: 0.21, 0.82, 0.3, 0.8, and 0.72; Inspiris Resilia: 0.11, 0.82, 0.14, 0.79, and 0.68; Intuity: 0.45, 0.78, 0.19, 0.93, and 0.75). Conclusions: The consistency between PPMp and PPMm was suboptimal. We did not observe differences between PPMp and PPMm among different valve types. Discordance between PPMp and PPMm was more evident in smaller valve sizes. When implanting small valves, the evaluation of PPMp should be used with caution to avoid unexpected PPMm. Full article

(This article belongs to the Section Cardiology)

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10 pages, 1926 KiB

Open AccessArticle

The Analgesia Nociception Index’s Performance During Remimazolam-Based General Anesthesia: A Prospective Observational Study

by Joohyun Lee, Jung-Min Yi and Young Joo

Medicina 2025, 61(4), 742; https://doi.org/10.3390/medicina61040742 - 17 Apr 2025

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Abstract

Background and Objectives: The Analgesia Nociception Index (ANI), a surrogate marker derived from heart rate variability (HRV) analysis, has been validated for assessing the balance between antinociception and nociception during propofol anesthesia. The ANI continuously monitors this balance, with values above 50 [...] Read more.

Background and Objectives: The Analgesia Nociception Index (ANI), a surrogate marker derived from heart rate variability (HRV) analysis, has been validated for assessing the balance between antinociception and nociception during propofol anesthesia. The ANI continuously monitors this balance, with values above 50 indicating optimal analgesia. By adjusting analgesic administration based on ANI values, anesthesiologists can provide more personalized intraoperative pain control. Remimazolam, a novel benzodiazepine anesthetic lacking intrinsic analgesic properties, exhibits distinct HRV patterns compared to propofol. Considering these differences, the validity of the ANI during remimazolam anesthesia remains uncertain. We evaluated the validity of the ANI by assessing its ability to detect nociceptive stimuli during remimazolam anesthesia. Materials and Methods: In total, 28 patients were administered general anesthesia using remimazolam and remifentanil. We evaluated changes in the ANI before and after tetanic stimulation. In addition, we investigated the association between hemodynamic responses during surgical incisions and changes in the ANI. Results: Tetanic stimulation resulted in a significant (p < 0.001) reduction in the ANI, from 62.0 (interquartile range [IQR] 50.5–76.0) to 44.0 (IQR 37.0–55.5). Of the 13 patients who experienced hemodynamic responses during surgical incision, the ANI significantly decreased from 63.2 ± 13.6 to 36.9 ± 13.8 following noxious surgical stimulation (p < 0.001). Conclusions: The ANI reflects the dynamic equilibrium between antinociception and nociception during remimazolam-based general anesthesia. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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10 pages, 284 KiB

Open AccessArticle

Relationship Between Estradiol Levels Measured on the Initiation Day of GnRH Antagonist Treatment and Pregnancy Outcomes in Patients Receiving the Antagonist Protocol

by Pınar Karaçin, Runa Özelçi, Enes Kumcu, Dilek Kaya Kaplanoğlu, Serdar Dilbaz and Yaprak Üstün

Medicina 2025, 61(4), 741; https://doi.org/10.3390/medicina61040741 - 17 Apr 2025

Viewed by 152

Abstract

Background and Objectives: The aim of this study is to evaluate the relationship between serum estradiol (E2) levels measured on the day of antagonist administration and live birth rates (LBRs) in women undergoing IVF-ET with an antagonist protocol. Materials and Methods: Data from [...] Read more.

Background and Objectives: The aim of this study is to evaluate the relationship between serum estradiol (E2) levels measured on the day of antagonist administration and live birth rates (LBRs) in women undergoing IVF-ET with an antagonist protocol. Materials and Methods: Data from women who underwent IVF-ET with an antagonist protocol between 2011 and 2023 were retrospectively analyzed. Patients were divided into five groups on the basis of serum E2 levels measured on the day of antagonist administration (Group I: E2 < 400 pg/mL, Group II: 400 ≤ E2 < 650 pg/mL, Group III: 650 ≤ E2 < 800 pg/mL, Group IV:800 ≤ E2 < 1000 pg/mL, and Group V: E2 ≥ 1000 pg/mL). The independent effect of serum E2 levels on live birth was analyzed via an adjusted regression model. Results: A total of 1613 patients were included in the study. The overall LBR was 32.1%. The LBRs for Groups I, II, III, IV, and V were 28.9%, 37.8%, 26.4%, 32.2%, and 34.1%, respectively (p = 0.017). In the adjusted regression model, serum E2 levels measured on the day of antagonist administration < 400 pg/mL (OR: 0.752, 95% CI: 0.580–0.999, p = 0.048) and 650 ≤ E2 < 800 pg/mL (OR: 0.595, 95% CI: 0.388–0.911, p = 0.011) were identified as factors that reduce the likelihood of a live birth, adjusting for age, infertility duration, body mass index (BMI), cycle number, quality of embryo, and number of embryos transferred. Conclusions: The serum E2 level associated with the highest LBR in women undergoing IVF-ET with an antagonist protocol was found to be in the range of 400–650. Serum E2 levels < 400 pg/mL or in the range of 650–800 pg/mL were statistically significantly associated with a reduced LBR. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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Medicina, Volume 61, Issue 4 (April 2025) – 220 articles

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