Medicina

13 pages, 1262 KiB

Open AccessArticle

Selective Advantage of NACT in Advanced Ovarian Cancer: A Retrospective Single-Centre Analysis

by Adrienne Szilvia Berczi, Olivér Lampé, Zoárd Tibor Krasznai, Mónika Orosz, Lili Fábián and Rudolf Lampé

Medicina 2025, 61(8), 1493; https://doi.org/10.3390/medicina61081493 (registering DOI) - 20 Aug 2025

Abstract

Background and Objectives: Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients [...] Read more.

Background and Objectives: Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients with high tumor burden. However, its impact on surgical complexity remains debated. This study aimed to compare operative characteristics and survival outcomes between NACT + IDS and PDS using standardized scoring metrics in a real-world oncologic setting. Materials and Methods: We retrospectively analyzed 47 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV high-grade serous EOC treated between January 2018 and August 2022 at a single tertiary center. Twenty-five patients received platinum–taxane-based NACT followed by IDS, and twenty-two underwent upfront PDS with adjuvant chemotherapy. Surgical effort was quantified using the Surgical Complexity Score (SCS), and intra-abdominal tumor burden was assessed via the Peritoneal Cancer Index (PCI). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Hazard ratios (HRs) with 95% confidence intervals were derived from Cox proportional hazards models. Results: Complete cytoreduction (R0) was achieved in 76% of the NACT + IDS group and 68% of the PDS group. Mean surgical complexity and operative time were significantly lower following NACT (SCS 5.0 vs. 6.2, p = 0.04; 140 vs. 197 min, p = 0.001), without significant differences in blood loss, complication rates, or length of hospital stay. Median PFS was 25 months in the NACT + IDS group versus 21 months in the PDS group, and the difference was not statistically significant. Among patients with R0 resection, survival outcomes were comparable between treatment arms. Conclusions: NACT + IDS was associated with shorter and less complex surgeries in selected patients, but survival outcomes appeared similar when R0 was achieved. Data suggest that selective use of NACT in patients with extensive disease burden or limited general health status may be suitable, while confirming that complete cytoreduction remains the most critical prognostic factor, although these survival comparisons are exploratory given the retrospective design and limited sample size. Full article

(This article belongs to the Special Issue Update on Surgical Treatment for Ovarian Cancer)

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11 pages, 678 KiB

Open AccessArticle

Reliability of Body Fat Percentage Measurements and Their Impact on Airway Resistance: Does Leptin Play a Significant Role?

by Rodrigo Muñoz-Cofré, Edgardo Rojas-Mancilla, Pablo A. Lizana, Máximo Escobar-Cabello, Claudio García-Herrera, Daniel Conei, Fernando Valenzuela-Aedo, Francisco Javier Soto-Rodríguez and Mariano del Sol

Medicina 2025, 61(8), 1492; https://doi.org/10.3390/medicina61081492 (registering DOI) - 20 Aug 2025

Abstract

Background/Objectives: The measurement of body fat percentage (%BF) could alert us to potential respiratory problems; however, differences in %BF values have been reported depending on the method used. Therefore, the objectives of this study were to determine whether there are differences in %BF [...] Read more.

Background/Objectives: The measurement of body fat percentage (%BF) could alert us to potential respiratory problems; however, differences in %BF values have been reported depending on the method used. Therefore, the objectives of this study were to determine whether there are differences in %BF obtained through skinfold measurements (SF) and bioelectrical impedance analysis (BIA), and their correlation with airflow limitation (AFL), and secondly, to observe the relationship between leptin and AFL. Materials and Methods: A cross-sectional study was conducted with 80 participants (40 men and 40 women, aged 18–30 years). Assessments of %BF were made using SF and BIA. Spirometric parameters and pulmonary volumes were measured. Plasma leptin levels were determined using ELISA. Bivariate correlations and gender differences were analyzed. Results: When comparing %BF measured by SF and BIA, no significant differences were found between the two methods in either females or males. Furthermore, in both men and women, there was a direct and significant correlation between %BF obtained through BIA and SF (r = 0.936; r = 0.789, p < 0.001, respectively). Leptin showed a significant correlation with airway resistance (Raw) and specific airway resistance (sRaw) in men (r = 0.506; r = 0.553, p < 0.001, respectively) and women (r = 0.537, p = 0.001; r = 0.489, p = 0.003, respectively). Leptin also showed a significant correlation with %BF measured by both SF and BIA in men (r = 0.675; r = 0.687, p < 0.001, respectively) and women (r = 0.583; r = 0.682, p < 0.001, respectively). Conclusions: BIA and SF offer comparable results in estimating %BF. The significant correlation between leptin, %BF, and FEV1/FVC suggests a possible pathophysiological mechanism mediated by adiposity that could affect pulmonary function even in young and clinically healthy individuals. Full article

(This article belongs to the Section Pulmonology)

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15 pages, 936 KiB

Open AccessArticle

The Resurgence of Syphilis: A 20-Year Evaluation of Epidemiological Trends and Serological Test Performance Using Rapid Plasma Reagin and Indirect Hemagglutination Assays

by Melda Payaslıoğlu, İmran Sağlık and Esra Kazak

Medicina 2025, 61(8), 1491; https://doi.org/10.3390/medicina61081491 - 20 Aug 2025

Abstract

Background and Objectives: This retrospective single-center study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of syphilis cases diagnosed at our hospital between 2005 and 2024, with a focus on the performance of serological tests used for diagnosis. The study also [...] Read more.

Background and Objectives: This retrospective single-center study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of syphilis cases diagnosed at our hospital between 2005 and 2024, with a focus on the performance of serological tests used for diagnosis. The study also sought to characterize changing epidemiological trends of syphilis over this 20-year period. Materials and Methods: Data from 671 patients with confirmed syphilis diagnoses were retrospectively analyzed. Demographic information, transmission routes, co-infection status, and serological test results—including Rapid Plasma Reagin (RPR) and Indirect Hemagglutination Assay (IHA)—were evaluated. Statistical analyses were performed using chi-square and Fisher-based tests, with Bonferroni correction applied for multiple comparisons Results: Of the 671 cases, 74.6% were male and 25.4% female, with the highest incidence in the 22–41 age group. The number of diagnosed cases increased approximately 6-fold after 2016 compared to the preceding years. Unprotected sexual contact was the most common transmission route. HIV co-infection was present in 32.6% of cases, predominantly in males. Significant differences in RPR and IHA titers were observed across clinical stages of syphilis, with notably higher titers in late latent and neurosyphilis cases. Conclusions: The 6-fold increase in syphilis diagnoses since 2016, alongside a high rate of HIV co-infection, underscores the need for targeted prevention and screening programs for high-risk populations. Serological testing remains essential for diagnosis and disease monitoring. Full article

(This article belongs to the Section Infectious Disease)

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17 pages, 989 KiB

Open AccessArticle

The Use of Serum Scoring Systems in Predicting Liver Fibrosis Caused by Chronic Hepatitis B: A Retrospective Case-Control Study

by Müge Özgüler, Samet Durak, Özgen Arslan Solmaz, Gülden Eser Karlıdağ, Ömür Gündağ, Yasemin Kırık, Büşra Tanır and Sümeyye Selim Kara

Medicina 2025, 61(8), 1490; https://doi.org/10.3390/medicina61081490 - 20 Aug 2025

Abstract

Background and Objectives: Early diagnosis and monitoring of liver fibrosis in chronic hepatitis B are crucial for effective disease management and prognosis. Traditionally, percutaneous liver biopsy has been regarded as the gold standard for assessing the degree of fibrosis histopathologically. However, this [...] Read more.

Background and Objectives: Early diagnosis and monitoring of liver fibrosis in chronic hepatitis B are crucial for effective disease management and prognosis. Traditionally, percutaneous liver biopsy has been regarded as the gold standard for assessing the degree of fibrosis histopathologically. However, this method has several drawbacks. Consequently, non-invasive serum scoring systems are becoming increasingly preferred. These serum scoring systems have emerged as valuable non-invasive tools for predicting liver fibrosis in patients with chronic hepatitis B. Multiple serum-based scoring systems have been developed and validated for this purpose. The aim of this study is to determine the role of serum scoring systems in chronic hepatitis B, evaluate their performance, and analyze their correlation with liver biopsy results. Materials and Methods: Patients diagnosed with Chronic Hepatitis B who underwent liver biopsy and were found to have liver fibrosis associated with chronic hepatitis B between August 2018 and July 2024 were included in this retrospective comparative case-control study and liver function tests, INR, alpha-fetoprotein levels, hemogram parameters, kidney function tests, and cholesterol levels at the time of biopsy were recorded. Results: The present study included a total of 249 patients, comprising 138 men (55.5%; mean age 42.1 years) and 111 women (44.5%; mean age 45.8 ± 13.5 years). The results of sixteen commonly used scoring systems in the current literature were evaluated for predicting fibrosis. According to ROC analysis, the most notable score identified was the KING score (0.775). The subsequent scores, in order, were AGAP (0.768), GUCI (0.748), FIB-4 (0.735), APRI (0.729), and S-INDEX (0.701). Conclusions: Non-invasive methods offer potential advantages over liver biopsy. While these scoring systems demonstrate good accuracy in identifying advanced fibrosis and cirrhosis, their performance in detecting mild to moderate fibrosis is generally less reliable. They can function as preliminary screening tests to identify patients who may require further evaluation or to prioritize individuals for more advanced imaging studies or liver biopsy. Full article

(This article belongs to the Section Infectious Disease)

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16 pages, 818 KiB

Open AccessReview

Psychoneurobiological Aspects of Burning Mouth Syndrome and Oral Lichen Planus: A Narrative Review

by Dora Martić, Ana Glavina, Liborija Lugović-Mihić and Maja Vilibić

Medicina 2025, 61(8), 1489; https://doi.org/10.3390/medicina61081489 - 20 Aug 2025

Abstract

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, [...] Read more.

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, endocrine, and immunological factors, i.e., complex disorders in interconnected biological and psychological systems. In BMS, patients often suffer from persistent burning sensations without visible lesions, which may be related to altered pain processing, emotional stress, and dysregulation in the brain regions responsible for interoception and perception. Although OLP is primarily characterised by immune-mediated mucosal damage, it often has significant psychological comorbidity, particularly in the erosive form. Common features such as cortisol imbalance, disturbed cytokine patterns, and high levels of anxiety and depression suggest that these conditions may be due to overlapping systemic disorders. It is no longer sufficient to focus only on the visible lesions or symptom relief. Understanding these diseases/disorders through a more comprehensive psychoneuroendocrine immune system (PNEI) opens up new opportunities for early intervention, improved diagnostics, and more personalised therapeutic strategies that go beyond treating symptoms. Ultimately, these diseases/disorders require a more integrated and patient-centred approach, where understanding the whole system is as important as treating its individual parts. Full article

(This article belongs to the Topic Oral Health Management and Disease Treatment)

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24 pages, 3018 KiB

Open AccessSystematic Review

The Effects of Hyaluronic Acid on Gait Parameters in Patients with Knee Osteoarthritis: A Systematic Literature Review

by Cosimo Costantino, Sara Ronzoni, Annalisa Ingletto, Roberto Sabato, Antonello Salerno, Stefano Palermi, Ruben Foresti, Chiara Martini and Andrea Demeco

Medicina 2025, 61(8), 1488; https://doi.org/10.3390/medicina61081488 - 20 Aug 2025

Abstract

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and [...] Read more.

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and in this context, gait analysis could provide an objective assessment of walking patterns to identify any deficits. This systematic review investigates the short and long-term effects of intra-articular HA injections on gait kinematics, pain and activities of daily living (ADL), investigating the correlation between outcomes. Materials and Methods: The review followed PRISMA guidelines. The PICO model included patients with radiographic knee osteoarthritis who received intra-articular HA injections, comparing them to healthy controls or those receiving corticosteroids or placebo. Outcomes included gait kinetics and functional scales at baseline and during follow-ups. Results: From 342 identified articles, 13 were included, comprising a total of 321 patients. The gait analysis utilized optoelectronic systems, inertial sensors, and electromyographic sensors pre- and post-HA treatment. Clinical parameters were assessed using the Visual Analogue Scale, WOMAC OA, Knee Society Score, Lequesne Score, and SF-36. The data showed significant improvement in speed (p = 0.001) and step cadence (p < 0.005) 30 days post-treatment and improvements in knee adduction moment (p < 0.001) and sagittal ground reaction force vectors (p < 0.01) up to six months post-treatment. Pain reduction and improvements in VAS (p < 0.001) and Lequesne score (p < 0.001) were observed in short-term follow-ups. Conclusions: Our study suggests an improvement in pain and knee function after hyaluronic acid injection. Moreover, gait analysis is an important tool for objectively assessing deficits and developing personalized rehabilitation programs. Furthermore, combining infiltrative treatment with rehabilitation could extend the effects of hyaluronic acid and improve results. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 1087 KiB

Open AccessArticle

Optimal Maintenance Strategy for Patients with Improved Left Ventricular Function Following Sacubitril/Valsartan Therapy

by Yoonjee Park, Minjung Bak, Heayoung Shin, David Hong, Jeong Hoon Yang, Darae Kim, Eun-Seok Jeon and Jin-Oh Choi

Medicina 2025, 61(8), 1487; https://doi.org/10.3390/medicina61081487 - 19 Aug 2025

Abstract

Background and Objectives: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to [...] Read more.

Background and Objectives: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to a renin–angiotensin system blocker (RASB). Material and Method: A total of 354 patients with recovered LVEF of at least 40% after S/V treatment from a single center were retrospectively analyzed. Patients were categorized into three groups: those who continued S/V (n = 294), those who switched to RASB (n = 47), and those who discontinued both S/V and RASB (n = 13). The primary endpoint was HF relapse, defined as a two-fold increase in baseline serum N-terminal-pro hormone B-type natriuretic peptide (NT-proBNP) concentration exceeding 400 pg/dL. Secondary endpoints included the ratio and difference between baseline and peak NT-proBNP levels. Result: Baseline clinical characteristics were well balanced among groups. Over a median follow-up of 399 (252–589) days, HF relapse occurred more frequently in patients who discontinued both S/V and RASB compared to those who maintained either treatment (53.8% vs. 16.3% vs. 10.6%; p = 0.001). NT-proBNP levels also showed a more pronounced increase in this group. However, there were no significant differences in primary or secondary outcomes between the S/V and RASB groups. Conclusions: Our findings suggest that replacing S/V with another RASB does not worsen outcomes in patients with HFimpEF after S/V treatment, whereas discontinuation of both therapies is associated with a significantly higher risk of HF relapse. A prospective trial is warranted to confirm the safety and effectiveness of this approach in maintaining remission. Full article

(This article belongs to the Section Cardiology)

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15 pages, 1412 KiB

Open AccessArticle

A Single Bout of Foam Rolling After Nordic Hamstring Exercise Improves Flexibility but Has No Effect on Muscle Stiffness or Functional Muscle Parameters

by Coşkun Rodoplu, Christian Burger, Josef Fischer, Josefina Manieu Seguel, Ramiz Arabacı and Andreas Konrad

Medicina 2025, 61(8), 1486; https://doi.org/10.3390/medicina61081486 - 19 Aug 2025

Abstract

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief [...] Read more.

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief that it can speed up recovery. Thus, this study investigated the acute and 48-h effects of FR following the NHE on muscle stiffness, pain pressure threshold (PPT), flexibility, countermovement jump (CmJ) height, and maximal voluntary isometric contraction (MVIC). Materials and Methods: Thirty-two active males were randomly assigned to either an FR group (n = 16) or a passive recovery (PR, n = 16) group. Measurements were taken at three time points: pre-test, post-test_0h, and post-test_48h. Participants performed the NHE (3 sets × 10 reps) before the recovery interventions. Variables assessed included muscle stiffness (MyotonPro), flexibility (sit and reach), PPT (algometer), jump performance (force platform), and MVIC peak torque (dynamometer). Results: FR significantly improved acute flexibility (12.7%, p < 0.001) following the NHE and prevented flexibility loss at 48 h, compared to the PR group. However, FR showed no significant advantages over PR in terms of muscle stiffness, PPT, CmJ, or MVIC, both acutely and at 48 h (p > 0.05). Conclusions: FR is an effective acute recovery strategy for improving flexibility after the NHE but offers limited effects for muscle stiffness, PPT, and other functional muscle parameters, both acutely and at 48 h. Further research should explore the long-term effects and efficacy of FR across diverse populations and recovery scenarios. Full article

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9 pages, 261 KiB

Open AccessArticle

Evaluating Maternal Healthcare Quality Through the Lens of Maternal near Miss: A Retrospective Analysis from a High-Volume Tertiary Center

by İbrahim Polat and Tuğçe Arslanoğlu

Medicina 2025, 61(8), 1485; https://doi.org/10.3390/medicina61081485 - 19 Aug 2025

Abstract

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term [...] Read more.

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term adapted from aviation—to standardize the identification and analysis of severe maternal complications. In addition to MNM, various indices are used to assess both access to and the quality of healthcare services. Materials and Methods: This retrospective study evaluated all pregnant women who presented at Başakşehir Çam and Sakura City Hospital, including postpartum referrals, between May 2020 and May 2023. Given the ongoing COVID-19 pandemic during the study period, data from COVID-19-positive patients were reported separately. All definitions and classifications were based on the standardized WHO MNM criteria. Results: A total of 45,458 births occurred at our institution during the study period. Among the COVID-19-excluded cohort, we identified 223 life-threatening conditions (LTCs), 206 MNM cases, and 17 maternal deaths. The resulting mortality index was 7.62%. The most frequent primary diagnoses included placental invasion anomalies, severe preeclampsia, and uterine atony. The most common interventions among LTC cases were ICU admission, prolonged hospitalization, hysterectomy, and massive transfusion. Conclusions: Although the rates of LTCs, MNM, and maternal mortality (MM) are gradually declining, they remain essential metrics for assessing healthcare quality. This study reveals that, while tertiary centers may report higher-than-global-average indices, there remains a significant gap between current outcomes and ideal targets. Enhancing diagnostic training, optimizing intervention strategies, and implementing robust clinical algorithms are critical steps toward reducing severe maternal morbidity and mortality. Full article

(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)

12 pages, 299 KiB

Open AccessArticle

Low-Density Lipoprotein Cholesterol Target Attainment in Lithuania: A Nationwide Analysis of Real-World Health Data

by Gediminas Urbonas, Tomas Lapinskas, Indrė Čeponienė, Olga Vasiliauskienė, Jelena Umbrasienė, Ingrida Grabauskytė and Jurgita Plisienė

Medicina 2025, 61(8), 1484; https://doi.org/10.3390/medicina61081484 - 19 Aug 2025

Abstract

Background and Objectives: Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and Methods: [...] Read more.

Background and Objectives: Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and Methods: This retrospective study used anonymized health data from the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) in Lithuania. Adults aged ≥40 years with at least one LDL-C measurement in 2023 and no documented cancer diagnosis were included. The primary outcome was the proportion of patients achieving LDL-C < 1.8 mmol/L, the target recommended by the European Society of Cardiology guidelines for high-risk individuals. Univariate logistic regression analysis was conducted to identify factors associated with achieving the LDL-C target. Results: The study included 396,835 patients (mean age, 66.9 years). The mean LDL-C concentration was 3.32 mmol/L, and only 8.1% of patients achieved LDL-C < 1.8 mmol/L. Target achievement was higher among patients in the secondary CVD prevention group compared to primary prevention (20.6% vs. 7.3%). Over half of patients (56.4%) received no lipid-lowering therapy (LLT). Statin monotherapy was the most prescribed LLT (31.3%), while only 2.7% of patients received statin and ezetimibe combination. In logistic regression analysis, secondary prevention status, more frequent cardiologist consultations, and higher LLT prescription frequency were associated with LDL-C target achievement. Compared to patients not receiving LLT, the odds of achieving LDL-C < 1.8 mmol/L were significantly higher in those receiving statin monotherapy (odds ratio [OR]: 3.153, 95% confidence interval [CI]: 3.069–3.240), statin and ezetimibe (OR: 7.631, 95% CI: 7.267–8.013), or statin and antihypertensive (OR: 3.945, 95% CI: 3.803–4.092). Conclusions: LDL-C target attainment remains low in Lithuania, with the underuse of LLT. Broader implementation of guideline-recommended lipid-lowering strategies is needed to improve LDL-C control. Full article

(This article belongs to the Special Issue Primary Care in the Post-Pandemic Era)

16 pages, 1531 KiB

Open AccessReview

Desquamative Gingivitis Revisited: A Narrative Review on Pathophysiology, Diagnostic Challenges, and Treatment

by Doina Iulia Rotaru, Ioana Chifor Porumb, Lorentz Jäntschi and Radu Marcel Chisnoiu

Medicina 2025, 61(8), 1483; https://doi.org/10.3390/medicina61081483 - 19 Aug 2025

Abstract

Background and objectives: Desquamative gingivitis (DG) is a clinical term used to describe gingival conditions marked by erythema (unrelated to dental plaque), epithelial desquamation, and various intraoral lesions, with occasional extraoral involvement. It is typically linked to a range of underlying diseases. [...] Read more.

Background and objectives: Desquamative gingivitis (DG) is a clinical term used to describe gingival conditions marked by erythema (unrelated to dental plaque), epithelial desquamation, and various intraoral lesions, with occasional extraoral involvement. It is typically linked to a range of underlying diseases. Materials and methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching with keywords like “oral dysplasia”, “oral mucosa lesions”, or “desquamative gingivitis”. In addition to the literature review, a case report of a patient with DG is included to illustrate the diagnostic challenges and treatment considerations in a clinical setting, and to design and test simplified diagnosis and treatment-planning algorithms. Results: Diagnosis can be supported by a standard punch biopsy to obtain tissue samples for histopathological evaluation. The complex clinical case presented illustrates the clinical features of DG and highlights the challenges associated with its diagnosis and management. The mainstay of treatment, as resulted from 96 studies included in our review, involves topical and systemic corticosteroids, with topical calcineurin inhibitors serving as adjunctive therapy. Conclusions: A universally accepted treatment protocol is still lacking for DG, so this report outlines an effective, experience-based therapeutic approach. Additionally, it offers a simplified framework for diagnosis, treatment planning, and therapeutic management, contributing to the growing knowledge base needed for a decision-support algorithm development. Full article

(This article belongs to the Special Issue Current and Future Trends in Dentistry and Oral Health)

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13 pages, 1308 KiB

Open AccessArticle

Toward Standardized Assessment of Dynamic Subjective Visual Vertical: Effects of Visual Stimulus Intensity in Health and Multiple Sclerosis

by Tautvydas Klėgėris, Diego Kaski, Renata Balnytė, Virgilijus Uloza, Alina Kuzminienė and Ingrida Ulozienė

Medicina 2025, 61(8), 1482; https://doi.org/10.3390/medicina61081482 - 18 Aug 2025

Abstract

Background and Objectives: Decreased balance function in multiple sclerosis (MS) patients is influenced by impaired gravity perception, which can be measured by the subjective visual vertical (SVV) test. The value of this test can be increased by executing it in a moving [...] Read more.

Background and Objectives: Decreased balance function in multiple sclerosis (MS) patients is influenced by impaired gravity perception, which can be measured by the subjective visual vertical (SVV) test. The value of this test can be increased by executing it in a moving visual background (i.e., dynamic SVV). However, clinicians and researchers use varying dynamic stimulus properties due to the lack of consensus on optimal parameters for reliably distinguishing between health and disease. Materials and Methods: To evaluate how dynamic visual stimulus intensity affects the perception of verticality in patients with MS and healthy individuals. Materials and Methods: We assessed static and dynamic SVV in 31 MS patients with dizziness and 32 age- and sex-matched controls using the virtual reality application VIRVEST. We evaluated the effects of modifying two parameters in dynamic SVV testing: rotation velocity (10°/s, 30°/s, and 60°/s) and visual field coverage (small vs. large). Results: The median of static SVV deviations was significantly greater in the MS group (1.8° vs. 0.9°). The mildest dynamic stimulus intensity of 10°/s, with a small visual field coverage, yielded the greatest discriminatory capacity to differentiate between the groups (AUC = 0.897; p < 0.001). This stimulus elicited a median SVV deviation of 4.3° in the MS group and 2.1° in the control group (p < 0.001) while also inducing significantly lower test-induced dizziness compared with stronger stimuli. Median visual dependence values measured at 10°/s with a small visual field coverage were 4.2 in the MS group and 2.02 in the control group (p < 0.001), also yielding the greatest AUC values compared to stronger stimuli (AUC = 0.828; p < 0.001). Conclusions: Our results support the use of relatively mild dynamic stimulus intensity. Future studies are encouraged to evaluate different dynamic stimulus parameters and patient populations. Full article

(This article belongs to the Special Issue Multiple Sclerosis and Related Disorders: Theory, Methods and Applications)

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9 pages, 644 KiB

Open AccessArticle

Optimizing Endoscopic Transpyloric Feeding Tube Placement in Low Birth Weight Infants: Practical Insights from Clinical Experience

by Yeoun Joo Lee, Hansol Kim, Shin Yun Byun, Narae Lee, Mun Hui Jung and Seung Hee Jeong

Medicina 2025, 61(8), 1481; https://doi.org/10.3390/medicina61081481 - 18 Aug 2025

Abstract

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body [...] Read more.

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body size and the limited availability of appropriately sized equipment. Materials and Methods: We retrospectively reviewed 15 endoscopic TP tube placements performed in 12 LBWIs weighing less than 2.5 kg between May 2017 and March 2025. Emphasis was placed on procedural techniques, equipment selection, and troubleshooting strategies for successful bedside execution. Results: All procedures were performed without the use of additional accessories, by advancing a feeding tube preloaded with a guidewire under direct visualization provided by a 5.5 mm outer diameter endoscope. All procedures were technically successful, including 14 performed at the bedside using a portable endoscope. A 6 or 8 Fr feeding tube loaded with a soft-tipped guidewire was advanced through the pylorus under direct endoscopic visualization. The average body weight at the time of the procedure was 1950 ± 296 g. No complications such as mucosal injury, perforation, or tube dislodgement occurred during the procedure. The average enteral feeding volume increased from 33.4 ± 52.8 cc/kg to 92.0 ± 44.4 cc/kg within 7 days. Full enteral nutrition was achieved in all surviving patients within three weeks. The feeding tube remained in place for a mean duration of 26.1 ± 19.2 days. Conclusions: Endoscopic TP tube placement in LBWIs can be safely and reliably performed at the bedside with appropriate technical modifications. It facilitates earlier advancement to full enteral nutrition and may serve as a viable option for LBWIs unresponsive to standard feeding methods. Full article

(This article belongs to the Section Pediatrics)

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3 pages, 199 KiB

Open AccessEditorial

Editorial for the Special Issue “Hot Topics and Innovations in Reconstructive and Cosmetic Surgery/Aesthetic Medicine”

by Luigi Losco

Medicina 2025, 61(8), 1480; https://doi.org/10.3390/medicina61081480 - 18 Aug 2025

Abstract

Innovations and emerging trends in Plastic Reconstructive and Aesthetic Surgery—as well as in Aesthetic Medicine—are continuously expanding the frontiers of modern clinical practice [...] Full article

(This article belongs to the Special Issue Hot Topics and Innovations in Reconstructive and Cosmetic Surgery/Aesthetic Medicine)

13 pages, 278 KiB

Open AccessArticle

Association of Apolipoprotein C-III Gene Polymorphisms (rs2854116 and rs2854117) with Susceptibility to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in a Turkish Population

by Damla Karaagac, Suat Morkuzu, Naci Senkal, Ersel Bilgin, Yasemin Oyacı, Tufan Tükek, Sacide Pehlivan and Alpay Medetalibeyoglu

Medicina 2025, 61(8), 1479; https://doi.org/10.3390/medicina61081479 - 18 Aug 2025

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Abstract

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of fat in the liver, progressing from simple steatosis to various complications, with increasing prevalence in the modern world. Our study aimed to investigate the relationship between MASLD [...] Read more.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of fat in the liver, progressing from simple steatosis to various complications, with increasing prevalence in the modern world. Our study aimed to investigate the relationship between MASLD pathogenesis and the presence of apolipoprotein C-III (ApoC-III) gene variants rs2854116 and rs2854117 by comparing allele and genotype frequencies between MASLD patients and healthy individuals, as well as analyzing their association with biochemical parameters in Turkish populations. Materials and Methods: The study included 202 MASLD patients and 100 healthy controls who presented to our outpatient clinic. MASLD presence was determined by ultrasonography (USG). The demographic, laboratory, and clinical data of the participants were recorded. ApoC-III gene variants rs2854116 and rs2854117 were genotyped using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method from genomic DNA samples obtained from blood. Results: The genotype and allele frequencies of ApoC-III gene variants rs2854116 and rs2854117 did not show significant differences between patient and healthy groups (p > 0.05). When biochemical parameters were evaluated, the LDH value of rs2854116 variant CT/CC genotype carriers was found to be significantly higher than TT genotype carriers (p = 0.016). Conclusions: We observed a high prevalence of MASLD in our Turkish cohort. However, the specific genetic variants we investigated were not associated with MASLD status. This suggests that these variants may not be significant contributing factors to MASLD in this population. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

14 pages, 843 KiB

Open AccessArticle

Epidemiology of Tennis-Related Injuries Among Competitive Youth Players in Tunisia: Frequency, Characteristics, and Management Patterns

by Saoussen Layouni, Ismail Dergaa, Hela Ghali, Halil İbrahim Ceylan, Valentina Stefanica, Marwa Neguez, Ines Loubiri, Wissem Dhahbi, Chaima Rjiba, Sarra Ksibi, Sahbi Elmtaoua, Sonia Jemni and Helmi Ben Saad

Medicina 2025, 61(8), 1478; https://doi.org/10.3390/medicina61081478 - 18 Aug 2025

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Abstract

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of [...] Read more.

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of tennis-related injuries among competitive Tunisian youth players. Materials and Methods: A cross-sectional study was conducted among players aged 5–18 years from tennis clubs (October 2023–November 2024). Data were collected using researcher-administered questionnaires, incorporating the Oslo Sports Trauma Research Center Overuse Injury Questionnaire and a sport-specialization assessment, following International Olympic Committee guidelines. Results: Among 256 players, 53.5% (n = 137) reported 366 injuries. Lower limbs were most affected (58.5%), followed by upper limbs (32.8%); knees (23.2%), ankles (17.5%), and wrists (10.1%). Muscle/tendon (36.9%), superficial tissue (28.1%), and ligament/joint capsule injuries (27.6%) predominated. Most injuries occurred during practice (74.9%) and hot weather (93.4%). Severe injuries represented 24%, while 29.5% were minor without time loss. Subsequent injuries occurred in 54.6% of injured players, with significantly higher rates in those with incomplete rehabilitation (p < 0.001). Conclusions: The high frequency of recurrent injuries and limited rehabilitation highlight critical gaps in injury management, emphasizing the need for targeted neuromuscular training, accessible rehabilitation, and standardized return-to-play protocols. Full article

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

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11 pages, 519 KiB

Open AccessArticle

Free vs. Local Tissue Transfer and Reconstruction in Pediatric Head and Neck Cancer Patients: A Comparable Complication Outcome Review

by Valeria Mejia, Asli Pekcan, Melanie Bakovic, Raina Kushal Patel, Marvee Turk, Idean Roohani, Pasha Shakoori, Mark Urata and Jeffrey A. Hammoudeh

Medicina 2025, 61(8), 1477; https://doi.org/10.3390/medicina61081477 - 18 Aug 2025

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Abstract

Background and Objectives: Reconstructive outcomes following head and neck (H&N) cancer resection in pediatric patients remain understudied, particularly regarding the comparative efficacy of free versus local tissue transfer. Materials and Methods: A retrospective review was conducted on pediatric patients undergoing malignant [...] Read more.

Background and Objectives: Reconstructive outcomes following head and neck (H&N) cancer resection in pediatric patients remain understudied, particularly regarding the comparative efficacy of free versus local tissue transfer. Materials and Methods: A retrospective review was conducted on pediatric patients undergoing malignant H&N tumor resection at a tertiary center from 2007 to 2024. Patients were stratified by reconstruction type (free vs. local flap), and outcomes assessed included flap failure, wound complications, revision rates, operative time, hospital stay, and 30-day readmission. Results: A total of 41 patients (mean age: 10.6 years) met inclusion criteria; 18 underwent free flaps and 23 received local flaps. Common diagnoses included osteosarcoma (21.9%) and rhabdomyosarcoma (12.2%). Anterolateral thigh (44.4%) and fibula (33.3%) were the most common free flaps; temporalis (21.7%) and pectoralis (13.0%) were common local flaps. Flap survival was high in both groups (94.4% vs. 100%). However, local flaps had significantly higher rates of hardware exposure (34.7% vs. 5.5%, p = 0.025) and wound dehiscence (39.1% vs. 5.5%, p = 0.045). Free flaps were associated with longer operative times (10.3 vs. 6.5 h, p = 0.011) and hospital stays (29.1 vs. 13.9 days, p = 0.036). Conclusions: While both approaches achieved high flap survival, free flaps may offer more durable reconstruction and reduce wound-related complications in complex pediatric H&N oncologic cases. Full article

(This article belongs to the Section Pediatrics)

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21 pages, 2014 KiB

Open AccessSystematic Review

Interventional Procedures in Deep Venous Thrombosis Treatment: A Review of Techniques, Outcomes, and Patient Selection

by Arkadiusz Kacała, Mateusz Dorochowicz, Jędrzej Fischer, Adrian Korbecki, Aleksander Truszyński, Anna Madura, Krzysztof Dyś, Andrzej Szuba and Maciej Guziński

Medicina 2025, 61(8), 1476; https://doi.org/10.3390/medicina61081476 - 18 Aug 2025

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Abstract

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have [...] Read more.

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have been introduced to restore venous patency and reduce complications. This systematic review summarizes current evidence on outcomes, safety, and patient selection for these procedures. Materials and Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for studies published between January 2000 and February 2024. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, and observational studies with ≥20 patients. Extracted outcomes were technical success, thrombus clearance, venous patency, PTS, quality of life, and complications. Risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle–Ottawa Scale, and AMSTAR-2. Results: Of 456 records screened, 35 studies were included. Randomized trials (CaVenT, ATTRACT, CAVA) showed that catheter-directed and pharmacomechanical approaches improved venous patency and reduced moderate-to-severe PTS in selected patients with iliofemoral DVT, though overall benefit was variable. Mechanical thrombectomy devices (e.g., AngioJet, ClotTriever, FlowTriever) achieved high thrombus clearance and shorter procedural times, with device-specific complication profiles. Observational data demonstrated venous stenting patency rates of 74–89% at 12 months. Study heterogeneity limited direct comparisons. Conclusions: Interventional procedures can reduce PTS and improve outcomes in carefully selected patients, particularly those with acute iliofemoral DVT. Modern mechanical and pharmacomechanical techniques enhance efficiency and safety, while venous stenting addresses underlying obstructions. Further high-quality trials with long-term follow-up are needed to define optimal patient selection and comparative effectiveness. Full article

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

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9 pages, 357 KiB

Open AccessArticle

by Zornitsa Mitkova, Elena Dimitrova, Hristiana Tomova, Nikolay Gerasimov, Diyan Gospodinov, Konstantin Mitov, Stamen Pishev, Boryana Parashkevova and Guenka Petrova

Medicina 2025, 61(8), 1475; https://doi.org/10.3390/medicina61081475 - 17 Aug 2025

Viewed by 228

Abstract

Background and Objectives: The goal of this study is to assess health-related quality of life (HRQoL) using the EuroQoL (EQ-5D-5L) and identify factors that might contribute to it. Materials and Methods: This is a real-life, observational study involving 234 hypertensive patients [...] Read more.

Background and Objectives: The goal of this study is to assess health-related quality of life (HRQoL) using the EuroQoL (EQ-5D-5L) and identify factors that might contribute to it. Materials and Methods: This is a real-life, observational study involving 234 hypertensive patients from Sofia and Burgas, conducted between January 2024 and July 2024. Patients were interviewed during their regular outpatient examinations and completed the questionnaire independently. Results: In total, 141 out of 234 respondents reported a visual analog scale (VAS) score of 70, and 152 reported a utility score of 0.7. The average VAS scores for males and females were 77.5 and 77.0, respectively, and the utility scores were 0.848 and 0.768, respectively. With advancing age, patients’ quality of life (QoL) decreased from 0.879 to 0.652 utility. Respondents with higher levels of education had higher utility scores (0.848 for bachelor’s/master’s degrees vs. 0.542 for primary education). With an increase in the number of concomitant diseases and prescribed medications, the QoL decreased (0.848 vs. 0.623 and 0.848 vs. 0.736, respectively). Conclusions: This first study of HRQoL using EQ-5D-5L among Bulgarian hypertensive patients revealed relatively high average VAS and utility scores. These results suggest that the disease is under control and that patients are being successfully treated and monitored. Factors such as comorbidity, residence, education, disability, and disease duration significantly affected and worsened patients’ HRQoL. Full article

(This article belongs to the Section Cardiology)

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13 pages, 612 KiB

Open AccessArticle

Glycated Hemoglobin as a Predictor of Postoperative Delirium in Diabetic Patients Undergoing Noncardiac Surgery: A Retrospective Study

by Mahir Bahceci, Ersel Gulec, Mediha Turktan, Zehra Hatipoglu and Dilek Ozcengiz

Medicina 2025, 61(8), 1474; https://doi.org/10.3390/medicina61081474 - 16 Aug 2025

Viewed by 179

Abstract

Background and Objectives: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible [...] Read more.

Background and Objectives: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible associations between preoperative HbA1c levels and POD development; this will allow for larger, definitive studies to be designed and preliminary effect sizes to be established for future research. Materials and Methods: This retrospective pilot study included 78 patients with diabetes who underwent elective noncardiac surgery under general anesthesia between July 2020 and January 2021. We obtained the patients’ demographic data, medical history, surgical parameters, and preoperative HbA1c levels to determine the occurrence of POD (using CAM-ICU). Univariate and multivariate regression analyses were applied to check the leading associations for the development of POD. Results: POD was observed in seven patients (9.0%). The results of the preliminary multivariate analysis suggested that HbA1c may be associated with POD (OR, 2.96; 95% CI [1.34–6.52], p = 0.007); fasting blood glucose (OR, 1.04; 95% CI [1.01–1.07], p = 0.013); and duration of anesthesia (OR, 1.02; 95% CI [1.00–1.04], p = 0.019). The ROC analysis of HbA1c showed an optimal threshold of 7.4%, with a sensitivity of 91.5%, and a specificity of 85.7% in terms of predicting POD (AUC = 0.91, p < 0.001). Conclusions: Through this pilot study, we have provided evidence that leads to the assumption that preoperative HbA1c at, or above, 7.4% can result in an increased risk of delirium in diabetic patients who undergo noncardiac surgery. The findings of this study allow for the implementation of the proposed methodology and the collection of critical data necessary for the design of appropriately powered definitive trials. Full article

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

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18 pages, 828 KiB

Open AccessArticle

Relative Grip Strength as a Screening Indicator for Metabolic Syndrome in Korean Adults: A Cross-Sectional Study Using Data from KNHANES

by Jongsuk Park and Sangho Kim

Medicina 2025, 61(8), 1473; https://doi.org/10.3390/medicina61081473 - 16 Aug 2025

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Abstract

Background and Objectives: This study aimed to assess the association between relative grip strength (RGS) and metabolic syndrome (MetS) in Korean adults and to explore sex- and age-specific cutoff values for screening purposes. Materials and Methods: This cross-sectional study analyzed data [...] Read more.

Background and Objectives: This study aimed to assess the association between relative grip strength (RGS) and metabolic syndrome (MetS) in Korean adults and to explore sex- and age-specific cutoff values for screening purposes. Materials and Methods: This cross-sectional study analyzed data from 12,072 Korean adults (aged 19–64 years) who participated in the 2017–2019 Korea National Health and Nutrition Examination Survey. Receiver operating characteristic (ROC) curve analysis was performed stratified by sex and age group, and participants were categorized into adequate (ARG) and low (LRG) RGS groups. Multivariable logistic regression was used to examine the association between RGS (as both categorical and continuous variables) and MetS, adjusting for lifestyle and behavioral covariates. Results: The RGS demonstrated moderate discriminatory power for MetS, with area under the curve (AUC) values ranging from 0.601 to 0.742. Age- and sex-specific cutoff values for RGS progressively decreased with age. Individuals in the LRG group had significantly higher odds of MetS across all age and sex groups. The LRG group had significantly greater odds of MetS in nearly all subgroups (e.g., women aged 20–39 years: odds ratio [OR] = 6.846; men: OR = 3.502). As a continuous variable, each 0.1-unit increase in RGS was associated with a 22.1–33.4% reduction in the odds of MetS (p < 0.001). Conclusions: RGS is inversely associated with MetS, particularly in women and younger adults. Although its discriminatory ability is moderate, the RGS may serve as a simple and accessible screening indicator to help identify individuals with an increased metabolic risk. Full article

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

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11 pages, 797 KiB

Open AccessReview

Heart Failure in Poland: A 20-Year Epidemiological Perspective

by Michał Bohdan, Anna Kowalczys, Jadwiga Nessler, Ewa Straburzyńska-Migaj, Marcin Gruchała and Małgorzata Lelonek

Medicina 2025, 61(8), 1472; https://doi.org/10.3390/medicina61081472 - 16 Aug 2025

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Abstract

Background and Objectives: Cardiovascular diseases (CVDs) remain the leading cause of mortality in Poland, with heart failure (HF) presenting a significant public health issue. Materials and Methods: This study aimed to analyze trends in HF incidence, hospitalization rates, patient demographics, and [...] Read more.

Background and Objectives: Cardiovascular diseases (CVDs) remain the leading cause of mortality in Poland, with heart failure (HF) presenting a significant public health issue. Materials and Methods: This study aimed to analyze trends in HF incidence, hospitalization rates, patient demographics, and mortality over two decades A comparative analysis was performed using data from two national reports: (1) the 2013 report “Heart Failure—Analysis of Economic and Social Costs, “ assessing HF patients from 2004 to 2012, and (2) the 2023 report “Heart Failure in Poland 2014–2021,” based on data from the Polish Ministry of Health, National Health Fund, and HTA Consulting. This study examined the prevalence of HF (ICD-10 codes: I50, J81), hospitalization rates, comorbidities, mortality trends, and access to rehabilitation. Results: Between 2014 and 2019, the number of HF patients grew by 34%, reaching 1.02 million in 2019. Only 9% of HF patients were younger than 60 years. Multimorbidity was common, with arterial hypertension, atherosclerotic cardiovascular disease, and arrhythmias, often preceding HF diagnosis. HF-related mortality increased, with 149,963 in 2021, compared to 16,606 in 2012. In 2019, hospitalizations related to HF increased by 41% compared to 2014. The economic burden of HF care increased by 117% between 2014 and 2020, with hospitalizations accounting for 94% of total costs, up from 65% in 2012. Access to cardiac rehabilitation remained limited. Conclusions: HF prevalence, hospitalization rates, and mortality have increased in Poland, alongside a rising burden of multimorbidity. These findings provide a foundation for future healthcare planning to reduce the impact of HF in Poland. Full article

(This article belongs to the Special Issue New Insights into Heart Failure)

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9 pages, 492 KiB

Open AccessArticle

Efficacy of Dupilumab in Patients with Chronic Rhinosinusitis with Nasal Polyps and Eosinophilic Otitis Media: A Six-Month Observational Study

by Cosimo Galletti, Federica Giammona Indaco, Daniele Portelli, Giulia Laterra, Patrizia Zambito, Maria Grazia Ferrisi, Leonard Freni, Francesco Ciodaro, Francesco Freni, Salvatore Maira and Bruno Galletti

Medicina 2025, 61(8), 1471; https://doi.org/10.3390/medicina61081471 - 15 Aug 2025

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Abstract

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and [...] Read more.

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and anti-IL-13, has demonstrated a promising profile of efficacy and safety in the treatment of CRSwNP; however, evidence on its role in concomitant EOM and CRSwNP remains limited in the literature. This study aims to evaluate the clinical efficacy of dupilumab in patients with concomitant CRSwNP and EOM over a six-month observational period. Materials and Methods: A retrospective observational cohort study was conducted on twenty-two patients (aged 18–75 years) over six months with severe uncontrolled CRSwNP and confirmed refractory EOM who were treated with dupilumab (300 mg every two weeks). Demographic data are collected, and outcome measures included Nasal Polyp Score (NPS), Sino-Nasal Outcome Test (SNOT-22), Visual Analog Scale for nasal congestion (VAS), tympanogram classification, and Chronic Otitis Media Outcome Test (COMOT-15), evaluated at baseline and 6 months. Results: Over the six-month treatment period, patients with coexisting CRSwNP and eosinophilic otitis media experienced significant improvements across the multiple validated clinical and patient-reported outcome measures. The Nasal Polyp Score (NPS) significantly decreased from a median of 5.7 (IQR: 1.2) at baseline to 1.5 (IQR: 1.3) at six months (p < 0.0001). The SNOT-22 showed a substantial decline from a median of 77.6 (IQR: 19.0) to 21.5 (IQR: 13.4), p < 0.0001. Visual Analog Scale (VAS) scores for nasal congestion improved significantly from 8.4 (IQR: 1.1) to 1.7 (IQR: 1.2), p < 0.0001. Tympanogram scores improved from Tympanogram type “B” to Tympanogram type “A” (p = 0.018). COMOT-15 scale decreased from a median of 51.3 (IQR: 8.4) to 19.2 (IQR: 5.0) (p < 0.0001). Peripheral eosinophil counts remained unchanged or increased (baseline 0.80 vs. 0.84 cells/μL at six months, (p = 0.834)). Conclusions: Dupilumab treatment in patients with CRSwNP and EOM led to significant clinical improvements in sinonasal symptoms, middle ear function, and quality of life over six months, with no significant change in peripheral eosinophilia. Full article

(This article belongs to the Special Issue Chronic Rhinosinusitis with Nasal Polyps: Latest Trends in Diagnosis and Treatment)

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19 pages, 1890 KiB

Open AccessReview

Coronary Angioplasty with Drug-Coated Balloons: Pharmacological Foundations, Clinical Efficacy, and Future Directions

by Valentin Chioncel, Flavius Gherasie, Alexandru Iancu and Anamaria-Georgiana Avram

Medicina 2025, 61(8), 1470; https://doi.org/10.3390/medicina61081470 - 15 Aug 2025

Viewed by 362

Abstract

Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs directly to the arterial wall, offering a stent-less approach that mitigates the risks associated with permanent metallic implants. Initially developed for in-stent restenosis (ISR), DCBs have demonstrated robust efficacy in [...] Read more.

Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs directly to the arterial wall, offering a stent-less approach that mitigates the risks associated with permanent metallic implants. Initially developed for in-stent restenosis (ISR), DCBs have demonstrated robust efficacy in reducing neointimal hyperplasia and target lesion revascularization (TLR) rates across diverse coronary lesions, including small vessel disease (SVD), de novo lesions, and complex anatomies such as bifurcation lesions. Paclitaxel-coated balloons have long been the cornerstone of DCB therapy due to their established clinical outcomes, but sirolimus-coated balloons are emerging as a promising alternative with potentially superior safety profiles and sustained drug release. The pharmacological mechanism of DCBs relies on rapid drug transfer during brief balloon inflation, achieving high local concentrations without residual foreign material. Landmark trials, such as BASKET-SMALL 2, RESTORE SVD, and AGENT IDE, have demonstrated comparable or non-inferior outcomes of DCBs versus drug-eluting stents (DESs) in specific settings, with lower rates of stent thrombosis and shorter dual antiplatelet therapy (DAPT) requirements. Despite these advances, challenges persist, including optimizing drug formulations, ensuring uniform delivery, and addressing calcified lesions. Ongoing research into novel coatings, dual–drug systems, and artificial intelligence (AI)-guided interventions is poised to redefine PCI strategies. This review provides a comprehensive analysis of drug-coated balloon (DCB) angioplasty, not limited to specific clinical scenarios such as in-stent restenosis, small vessel disease, or bifurcation lesions, highlighting their transformative role in coronary artery disease (CAD) management. Instead, it addresses the full spectrum of pharmacological principles, mechanisms of action, clinical indications, comparative efficacy across various coronary artery disease contexts, and future directions of DCBs. Full article

(This article belongs to the Special Issue Updates on Risk Factors and Prevention of Coronary Artery Disease)

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21 pages, 2752 KiB

Open AccessArticle

Right Ventricular Function Improves After Bench Press: A Speckle Tracking Echocardiography Study

by María Belén Martínez-Lechuga, Javier Hidalgo-Martín and Manuel Ruiz-Bailén

Medicina 2025, 61(8), 1469; https://doi.org/10.3390/medicina61081469 - 15 Aug 2025

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Abstract

Objective: The association between right ventricular myocardial fiber deformation and nutrition in weightlifters has not been fully characterized. This study analyzed nutritional factors and right ventricle speckle tracking echocardiography parameters in weightlifters before and after bench press exercises. Methods: This interventional [...] Read more.

Objective: The association between right ventricular myocardial fiber deformation and nutrition in weightlifters has not been fully characterized. This study analyzed nutritional factors and right ventricle speckle tracking echocardiography parameters in weightlifters before and after bench press exercises. Methods: This interventional study examined the effects of bench press exercises on myocardial function. Nutritional parameters were assessed prior to exercise. Echocardiography with speckle tracking using vector velocity analysis was performed before and immediately after the bench press exercise. This study included a group of non-elite athlete weightlifters and a non-athlete control group to compare right myocardial function. In the athlete group, transthoracic echocardiograms (TTEs) were conducted before and after the exercise to assess changes in systolic and diastolic right heart function. A cohort of 30 weightlifters from 2014 who continued regular training was re-evaluated in 2024, and nutritional data were collected. Data analyses included ANOVA and Student’s T-tests, and correlation coefficients were calculated to explore associations with speckle tracking results. Results: This study involved 211 male weightlifters and a control group of 60 non-athletes. Measured values for the control group and athletes before and after bench press exercise were as follows: right longitudinal global strain (−27.31 ± 1.47, −23.55 ± 2.37, −30.98 ± 2.12); right global longitudinal strain rate (−1.79 ± 0.078, −1.48 ± 0.33, −2.88 ± 0.259 1/s), all p < 0.001; and isovolumic acceleration (2.38 ± 0.22, 3.52 ± 0.15, 6.66 ± 0.88 m/s², p < 0.001). Following exercise, right intraventricular synchrony increased, and longitudinal strain delay decreased (144.88 ± 22.52, 168.92 ± 29.35, 98.27 ± 12.11 ms, p < 0.001). The follow-up group demonstrated a similar response to exercise as the other weightlifters. Right ventricular longitudinal strain showed correlations with protein, vitamin E, and zinc levels (R² = 0.399, p = 0.021; R² = 0.378, p = 0.03; R² = 0.566, p < 0.01), and right ventricular radial velocities correlated with group B vitamins. Conclusions: Weightlifters show less right ventricular deformity before exercise compared to controls, but their strain increases significantly post-exercise. Speckle tracking values might correlate with nutrition. Full article

(This article belongs to the Special Issue New Insights into Heart Failure)

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16 pages, 1636 KiB

Open AccessArticle

Cardiovascular Risk in People Living with HIV: A Preliminary Case Study from Romania

by Manuela Arbune, Alina Plesea-Condratovici, Anca-Adriana Arbune, Geanina Andronache, Catalin Plesea-Condratovici and Cristian Gutu

Medicina 2025, 61(8), 1468; https://doi.org/10.3390/medicina61081468 - 15 Aug 2025

Viewed by 196

Abstract

Background and Objectives: AIDS-related mortality has significantly decreased due to antiretroviral therapy (ART), leading to a substantial increase in average lifespan. Consequently, cardiovascular diseases have become a growing concern among people living with HIV (PLWH). This study aimed to assess the cardiovascular risk [...] Read more.

Background and Objectives: AIDS-related mortality has significantly decreased due to antiretroviral therapy (ART), leading to a substantial increase in average lifespan. Consequently, cardiovascular diseases have become a growing concern among people living with HIV (PLWH). This study aimed to assess the cardiovascular risk profile of people living with HIV receiving ART and to explore the association between traditional and HIV-related factors with increased cardiovascular risk. Materials and Methods: We conducted a case study involving 112 PLWH receiving ART at a specialized clinic in southeastern Romania to estimate cardiovascular risk (CVR) using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D^®) score. For participants aged 40 and above, the SCORE2 algorithm was additionally applied. Results: Most participants were male and under 40 years of age, including 34 individuals from Romania’s distinct pediatric HIV cohort. We observed a substantial cardiovascular risk burden: abdominal obesity was present in 24.1% of participants, active smoking was reported by 55.4%, and over 70% had low physical activity levels. Among participants aged 40 and above, the D:A:D^® and SCORE2 scores were strongly correlated, with an average cardiovascular age exceeding chronological age by a mean of 7.5 years. Although CVR remained similarly low among subgroups of PLWH under 40, the prevalence of metabolic syndrome was higher in patients from the pediatric cohort compared to those diagnosed later. Traditional risk factors—such as age, obesity, hypertension, dyslipidemia, smoking, and alcohol use—as well as elevated C-reactive protein levels, were significantly associated with increased CVR. Conclusions: Residual inflammation in PLWH, despite complete viral suppression in combination with metabolic syndrome, is associated with increased cardiovascular risk even in younger and clinically stable populations. Routine integration of metabolic and cardiovascular risk screening into HIV care may support timely prevention and personalized management strategies starting at an early age. Full article

(This article belongs to the Special Issue Updates on Risk Factors and Prevention of Coronary Artery Disease)

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16 pages, 1522 KiB

Open AccessArticle

Evaluation of PD-L1 Expression and Anti-EGFR Therapy in EGFR-Mutant Non-Small-Cell Lung Cancer

by Gizem Teoman, Elanur Karaman, Şafak Ersöz and Sevdegül Aydın Mungan

Medicina 2025, 61(8), 1467; https://doi.org/10.3390/medicina61081467 - 15 Aug 2025

Viewed by 365

Abstract

Background and Objectives: Non-small-cell lung cancer (NSCLC) often has epidermal growth factor receptor (EGFR) mutations, which are key targets for therapy. EGFR mutation subtypes, especially exon 19 deletions and exon 21 L858R mutations, influence responses to EGFR tyrosine kinase inhibitors [...] Read more.

Background and Objectives: Non-small-cell lung cancer (NSCLC) often has epidermal growth factor receptor (EGFR) mutations, which are key targets for therapy. EGFR mutation subtypes, especially exon 19 deletions and exon 21 L858R mutations, influence responses to EGFR tyrosine kinase inhibitors (TKIs) and patient survival. Despite progress in TKI treatments, resistance and different responses remain challenges. This study explores the relationship between EGFR mutation subtypes, PD-L1 expression, and patient outcomes after anti-EGFR therapy. Materials and Methods: We studied 176 cases of EGFR mutation-positive NSCLC. Next-generation sequencing was used to analyze EGFR and other mutations, while PD-L1 expression was evaluated through immunohistochemistry. We analyzed EGFR mutation subtypes, PD-L1 status, treatments, and survival outcomes. Results: Among 176 cases, 88.6% were adenocarcinomas. Within the EGFR mutation spectrum, exon 19 deletions were the most common subtype, accounting for 40.9% of cases, followed by the point mutation in exon 21, which occurred in 35.8% of cases. Less frequent alterations, making up 23.3% of all detected mutations, included mutations in exon 18, insertions, and point mutations such as S768I and T790M in exon 20, as well as changes in exon 2, exon 7, and other less frequently affected regions. Exon 19 mutations were associated with older age, female sex, adenocarcinoma, and bone metastasis (p < 0.05). TP53 was the most common concurrent mutation (44.3%). PD-L1 positivity (TPS ≥ 1%) was observed in 48.3%, with high expression (TPS ≥ 50%) in 25.9%. Exon 21 mutations were significantly linked to PD-L1 negativity (p = 0.008). The median overall survival was longest with TKI therapy (51 months), and this was also observed in PD-L1-positive patients, although the difference was not statistically significant. The median progression-free survival for patients treated with TKIs and those with EGFR mutations was 14 months. PD-L1-positive patients receiving TKIs had significantly longer survival than those who did not (51 vs. 17 months, p = 0.003). Conclusions: EGFR mutation subtypes and PD-L1 expression seem to affect treatment outcomes and survival in NSCLC. The observed links emphasize the potential value of combining molecular and immunological markers to guide therapy choices. Full article

(This article belongs to the Section Pulmonology)

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17 pages, 855 KiB

Open AccessArticle

Prognostic Significance of aVR Lead and QTc Prolongation in Patients with Early Repolarization

by Ertugrul Altinbilek, Abuzer Coskun, Burak Demirci, Ismail Oymak, Mustafa Calik, Derya Öztürk, Mustafa Ahmet Afacan and Burcu Bayramoglu

Medicina 2025, 61(8), 1466; https://doi.org/10.3390/medicina61081466 - 14 Aug 2025

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Abstract

Background and Objectives: Early repolarization (ER), previously considered benign for many years, is now recognized as a substantial risk factor for malignant arrhythmia, coronary artery disease, and mortality. The ER pattern, previously regarded as a benign electrocardiographic characteristic, has lately been demonstrated [...] Read more.

Background and Objectives: Early repolarization (ER), previously considered benign for many years, is now recognized as a substantial risk factor for malignant arrhythmia, coronary artery disease, and mortality. The ER pattern, previously regarded as a benign electrocardiographic characteristic, has lately been demonstrated to have a strong association with malignant arrhythmias, coronary artery disease, and elevated death rates. This study seeks to illustrate the prognostic significance of QT interval (QTc) prolongation on electrocardiograms for acute coronary syndrome and death in emergency cases. Prolongation of QTc duration on electrocardiography in emergency room cases may serve as a possible predictor for acute coronary syndrome and mortality. Materials and Methods: A retrospective study was conducted on 924 patients diagnosed with ER in the emergency department from 2020 to 2023. The QTc durations, serum glucose levels, troponin I levels, and additional auxiliary data of the patients were assessed. The alteration in the aVR derivation, often overlooked and deemed insignificant, was compared with clinical severity in ER cases. Results: The average age of the 924 patients in the study was 48.43 (9.65) years, with 30.7% being female. In the non-cardiac group, the mean age was 51.67 (7.98) years, with 738 females (31.9%). The QTc interval in the patient group was 409.54 (33.46) ms, while in the control group it was 411.57 (27.91) ms (p < 0.001). The one-year death rate was 49 (5.3%) for the ER group and nine (0.9%) for the follow-up group. The most common comorbid condition in both groups was tobacco and/or tobacco product intake. Univariate and multivariate regression analyses conducted for both ER types and mortality indicated that QTc prolongation may serve as a predictive factor (p < 0.001). The sensitivity and specificity of prolonged QTc in predicting acute coronary syndrome and mortality were determined to be 76% at the lowest and 98% at the highest levels in ER cases (p < 0.001). The Kaplan–Meier survival analysis for ER types revealed 321 days for the horizontal type and 363 days for the ascending type. Conclusions: Prolonged QTc duration in early repolarization cases may serve as an independent predictor of acute coronary syndrome and mortality. Full article

(This article belongs to the Section Cardiology)

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22 pages, 1383 KiB

Open AccessArticle

The Association Between Borderline Personality Disorder Symptoms and Social Behaviour Among University Students

by Andreea Sălcudean, Iustin Olariu, Mădălina-Gabriela Cincu, Ramona Amina Popovici, Iuliana Comșulea, Cristina-Raluca Bodo, Dora-Mihaela Cîmpian and Elena-Gabriela Strete

Medicina 2025, 61(8), 1465; https://doi.org/10.3390/medicina61081465 - 14 Aug 2025

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Abstract

Background and Objectives: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, a fluctuating self-image, and persistent difficulties in maintaining close interpersonal relationships. Among university students, these traits may be associated with social adjustment and academic functioning difficulties. [...] Read more.

Background and Objectives: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, a fluctuating self-image, and persistent difficulties in maintaining close interpersonal relationships. Among university students, these traits may be associated with social adjustment and academic functioning difficulties. The present study aimed to examine the prevalence of borderline traits within a Romanian student population and to investigate the associations between these traits and interpersonal difficulties encountered in family life, romantic relationships, and academic environments. Materials and Methods: This cross-sectional study included a total of 151 undergraduate students enrolled in higher education institutions across Romania. Data were gathered through an online questionnaire available between March and May 2025. The instrument comprised items addressing socio-demographic characteristics, diagnostic criteria for borderline personality traits according to the DSM, as well as self-reported social behaviour patterns. Statistical analysis was performed using GraphPad Prism 9, version 9.3.1 for Windows, employing Fisher’s exact test and the odds ratio (OR), with a significance threshold set at p < 0.05. Results: Most participants reported experiencing affective instability (71.5%) and distorted self-image (58.9%). Fear of abandonment was present in 29.4% of the respondents, while impulsivity was identified in 37.7%. Borderline personality traits were significantly associated with a range of social difficulties, including relational anxiety, outbursts of anger, peer conflicts, social withdrawal, and dissociative symptoms. Individuals who exhibited impulsivity, self-injurious behaviours, or dissociative episodes demonstrated a markedly increased risk of social dysfunction, with odds ratios ranging from 3 to 10 (p < 0.0001). Conclusions: The findings reveal a high prevalence of borderline traits within the analysed sample, along with statistically significant associations with social and emotional difficulties. These results underscore the importance of implementing psychological screening programs in universities, as well as early intervention strategies focused on the mental well-being of young adults. Establishing a supportive academic environment and fostering collaboration between faculty members and mental health professionals may play a key role in preventing symptom escalation and in promoting healthy personal and relational development. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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11 pages, 935 KiB

Open AccessArticle

Androgen Receptor: Clinical Importance in Breast Cancer Patients Receiving CDK 4/6 Inhibitor Treatment

by Seray Saray, Tufan Yılmaz, Hüseyin Kanmaz and Yakup İriağaç

Medicina 2025, 61(8), 1464; https://doi.org/10.3390/medicina61081464 - 14 Aug 2025

Viewed by 254

Abstract

Background and Objectives: The effect of AR expression on prognosis in hormone receptor-positive her2-negative breast cancer is controversial. There are studies showing that AR is a treatment target, a mechanism of resistance to endocrine treatments, and a prognostic indicator in these patients whose [...] Read more.

Background and Objectives: The effect of AR expression on prognosis in hormone receptor-positive her2-negative breast cancer is controversial. There are studies showing that AR is a treatment target, a mechanism of resistance to endocrine treatments, and a prognostic indicator in these patients whose standard treatment is a CDK 4/6 inhibitor added to endocrine treatment. We aimed to investigate the effect of AR, the AR/ER ratio, and the AR/PR ratio on CDK4/6 inhibitor treatment response in breast cancer, as well as their effects on PFS, and to validate the hypothesis that AR is a target for research. Materials and Methods: Patients who were diagnosed with metastatic hormone receptor-positive her2-negative breast cancer and received cdk4/6 inhibitor + aromatase inhibitor in first-line therapy were included in this study conducted at Balıkesir Atatürk City Hospital. The tru-cut biopsy samples of the patients were evaluated immunohistochemically for AR, ER, and PR. Kaplan–Meier analysis was used to calculate the estimated median survival in PFS analyses, and the variables were compared with the Log-Rank test. Receiver Operating Characteristic (ROC) analysis was applied to determine the ideal cut-off. Cox regression analysis was used in univariate survival models, and the multivariate model was established with the “Forward: Likelihood Ratio (LR)” method. Hazard ratios (HRs) were also calculated as 95% confidence intervals (95% CIs). A p value below 0.05 was accepted for statistical significance. Results: In total, 41 patients were included in the study, and 73% (n = 30) of the patients were AR-positive. Increased AR (HR 1.014; 95% CI: 1.002–1.026; p = 0.023) was an unfavorable prognostic indicator. In our study, being ≥55 years old, being postmenopausal, not having visceral metastasis, having a non-IDC histology, having a low AR level (<50%), having an AR/ER ratio < 0.74, and having an AR/PR ratio < 1.00 were found to be associated with longer PFS. All factors were evaluated with univariate Cox regression analysis. Increasing AR (HR 1.014; 95% CI: 1.002–1.026; p = 0.023) was an unfavorable prognostic marker. Having an AR/ER ratio ≥ 0.74 (HR: 2.522; 95% CI: 1.004–6.336; p = 0.049) and having AR/PR ≥ 1 (HR: 2.659; 95% CI: 1.029–6.869; p = 0.043) were negative prognostic indicators. Conclusions: Our results were consistent with the literature and demonstrated the value of the androgen receptor as a therapeutic target, a mechanism explaining resistance to endocrine therapy, and an adverse prognostic indicator for creating resistance to endocrine therapy in breast cancer. Full article

(This article belongs to the Collection Frontiers in Breast Cancer Diagnosis and Treatment)

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Medicina, Volume 61, Issue 8 (August 2025) – 180 articles

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