Medicina

15 pages, 1588 KiB

Open AccessArticle

A Computed Tomography-Based Morphometric Assessment of the Foramen Lacerum in a Turkish Population Using the 3D Slicer Method

by Merve Muslu, Ömür Karaca, Aybars Kökçe and Niyazi Acer

Medicina 2025, 61(5), 943; https://doi.org/10.3390/medicina61050943 - 21 May 2025

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Abstract

Background and Objectives: The foramen lacerum (FL), located at the base of the skull, is generally considered the safest anatomical pathway for accessing the internal carotid artery (ICA) and the vidian canal (VC) during surgical procedures. We aimed to evaluate the morphometric [...] Read more.

Background and Objectives: The foramen lacerum (FL), located at the base of the skull, is generally considered the safest anatomical pathway for accessing the internal carotid artery (ICA) and the vidian canal (VC) during surgical procedures. We aimed to evaluate the morphometric characteristics of FL, VC, and related structures. Materials and Methods: This study utilized cranial computed tomography (CT) images obtained between 2016 and 2018 at Balıkesir University Faculty of Medicine for various clinical indications. A retrospective analysis was performed on cranial CT images from 77 patients, comprising 42 females and 35 males. The length and width of the FL, the length of the VC, and the angles formed between the VC and the pterygosphenoidal fissure and between the VC and the palatovaginal canal were measured. All measurements were performed using the three-dimensional (3D) Slicer software to ensure precision and consistency. Results: Males had significantly longer right and left FL lengths and left FL width than females (p < 0.05). No significant gender-based differences were found in VC length on either side. The angle between the VC and the pterygosphenoidal fissure was significantly larger in males (p < 0.05). Additionally, increased FL length and width were significantly correlated with larger angles between the VC and the pterygosphenoidal fissure in all subjects (p < 0.05). The anatomical variations of the FL Type 1 (normal) were identified as the most prevalent configuration across the study population. Type 2 (canal-shaped) ranked as the second most frequent variant in females, whereas Type 3 (bridged) was the second most commonly observed form in males. Conclusions: Preoperative identification of FL anatomical variations, which differ between individuals and sexes, may enhance the safety of skull base surgeries and minimize postoperative complications. The morphometric data presented in this study provide valuable guidance for clinicians planning interventions involving the FL and surrounding structures, and contribute valuable insights to anatomists regarding regional morphology. Full article

(This article belongs to the Special Issue Advances in Skull Base Surgery)

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19 pages, 2245 KiB

Open AccessArticle

Core Exercise as Non-Pharmacological Strategy for Improving Metabolic Health in Prediabetic Women

by Nuray Yiğiter, Faruk Akçınar, Yavuz Yasul, Vedat Çınar, Taner Akbulut and Gian Mario Migliaccio

Medicina 2025, 61(5), 942; https://doi.org/10.3390/medicina61050942 - 21 May 2025

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Abstract

Background and Objectives: Prediabetes (PD) is characterized by impaired glucose metabolism and is associated with an elevated risk of type 2 diabetes and cardiovascular diseases. This study aimed to investigate the effects of an 8-week core exercise intervention on glycemic control, lipid [...] Read more.

Background and Objectives: Prediabetes (PD) is characterized by impaired glucose metabolism and is associated with an elevated risk of type 2 diabetes and cardiovascular diseases. This study aimed to investigate the effects of an 8-week core exercise intervention on glycemic control, lipid profiles, insulin sensitivity, body composition, and physical performance in prediabetic women. Materials and Methods: Eighteen prediabetic women aged 20–55 years were randomly allocated to either a core exercise group (n = 9) or a control group (n = 9). The intervention group completed 24 supervised core exercise sessions over 8 weeks, whereas the control group remained sedentary. Pre- and post-intervention evaluations included anthropometric measurements, flexibility and strength tests, fasting and postprandial glucose levels, HbA1c, insulin, HOMA-IR, lipid profiles, and serum iron levels. Non-parametric tests were used for statistical analysis, and a Principal Component Analysis (PCA) and hierarchical clustering were conducted to explore multidimensional metabolic changes. Results: Core exercise significantly improved the body weight, BMI, fat percentage, and circumferences (shoulder, chest, and hip), along with an enhanced flexibility and back-leg strength (p < 0.05). Glycemic indices (FBG, PBG, and HbA1c), insulin, and HOMA-IR levels were significantly reduced, while serum iron and HDL-C increased (p < 0.05). Lipid markers, including the TG, LDL-C, CHOL, and TG/HDL-C ratio, showed significant improvements. The PCA and cluster analyses identified three clusters reflecting metabolic risk, body composition, and protective factors. Conclusions: This study demonstrates that an 8-week structured core exercise program significantly improves glycemic control, lipid profiles, insulin sensitivity, and body composition in women with prediabetes. Multivariate analyses (PCA and hierarchical clustering) corroborate a metabolic shift towards a reduced insulin resistance and a more favorable cardiometabolic profile, supporting core training as a viable, evidence-based non-pharmacological intervention to mitigate metabolic risk. Full article

(This article belongs to the Special Issue Novel Innovations in Diabetes Mellitus Prevention, Screening and Management)

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10 pages, 1511 KiB

Open AccessReview

Genicular Arteries Embolization for Patients with Osteoarthritis, Their Selection, and Follow-Up Based on MRI Findings

by Aurelija Domarkienė, Lukas Kalytis, Gytis Kanapienis, Marius Kurminas and Algirdas Edvardas Tamošiūnas

Medicina 2025, 61(5), 941; https://doi.org/10.3390/medicina61050941 - 21 May 2025

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Abstract

Osteoarthritis (OA) is a leading cause of disability worldwide, with its prevalence rising due to aging populations. Management ranges from conservative treatments such as weight management and pharmacologic therapy to surgical interventions such as total joint replacement. However, treating moderate knee OA remains [...] Read more.

Osteoarthritis (OA) is a leading cause of disability worldwide, with its prevalence rising due to aging populations. Management ranges from conservative treatments such as weight management and pharmacologic therapy to surgical interventions such as total joint replacement. However, treating moderate knee OA remains challenging for patients unresponsive to conservative care but not yet surgical candidates. Genicular artery embolization (GAE) has emerged as a minimally invasive procedure targeting abnormal angiogenesis and inflammation in OA. This article explores GAE’s mechanism, patient-selection criteria, and effectiveness in pain reduction and functional improvement. Studies suggest that GAE has the potential to significantly improve pain and function in mild to moderate OA, with sustained benefits. Patient selection is crucial for optimal outcomes, with imaging playing a key role. While conventional MRI assesses structural damage, Dynamic Contrast-Enhanced MRI (DCE-MRI) offers superior insights by evaluating synovitis, quantifying cartilage degradation, and monitoring treatment response. Due to its strong correlation with pain scores and status as the best surrogate marker for inflammation in synovitis, DCE-MRI holds significant potential to enhance patient selection and treatment monitoring for GAE. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 1688 KiB

Open AccessArticle

Computer Viewing Model for Classification of Erythrocytes Infected with Plasmodium spp. Applied to Malaria Diagnosis Using Optical Microscope

by Eduardo Rojas, Irene Cartas-Espinel, Priscila Álvarez, Matías Moris, Manuel Salazar, Rodrigo Boguen, Pablo Letelier, Lucia San Martín, Valeria San Martín, Camilo Morales and Neftalí Guzmán

Medicina 2025, 61(5), 940; https://doi.org/10.3390/medicina61050940 - 21 May 2025

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Abstract

Background and Objectives: Malaria is a disease that can result in a variety of complications. Diagnosis is carried out by an optical microscope and depends on operator experience. The use of artificial intelligence to identify morphological patterns in erythrocytes would improve our diagnostic [...] Read more.

Background and Objectives: Malaria is a disease that can result in a variety of complications. Diagnosis is carried out by an optical microscope and depends on operator experience. The use of artificial intelligence to identify morphological patterns in erythrocytes would improve our diagnostic capability. The object of this study was therefore to establish computer viewing models able to classify blood cells infected with Plasmodium spp. to support malaria diagnosis by optical microscope. Materials and Methods: A total of 27,558 images of human blood sample extensions were obtained from a public data bank for analysis; half were of parasite-infected red cells (n = 13,779), and the other half were of uninfected erythrocytes (n = 13,779). Six models (five machine learning algorithms and one pre-trained for a convolutional neural network) were assessed, and the performance of each was measured using metrics like accuracy (A), precision (P), recall, F1 score, and area under the curve (AUC). Results: The model with the best performance was VGG-19, with an AUC of 98%, accuracy of 93%, precision of 92%, recall of 94%, and F1 score of 93%. Conclusions: Based on the results, we propose a convolutional neural network model (VGG-19) for malaria diagnosis that can be applied in low-complexity laboratories thanks to its ease of implementation and high predictive performance. Full article

(This article belongs to the Section Hematology and Immunology)

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10 pages, 1157 KiB

Open AccessArticle

Current Practices in Antibiotic Prophylaxis for Transoral Endoscopic Thyroid and Parathyroid Surgery: A Comparative Study

by Mehmet Ilker Turan, Senay Ozturk Durmaz, Mehmet Celik and Nedim Akgul

Medicina 2025, 61(5), 939; https://doi.org/10.3390/medicina61050939 - 21 May 2025

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Abstract

Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis [...] Read more.

Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. Materials and Methods: A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised t-tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. Results: The postoperative WBC and CRP levels were significantly higher in the pABX group (p = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance (p = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, p = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006–1.031, p = 0.004). Conclusions: Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens. Full article

(This article belongs to the Section Surgery)

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11 pages, 428 KiB

Open AccessArticle

Can Antidromic and Orthodromic Stimulation Both Be Used for Correct Carpal Tunnel Syndrome Staging by J. D. Bland and L. Padua?

by Vlada Meļņikova, Maksims Timčenko, Solvita Bērziņa and Guntis Karelis

Medicina 2025, 61(5), 938; https://doi.org/10.3390/medicina61050938 - 21 May 2025

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Abstract

Background and Objectives: Padua (1997) and Bland (2000) have already proposed neurophysiological classification scales for patients with carpal tunnel syndrome (CTS), where the absence of orthodromic sensory response is used as a criterion of a severe stage. We hypothesized that antidromic values [...] Read more.

Background and Objectives: Padua (1997) and Bland (2000) have already proposed neurophysiological classification scales for patients with carpal tunnel syndrome (CTS), where the absence of orthodromic sensory response is used as a criterion of a severe stage. We hypothesized that antidromic values cannot be used equally for correct staging. Materials and Methods: We performed a consecutive investigation with nerve conduction studies in 60 arms of patients with CTS and prolonged distal motor latency. Results: In 11 out of 60 arms (18.3% of cases), orthodromic sensory nerve action potential (SNAP) was undetectable, while the antidromic SNAP was present. ROC curve analysis with Yoden index calculation were utilized in the study. The cut-off value of antidromic SNAP amplitude as a diagnostic marker of unrecordable orthodromic SNAP was 3.9 µV with high sensitivity and specificity. Conclusions: Our findings conflict with Padua et al.’s assertion that CTS staging can be determined irrespective of the stimulation technique. Antidromic SNAP amplitude is the most reliable parameter for predicting the absent orthodromic SNAP. Our study addresses the bias associated with the application of antidromic stimulation of median nerve sensory fibers for accurately staging moderate to severe CTS. Full article

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

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10 pages, 567 KiB

Open AccessArticle

Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study

by Hidenori Takahashi, Yugo Satake, Saori Shimizu, Satomi Fujihara, Syunsuke Takano, Suzuko Fukasawa, Kaeyong Park, Naoya Toba, Takahiko Yano, Hiroki Nagamatsu, Ryutaro Hirose, Mio Toyama-Kousaka, Shinichiro Ota, Miwa Morikawa and Masaharu Shinkai

Medicina 2025, 61(5), 937; https://doi.org/10.3390/medicina61050937 - 21 May 2025

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Abstract

Background and Objectives: Group A Streptococcus (GAS) is a leading cause of acute pharyngitis with seasonal outbreaks. The coronavirus disease 2019 (COVID-19) pandemic significantly altered respiratory infection trends; however, its impact on GAS pharyngitis (GAS-P) incidence remains unclear. Additionally, data on co-infections [...] Read more.

Background and Objectives: Group A Streptococcus (GAS) is a leading cause of acute pharyngitis with seasonal outbreaks. The coronavirus disease 2019 (COVID-19) pandemic significantly altered respiratory infection trends; however, its impact on GAS pharyngitis (GAS-P) incidence remains unclear. Additionally, data on co-infections with GAS and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. In this study, temporal trends in GAS-P incidence and characteristics of GAS–SARS-CoV-2 co-infections in Japan were examined. Materials and Methods: In this observational study, data from patients who visited the Tokyo Shinagawa Hospital between January 2019 and December 2024 were retrospectively analyzed. Data on GAS and SARS-CoV-2 test results and patient demographics were extracted from medical records. The study period was categorized based on COVID-19-related public health measures as follows: pre-COVID-19 social period (January 2019–April 2020), restricted social period (May 2020–April 2023), and post-restriction period (May 2023–December 2024). GAS incidence stratified by sex, age, and period was calculated. Clinical characteristics of patients co-infected with GAS and SARS-CoV-2 were analyzed. Results: Among 4837 GAS tests, 463 (9.6%) were positive. GAS positivity rates varied significantly: 11.4% (pre-COVID-19), 7.1% (restricted social period), and 12.6% (post-restriction period; p < 0.001). The proportion of pediatric cases decreased significantly during the restricted social period (24.8–5.3%) before rising sharply in the post-restriction period (47.1%, p < 0.001). Among 151 patients tested for GAS and SARS-CoV-2, 14 (9.3%) had co-infections, which were identified exclusively after July 2022. Most patients exhibited mild symptoms, primarily fever and sore throat, with decreased lymphocyte counts despite normal white blood cell counts. Conclusions: In our cohort, the incidence of GAS pharyngitis temporarily declined during COVID-19-related public health measures and subsequently increased, particularly among children, after restrictions were lifted. Limited testing may contribute to the underdiagnosis of GAS–SARS-CoV-2 co-infections. Further large-scale studies are warranted to assess microbial interactions, disease severity, and long-term outcomes. Full article

(This article belongs to the Special Issue Advances in Infectious Diseases and Clinical Microbiology during and after the COVID-19 Pandemic: 2nd Edition)

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Graphical abstract

12 pages, 294 KiB

Open AccessReview

Corticosteroid Use in Musculoskeletal and Neuraxial Interventions: Effects on Glycemic Control

by Brian Singer, Dovid Chaimovitz, Thomas Bucek, Eli Dayon, Aimee Abbott-Korumi, Moshe Spatz, Tejaswi Makkapati, Hayk Petrosyan and Laurent Delavaux

Medicina 2025, 61(5), 936; https://doi.org/10.3390/medicina61050936 - 21 May 2025

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Abstract

Effective multidisciplinary pain management involves an in-depth knowledge not only of diagnosis and treatment but of how interventional procedures affect patients across all health domains. One of the most common pharmacological tools utilized in patients suffering from chronic pain disorders is corticosteroids. Corticosteroids [...] Read more.

Effective multidisciplinary pain management involves an in-depth knowledge not only of diagnosis and treatment but of how interventional procedures affect patients across all health domains. One of the most common pharmacological tools utilized in patients suffering from chronic pain disorders is corticosteroids. Corticosteroids are leveraged for their anti-inflammatory properties across a wide range of disorders. This review examines the role of corticosteroids and pain management with a specific focus on their metabolic impact regarding glucose metabolism. Corticosteroids have been shown to increase gluconeogenesis, resulting in reduced insulin sensitivity and an impaired peripheral glucose uptake. These varied responses to corticosteroids are especially concerning given the high prevalence of diabetes mellitus in chronic pain patients. There is well-documented evidence of not only transient hyperglycemia but emerging literature on prolonged glycemic disturbances that may have a greater effect on patients than previously recognized. A review of the available literature reveals variations in hyperglycemia depending on corticosteroid type, dose, and various patient-specific factors. Some research does suggest that lower corticosteroid dosages can provide similar therapeutic benefits and potentially reduce glycemic aberrations. Given the current evidence, clinicians should closely monitor patients’ hemoglobin A1C levels when determining the risks and benefits of an interventional procedure and consider alternative pain management strategies when appropriate. Future research should focus on optimizing corticosteroid selection and dosing to balance the safety, particularly in diabetic or prediabetic patient populations. Full article

(This article belongs to the Special Issue Physiotherapy in Musculoskeletal Pain: Assessment and Management)

13 pages, 447 KiB

Open AccessArticle

Psychometric Properties of the Improved Report of Oslo Trauma Research Centre Questionnaires on Overuse Injuries (OSTRC-O2) and Health Problems (OSTRC-H2)

by Giulio Leonardi, Giovanni Galeoto, Filippo Maselli, Roberto Napoli, Simone Favaretto, Martina Tomassini, Giuseppe Plebani, Lorenzo Carraro and Domenico Angilecchia

Medicina 2025, 61(5), 935; https://doi.org/10.3390/medicina61050935 - 21 May 2025

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Abstract

Background and Objectives: The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O2) and the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2) scales are designed to objectively monitor various overuse or acute injuries of professional and non-professional athletes in association [...] Read more.

Background and Objectives: The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O2) and the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2) scales are designed to objectively monitor various overuse or acute injuries of professional and non-professional athletes in association with other physical problems that relate to health spheres. The aim of this study was to validate these questionnaires in a population of professional and amateur Italian athletes and to analyze their psychometric properties, in order to verify that both scales have equivalent properties in different linguistic and cultural contexts. Materials and Methods: The Italian versions of the OSTRC-O2 (OSTRC-O2-IT) and the OSTRC-H2 (OSTRC-H2-IT) were administered to 102 professional and non-professional athletes over a period of 3 months, once a week, for each rating scale. The inclusion criteria were: age over 18 years, practicing a sports activity for at least 1 year and having had at least one injury. The internal consistency and reliability of both scales and their correlations with pain and quality of life scales have been analyzed. Results: The psychometric properties of the scales turned out to be very high and statistically significant for both scales proposed to the athletes. A Cronbach’s Alpha of 0.946 and an ICC between 0.705 and 0.746 confirmed the good reliability of the questionnaires. Conclusions: The Italian versions of the OSTRC-O2-IT and OSTRC-H2-IT assessment scales are reliable and valid tools for the monitoring of overload injuries. This study shows that they are easy to understand for the Italian sports population and may be of help to the scientific community to increase precautionary control and prevention measures for overuse injuries in professional and amateur athletes, favoring a safer return to the field. Full article

(This article belongs to the Special Issue Development and Application of Objective Measures in Physiotherapy for Musculoskeletal Disorders, Orthopedics, and Sports Medicine—2nd Edition)

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11 pages, 561 KiB

Open AccessArticle

Sex Differences in Epicardial Adipose Tissue and Other Risk Factors for Coronary Artery Disease

by Vesna Lesjak and Laura Kocet

Medicina 2025, 61(5), 934; https://doi.org/10.3390/medicina61050934 - 21 May 2025

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Abstract

Background and Objectives: To examine individual-level sex differences in traditional and non-traditional risk factors and their potential effects on the severity of coronary artery disease (CAD). Materials and Methods: A cross-sectional analysis was performed on 208 patients with a low-to-intermediate pretest probability of [...] Read more.

Background and Objectives: To examine individual-level sex differences in traditional and non-traditional risk factors and their potential effects on the severity of coronary artery disease (CAD). Materials and Methods: A cross-sectional analysis was performed on 208 patients with a low-to-intermediate pretest probability of CAD, referred to a Coronary CT angiography (CCTA) at the Department of Radiology, Maribor University Medical Centre, from January 2022 to January 2024. CCTA-derived EAT (epicardial adipose tissue) attenuation and CAC (coronary artery calcification) values were measured. The association between CAD, EAT, and risk factors was analyzed by sex, using correlation analysis and multivariate regression. Results: In the results obtained using the univariate logistic regression model, age (OR 1.122, p < 0.001) and hypertension (OR 4.087, p = 0.048) were significantly associated with the presence of obstructive CAD in women, while in men, age (OR 1.052, p = 0.008), hypercholesterolemia (OR 3.765, p = 0.042), and EAT attenuation (OR 1.053, p = 0.011) were significant factors. In results obtained using the multivariable logistic regression analysis model, EAT attenuation was found to be significantly associated with the presence of obstructive CAD in men (OR 1.087, p = 0.012), and age was a significant factor in women (OR =1.108, p = 0.033), while hypertension, body mass index (BMI), diabetes, hypercholesterolemia, angina pectoris, and smoking were not. Conclusions: In the sex-specific multivariable logistic regression analysis model, EAT attenuation was significantly associated with obstructive CAD in men, while in women, it was associated with age. EAT may function as a beneficial alternative indicator in identifying patients with CAD. 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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23 pages, 451 KiB

Open AccessReview

Etiology and Risk Factors for Splanchnic Vein Thrombosis in Non-Cirrhotic, Non-Neoplastic Patients: A Narrative Review

by Mihaela Hostiuc and Ionut Negoi

Medicina 2025, 61(5), 933; https://doi.org/10.3390/medicina61050933 - 21 May 2025

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Abstract

Splanchnic vein thrombosis (SVT) is a heterogeneous group of disorders affecting the portal, mesenteric, splenic, and hepatic veins. While frequently associated with liver cirrhosis and malignancy, SVT also occurs in non-cirrhotic, non-neoplastic patients. This narrative review evaluates the epidemiology and risk factors for [...] Read more.

Splanchnic vein thrombosis (SVT) is a heterogeneous group of disorders affecting the portal, mesenteric, splenic, and hepatic veins. While frequently associated with liver cirrhosis and malignancy, SVT also occurs in non-cirrhotic, non-neoplastic patients. This narrative review evaluates the epidemiology and risk factors for SVT in this population. The prevalence and incidence of SVT in non-cirrhotic, non-neoplastic patients remain incompletely characterized, with estimates varying widely across studies. The clinical significance of SVT relates to potential complications, including intestinal ischemia, portal hypertension, and a possible underlying systemic disorder. Risk factors for SVT can be categorized into local abdominal conditions, thrombophilias, and systemic disorders. Local factors include inflammatory bowel disease, pancreatitis, abdominal surgery, and trauma. Thrombophilias, both inherited and acquired, are significant contributors to SVT risk. Systemic conditions associated with SVT include autoimmune disorders, pregnancy, hematological diseases, and infections. The complex interplay of these risk factors highlights the need for a comprehensive evaluation of SVT patients. Early recognition and management of these conditions can prevent potentially life-threatening complications and guide decisions regarding anticoagulation and long-term follow-up. Full article

(This article belongs to the Special Issue Progress in Venous Thromboembolism Research)

16 pages, 898 KiB

Open AccessArticle

Integrating Brain-Computer Interface Systems into Occupational Therapy for Enhanced Independence of Stroke Patients: An Observational Study

by Erika Endzelytė, Daiva Petruševičienė, Raimondas Kubilius, Sigitas Mingaila, Jolita Rapolienė and Inesa Rimdeikienė

Medicina 2025, 61(5), 932; https://doi.org/10.3390/medicina61050932 - 21 May 2025

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Abstract

Background and Objectives: Brain-computer interface (BCI) technology is revolutionizing stroke rehabilitation by offering innovative neuroengineering solutions to address neurological deficits. By bypassing peripheral nerves and muscles, BCIs enable individuals with severe motor impairments to communicate their intentions directly through control signals derived [...] Read more.

Background and Objectives: Brain-computer interface (BCI) technology is revolutionizing stroke rehabilitation by offering innovative neuroengineering solutions to address neurological deficits. By bypassing peripheral nerves and muscles, BCIs enable individuals with severe motor impairments to communicate their intentions directly through control signals derived from brain activity, opening new pathways for recovery and improving the quality of life. The aim of this study was to explore the beneficial effects of BCI system-based interventions on upper limb motor function and performance of activities of daily living (ADL) in stroke patients. We hypothesized that integrating BCI into occupational therapy would result in measurable improvements in hand strength, dexterity, independence in daily activities, and cognitive function compared to baseline. Materials and Methods: An observational study was conducted on 56 patients with subacute stroke. All patients received standard medical care and rehabilitation for 54 days, as part of the comprehensive treatment protocol. Patients underwent BCI training 2–3 times a week instead of some occupational therapy sessions, with each patient completing 15 sessions of BCI-based recoveriX treatment during rehabilitation. The occupational therapy program included bilateral exercises, grip-strengthening activities, fine motor/coordination tasks, tactile discrimination exercises, proprioceptive training, and mirror therapy to enhance motor recovery through visual feedback. Participants received ADL-related training aimed at improving their functional independence in everyday activities. Routine occupational therapy was provided five times a week for 50 min per session. Upper extremity function was evaluated using the Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and dynamometry to assess gross manual dexterity, fine motor skills, and grip strength. Independence in daily living was assessed using the Functional Independence Measure (FIM). Results: Statistically significant improvements were observed across all the outcome measures (p < 0.001). The strength of the stroke-affected hand improved from 5.0 kg to 6.7 kg, and that of the unaffected hand improved from 29.7 kg to 40.0 kg. Functional independence increased notably, with the FIM scores rising from 43.0 to 83.5. Cognitive function also improved, with MMSE scores increasing from 22.0 to 26.0. The effect sizes ranged from moderate to large, indicating clinically meaningful benefits. Conclusions: This study suggests that BCI-based occupational therapy interventions effectively improve upper extremity motor function and daily functions and have a positive impact on the cognition of patients with subacute stroke. Full article

(This article belongs to the Special Issue New Advances in Acute Stroke Rehabilitation)

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16 pages, 324 KiB

Open AccessArticle

Biomarker Patterns and Their Association with Lung Injury in COVID-19 Patients

by Alexandru Constantin Sîrbu, Anca Daniela Farcaș, Ioana Corina Bocsan, Maria Adriana Neag, Ștefan Cristian Vesa, Șoimița Mihaela Suciu and Anca Dana Buzoianu

Medicina 2025, 61(5), 931; https://doi.org/10.3390/medicina61050931 - 21 May 2025

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Abstract

Background and Objectives: The study investigates the relationship between accessible biomarkers and the extent of lung damage, assessed with computed tomography (CT) imaging, in patients hospitalized for COVID-19. Materials and Methods: This retrospective analysis was conducted in a hospital in Cluj-Napoca, [...] Read more.

Background and Objectives: The study investigates the relationship between accessible biomarkers and the extent of lung damage, assessed with computed tomography (CT) imaging, in patients hospitalized for COVID-19. Materials and Methods: This retrospective analysis was conducted in a hospital in Cluj-Napoca, Romania, and it includes 111 patients diagnosed with moderate to severe forms of COVID-19 during the Delta and Omicron waves. We evaluated the association of affordable lab works, such as C-reactive protein (CRP), procalcitonin, ferritin, neutrophil and lymphocyte counts, D-dimers, and albumin levels, with the extents of lung injury, pleural effusion, pulmonary embolism, and thoracic adenopathy. Results: Our data show that high CRP, neutrophil counts, ferritin, and procalcitonin levels, combined with lower lymphocyte and albumin levels, were significantly associated with >25% lung damage (p < 0.05). Elevated ferritin (≥274 ng/mL) and neutrophil counts (≥5.2 × 10⁹/L) were independently associated with this threshold. CRP (≥2.67 mg/dL), CRP/albumin ratio (≥0.736), and ferritin had the highest sensitivity (86.8%). D-dimer was the sole biochemical marker associated with pulmonary embolism (p = 0.036). Pleural effusion was independently associated with lymphocyte count (cut-off < 0.605 × 10⁹/L, p = 0.013). Thoracic lymphadenopathy was also associated with increased neutrophil counts and a heightened inflammatory response. Conclusions: These findings suggest that ferritin and the CRP/albumin ratio can serve as indicators for patients with extensive parenchymal damage. D-dimer levels were the only ones significantly associated with thromboembolic events, while lymphopenia appears to be a useful indicator of pleural involvement. Thus, these readily available biomarkers can prove useful in anticipating radiological severity in patients hospitalized with COVID-19. Full article

(This article belongs to the Special Issue Impact on Human Health, Lifestyle and Quality of Care After COVID-19, 2nd Edition)

13 pages, 290 KiB

Open AccessArticle

Quality of Life, Caregiver Burden, and Symptoms of Depression and Anxiety in Parents of Children with Spinal Muscular Atrophy: A Comparison with Healthy Controls

by Zehra Koyuncu, Seda Sönmez Kurukaya, Fitnat Uluğ, Tuğçe Damla Dilek, Yılmaz Zindar, Büşra Arslan, Berkay Tayşi, Elif Anaç, Mustafa Balkanas, Sena Kesik, Kevser Sak, Ömer Faruk Demirel, Burak Doğangün and Sema Saltık

Medicina 2025, 61(5), 930; https://doi.org/10.3390/medicina61050930 - 21 May 2025

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Abstract

Background: Spinal muscular atrophy (SMA) is a disease that leads to muscle weakness and significantly affects the lives of both patients and caregivers. This study aims to compare quality of life, caregiver burden, symptoms of depression and anxiety, life satisfaction, and mental [...] Read more.

Background: Spinal muscular atrophy (SMA) is a disease that leads to muscle weakness and significantly affects the lives of both patients and caregivers. This study aims to compare quality of life, caregiver burden, symptoms of depression and anxiety, life satisfaction, and mental well-being between parents of children with SMA and those of healthy children. Methods: This cross-sectional study included parents of children under 18 years old, both healthy and diagnosed with SMA. The participants completed the WHOQOL-BREF, Zarit Caregiver Burden Scale (ZCBS), Hospital Anxiety and Depression Scale (HADS), Satisfaction with Life Scale (SWLS), and the Flourishing Scale (FS). In addition, the relationships among these measures were analyzed. Results: Our study showed that the parents of children with SMA had significantly higher scores across all subscales of the WHOQOL-BREF (p = 0.004, p = 0.009, p = 0.007, p < 0.001) and the HADS depression subscale (p = 0.005). However, no significant differences were found between the groups in terms of the ZCBS, the HADS anxiety subscale (p = 0.802), SWLS (p = 0.251), or FS (p = 0.929) scores. Additionally, the ZCBS and HADS anxiety scores were significantly higher among parents of children with SMA type 1 compared to those with type 3 (p = 0.010 and p = 0.037, respectively). Lastly, a moderate positive correlation was found between the ZCBS and the HADS anxiety subscales (r = 0.632, p < 0.001). Conclusions: This study highlights the decline in quality of life and increased depression symptoms among parents of children with SMA, suggesting the need for psychiatric evaluation and additional support for those caregivers. Full article

(This article belongs to the Section Neurology)

11 pages, 990 KiB

Open AccessSystematic Review

Efficacy and Safety of Nitrous Oxide (N₂O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis

by Francesca Piccialli, Marco Fiore, Roberto Giurazza, Fabrizio Falso, Vittorio Simeon, Paolo Chiodini, Diana Russo and Luigi Laino

Medicina 2025, 61(5), 929; https://doi.org/10.3390/medicina61050929 - 20 May 2025

Viewed by 122

Abstract

Background and Objectives: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician’s work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (N₂O) [...] Read more.

Background and Objectives: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician’s work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (N₂O) has been widely employed as a sedative agent in dental practice. This systematic review aimed to assess the efficacy and safety of N₂O compared to alternative sedative agents and techniques in dental surgical procedures. Materials and Methods: This review protocol was prospectively registered on PROSPERO (CRD42020213429) and conducted in accordance with PRISMA guidelines. Results: A total of 1809 records were screened (1134 from Embase, 638 from PubMed, and 37 from CENTRAL). The meta-analysis focused on the following three primary outcomes: 1. Patient satisfaction: Eight studies comprising 422 participants (165 treated with N₂O and 176 with other sedatives) were included. 2. Recall of the procedure: Five studies with a total of 288 patients (68 receiving N₂O and 64 other agents) assessed patients’ ability to recall tooth extraction. 3. Successful completion of the procedure: Three studies involving 1578 patients (434 treated with N₂O and 989 with alternative sedation methods) were analyzed. Conclusions: No statistically significant differences were observed between N₂O and other sedative techniques across all outcomes evaluated. Safety could not be adequately assessed as none of the included studies systematically investigated this outcome. Further high-quality research is warranted to rigorously evaluate the safety profiles of various sedation strategies in dental surgery. Full article

(This article belongs to the Special Issue Advancements in Dental Medicine, Oral Anesthesiology and Surgery)

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10 pages, 961 KiB

Open AccessArticle

Biochemical Recurrence in High-Risk Localized Prostate Cancer: A Comparison of Laparoscopic Prostatectomy and External Radiotherapy

by Lubos Rybar, Patrik Hesko, Michal Miko, Peter Bujdak and Stefan Harsanyi

Medicina 2025, 61(5), 928; https://doi.org/10.3390/medicina61050928 - 20 May 2025

Viewed by 145

Abstract

Background: This retrospective study evaluated and compared oncological outcomes in patients with localized prostate cancer treated either by laparoscopic radical prostatectomy (LRP) or by external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT). The primary aim was to identify predictors of [...] Read more.

Background: This retrospective study evaluated and compared oncological outcomes in patients with localized prostate cancer treated either by laparoscopic radical prostatectomy (LRP) or by external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT). The primary aim was to identify predictors of biochemical recurrence (BCR) and to assess recurrence-free survival. Subjects and methods: A total of 107 patients diagnosed with localized prostate cancer and treated between 2016 and 2023 were included in the analysis. Of these, 61 patients underwent LRP, and 46 patients received EBRT+ADT. The median follow-up period was 60 months for the LRP group (IQR 24–72) and 66 months for the EBRT group (IQR 49.5–72). Biochemical recurrence (BCR) was defined as a PSA level > 0.2 ng/mL after LRP or an increase > 2 ng/mL above nadir following EBRT. Kaplan–Meier survival curves, log-rank tests, Pearson’s chi-square, and Cox regression models were used to evaluate outcomes and identify predictors of recurrence, with significance set at p < 0.05. Results: Biochemical recurrence occurred in 21 (34.4%) of LRP patients and 10 (21.7%) of EBRT patients. The five-year BCR-free survival was 40 (65.6%) patients in the LRP group and 33 (71.7%) for EBRT, with a trend toward improved outcomes in the EBRT group that approached statistical significance (log-rank p = 0.089). Median time to recurrence was 30 months for LRP (IQR 12.75–60) and 48 months for EBRT (IQR 30–60). Predictive analysis revealed that in the LRP group, higher ISUP grade at biopsy (p = 0.001), advanced pathological stage (p < 0.001), positive surgical margins (p < 0.001), and intermediate initial PSA levels (10–20 ng/mL; p = 0.080) were associated with increased risk of BCR. No independent predictors of recurrence were identified in the EBRT group. Conclusions: Both LRP and EBRT+ADT provide effective cancer control with similar five-year BCR-free survival. However, LRP was associated with a higher recurrence rate, particularly among patients with intermediate-risk features such as iPSA 10–20 ng/mL, high ISUP grade, advanced pathological stage, or positive surgical margins. These findings highlight the need for risk-adapted follow-up and timely salvage treatment in high-risk LRP patients to improve long-term outcomes. Full article

(This article belongs to the Special Issue Urologic Oncology: Current Issues and Future Directions)

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19 pages, 842 KiB

Open AccessArticle

Non-Thyroidal Illness Syndrome: A Predictor of Non-Invasive Ventilation Failure and Mortality in Critically Ill Patients

by Dursun Elmas and Muhammet Cemal Kizilarslanoglu

Medicina 2025, 61(5), 927; https://doi.org/10.3390/medicina61050927 - 20 May 2025

Viewed by 105

Abstract

Aim: This study aimed to investigate the effect of Euthyroid Sick Syndrome (ESS) on non-invasive mechanical ventilation (NIV) failure and in-hospital mortality. We also examined the impact of prolonged low fT3 levels before intensive care unit (ICU) admission on mortality and NIV failure. [...] Read more.

Aim: This study aimed to investigate the effect of Euthyroid Sick Syndrome (ESS) on non-invasive mechanical ventilation (NIV) failure and in-hospital mortality. We also examined the impact of prolonged low fT3 levels before intensive care unit (ICU) admission on mortality and NIV failure. Methods: The study included 386 ICU patients who received NIV. The patients were categorized into two groups: those with ESS and those without (Non-ESS). Additionally, retrospective fT3 levels were examined in the ESS group over 6 months before ICU admission, and 61 patients with prolonged ESS were identified. The primary endpoints of this study (NIV failure and mortality) were compared between study groups. Results: Of the 386 patients included in the study, comprising 332 survivors and 54 deceased individuals, ESS was observed in 49.0% of the total patient population, with a significantly higher prevalence (p = 0.005) among deceased patients (66.7%) compared to survivors (46.1%). Among the 189 patients with low fT3 levels, there was a significant disparity between survivors and deceased patients (p < 0.001). Of these, 32.3% had low fT3 levels both before and during ICU admission (prolonged ESS), with 26.1% survivors and 58.3% deceased (p < 0.001). NIV failure was significantly more common in the ESS group (44.4%) than in the non-ESS group (26.4%; p < 0.001). Conclusion: Our study demonstrates that ESS, mainly characterized by low fT3 levels, was significantly associated with increased mortality rates in ICU patients and a higher failure rate of NIV. Full article

(This article belongs to the Section Endocrinology)

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11 pages, 1630 KiB

Open AccessArticle

Clinical Effectiveness, Clinical Stability, and Effects on Serum Galectin-7 Levels of Dupilumab and JAK Inhibitors in Moderate-to-Severe Atopic Dermatitis: A Real-World, Single-Center Analysis

by Akihiro Horie, Tomomitsu Miyagaki, Chikako Hiranuma, Mami Iijima, Yoshiaki Hara, Shinya Oba, Mina Hashimoto, Reina Omori, Tatsuro Okano and Takafumi Kadono

Medicina 2025, 61(5), 926; https://doi.org/10.3390/medicina61050926 - 20 May 2025

Viewed by 130

Abstract

Background and Objectives: Several biologics and oral Janus kinase (JAK) inhibitors have been developed and shown in clinical trials and real-world studies to be effective and safe in moderate-to-severe atopic dermatitis (AD). In this study, we aimed to evaluate the real-world outcomes of [...] Read more.

Background and Objectives: Several biologics and oral Janus kinase (JAK) inhibitors have been developed and shown in clinical trials and real-world studies to be effective and safe in moderate-to-severe atopic dermatitis (AD). In this study, we aimed to evaluate the real-world outcomes of patients with moderate-to-severe AD treated with dupilumab and JAK inhibitors in our facility, focusing on their short-term effect on serum galectin-7 levels, a biomarker reflecting skin barrier impairment, and one-year stability based on patient-oriented outcomes. Materials and Methods: In a single-center, retrospective study of AD patients treated with dupilumab or JAK inhibitors between January 2018 and December 2024, we assessed physician-oriented outcomes until 16 weeks and patient-oriented outcomes until 52 weeks. Serum galectin-7 levels at baseline and 4 and/or 16 weeks after treatment were measured in 14 patients. Results: A total of 45 patients starting dupilumab and 10 patients starting JAK inhibitors were enrolled. Percentage reductions in EASI scores from baseline at 4, 8, and 16 weeks were 58.36 ± 22.09, 69.59 ± 20.96, and 75.98 ± 19.70, with no significant differences between patients treated with dupilumab and JAK inhibitors. Serum galectin-7 levels were significantly reduced after treatment at 4 and 16 weeks in the entire population. Both DLQI and POEM scores were reduced at 4 weeks and gradually decreased until 52 weeks. The reduction was faster with JAK inhibitors than with dupilumab. Visits with unstable effectiveness, defined as a visit with a three-point or greater increase in the POEM score at 28, 40, and 52 weeks, were more frequent in JAK inhibitor patients. Conclusions: Both dupilumab and JAK inhibitors showed high effectiveness on skin inflammation and decreased a marker of skin barrier dysfunction within 16 weeks. JAK inhibitors improved patient-reported outcomes more quickly than dupilumab, but instability of effectiveness during 16 and 52 weeks was higher with JAK inhibitors. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: Where We Are and Where We Are Going: 2nd Edition)

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12 pages, 265 KiB

Open AccessArticle

Clinical and Sociodemographic Characteristics of Patients with Peripheral Facial Paralysis in Medical Rehabilitation: A Comprehensive Description

by María Navarro-Martínez, Paula Rodríguez-Fernández, Sandra Núñez-Rodríguez and Jerónimo Javier González-Bernal

Medicina 2025, 61(5), 925; https://doi.org/10.3390/medicina61050925 - 20 May 2025

Viewed by 133

Abstract

Background and Objectives: Peripheral facial paralysis (PFP) is a condition with diverse etiologies, requiring multidisciplinary management. This study aimed to describe the sociodemographic, clinical, and functional characteristics of patients with PFP treated at the Rehabilitation Service of the University Hospital of Burgos [...] Read more.

Background and Objectives: Peripheral facial paralysis (PFP) is a condition with diverse etiologies, requiring multidisciplinary management. This study aimed to describe the sociodemographic, clinical, and functional characteristics of patients with PFP treated at the Rehabilitation Service of the University Hospital of Burgos and to evaluate factors associated with the initial degree of impairment. Materials and Methods: A descriptive, cross-sectional study was conducted on 45 patients referred to the Rehabilitation Service from July 2018 to July 2023. Inclusion criteria included first-time rehabilitation visits for PFP during the study period with signed informed consent. Patients with prior PFP on the affected side or severe comorbidities, such as stroke, were excluded. Data were collected from medical records and initial evaluations. The Sunnybrook Facial Grading System (SFGS) was used to assess impairment. Results: Idiopathic paralysis was the most common etiology, with a predominance in men (60.9%) and middle-aged or older adults. Otorhinolaryngology was the leading referral service, though primary care referrals were underrepresented. Delays in initiating rehabilitation were identified, especially in complex cases like acoustic neurinoma. The ANOVA test revealed no significant differences in functional assessments based on age, sex, or etiology, likely due to the limited sample size. Conclusions: The study highlights the predominance of idiopathic etiology in PFP and the importance of otorhinolaryngology in referrals. Greater awareness in primary care and early identification are crucial. Future studies with larger samples are needed to evaluate predictors of impairment and optimize rehabilitation strategies. Full article

(This article belongs to the Section Surgery)

12 pages, 280 KiB

Open AccessReview

Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) in Initial Staging of Prostate Cancer Patients: The Beginning of a New Era

by Juan Gómez Rivas, Irene de la Parra, Sarelis Infante, Laura Ibañez, Beatriz Gutierrez Hidalgo, María Nieves Cabrera, Javier Puente, Noelia Sanmamed, Luis Enrique Ortega Polledo, María Isabel Galante and Jesús Moreno Sierra

Medicina 2025, 61(5), 924; https://doi.org/10.3390/medicina61050924 - 20 May 2025

Viewed by 119

Abstract

Background and Objectives: Prostate cancer (PCa) is a common disease, with a significant number of patients initially diagnosed with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Given the recognized limitations of [...] Read more.

Background and Objectives: Prostate cancer (PCa) is a common disease, with a significant number of patients initially diagnosed with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Given the recognized limitations of traditional imaging methods, PSMA-PET has emerged as a promising tool that may revolutionize the management of PCa. Material and Methods: We conducted a comprehensive literature review from August to October 2023 using databases and a review of key clinical guidelines on the topic, focusing on the sensitivity and specificity of PSMA-PET, its use in detecting lymph node metastases (LNm), its integration into nomograms, its comparison with conventional imaging and current guideline recommendations. Results: After considering the search strategy, as well as the inclusion and exclusion criteria, four articles and five guidelines were particularly considered in this review. Most of them suggest high specificity and limited sensitivity for ⁶⁸Ga-PSMA-PET, with increased detection rates compared to conventional imaging modalities, especially in high-risk PCa patients. However, it cannot replace an extended pelvic lymph node dissection (ePLND) at this time. Conclusions: Although the enhanced sensitivity and specificity of PSMA-PET relative to conventional imaging modalities offers a more precise evaluation of disease extent, prospective studies demonstrating a survival benefit are currently lacking; therefore, caution is advised when making therapeutic decisions. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Urologic Oncology)

9 pages, 468 KiB

Open AccessReview

Artificial Intelligence and Novel Technologies for the Diagnosis of Upper Tract Urothelial Carcinoma

by Nikolaos Kostakopoulos, Vasileios Argyropoulos, Themistoklis Bellos, Stamatios Katsimperis and Athanasios Kostakopoulos

Medicina 2025, 61(5), 923; https://doi.org/10.3390/medicina61050923 - 20 May 2025

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Abstract

Background and Objectives: Upper tract urothelial carcinoma (UTUC) is one of the most underdiagnosed but, at the same time, one of the most lethal cancers. In this review article, we investigated the application of artificial intelligence and novel technologies in the prompt [...] Read more.

Background and Objectives: Upper tract urothelial carcinoma (UTUC) is one of the most underdiagnosed but, at the same time, one of the most lethal cancers. In this review article, we investigated the application of artificial intelligence and novel technologies in the prompt identification of high-grade UTUC to prevent metastases and facilitate timely treatment. Materials and Methods: We conducted an extensive search of the literature from the Pubmed, Google scholar and Cochrane library databases for studies investigating the application of artificial intelligence for the diagnosis of UTUC, according to the PRISMA guidelines. After the exclusion of non-associated and non-English studies, we included 12 articles in our review. Results: Artificial intelligence systems have been shown to enhance post-radical nephroureterectomy urine cytology reporting, in order to facilitate the early diagnosis of bladder recurrence, as well as improve diagnostic accuracy in atypical cells, by being trained on annotated cytology images. In addition to this, by extracting textural radiomics features from data from computed tomography urograms, we can develop machine learning models to predict UTUC tumour grade and stage in small-size and especially high-grade tumours. Random forest models have been shown to have the best performance in predicting high-grade UTUC, while hydronephrosis is the most significant independent factor for high-grade tumours. ChatGPT, although not mature enough to provide information on diagnosis and treatment, can assist in improving patients’ understanding of the disease’s epidemiology and risk factors. Computer vision models, in real time, can augment visualisation during endoscopic ureteral tumour diagnosis and ablation. A deep learning workflow can also be applied in histopathological slides to predict UTUC protein-based subtypes. Conclusions: Artificial intelligence has been shown to greatly facilitate the timely diagnosis of high-grade UTUC by improving the diagnostic accuracy of urine cytology, CT Urograms and ureteroscopy visualisation. Deep learning systems can become a useful and easily accessible tool in physicians’ armamentarium to deal with diagnostic uncertainties in urothelial cancer. Full article

(This article belongs to the Section Urology & Nephrology)

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26 pages, 644 KiB

Open AccessReview

Strategies to Reduce Hospital Length of Stay: Evidence and Challenges

by Rahim Hirani, Dhruba Podder, Olivia Stala, Ryan Mohebpour, Raj K. Tiwari and Mill Etienne

Medicina 2025, 61(5), 922; https://doi.org/10.3390/medicina61050922 - 20 May 2025

Viewed by 230

Abstract

Hospital length of stay (HLOS) is a critical healthcare metric influencing patient outcomes, resource utilization, and healthcare costs. While reducing HLOS can improve hospital efficiency and patient throughput, it also poses risks such as premature discharge, increased readmission rates, and potential compromise of [...] Read more.

Hospital length of stay (HLOS) is a critical healthcare metric influencing patient outcomes, resource utilization, and healthcare costs. While reducing HLOS can improve hospital efficiency and patient throughput, it also poses risks such as premature discharge, increased readmission rates, and potential compromise of patient safety. This literature review synthesizes current evidence on the determinants of HLOS, including patient-specific factors such as demographics, comorbidities, and socioeconomic status, as well as hospital-related factors like admission route, resource allocation, and institutional policies. We also examine the relationship between HLOS and key clinical outcomes, including mortality, readmission rates, and healthcare-associated infections. Additionally, we evaluate predictive modeling approaches, including artificial intelligence and machine learning, for forecasting HLOS and guiding early intervention strategies. While interventions such as enhanced recovery after surgery (ERAS) protocols, multidisciplinary care teams, and structured discharge planning have demonstrated efficacy in reducing HLOS, their success varies based on healthcare setting, patient complexity, and resource availability. Predictive analytics, incorporating clinical and non-clinical variables, offer promising avenues for improving hospital efficiency, yet may carry risks related to data quality and model bias. Given the impact of HLOS on clinical and economic outcomes, targeted interventions and predictive models should be applied cautiously, with future research focusing on refining personalized discharge strategies and addressing disparities across diverse patient populations. Full article

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

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10 pages, 290 KiB

Open AccessReview

SGLT2 Inhibitors in Patients with Urogenital Malformations and Urinary Diversions: Risks, Benefits, and Clinical Considerations

by Mohammed Abdulrasak, Ali Someili and Mostafa Mohrag

Medicina 2025, 61(5), 921; https://doi.org/10.3390/medicina61050921 - 20 May 2025

Viewed by 146

Abstract

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are increasingly used in patients with type 2 diabetes, chronic kidney disease, and heart failure. However, their safety and efficacy in patients with congenital or surgically altered urogenital anatomy remains underexplored. Methods: We conducted a narrative [...] Read more.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are increasingly used in patients with type 2 diabetes, chronic kidney disease, and heart failure. However, their safety and efficacy in patients with congenital or surgically altered urogenital anatomy remains underexplored. Methods: We conducted a narrative review of current evidence regarding the use of SGLT2i in patients with urinary tract malformations, urinary diversions, and functional voiding disorders. Key risks, clinical considerations, and management strategies were synthesized from the existing literature and case reports. Results: Patients with benign prostatic hyperplasia, vesicoureteral reflux, neurogenic bladder, nephrostomies, and ileal conduits may face increased risks of urinary tract infections, fungal colonization, and therapy-related complications due to persistent glycosuria and altered urinary flow. Nevertheless, these patients may still benefit from SGLT2i’s systemic renal and cardiovascular effects. Individualized risk assessment, close monitoring, and multidisciplinary management are essential. Conclusions: Patients with urological abnormalities represent a high-risk but potentially high-reward population for SGLT2i therapy. A cautious, tailored approach is necessary, and future dedicated research is urgently needed to better guide clinical practice. Full article

(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment—2nd Edition)

14 pages, 4098 KiB

Open AccessSystematic Review

Comparative Efficacy and Tolerability of Treatments for Erythromelalgia: A Systematic Review

by Abdullah S. Algarni, Reem M. Alharthi, Shaden O. Alqurashi, Ruba M. Alghanmi, Rimaz R. Aldawsari, Maysaa A. Alghamdi and Ramy Samargandi

Medicina 2025, 61(5), 920; https://doi.org/10.3390/medicina61050920 - 19 May 2025

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Abstract

Background and Objectives: Erythromelalgia (EM) is an uncommon condition marked by recurring redness, intense burning sensations, and elevated limb warmth. This syndrome can be significantly debilitating, and finding effective treatment options often proves to be quite difficult. The symptoms can severely impact [...] Read more.

Background and Objectives: Erythromelalgia (EM) is an uncommon condition marked by recurring redness, intense burning sensations, and elevated limb warmth. This syndrome can be significantly debilitating, and finding effective treatment options often proves to be quite difficult. The symptoms can severely impact the quality of life of those affected, resulting in considerable disability. This systematic review aims to compare available medical treatments for EM by evaluating their efficacy and safety. Materials and Methods: Following PRISMA guidelines, the search included the PubMed, Medline, and Web of Science databases, using the keywords (“Erythromelalgia” OR “Mitchell’s Disease”) AND (“Erythromelalgia Treatment” OR “Erythromelalgia Management”). Results: From the 103 papers extracted through the database search, six articles were considered suitable for the systematic review. The included studies investigated various interventions used for a total of 120 patients, including iloprost (n = 8), misoprostol (n = 21), topical amitriptyline-ketamine (n = 36), lidocaine (n = 27), chemical lumbar sympathectomy (CLS, n = 13), and various pharmacological agents (n = 11). The outcomes showed significant improvements in areas like pain reduction, cooling scores, and temperature regulation. Iloprost and misoprostol exhibited notable benefits in cooling scores, sympathetic dysfunction, and EM severity compared to placebos. About 75% of the patients reported pain relief with topical amitriptyline-ketamine, while lidocaine reduced nociceptive feelings in a dose-dependent manner. Conclusions: Comparing interventions demonstrated consistent clinical benefit with varied tolerability. However, adverse events ranged from mild gastrointestinal symptoms to severe complications such as disability and depression, requiring careful monitoring. Given EM’s diverse symptoms and comorbidities, treatment efficacy varies among individuals. A personalized approach incorporating genetic testing, multidisciplinary care, and long-term monitoring is essential to optimize outcomes. Continued research is vital to advance understanding of EM’s pathophysiology and improve patient care. Full article

(This article belongs to the Section Dermatology)

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11 pages, 719 KiB

Open AccessArticle

Comparison of the Effects of Spinal Anaesthesia on Frontal QRS-T Angle in Term and Post-Term Pregnancies Planned for Elective Caesarean Section: A Prospective Study

by Ahmet Kaya, Mahmut Alp Karahan, Tugba Bingol Tanriverdi, Alev Esercan, Melike Bostanci Erkmen and Zulkif Tanriverdi

Medicina 2025, 61(5), 919; https://doi.org/10.3390/medicina61050919 - 19 May 2025

Viewed by 145

Abstract

Background and Objectives: Post-term pregnancies are associated with increased risks of perinatal complications. This study aimed to evaluate potential cardiac electrophysiological changes in pregnant women by comparing the QRS duration, interval of corrected QT (QTc), and frontal QRS-T angle [f(QRS-T)] between term [...] Read more.

Background and Objectives: Post-term pregnancies are associated with increased risks of perinatal complications. This study aimed to evaluate potential cardiac electrophysiological changes in pregnant women by comparing the QRS duration, interval of corrected QT (QTc), and frontal QRS-T angle [f(QRS-T)] between term and post-term pregnancies. Materials and Methods: In this observational prospective study, 120 pregnant women were enrolled—60 term (37–41 weeks) and 60 post-term (≥42 weeks). All participants underwent standard 12-lead electrocardiography (ECG) and caesarean section with spinal anaesthesia. The QTc interval, QRS duration, and frontal QRS-T angle were measured. Demographic parameters such as age, gestational week, height, and weight were recorded. The SPSS software was used to analyse the data with p < 0.05 as the threshold for significance. Results: Post-operative QTc interval (417.3 ± 20.5 vs. 410.2 ± 14.5, p = 0.032) and f(QRS-T) (28 [16–55] vs. 22 [14–34], p = 0.042) were significantly higher in the post-term group than in the term group. When the change in the f(QRS-T) angle was analysed, there was a significant widening of this angle in the post-term group (from 21 [11–37] to 28 [16–55], p = 0.002). The increased f(QRS-T) angle reflects greater heterogeneity in ventricular depolarisation and repolarisation, which may indicate sub-clinical myocardial stress or altered autonomic regulation in the post-term period. Although no overt arrhythmias were observed, subtle changes in P-wave morphology and QT dispersion were more prevalent in the post-term group. Conclusions: Prolonged QRS duration and an increased f(QRS-T) angle in post-term pregnancies can reflect the underlying changes in cardiac electrophysiology related to prolonged gestation. These ECG parameters may serve as non-invasive indicators of sub-clinical cardiac stress, which could be relevant for anaesthetic risk assessment and perinatal management. Full article

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

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10 pages, 246 KiB

Open AccessPerspective

We Need to Talk About Quality of Life with Cancer Patients: Primum Non Nocere in Oncology

by Vlad Bogin

Medicina 2025, 61(5), 918; https://doi.org/10.3390/medicina61050918 - 19 May 2025

Viewed by 207

Abstract

The Hippocratic principle primum non nocere, or “first, do no harm”, serves as a vital lens through which to re-evaluate modern oncology practices. While recent advances such as immunotherapy, targeted agents, and precision medicine have transformed cancer care, these treatments are not without [...] Read more.

The Hippocratic principle primum non nocere, or “first, do no harm”, serves as a vital lens through which to re-evaluate modern oncology practices. While recent advances such as immunotherapy, targeted agents, and precision medicine have transformed cancer care, these treatments are not without risk. Even with improved tolerability, they may still lead to substantial toxicities, particularly in frail patients with advanced cancer. The pursuit of survival often overshadows the patient’s quality of life, with aggressive interventions frequently continuing beyond the point of meaningful benefit. This perspective article argues for a more individualized and ethically grounded approach to cancer treatment, emphasizing the careful assessment of each patient’s clinical status, values, and goals. By integrating geriatric and palliative assessments, improving shared decision making, and moving away from a default treatment-at-all-costs mindset, clinicians can better align care with what truly matters to patients. Honoring primum non nocere in oncology means not only extending life when appropriate but ensuring that life remains worth living. Full article

(This article belongs to the Special Issue Quality of Life Assessment in Oncology Patients)

12 pages, 1304 KiB

Open AccessArticle

The Interplay of Cancer and Hypertension: Rising Mortality and Widening Disparities Across the United States (1999–2023)

by Ibrahim Ali Nasser, Shereen Asghar, Laraib Masud, Muhammad Ali Hafeez, Sonia Hurjkaliani, Eeshal Zulfiqar, Maryam Shahzad, Husain Ahmed, Shahrukh Khan, Sajeel Ahmed, Qadeer Abdul, Muhammed Ameen Noushad, Rabia Nusrat, Sana Azhar, Charles Dominic Ward, Mushood Ahmed and Raheel Ahmed

Medicina 2025, 61(5), 917; https://doi.org/10.3390/medicina61050917 - 19 May 2025

Viewed by 307

Abstract

Background and Objectives: Growing evidence suggests a strong relationship between hypertension and cancer, which can increase the risk of poor prognosis. However, data regarding mortality related to cancer and hypertension are limited. Our study aims to analyze the mortality trends related to [...] Read more.

Background and Objectives: Growing evidence suggests a strong relationship between hypertension and cancer, which can increase the risk of poor prognosis. However, data regarding mortality related to cancer and hypertension are limited. Our study aims to analyze the mortality trends related to cancer and hypertension in the United States from 1999 to 2023. Materials and Methods: A retrospective observational analysis was conducted using mortality data for the adult U.S. population from 1999 to 2023, retrieved from the CDC WONDER database using death certificates. Age-adjusted mortality rates (AAMRs) were calculated, and annual percentage changes (APCs) were analyzed using JoinPoint Regression. Results: From 1999 to 2023, a total of 1,406,107 deaths related to cancer and hypertension were recorded in the United States. The AAMR increased from 12.59 in 1999 to 35.49 in 2023. Males had a higher mortality rate compared to women throughout the study period (AAMR; 30.3 vs. 20.4). Non-Hispanic (NH) Black Americans, or African Americans had the highest mortality rates, followed by NH white, Hispanic or Latino groups, and other NH groups. The highest AAMR was observed in the South, followed by the Midwest, the Northeast, and the West. Rural areas had higher mortality rates compared to urban areas. Conclusions: Cancer- and hypertension-related mortality rates have consistently increased in the United States from 1999 to 2023, particularly affecting males, NH Black Americans, the southern region, and rural areas. The trends highlight the need for targeted prevention, including early screening, lifestyle changes, and treatment adherence. Full article

(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)

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13 pages, 2071 KiB

Open AccessArticle

Exploratory Cluster-Based Radiographic Phenotyping of Degenerative Cervical Disorder: A Retrospective Study

by Si-Hyung Lew, Ye-Jin Jeong, Ye-Ri Roh and Dong-Ho Kang

Medicina 2025, 61(5), 916; https://doi.org/10.3390/medicina61050916 - 19 May 2025

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Abstract

Background and Objectives: Degenerative cervical myelopathy (DCM), a major subtype of degenerative cervical disorders, presents with diverse sagittal alignment patterns. However, radiography-based phenotyping remains underexplored. This study aimed to identify distinct cervical alignment subgroups using unsupervised clustering analysis and to explore their [...] Read more.

Background and Objectives: Degenerative cervical myelopathy (DCM), a major subtype of degenerative cervical disorders, presents with diverse sagittal alignment patterns. However, radiography-based phenotyping remains underexplored. This study aimed to identify distinct cervical alignment subgroups using unsupervised clustering analysis and to explore their potential clinical relevance. Materials and Methods: We analyzed 1371 lateral cervical radiographs of patients with DCM. C3–C7 sagittal vertical axis (SVA), lordosis, vertical length, and curved length were determined. K-means clustering was applied, and the optimal cluster number was determined using the elbow method and silhouette analysis. Clustering validity was assessed using the Calinski–Harabasz and Davies–Bouldin indices. Results: The final clustering solution was validated with a high Calinski–Harabasz index (1171.70) and an acceptable Davies–Bouldin index (0.99) at k = 3, confirming the stability and robustness of the classification. Cluster 1 (forward-head type) exhibited low lordosis (8.3° ± 4.7°), moderate SVA (95.9 ± 60.2 mm), and a compact cervical structure, consistent with kyphotic alignment and forward-head displacement. Cluster 2 (normal) showed the highest lordosis (24.1° ± 6.8°), moderate SVA (70.6 ± 50.2 mm), and balanced sagittal alignment, indicating a biomechanically stable cervical posture. Cluster 3 (long-neck type) displayed the highest SVA (135.6 ± 76.7 mm), the longest vertical and curved lengths, and moderate lordosis, suggesting a structurally elongated cervical spine with anterior head displacement. Significant differences (p < 0.01) were observed across all clusters, confirming distinct phenotypic patterns in cervical sagittal alignment. Conclusions: This exploratory clustering analysis identified three distinct radiographic phenotypes of DCM, reflecting biomechanical heterogeneity. Although prospective studies linking these phenotypes to clinical outcomes are warranted, our findings provide a framework for personalized spinal care in the future. Full article

(This article belongs to the Special Issue Clinical Advances in Spine Surgery)

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Open AccessReview

The Global Burden of Maxillofacial Trauma in Critical Care: A Narrative Review of Epidemiology, Prevention, Economics, and Outcomes

by Antonino Maniaci, Mario Lentini, Luigi Vaira, Salvatore Lavalle, Salvatore Ronsivalle, Francesca Maria Rubulotta, Lepanto Lentini, Daniele Salvatore Paternò, Cosimo Galletti, Massimiliano Sorbello, Jerome R Lechien and Luigi La Via

Medicina 2025, 61(5), 915; https://doi.org/10.3390/medicina61050915 - 18 May 2025

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Abstract

Background and Objectives: Maxillofacial trauma represents a significant global health challenge with substantial physical, psychological, and socioeconomic consequences. Materials and Methods: This narrative review analyzed 112 articles published between 2000 and 2024 examining epidemiology, prevention, economics, and outcomes of maxillofacial trauma in [...] Read more.

Background and Objectives: Maxillofacial trauma represents a significant global health challenge with substantial physical, psychological, and socioeconomic consequences. Materials and Methods: This narrative review analyzed 112 articles published between 2000 and 2024 examining epidemiology, prevention, economics, and outcomes of maxillofacial trauma in critical care settings. Results: Road traffic accidents remain the primary cause globally, followed by interpersonal violence and occupational injuries. Effective prevention strategies include seat belt laws, helmet legislation, and violence prevention programs. Economic burden encompasses direct healthcare costs (averaging USD 55,385 per hospitalization), productivity losses (11.8 workdays lost per incident), and rehabilitation expenses (USD 3800–18,000 per patient). Surgical management has evolved toward early intervention, minimally invasive approaches, and advanced techniques using computer-aided design and 3D printing. Complications affect 3–33% of patients, with significant functional disabilities and psychological sequelae (post-traumatic stress disorder in 27%, depression/anxiety in 20–40%). Conclusion: Maxillofacial trauma management requires multidisciplinary approaches addressing both immediate treatment and long-term rehabilitation. Despite technological advances, disparities in specialized care access persist globally. Future efforts should implement evidence-based prevention strategies, reduce care disparities, and develop comprehensive approaches addressing physical, psychological, and socioeconomic dimensions through collaboration among healthcare professionals, policymakers, and community stakeholders. Full article

(This article belongs to the Section Surgery)

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Open AccessArticle

Osteogenic Potential and Bone Matrix Maturity: Comparison of Demineralized Bone Matrix and P15 Polypeptide iFactor^® in an In Vitro Study

by Anell Olivos-Meza, Monica Maribel Mata-Miranda, Marcelo Robles-Rodríguez, Gustavo Jesús Vázquez-Zapién, Melissa Guerrero-Ruiz and Carlos Landa-Solís

Medicina 2025, 61(5), 914; https://doi.org/10.3390/medicina61050914 - 18 May 2025

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Abstract

Background and Objectives: Demineralized bone matrix (DBM) is a widely used bone graft substitute due to its osteoconductive and osteoinductive properties. However, its efficacy varies due to differences in donor, processing, and storage conditions. Synthetic alternatives, such as iFactor^®, combine non-organic [...] Read more.

Background and Objectives: Demineralized bone matrix (DBM) is a widely used bone graft substitute due to its osteoconductive and osteoinductive properties. However, its efficacy varies due to differences in donor, processing, and storage conditions. Synthetic alternatives, such as iFactor^®, combine non-organic bone mineral and a small peptide (P-15) to enhance the cellular attachment and osteogenesis. To compare the osteogenic potential and bone matrix maturity of iFactor^® and a commercial DBM scaffold through calcium nodule formation and Fourier transform infrared spectroscopy (FTIR) analysis. Materials and Methods: Human mesenchymal stem cells (hMSCs) were cultured and exposed to iFactor^® or DBM in paracrine culture conditions for 21 days. Calcium nodule formation was assessed using alizarin red staining and quantified spectrophotometrically. The FTIR analysis of hMSCs exposed to the scaffolds for three months evaluated the biomolecular composition and bone matrix maturity. Results: Calcium nodules formed in both groups but in smaller quantities than in the positive control (p < 0.05). The biomolecular components of the DBM were similar to healthy bone (p > 0.05) than those of the iFactor^® group (p < 0.005). A different rate of bone regeneration was observed through the formation of a greater number of calcium nodule aggregates identified in the extracellular matrix of mesenchymal stem cell cultures exposed to iFactor^® compared to those cultures enriched with DBM. Conclusions: Both experimental matrices demonstrated similar osteogenic potential at the 3-month follow-up. Although DBM has a closer biomolecular composition and carbonate substitution compared to healthy bone, iFactor^® showed faster matrix maturity expressed through the formation of a greater number of calcium nodule aggregates and higher hMSCs proliferation. Full article

(This article belongs to the Section Orthopedics)

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Medicina, Volume 61, Issue 5 (May 2025) – 173 articles

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