Medicina

25 pages, 1253 KiB

Open AccessEditor’s ChoiceOpinion

European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE): Expert Consensus on the Diagnosis, Service Provision, and Care of People with ME/CFS in Europe

by Luis Nacul, François Jérôme Authier, Carmen Scheibenbogen, Lorenzo Lorusso, Ingrid Bergliot Helland, Jose Alegre Martin, Carmen Adella Sirbu, Anne Marit Mengshoel, Olli Polo, Uta Behrends, Henrik Nielsen, Patricia Grabowski, Slobodan Sekulic, Nuno Sepulveda, Fernando Estévez-López, Pawel Zalewski, Derek F. H. Pheby, Jesus Castro-Marrero, Giorgos K. Sakkas, Enrica Capelli, Ivan Brundsdlund, John Cullinan, Angelika Krumina, Jonas Bergquist, Modra Murovska, Ruud C. W. Vermuelen and Eliana M. Lacerda Show full author list Hide full author list

Medicina 2021, 57(5), 510; https://doi.org/10.3390/medicina57050510 - 19 May 2021

Cited by 90 | Viewed by 24521

Abstract

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action [...] Read more.

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS. Full article

(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)

7 pages, 261 KiB

Open AccessEditor’s ChoiceReview

Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

by Thomas F. Monaghan, Syed N. Rahman, Christina W. Agudelo, Alan J. Wein, Jason M. Lazar, Karel Everaert and Roger R. Dmochowski

Medicina 2021, 57(5), 503; https://doi.org/10.3390/medicina57050503 - 16 May 2021

Cited by 123 | Viewed by 13362

Abstract

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion [...] Read more.

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature. Full article

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

12 pages, 258 KiB

Open AccessEditor’s ChoiceReview

Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ)

by Sven Otto, Suad Aljohani, Riham Fliefel, Sara Ecke, Oliver Ristow, Egon Burian, Matthias Troeltzsch, Christoph Pautke and Michael Ehrenfeld

Medicina 2021, 57(5), 463; https://doi.org/10.3390/medicina57050463 - 9 May 2021

Cited by 54 | Viewed by 4730

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. [...] Read more.

Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis. Full article

(This article belongs to the Section Dentistry and Oral Health)

14 pages, 1049 KiB

Open AccessEditor’s ChoiceReview

Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

by Neil D. Reeves, Giorgio Orlando and Steven J. Brown

Medicina 2021, 57(5), 457; https://doi.org/10.3390/medicina57050457 - 8 May 2021

Cited by 34 | Viewed by 12640

Abstract

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This [...] Read more.

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions. Full article

(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)

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17 pages, 670 KiB

Open AccessEditor’s ChoiceReview

The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature

by Roberta Angelico, Francesca Blasi, Tommaso Maria Manzia, Luca Toti, Giuseppe Tisone and Roberto Cacciola

Medicina 2021, 57(5), 435; https://doi.org/10.3390/medicina57050435 - 30 Apr 2021

Cited by 28 | Viewed by 4110

Abstract

Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy [...] Read more.

Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy may protect from the cytokine storm induced by SARS-CoV-2 infection or a temporary adjustment/withdrawal of IS therapy to restore the immune system may be necessary. We performed a systematic literature review to investigate the current management of IS therapy in KT recipients with COVID-1. Materials and Methods: Out of 71 articles published from 1 February 2020 until 30 October 2020, 554 KT recipients with SARS-CoV-2 infection were identified. Results: Modifications of IS therapy were based on the clinical conditions. For asymptomatic patients or those with mild COVID-19 symptoms, a “wait and see approach” was mostly used; a suspension of antimetabolites drugs (347/461, 75.27%) or mTOR inhibitors (38/48, 79.2%) was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, the most frequent attitude was their maintenance (243/502, 48.4%) or dose-reduction (99/502, 19.72%) in patients asymptomatic or with mild COVID-19 symptoms, while drug withdrawal was the preferred choice in severely symptomatic patients (160/450, 31.87%). A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Renal function remained stable in 422(76.17%) recipients, while 49(8.84%) patients experienced graft loss. Eight (1.44%) patients experienced a worsening of renal function. The overall mortality was 21.84%, and 53(9.56%) patients died with functioning grafts. Conclusion: A tailored approach to the patient has been the preferred strategy for the management of IS therapy in KT recipients, taking into account the clinical conditions of patients and the potential interactions between IS and antiviral drugs, in the attempt to balance the risks of COVID-19-related complications and those due to rejection or graft loss. Full article

(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)

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14 pages, 443 KiB

Open AccessEditor’s ChoiceReview

Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)—A Systemic Review and Comparison of Clinical Presentation and Symptomatology

by Timothy L. Wong and Danielle J. Weitzer

Medicina 2021, 57(5), 418; https://doi.org/10.3390/medicina57050418 - 26 Apr 2021

Cited by 232 | Viewed by 26859

Abstract

Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness—myalgic encephalomyelitis/chronic fatigue [...] Read more.

Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness—myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A review study comparing and contrasting ME/CFS with reported symptoms of long COVID may yield mutualistic insight into the characterization and management of both conditions. Materials and Methods: A systemic literature search was conducted in MEDLINE and PsycInfo through to 31 January 2021 for studies related to long COVID symptomatology. The literature search was conducted in accordance with PRISMA methodology. Results: Twenty-one studies were included in the qualitative analysis. Long COVID symptoms reported by the included studies were compared to a list of ME/CFS symptoms compiled from multiple case definitions. Twenty-five out of 29 known ME/CFS symptoms were reported by at least one selected long COVID study. Conclusions: Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME/CFS. The need for monitoring and treatment for patients post-COVID is evident. Advancements and standardization of long COVID research methodologies would improve the quality of future research, and may allow further investigations into the similarities and differences between long COVID and ME/CFS. Full article

(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)

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7 pages, 524 KiB

Open AccessEditor’s ChoiceCase Report

Herpes Simplex Keratitis in Patients with SARS-CoV-2 Infection: A Series of Five Cases

by Nora Majtanova, Petra Kriskova, Petra Keri, Zlatica Fellner, Juraj Majtan and Petr Kolar

Medicina 2021, 57(5), 412; https://doi.org/10.3390/medicina57050412 - 24 Apr 2021

Cited by 25 | Viewed by 4205

Abstract

Herpes simplex virus type 1 (HSV-1) is a leading cause of infectious blindness worldwide. Most of the initial infection cases manifest as acute epithelial keratitis. Reactivation of herpesviruses is common in critically ill patients, including patients with severe Coronavirus disease (COVID-19). However, the [...] Read more.

Herpes simplex virus type 1 (HSV-1) is a leading cause of infectious blindness worldwide. Most of the initial infection cases manifest as acute epithelial keratitis. Reactivation of herpesviruses is common in critically ill patients, including patients with severe Coronavirus disease (COVID-19). However, the data on COVID-19-related ocular infections is sparse, despite recent observations that more than 30% of COVID-19-infected patients had ocular manifestations. We report five cases of HSV-1 keratitis in COVID-19 patients. In total, five COVID-19 patients underwent ophthalmic examination, showing similar symptoms, including photophobia, tearing, decreased vision, eye redness, and pain. After initial assessment, tests of visual acuity and corneal sensitivity, a fluorescein staining test, and complete anterior and posterior segment examinations were performed. A diagnosis of HSV-1 keratitis was confirmed in all cases. Therapy was initiated using a local and systemic antiviral approach together with local antibiotic and mydriatic therapy. The complete reduction of keratitis symptoms and a clear cornea was achieved in all patients within 2 weeks. SARS-CoV-2 infection may be a risk factor for developing HSV-1 keratitis, or it may act as a potential activator of this ocular disease. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 359 KiB

Open AccessEditor’s ChoiceOpinion

Obese Animals as Models for Numerous Diseases: Advantages and Applications

by Abdelaziz Ghanemi, Mayumi Yoshioka and Jonny St-Amand

Medicina 2021, 57(5), 399; https://doi.org/10.3390/medicina57050399 - 21 Apr 2021

Cited by 14 | Viewed by 3609

Abstract

With the advances in obesity research, a variety of animal models have been developed to investigate obesity pathogenesis, development, therapies and complications. Such obese animals would not only allow us to explore obesity but would also represent models to study diseases and conditions [...] Read more.

With the advances in obesity research, a variety of animal models have been developed to investigate obesity pathogenesis, development, therapies and complications. Such obese animals would not only allow us to explore obesity but would also represent models to study diseases and conditions that develop with obesity or where obesity represents a risk factor. Indeed, obese subjects, as well as animal models of obesity, develop pathologies such as cardiovascular diseases, diabetes, inflammation and metabolic disorders. Therefore, obese animals would represent models for numerous diseases. Although those diseases can be induced in animals by chemicals or drugs without obesity development, having them developed as consequences of obesity has numerous advantages. These advantages include mimicking natural pathogenesis processes, using diversity in obesity models (diet, animal species) to study the related variabilities and exploring disease intensity and reversibility depending on obesity development and treatments. Importantly, therapeutic implications and pharmacological tests represent key advantages too. On the other hand, obesity prevalence is continuously increasing, and, therefore, the likelihood of having a patient suffering simultaneously from obesity and a particular disease is increasing. Thus, studying diverse diseases in obese animals (either induced naturally or developed) would allow researchers to build a library of data related to the patterns or specificities of obese patients within the context of pathologies. This may lead to a new branch of medicine specifically dedicated to the diseases and care of obese patients, similar to geriatric medicine, which focuses on the elderly population. Full article

(This article belongs to the Special Issue Muscles, Exercise, and Obesity)

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Graphical abstract

35 pages, 5879 KiB

Open AccessEditor’s ChoiceReview

Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome

by Mark I. Johnson

Medicina 2021, 57(4), 378; https://doi.org/10.3390/medicina57040378 - 14 Apr 2021

Cited by 31 | Viewed by 18197

Abstract

Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to ‘electrically rubbing [...] Read more.

Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to ‘electrically rubbing pain away’. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the ‘efficacy-impasse’. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a ‘run-in phase’ to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings. Full article

(This article belongs to the Special Issue Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromodulation Techniques for Pain Management)

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8 pages, 5003 KiB

Open AccessEditor’s ChoiceReview

Skeletal Muscle Damage in COVID-19: A Call for Action

by Amira Mohammed Ali and Hiroshi Kunugi

Medicina 2021, 57(4), 372; https://doi.org/10.3390/medicina57040372 - 12 Apr 2021

Cited by 73 | Viewed by 9439

Abstract

Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as [...] Read more.

Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary. Full article

(This article belongs to the Special Issue Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic)

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5 pages, 14729 KiB

Open AccessEditor’s ChoiceCase Report

Primary Mucosal Melanoma Presenting with a Unilateral Nasal Obstruction of the Left Inferior Turbinate

by Nicola Lombardo, Marcello Della Corte, Corrado Pelaia, Giovanna Piazzetta, Nadia Lobello, Ester Del Duca, Luigi Bennardo and Steven Paul Nisticò

Medicina 2021, 57(4), 359; https://doi.org/10.3390/medicina57040359 - 8 Apr 2021

Cited by 28 | Viewed by 3349

Abstract

We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. [...] Read more.

We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the facial massif revealed turbinate hypertrophy and a polypoid phlogistic tissue isointense in T1 with an intermediate signal in T2 and Short-TI Inversion Recovery (STIR)-T2, occupying the middle meatus and the anterior upper and lower left meatus with partial obliteration of the ostium and the infundibulum of the maxillary sinus. The Positron emission tomography (PET) exam was negative for metastases. Conservatory surgery in the left anterior video rhinoscopy was performed, allowing a radical 4-cm tumor excision. Histology reported epithelioid cell melanoma, PanK−, CD45−, and PanMelanoma+. Adjuvant radiotherapy was suggested, even considering a complete resection as the result of surgery. No local or systemic relapse was noticed at the 2-month follow-up visit. Although mucosal melanoma is a rare and aggressive malignancy characterized by a poor prognosis, early diagnosis allows a more conservative approach, with little surgical difficulty and no aesthetic effect. Our case raises awareness of the importance of early intervention even in those cases where the clinic symptoms and diagnostic images show uncertain severity. Full article

(This article belongs to the Special Issue New Perspectives in the Treatment of Skin Disease)

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15 pages, 591 KiB

Open AccessEditor’s ChoiceReview

Management of Myositis-Associated Interstitial Lung Disease

by Tomoyuki Fujisawa

Medicina 2021, 57(4), 347; https://doi.org/10.3390/medicina57040347 - 3 Apr 2021

Cited by 46 | Viewed by 11858

Abstract

Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. [...] Read more.

Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. The management of PM-/DM-/CADM-associated ILD (PM/DM/CADM-ILD) requires careful evaluation of the disease severity and clinical subtype, including the ILD forms (acute/subacute or chronic), because of the substantial heterogeneity of their clinical courses. Recent studies have highlighted the importance of myositis-specific autoantibodies’ status, especially anti-melanoma differentiation-associated gene 5 (MDA5) and anti-aminoacyl tRNA synthetase (ARS) antibodies, in order to evaluate the clinical phenotypes and treatment of choice for PM/DM/CADM-ILD. Because the presence of the anti-MDA5 antibody is a strong predictor of a worse prognosis, combination treatment with glucocorticoids (GCs) and calcineurin inhibitors (CNIs; tacrolimus (TAC) or cyclosporin A (CsA)) is recommended for patients with anti-MDA5 antibody-positive DM/CADM-ILD. Rapidly progressive DM/CADM-ILD with the anti-MDA5 antibody is the most intractable condition, which requires immediate combined immunosuppressive therapy with GCs, CNIs, and intravenous cyclophosphamide. Additional salvage therapies (rituximab, tofacitinib, and plasma exchange) should be considered for patients with refractory ILD. Patients with anti-ARS antibody-positive ILD respond better to GC treatment, but with frequent recurrence; thus, GCs plus immunosuppressants (TAC, CsA, azathioprine, and mycophenolate mofetil) are often needed in order to achieve favorable long-term disease control. PM/DM/CADM-ILD management is still a therapeutic challenge for clinicians, as evidence-based guidelines do not exist to help with management decisions. A few prospective clinical trials have been recently reported regarding the treatment of PM/DM/CADM-ILD. Here, the current knowledge on the pharmacologic managements of PM/DM/CADM-ILD was mainly reviewed. Full article

(This article belongs to the Special Issue Myositis-Associated Interstitial Lung Disease)

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22 pages, 2459 KiB

Open AccessEditor’s ChoiceReview

Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

by Francesco Sessa, Monica Salerno and Cristoforo Pomara

Medicina 2021, 57(4), 309; https://doi.org/10.3390/medicina57040309 - 25 Mar 2021

Cited by 22 | Viewed by 4471

Abstract

In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east [...] Read more.

In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome—Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality. Full article

(This article belongs to the Special Issue Update in Forensic Sciences)

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15 pages, 40176 KiB

Open AccessEditor’s ChoiceCase Report

COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection—The First Case Confirmed through Autopsy

by Ionuț Isaia Jeican, Patricia Inișca, Dan Gheban, Flaviu Tăbăran, Maria Aluaș, Veronica Trombitas, Victor Cristea, Carmen Crivii, Lia Monica Junie and Silviu Albu

Medicina 2021, 57(4), 302; https://doi.org/10.3390/medicina57040302 - 24 Mar 2021

Cited by 25 | Viewed by 4918

Abstract

Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case [...] Read more.

Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples. Full article

(This article belongs to the Section Infectious Disease)

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7 pages, 967 KiB

Open AccessEditor’s ChoiceCase Report

SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples

by Barbara Brogna, Carlo Brogna, Mauro Petrillo, Adriana Modestina Conte, Giulio Benincasa, Luigi Montano and Marina Piscopo

Medicina 2021, 57(3), 290; https://doi.org/10.3390/medicina57030290 - 20 Mar 2021

Cited by 33 | Viewed by 5163

Abstract

Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, [...] Read more.

Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, who resulted in being negative to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests performed on different oropharyngeal and nasopharyngeal swabs, despite serology having confirmed the presence of SARS-CoV-2 IgM. The patient underwent a chest computed tomography (CT) that showed typical imaging findings of COVID-19 pneumonia. The presence of viral SARS-CoV-2 was confirmed only by performing a SARS-CoV-2 RT-PCR test on stool. Performing of SARS-CoV-2 RT-PCR test on fecal samples can be a rapid and useful approach to confirm COVID-19 diagnosis in cases where there is an apparent discrepancy between COVID-19 clinical symptoms coupled with chest CT and SARS-CoV-2 RT-PCR tests’ results on samples from the upper respiratory tract. Full article

(This article belongs to the Section Infectious Disease)

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12 pages, 2271 KiB

Open AccessEditor’s ChoiceReview

Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature

by Giovanni Coloccia, Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Giuseppina Malcangi, Valentina Montenegro, Assunta Patano, Grazia Marinelli, Claudia Laudadio, Luisa Limongelli, Daniela Di Venere, Denisa Hazballa, Maria Teresa D’Oria, Ioana Roxana Bordea, Edit Xhajanka, Antonio Scarano, Felice Lorusso, Alessandra Laforgia, Francesco Inchingolo and Gianna Dipalma

Medicina 2021, 57(3), 288; https://doi.org/10.3390/medicina57030288 - 19 Mar 2021

Cited by 40 | Viewed by 8236

Abstract

Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander [...] Read more.

Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander approaches. Materials and Methods: The database used to perform the screening and determine the eligibility of the clinical papers was PubMed (Medline). Results: The database search included a total of 284 results, while 271 articles were excluded. A total of 14 articles were included for the qualitative assessment. Conclusions: The effectiveness of the present studies reported that skeletal expansion was a useful approach to increase the transverse changes for subjects with constricted maxillary arches. Full article

(This article belongs to the Special Issue Orthodontic Treatment and Its Impact on Oral Health-Related Quality of Life)

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12 pages, 2391 KiB

Open AccessEditor’s ChoiceArticle

Protective Effect of Spirulina-Derived C-Phycocyanin against Ultraviolet B-Induced Damage in HaCaT Cells

by Young Ah Jang and Bo Ae Kim

Medicina 2021, 57(3), 273; https://doi.org/10.3390/medicina57030273 - 16 Mar 2021

Cited by 19 | Viewed by 4565

Abstract

Background and objectives: Reactive oxygen species (ROS) overwhelm the antioxidant defense system, induce oxidative stress, and increase matrix metalloproteinase (MMP) expression, resulting in skin aging. Thus, preventing ultraviolet B (UVB)-induced skin damage can attenuate skin aging. Spirulina (a biomass of cyanobacteria, also called [...] Read more.

Background and objectives: Reactive oxygen species (ROS) overwhelm the antioxidant defense system, induce oxidative stress, and increase matrix metalloproteinase (MMP) expression, resulting in skin aging. Thus, preventing ultraviolet B (UVB)-induced skin damage can attenuate skin aging. Spirulina (a biomass of cyanobacteria, also called blue-green algae) is comprised of prokaryotes, whereas microalgae are eukaryotes and are rich in phycocyanin, a powerful antioxidant. Materials and Methods: Here, we investigated the photoprotective effects of spirulina-derived C-phycocyanin (C-PC) against UVB radiation using keratinocytes (HaCaT cells). Results: UVB radiation increased MMP-1 and MMP-9 expression but decreased involucrin, filaggrin, and loricrin expression. C-PC showed no toxicity at concentrations of 5–80 μg/mL in terms of HaCaT cell viability. UVB-irradiated HaCaT cells had a 50.8% survival rate, which increased to 80.3% with C-PC treatment. MMP expression increased with UVB treatment, whereas MMP-1 and MMP-9 concentrations decreased with C-PC treatment. UVB reduced involucrin, filaggrin, and loricrin expression in HaCaT cells, but 80 μg/mL C-PC increased their expression by >25%. In the UVB radiation group, dichlorofluorescin diacetate fluorescence intensity in HaCaT cells increased by 81.6% compared with that in the control group, whereas ROS production was reduced by 51.2% and 55.1% upon treatment with 40 and 80 μg/mL C-PC, respectively. Conclusions: C-PC might reduce or prevent skin aging by reducing UVB irradiation-induced skin wrinkles and free radicals. Full article

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9 pages, 323 KiB

Open AccessEditor’s ChoiceReview

New-Onset Diabetes after Kidney Transplantation

by Claudio Ponticelli, Evaldo Favi and Mariano Ferraresso

Medicina 2021, 57(3), 250; https://doi.org/10.3390/medicina57030250 - 8 Mar 2021

Cited by 39 | Viewed by 5226

Abstract

New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, [...] Read more.

New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, whilst the modifiable factors include peri-operative stress, hepatitis C or cytomegalovirus infection, vitamin D deficiency, hypomagnesemia, and immunosuppressive medications such as glucocorticoids, calcineurin inhibitors (tacrolimus more than cyclosporine), and mTOR inhibitors. The most worrying complication of NODAT are major adverse cardiovascular events which represent a leading cause of morbidity and mortality in transplanted patients. However, NODAT may also result in progressive diabetic kidney disease and is frequently associated with microvascular complications, eventually determining blindness or amputation. Preventive measures for NODAT include a careful assessment of glucose tolerance before transplantation, loss of over-weight, lifestyle modification, reduced caloric intake, and physical exercise. Concomitant measures include aggressive control of systemic blood pressure and lipids levels to reduce the risk of cardiovascular events. Hypomagnesemia and low levels of vitamin D should be corrected. Immunosuppressive strategies limiting the use of diabetogenic drugs are encouraged. Many hypoglycemic drugs are available and may be used in combination with metformin in difficult cases. In patients requiring insulin treatment, the dose and type of insulin should be decided on an individual basis as insulin requirements depend on the patient’s diet, amount of exercise, and renal function. Full article

(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)

12 pages, 342 KiB

Open AccessEditor’s ChoiceReview

Antiviral and Immunomodulation Effects of Artemisia

by Suhas G. Kshirsagar and Rammohan V. Rao

Medicina 2021, 57(3), 217; https://doi.org/10.3390/medicina57030217 - 27 Feb 2021

Cited by 38 | Viewed by 7207

Abstract

Background and Objectives: Artemisia is one of the most widely distributed genera of the family Astraceae with more than 500 diverse species growing mainly in the temperate zones of Europe, Asia and North America. The plant is used in Chinese and Ayurvedic systems [...] Read more.

Background and Objectives: Artemisia is one of the most widely distributed genera of the family Astraceae with more than 500 diverse species growing mainly in the temperate zones of Europe, Asia and North America. The plant is used in Chinese and Ayurvedic systems of medicine for its antiviral, antifungal, antimicrobial, insecticidal, hepatoprotective and neuroprotective properties. Research based studies point to Artemisia’s role in addressing an entire gamut of physiological imbalances through a unique combination of pharmacological actions. Terpenoids, flavonoids, coumarins, caffeoylquinic acids, sterols and acetylenes are some of the major phytochemicals of the genus. Notable among the phytochemicals is artemisinin and its derivatives (ARTs) that represent a new class of recommended drugs due to the emergence of bacteria and parasites that are resistant to quinoline drugs. This manuscript aims to systematically review recent studies that have investigated artemisinin and its derivatives not only for their potent antiviral actions but also their utility against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and Methods: PubMed Central, Scopus and Google scholar databases of published articles were collected and abstracts were reviewed for relevance to the subject matter. Conclusions: The unprecedented impact that artemisinin had on public health and drug discovery research led the Nobel Committee to award the Nobel Prize in Physiology or Medicine in 2015 to the discoverers of artemisinin. Thus, it is clear that Artemisia’s importance in indigenous medicinal systems and drug discovery systems holds great potential for further investigation into its biological activities, especially its role in viral infection and inflammation. Full article

(This article belongs to the Special Issue The Future of Medicine: Frontiers in Integrative Health and Medicine)

11 pages, 1803 KiB

Open AccessEditor’s ChoiceArticle

Perceptions of European ME/CFS Experts Concerning Knowledge and Understanding of ME/CFS among Primary Care Physicians in Europe: A Report from the European ME/CFS Research Network (EUROMENE)

by John Cullinan, Derek F. H. Pheby, Diana Araja, Uldis Berkis, Elenka Brenna, Jean-Dominique de Korwin, Lara Gitto, Dyfrig A. Hughes, Rachael M. Hunter, Dominic Trepel and Xia Wang-Steverding

Medicina 2021, 57(3), 208; https://doi.org/10.3390/medicina57030208 - 26 Feb 2021

Cited by 16 | Viewed by 5068

Abstract

Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as [...] Read more.

Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as to how this could be improved. Materials and Methods: A questionnaire was sent to all national representatives and members of the EUROMENE Core Group and Management Committee. Survey responses were collated and then summarized based on the numbers and percentages of respondents selecting each response option, while weighted average responses were calculated for questions with numerical value response options. Free text responses were analysed using thematic analysis. Results: Overall there were 23 responses to the survey from participants across 19 different European countries, with a 95% country-level response rate. Serious concerns were expressed about GPs’ knowledge and understanding of ME/CFS, and, it was felt, about 60% of patients with ME/CFS went undiagnosed as a result. The vast majority of GPs were perceived to lack confidence in either diagnosing or managing the condition. Disbelief, and misleading illness attributions, were perceived to be widespread, and the unavailability of specialist centres to which GPs could refer patients and seek advice and support was frequently commented upon. There was widespread support for more training on ME/CFS at both undergraduate and postgraduate levels. Conclusion: The results of this survey are consistent with the existing scientific literature. ME/CFS experts report that lack of knowledge and understanding of ME/CFS among GPs is a major cause of missed and delayed diagnoses, which renders problematic attempts to determine the incidence and prevalence of the disease, and to measure its economic impact. It also contributes to the burden of disease through mismanagement in its early stages. Full article

(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)

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9 pages, 285 KiB

Open AccessEditor’s ChoiceArticle

Study on the Effects of Melatonin on Glycemic Control and Periodontal Parameters in Patients with Type II Diabetes Mellitus and Periodontal Disease

by Diana-Maria Anton, Maria-Alexandra Martu, Marius Maris, George-Alexandru Maftei, Irina-Georgeta Sufaru, Diana Tatarciuc, Ionut Luchian, Nicoleta Ioanid and Silvia Martu

Medicina 2021, 57(2), 140; https://doi.org/10.3390/medicina57020140 - 5 Feb 2021

Cited by 28 | Viewed by 3719

Abstract

Background and Objectives: There is evidence that melatonin could improve the periodontal status and also glycemic control of patients with diabetes mellitus. Therefore, the aim of this study was to assess the effects of scaling and root planing plus adjunctive systemic treatment [...] Read more.

Background and Objectives: There is evidence that melatonin could improve the periodontal status and also glycemic control of patients with diabetes mellitus. Therefore, the aim of this study was to assess the effects of scaling and root planing plus adjunctive systemic treatment with melatonin on periodontal parameters and glycemic control in patients with type 2 diabetes and chronic periodontitis. Materials and Methods: The study was conducted on 54 subjects with periodontitis and diabetes mellitus randomly assigned to the study group (n = 27, subjects with scaling and root planing + melatonin) or control group (n = 27, subjects with scaling and root planing + placebo). Periodontal parameters (probing depth—PD; clinical attachment loss—CAL; bleeding on probing—BOP; and hygiene level) and glycated hemoglobin (HbA1c) were assessed at baseline and 8 weeks after. Results: At baseline, there were no significant differences between groups, but at the second evaluation 8 weeks later the association of melatonin with the non-surgical periodontal therapy exerted statistically significant improvements, both in periodontal parameters, with a significant decrease in periodontal disease severity, and glycated hemoglobin when compared to the control subjects. Conclusions: In our study, combined non-surgical periodontal treatment and systemic treatment with melatonin provided additional improvements to severe periodontal condition and the glycemic control of patients with diabetes type 2 when compared to non-surgical periodontal treatment alone. Full article

(This article belongs to the Section Dentistry and Oral Health)

16 pages, 410 KiB

Open AccessEditor’s ChoiceReview

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

by Mariarosaria Aromatario, Alessandra Torsello, Stefano D’Errico, Giuseppe Bertozzi, Francesco Sessa, Luigi Cipolloni and Benedetta Baldari

Medicina 2021, 57(2), 125; https://doi.org/10.3390/medicina57020125 - 1 Feb 2021

Cited by 38 | Viewed by 9777

Abstract

Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, [...] Read more.

Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included. Full article

(This article belongs to the Special Issue Update in Forensic Sciences)

13 pages, 763 KiB

Open AccessEditor’s ChoiceReview

Mast Cell Activation Disorders

by Arianna Giannetti, Emanuele Filice, Carlo Caffarelli, Giampaolo Ricci and Andrea Pession

Medicina 2021, 57(2), 124; https://doi.org/10.3390/medicina57020124 - 30 Jan 2021

Cited by 20 | Viewed by 6014

Abstract

Background and Objectives: Mast cell disorders comprise a wide spectrum of syndromes caused by mast cells’ degranulation with acute or chronic clinical manifestations. Materials and Methods: In this review article we reviewed the latest findings in scientific papers about mast cell disorders with [...] Read more.

Background and Objectives: Mast cell disorders comprise a wide spectrum of syndromes caused by mast cells’ degranulation with acute or chronic clinical manifestations. Materials and Methods: In this review article we reviewed the latest findings in scientific papers about mast cell disorders with a particular focus on mast cell activation syndrome and mastocytosis in pediatric age. Results: Patients with mast cell activation syndrome have a normal number of mast cells that are hyperreactive upon stimulation of various triggers. We tried to emphasize the diagnostic criteria, differential diagnosis, and therapeutic strategies. Another primary mast cell disorder is mastocytosis, a condition with a long-known disease, in which patients have an increased number of mast cells that accumulate in different regions of the body with different clinical evolution in pediatric age. Conclusions: Mast cell activation syndrome overlaps with different clinical entities. No consensus was found on biomarkers and no clearly resolutive treatment is available. Therefore, a more detailed knowledge of this syndrome is of fundamental importance for a correct diagnosis and effective therapy. Full article

(This article belongs to the Special Issue Pediatric Allergy and Immunology)

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13 pages, 2518 KiB

Open AccessEditor’s ChoiceReview

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

by Alberto Forte, Giuseppe Sarli, Lorenzo Polidori, David Lester and Maurizio Pompili

Medicina 2021, 57(2), 109; https://doi.org/10.3390/medicina57020109 - 26 Jan 2021

Cited by 24 | Viewed by 7871

Abstract

Background and objectives: Suicide in adolescents represents a major public health concern. To date, a growing number of suicide preventive strategies based on the use of new technologies are emerging. We aimed to provide an overview of the present literature on the [...] Read more.

Background and objectives: Suicide in adolescents represents a major public health concern. To date, a growing number of suicide preventive strategies based on the use of new technologies are emerging. We aimed to provide an overview of the present literature on the use of new technologies in adolescent suicide prevention. Materials and methods: An electronic search was run using the following keywords: Technology OR Technologies OR APP OR Application OR mobile application) AND (Adolescent OR youth OR puberty) AND (Suicid* OR Self-harm OR self-destruction). Inclusion criteria were: English language, published in a peer-reviewed journal, suicide prevention with the use of new technologies among adolescents. Results: Our search strategy yielded a total of 12 studies on the use of telemedicine, 7 on mobile applications, and 3 on language detection. We also found heterogeneity regarding the study design: 3 are randomized controlled trials (RCT), 13 are open-label single group trials, 2 are randomized studies, and 1 is a cross-sectional study. Telemedicine was the most adopted tool, especially web-based approaches. Mobile applications mostly focused on screening of depressive symptoms and suicidal ideation, and for clinical monitoring through the use of text messages. Although telepsychiatry and mobile applications can provide a fast and safe tool, supporting and preceding a face-to-face clinical assessment, only a few studies demonstrated efficacy in preventing suicide among adolescents through the use of these interventions. Some studies suggested algorithms able to recognize people at risk of suicide from the exploration of the language on social media posts. Conclusions: New technologies were found to be well accepted and tolerated supports for suicide prevention in adolescents. However, to date, few data support the use of such interventions in clinical practice and preventive strategies. Further studies are needed to test their efficacy in suicide prevention among adolescents and young adults. Full article

(This article belongs to the Special Issue Youth Mental Health)

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9 pages, 1088 KiB

Open AccessEditor’s ChoiceReview

Diabetic Foot Disease during the COVID-19 Pandemic

by Andrew J. M. Boulton

Medicina 2021, 57(2), 97; https://doi.org/10.3390/medicina57020097 - 22 Jan 2021

Cited by 21 | Viewed by 6459

Abstract

Throughout 2020, the COVID-19 pandemic has had a major impact on the care of non-communicable diseases across the world and diabetes is no exception. Whereas many branches of medicine have adapted to telemedicine, this is difficult and challenging for the diabetic foot which [...] Read more.

Throughout 2020, the COVID-19 pandemic has had a major impact on the care of non-communicable diseases across the world and diabetes is no exception. Whereas many branches of medicine have adapted to telemedicine, this is difficult and challenging for the diabetic foot which often requires “hands on” treatment. This review covers the challenges that have faced clinicians across the world in the management of complex diabetic foot problems and also includes some illustrative case vignettes which show how it is possible to manage foot ulcers without the usual access to laboratory and radiological testing. There is no doubt that the COVID-19 experience when handling diabetic foot problems will likely transform our approach to the management of diabetic foot disease especially in the areas of digital health and smart technology. Full article

(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)

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6 pages, 777 KiB

Open AccessEditor’s ChoiceArticle

Glycemia, Beta-Cell Function and Sensitivity to Insulin in Mildly to Critically Ill Covid-19 Patients

by Ioannis Ilias, Aristidis Diamantopoulos, Maria Pratikaki, Efthymia Botoula, Edison Jahaj, Nikolaos Athanasiou, Stamatios Tsipilis, Alexandros Zacharis, Alice G. Vassiliou, Dimitra A. Vassiliadi, Anastasia Kotanidou, Stylianos Tsagarakis and Ioanna Dimopoulou

Medicina 2021, 57(1), 68; https://doi.org/10.3390/medicina57010068 - 14 Jan 2021

Cited by 28 | Viewed by 3457

Abstract

Background and objectives: Critically and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes. With this study we aimed to assess glucose, glycemic gap (GlyG) and insulin secretion/sensitivity measures in patients with Covid-19. Materials [...] Read more.

Background and objectives: Critically and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes. With this study we aimed to assess glucose, glycemic gap (GlyG) and insulin secretion/sensitivity measures in patients with Covid-19. Materials and Methods: We studied, upon admission, 157 patients with Covid-19 (84: in wards and 73: in intensive care units; ICU); 135 had no history of diabetes. We measured blood glucose upon admission as well as glycated hemoglobin (A1c), plasma insulin and C-peptide. We calculated the GlyG and the Homeostasis Model Assessment 2 (HOMA2) estimates of steady state beta cell function (HOMA2%B) and insulin sensitivity (HOMA2%S). Statistical assessment was done with analysis or the Kruskal-Wallis test. Results: Compared to patients in the wards without diabetes, patients with diabetes in the wards, as well as patients in the ICU (without or with diabetes) had higher admission glycemia. The GlyG was significantly higher in patients without diabetes in the ICU compared to patients without diabetes in the wards, while HOMA2%B based on glucose and insulin was significantly higher in the ICU patients compared to patients in the wards. Of all the parameters, HOMA2%S based on C-peptide/glucose was higher in survivors (n = 133). Conclusions: In our series of patients with Covid-19, a substantial number of patients with and without diabetes had admission hyperglycemia and those who were critically ill may have had compromised insulin secretion and lowered sensitivity to insulin. These findings lend credence to reports of association between Covid-19 and hyperglycemia/secondary diabetes. Full article

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5 pages, 266 KiB

Open AccessEditor’s ChoiceOpinion

Obesity as a Neuroendocrine Reprogramming

by Abdelaziz Ghanemi, Mayumi Yoshioka and Jonny St-Amand

Medicina 2021, 57(1), 66; https://doi.org/10.3390/medicina57010066 - 13 Jan 2021

Cited by 17 | Viewed by 2733

Abstract

Obesity represents a health problem resulting from a broken balance between energy intake and energy expenditure leading to excess fat accumulation. Elucidating molecular and cellular pathways beyond the establishment of obesity remains the main challenge facing the progress in understanding obesity and developing [...] Read more.

Obesity represents a health problem resulting from a broken balance between energy intake and energy expenditure leading to excess fat accumulation. Elucidating molecular and cellular pathways beyond the establishment of obesity remains the main challenge facing the progress in understanding obesity and developing its treatment. Within this context, this opinion presents obesity as a reprogrammer of selected neurological and endocrine patterns in order to adapt to the new metabolic imbalance represented by obesity status. Indeed, during obesity development, the energy balance is shifted towards increased energy storage, mainly but not only, in adipose tissues. These new metabolic patterns that obesity represents require changes at different cellular and metabolic levels under the control of the neuroendocrine systems through different regulatory signals. Therefore, there are neuroendocrine changes involving diverse mechanisms, such as neuroplasticity and hormonal sensitivity, and, thus, the modifications in the neuroendocrine systems in terms of metabolic functions fit with the changes accompanying the obesity-induced metabolic phenotype. Such endocrine reprogramming can explain why it is challenging to lose weight once obesity is established, because it would mean to go against new endogenous metabolic references resulting from a new “setting” of energy metabolism-related neuroendocrine regulation. Investigating the concepts surrounding the classification of obesity as a neuroendocrine reprogrammer could optimize our understanding of the underlying mechanisms and, importantly, reveal some of the mysteries surrounding the molecular pathogenesis of obesity, as well as focusing the pharmacological search for antiobesity therapies on both neurobiology synaptic plasticity and hormonal interaction sensitivity. Full article

(This article belongs to the Special Issue Muscles, Exercise, and Obesity)

18 pages, 2252 KiB

Open AccessEditor’s ChoiceReview

Triple Negative Breast Cancer: A Review of Present and Future Diagnostic Modalities

by Sylvia Annabel Dass, Kim Liu Tan, Rehasri Selva Rajan, Noor Fatmawati Mokhtar, Elis Rosliza Mohd Adzmi, Wan Faiziah Wan Abdul Rahman, Tengku Ahmad Damitri Al-Astani Tengku Din and Venugopal Balakrishnan

Medicina 2021, 57(1), 62; https://doi.org/10.3390/medicina57010062 - 12 Jan 2021

Cited by 68 | Viewed by 10221

Abstract

Triple-negative breast cancer (TNBC) is an aggressive breast type of cancer with no expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). It is a highly metastasized, heterogeneous disease that accounts for 10–15% of total breast cancer [...] Read more.

Triple-negative breast cancer (TNBC) is an aggressive breast type of cancer with no expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). It is a highly metastasized, heterogeneous disease that accounts for 10–15% of total breast cancer cases with a poor prognosis and high relapse rate within five years after treatment compared to non-TNBC cases. The diagnostic and subtyping of TNBC tumors are essential to determine the treatment alternatives and establish personalized, targeted medications for every TNBC individual. Currently, TNBC is diagnosed via a two-step procedure of imaging and immunohistochemistry (IHC), which are operator-dependent and potentially time-consuming. Therefore, there is a crucial need for the development of rapid and advanced technologies to enhance the diagnostic efficiency of TNBC. This review discusses the overview of breast cancer with emphasis on TNBC subtypes and the current diagnostic approaches of TNBC along with its challenges. Most importantly, we have presented several promising strategies that can be utilized as future TNBC diagnostic modalities and simultaneously enhance the efficacy of TNBC diagnostic. Full article

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18 pages, 383 KiB

Open AccessEditor’s ChoiceReview

Therapeutic Strategies for the Treatment of Chronic Hyperuricemia: An Evidence-Based Update

by Arrigo F. G. Cicero, Federica Fogacci, Masanari Kuwabara and Claudio Borghi

Medicina 2021, 57(1), 58; https://doi.org/10.3390/medicina57010058 - 10 Jan 2021

Cited by 59 | Viewed by 9382

Abstract

This article aims to critically review the evidence on the available therapeutic strategies for the treatment of hyperuricemia. For this reason, several papers were reviewed. Xanthine oxidase inhibitors are the safest and most effective uric acid lowering drugs for the management of chronic [...] Read more.

This article aims to critically review the evidence on the available therapeutic strategies for the treatment of hyperuricemia. For this reason, several papers were reviewed. Xanthine oxidase inhibitors are the safest and most effective uric acid lowering drugs for the management of chronic hyperuricemia, while the efficacy of uricosuric agents is strongly modulated by pharmacogenetics. Emergent drugs (lesinurad, peglotidase) were found to be more effective for the acute management of refractory hyperuricemia, but their use is supported by a relatively small number of clinical trials so that further well-designed clinical research is needed to deepen their efficacy and safety profile. Full article

11 pages, 738 KiB

Open AccessEditor’s ChoiceArticle

Increased Psychological Distress, Loneliness, and Unemployment in the Spread of COVID-19 over 6 Months in Germany

by Shuyan Liu, Stephan Heinzel, Matthias N. Haucke and Andreas Heinz

Medicina 2021, 57(1), 53; https://doi.org/10.3390/medicina57010053 - 9 Jan 2021

Cited by 51 | Viewed by 8845

Abstract

Background: The COVID-19 pandemic poses a challenge to global mental health. Loneliness and isolation may put people at higher risk for increased psychological distress. However, there is a lack of research investigating the development of COVID-19-related distress over time. Materials and Methods [...] Read more.

Background: The COVID-19 pandemic poses a challenge to global mental health. Loneliness and isolation may put people at higher risk for increased psychological distress. However, there is a lack of research investigating the development of COVID-19-related distress over time. Materials and Methods: We undertook an online survey among general population (N = 1903) in Germany throughout 6 months from the peak transmission period in April to the off-peak period by September 2020. Results: We found that the average prevalence of psychological distress caused by the COVID-19 pandemic significantly rose from 24% to 66% between the peak and off-peak transmission period, respectively. Unemployment rate and loneliness increased negative mental health outcomes, although the number of active COVID-19 cases decreased from April to September. Psychological distress scores increased mostly in female, young, and lonely people. Conclusions: Our results underline the importance of considering innovative alternatives to facilitate employment opportunities, distant contacts, and self-help over the course of the pandemic. Our study highlights the urgent need to pay attention to mental health services specifically targeting female, young, unemployed, and lonely people. Full article

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7 pages, 505 KiB

Open AccessEditor’s ChoiceReview

Is There a Relationship between COVID-19 and Hyponatremia?

by Gina Gheorghe, Madalina Ilie, Simona Bungau, Anca Mihaela Pantea Stoian, Nicolae Bacalbasa and Camelia Cristina Diaconu

Medicina 2021, 57(1), 55; https://doi.org/10.3390/medicina57010055 - 9 Jan 2021

Cited by 44 | Viewed by 9285

Abstract

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, [...] Read more.

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, and the absence of specific therapeutic methods. COVID-19 can manifest with non-specific symptoms and signs, especially among the elderly. In some cases, the clinical manifestations of hyponatremia may be the first to appear. The pathophysiological mechanisms of hyponatremia among patients with COVID-19 are diverse, including syndrome of inappropriate antidiuretic hormone secretion (SIADH), digestive loss of sodium ions, reduced sodium ion intake or use of diuretic therapy. Hyponatremia may also be considered a negative prognostic factor in patients diagnosed with COVID-19. We need further studies to evaluate the etiology and therapeutic management of hyponatremia in patients with COVID-19. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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8 pages, 286 KiB

Open AccessEditor’s ChoiceArticle

The Impact of the COVID-19 Pandemic on Endurance and Ultra-Endurance Running

by Volker Scheer, David Valero, Elias Villiger, Thomas Rosemann and Beat Knechtle

Medicina 2021, 57(1), 52; https://doi.org/10.3390/medicina57010052 - 9 Jan 2021

Cited by 24 | Viewed by 4674

Abstract

Background and objectives: The COVID-19 outbreak has become a major health and economic crisis. The World Health Organization declared it a pandemic in March 2020, and many sporting events were canceled. Materials and Methods: We examined the effects of the COVID-19 [...] Read more.

Background and objectives: The COVID-19 outbreak has become a major health and economic crisis. The World Health Organization declared it a pandemic in March 2020, and many sporting events were canceled. Materials and Methods: We examined the effects of the COVID-19 pandemic on endurance and ultra-endurance running (UER) and analyzed finishes and events during the COVID-19 pandemic (observation period March 2020–October 2020) to the same time period pre-COVID-19 outbreak (March 2019–October 2019). Results: Endurance finishes decreased during the pandemic (459,029 to 42,656 (male: 277,493 to 25,582; female 181,536 to 17,074; all p < 0.001). Similarly, the numbers of endurance events decreased (213 vs. 61 events; p < 0.001). Average marathon finishing times decreased during the pandemic in men (5:18:03 ± 0:16:34 vs. 4:43:08 ± 0:25:08 h:min:s (p = 0.006)) and women (5:39:32 ± 0:19:29 vs. 5:14:29 ± 0:26:36 h:min:s (p = 0.02)). In UER, finishes decreased significantly (580,289 to 110,055; p < 0.001) as did events (5839 to 1791; p < 0.001). Popular event locations in United States, France, UK, and Germany decreased significantly (p < 0.05). All distance and time-limited UER events saw significant decreases (p < 0.05). Conclusions: The COVID-19 pandemic has had a significant effect on endurance and UER, and it is unlikely that running activities return to pre-pandemic levels any time soon. Mitigation strategies and safety protocols should be established. Full article

(This article belongs to the Special Issue Advances in Sports Science)

19 pages, 4192 KiB

Open AccessEditor’s ChoiceReview

Imaging Characterization of Renal Masses

by Carlos Nicolau, Natalie Antunes, Blanca Paño and Carmen Sebastia

Medicina 2021, 57(1), 51; https://doi.org/10.3390/medicina57010051 - 8 Jan 2021

Cited by 46 | Viewed by 13651

Abstract

The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of [...] Read more.

The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of solid lesions depends on whether the lesion is well-defined or infiltrative. The approach to well-defined lesions focuses mainly on the differentiation between renal cancer and benign tumors such as angiomyolipoma (AML) and oncocytoma. Differential diagnosis of infiltrative lesions is wider, including primary and secondary malignancies and inflammatory disease, and knowledge of the patient history is essential. Radiologists may establish a possible differential diagnosis based on the imaging features of the renal masses and the clinical history. The aim of this review is to present the contribution of the different imaging techniques and image guided biopsies in the diagnostic management of cystic and solid renal lesions. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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10 pages, 324 KiB

Open AccessEditor’s ChoiceArticle

Physical Activity Levels and Mental Health during the COVID-19 Pandemic: Preliminary Results of a Comparative Study between Convenience Samples from Brazil and Switzerland

by Paulo J. Puccinelli, Taline S. Costa, Aldo Seffrin, Claudio A. B. de Lira, Rodrigo L. Vancini, Beat Knechtle, Pantelis T. Nikolaidis and Marilia S. Andrade

Medicina 2021, 57(1), 48; https://doi.org/10.3390/medicina57010048 - 8 Jan 2021

Cited by 21 | Viewed by 3758

Abstract

Background and objectives: It has been suggested that the COVID-19 pandemic impaired people’s moods and general levels of physical activity, but the way in which each country is coping with the situation may result in different outcomes. The aim of the present study [...] Read more.

Background and objectives: It has been suggested that the COVID-19 pandemic impaired people’s moods and general levels of physical activity, but the way in which each country is coping with the situation may result in different outcomes. The aim of the present study was to compare the mental health and physical activity levels between residents of Brazil and Switzerland during the social distancing period associated with COVID-19 pandemic. Materials and Methods: A self-administered questionnaire aiming to assess personal, quarantine, physical activity, and mood state disorders data was answered by 114 participants (57 from each country) of both sexes. Results: Swiss participants presented a higher frequency of people (47.4%) not abiding by social distancing measures compared to Brazilian participants (1.8%; p < 0.001, effect size = 0.56). There were no significant differences between the participants from the two countries regarding physical activity levels (p = 0.09). The Swiss presented a higher frequency (78.9%) of people without symptoms of depression compared to Brazilians (31.6%; p < 0.001, effect size = 0.48). The Swiss also presented a higher frequency (77.2%) of people without symptoms of anxiety compared to Brazilians (35.1%; p < 0.001, effect size = 0.43). There was a significant association between the restriction level and depression symptoms (p = 0.01, effect size = 0.25) but not with anxiety symptoms (p = 0.21, effect size = 0.16). Conclusions: According to the preliminary results, Brazilians presented a much higher frequency of depression and anxiety symptoms, which can be explained by characteristics other than the restriction level. Full article

(This article belongs to the Special Issue Pandemic Outbreak of Coronavirus)

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17 pages, 557 KiB

Open AccessEditor’s ChoiceReview

A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE)

by Derek F. H. Pheby, Diana Araja, Uldis Berkis, Elenka Brenna, John Cullinan, Jean-Dominique de Korwin, Lara Gitto, Dyfrig A. Hughes, Rachael M. Hunter, Dominic Trepel and Xia Wang-Steverding

Medicina 2021, 57(1), 7; https://doi.org/10.3390/medicina57010007 - 24 Dec 2020

Cited by 24 | Viewed by 6150

Abstract

Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The [...] Read more.

Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact. Full article

(This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)

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10 pages, 410 KiB

Open AccessEditor’s ChoiceReview

Update on COVID-19 Myocarditis

by Arianne Clare C. Agdamag, Jonathan B. Edmiston, Victoria Charpentier, Mohammed Chowdhury, Meg Fraser, Valmiki R. Maharaj, Gary S. Francis and Tamas Alexy

Medicina 2020, 56(12), 678; https://doi.org/10.3390/medicina56120678 - 9 Dec 2020

Cited by 40 | Viewed by 8294

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in [...] Read more.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in the human body. Cardiac manifestations may include myocarditis, life threatening arrhythmias, acute coronary syndrome, systolic heart failure, and cardiogenic shock. Myocarditis is increasingly recognized as a complication of Coronavirus-19 (COVID-19) and may result from direct viral injury or from exaggerated host immune response. The diagnosis is established similar to other etiologies, and is based on detailed history, clinical exam, laboratory findings and non-invasive imaging studies. When available, cardiac MRI is the preferred imaging modality. Endomyocardial biopsy may be performed if the diagnosis remains uncertain. Current management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, steroids, and convalescent plasma. In the setting of cardiogenic shock and refractory, life-threatening arrhythmias that persist despite medical therapy, advanced mechanical circulatory support devices should be considered. Ultimately, early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Our management strategy is expected to evolve further as we learn more about COVID-19 disease and the associated cardiac complications. Full article

(This article belongs to the Special Issue Heart Failure in the Era of COVID 19)

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9 pages, 296 KiB

Open AccessEditor’s ChoiceArticle

Infodemia: Another Enemy for Romanian Frontline Healthcare Workers to Fight during the COVID-19 Outbreak

by Ica Secosan, Delia Virga, Zorin Petrisor Crainiceanu, Lavinia Melania Bratu and Tiberiu Bratu

Medicina 2020, 56(12), 679; https://doi.org/10.3390/medicina56120679 - 9 Dec 2020

Cited by 29 | Viewed by 5021

Abstract

Background and Objectives: The population has been overwhelmed with false information related to the Coronavirus disease (COVID-19) crisis, spreading rapidly through social media and other channels. We aimed to investigate if frontline healthcare workers affected by infodemia show different psychological consequences than frontline [...] Read more.

Background and Objectives: The population has been overwhelmed with false information related to the Coronavirus disease (COVID-19) crisis, spreading rapidly through social media and other channels. We aimed to investigate if frontline healthcare workers affected by infodemia show different psychological consequences than frontline clinicians who do not declare to be affected by false news related to the COVID-19 pandemic. Materials and Methods: One hundred twenty-six frontline healthcare workers from the Intensive Care Unit (ICU) and Emergency Departments in Romania completed a survey to assess stress, depression, anxiety, and sleep disorders, between March and April 2020. We split the sample of frontline healthcare workers into two groups based on the self-evaluated criteria: if they were or were not affected by infodemia in their activity. Results: Considering limitations such as the cross-sectional design, the lack of causality relationship, and the sample size, the results show that, the frontline medical workers who declared to be affected by false news were significantly more stressed, felt more anxiety, and suffered more from insomnia than healthcare workers who are not affected by false information related to pandemic time. Conclusions: The infodemia has significant psychological consequences such as stress, anxiety, and insomnia on already overwhelmed doctors and nurses in the outbreak of the COVID-19 crisis. These findings suggest that medical misinformation’s psychological implications must be considered when different interventions regarding frontline healthcare workers during the COVID-19 pandemic are implemented. Full article

(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)

10 pages, 1185 KiB

Open AccessEditor’s ChoiceReview

The Social Brain and Emotional Contagion: COVID-19 Effects

by Anna Valenzano, Alessia Scarinci, Vincenzo Monda, Francesco Sessa, Antonietta Messina, Marcellino Monda, Francesco Precenzano, Maria Pina Mollica, Marco Carotenuto, Giovanni Messina and Giuseppe Cibelli

Medicina 2020, 56(12), 640; https://doi.org/10.3390/medicina56120640 - 25 Nov 2020

Cited by 30 | Viewed by 10974

Abstract

Background and objectives: Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease, responsible for a global pandemic that began in January 2020. Human/COVID-19 interactions cause different outcomes ranging from minor health consequences to death. Since social interaction is the default mode by [...] Read more.

Background and objectives: Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease, responsible for a global pandemic that began in January 2020. Human/COVID-19 interactions cause different outcomes ranging from minor health consequences to death. Since social interaction is the default mode by which individuals communicate with their surroundings, different modes of contagion can play a role in determining the long-term consequences for mental health and emotional well-being. We examined some basic aspects of human social interaction, emphasizing some particular features of the emotional contagion. Moreover, we analyzed the main report that described brain damage related to the COVID-19 infection. Indeed, the goal of this review is to suggest a possible explanation for the relationships among emotionally impaired people, brain damage, and COVID-19 infection. Results: COVID-19 can cause several significant neurological disorders and the pandemic has been linked to a rise in people reporting mental health problems, such as depression and anxiety. Neurocognitive symptoms associated with COVID-19 include delirium, both acute and chronic attention and memory impairment related to hippocampal and cortical damage, as well as learning deficits in both adults and children. Conclusions: Although our knowledge on the biology and long-term clinical outcomes of the COVID-19 infection is largely limited, approaching the pandemic based on lessons learnt from previous outbreaks of infectious diseases and the biology of other coronaviruses will provide a suitable pathway for developing public mental health strategies, which could be positively translated into therapeutic approaches, attempting to improve stress coping responses, thus contributing to alleviate the burden driven by the pandemic. Full article

(This article belongs to the Special Issue Update in Forensic Sciences)

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3 pages, 245 KiB

Open AccessEditor’s ChoiceEditorial

Epithelial–Mesenchymal Transition: A Major Pathogenic Driver in Idiopathic Pulmonary Fibrosis?

by Francesco Salton, Barbara Ruaro, Paola Confalonieri and Marco Confalonieri

Medicina 2020, 56(11), 608; https://doi.org/10.3390/medicina56110608 - 13 Nov 2020

Cited by 46 | Viewed by 2463

Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive disease of the lungs that leads to parenchymal scarring and death due to respiratory failure within a few years despite the recent therapeutic advances [...] Full article

(This article belongs to the Section Pulmonology)

24 pages, 3909 KiB

Open AccessEditor’s ChoiceReview

Nandrolone Decanoate: Use, Abuse and Side Effects

by Federico Giuseppe Patanè, Aldo Liberto, Andreana Nicoletta Maria Maglitto, Pasquale Malandrino, Massimiliano Esposito, Francesco Amico, Giuseppe Cocimano, Giuseppe Li Rosi, Dario Condorelli, Nunzio Di Nunno and Angelo Montana

Medicina 2020, 56(11), 606; https://doi.org/10.3390/medicina56110606 - 11 Nov 2020

Cited by 47 | Viewed by 16293

Abstract

Background and Objectives: Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused on maximizing the anabolic effects and minimizing the androgenic ones. Class II anabolic androgenic steroids (AAS), [...] Read more.

Background and Objectives: Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused on maximizing the anabolic effects and minimizing the androgenic ones. Class II anabolic androgenic steroids (AAS), including nandrolone, are rapidly becoming a widespread group of drugs used both clinically and illicitly. The illicit use of AAS is diffused among adolescent and bodybuilders because of their anabolic proprieties and their capacity to increase tolerance to exercise. This systematic review aims to focus on side effects related to illicit AAS abuse, evaluating the scientific literature in order to underline the most frequent side effects on AAS abusers’ bodies. Materials and Methods: A systematic review of the scientific literature was performed using the PubMed database and the keywords “nandrolone decanoate”. The inclusion criteria for articles or abstracts were English language and the presence of the following words: “abuse” or “adverse effects”. After applying the exclusion and inclusion criteria, from a total of 766 articles, only 148 were considered eligible for the study. Results: The most reported adverse effects (found in more than 5% of the studies) were endocrine effects (18 studies, 42%), such as virilization, gynecomastia, hormonal disorders, dyslipidemia, genital alterations, and infertility; cardiovascular dysfunctions (six studies, 14%) such as vascular damage, coagulation disorders, and arteriosus hypertension; skin disorders (five studies, 12%) such as pricking, acne, and skin spots; psychiatric and mood disorders (four studies, 9%) such as aggressiveness, sleep disorders and anxiety; musculoskeletal disorders (two studies, 5%), excretory disorders (two studies, 5%), and gastrointestinal disorders (two studies, 5%). Conclusions: Based on the result of our study, the most common adverse effects secondary to the abuse of nandrolone decanoate (ND) involve the endocrine, cardiovascular, skin, and psychiatric systems. These data could prove useful to healthcare professionals in both sports and clinical settings. Full article

(This article belongs to the Special Issue Anabolic Androgenic Steroids: Chemistry, Biological Action, Clinical Applications and New Molecular Biomarkers)

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25 pages, 1385 KiB

Open AccessEditor’s ChoiceReview

Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review

by Erica M. Filep, Yuki Murata, Brad D. Endres, Gyujin Kim, Rebecca L. Stearns and Douglas J. Casa

Medicina 2020, 56(11), 589; https://doi.org/10.3390/medicina56110589 - 5 Nov 2020

Cited by 42 | Viewed by 5364

Abstract

Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series [...] Read more.

Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into “adequate” (>0.15 °C/min) versus “insufficient” (<0.15 °C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer’s Exact test on 2 × 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates >0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate >0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia. Full article

(This article belongs to the Special Issue Prevention, Recognition, and Treatment of Exertional Heat Illnesses)

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19 pages, 991 KiB

Open AccessEditor’s ChoiceReview

Sudden Cardiac Death in Anabolic-Androgenic Steroid Users: A Literature Review

by Marco Torrisi, Giuliana Pennisi, Ilenia Russo, Francesco Amico, Massimiliano Esposito, Aldo Liberto, Giuseppe Cocimano, Monica Salerno, Giuseppe Li Rosi, Nunzio Di Nunno and Angelo Montana

Medicina 2020, 56(11), 587; https://doi.org/10.3390/medicina56110587 - 4 Nov 2020

Cited by 55 | Viewed by 13913

Abstract

Background and objectives: Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its related precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders, both for aesthetic uses and as performance enhancers to increase muscle growth [...] Read more.

Background and objectives: Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its related precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders, both for aesthetic uses and as performance enhancers to increase muscle growth and lean body mass. When used illicitly they can damage health and cause disorders affecting several functions. Sudden cardiac death (SCD) is the most common medical cause of death in athletes. SCD in athletes has also been associated with the use of performance-enhancing drugs. This review aimed to focus on deaths related to AAS abuse to investigate the cardiac pathophysiological mechanism that underlies this type of death, which still needs to be fully investigated. Materials and Methods: This review was conducted using PubMed Central and Google Scholar databases, until 21 July 2020, using the following key terms: “((Sudden cardiac death) OR (Sudden death)) AND ((androgenic anabolic steroid) OR (androgenic anabolic steroids) OR (anabolic-androgenic steroids) OR (anabolic-androgenic steroid))”. Thirteen articles met the inclusion and exclusion criteria, for a total of 33 reported cases. Results: Of the 33 cases, 31 (93.9%) were males while only 2 (61%) were females. Mean age was 29.79 and, among sportsmen, the most represented sports activity was bodybuilding. In all cases there was a history of AAS abuse or a physical phenotype suggesting AAS use; the total usage period was unspecified in most cases. In 24 cases the results of the toxicological analysis were reported. The most detected AASs were nandrolone, testosterone, and stanozolol. The most frequently reported macroscopic alterations were cardiomegaly and left ventricular hypertrophy, while the histological alterations were foci of fibrosis and necrosis of the myocardial tissue. Conclusions: Four principal mechanisms responsible for SCD have been proposed in AAS abusers: the atherogenic model, the thrombosis model, the model of vasospasm induced by the release of nitric oxide, and the direct myocardial injury model. Hypertrophy, fibrosis, and necrosis represent a substrate for arrhythmias, especially when combined with exercise. Indeed, AAS use has been shown to change physiological cardiac remodeling of athletes to pathophysiological cardiac hypertrophy with an increased risk of life-threatening arrhythmias. Full article

(This article belongs to the Special Issue Anabolic Androgenic Steroids: Chemistry, Biological Action, Clinical Applications and New Molecular Biomarkers)

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13 pages, 800 KiB

Open AccessEditor’s ChoiceArticle

The Influence of Gender and Year of Study on Stress Levels and Coping Strategies among Polish Dental

by Katarzyna Mocny-Pachońska, Agata Trzcionka, Rafał J. Doniec, Szymon Sieciński and Marta Tanasiewicz

Medicina 2020, 56(10), 531; https://doi.org/10.3390/medicina56100531 - 12 Oct 2020

Cited by 17 | Viewed by 3351

Abstract

Background and objectives: Stress is a common term used to describe various adverse psychological conditions. Students in the dentistry field face many negative psychological outcomes. The core factors for stress among dental students are related to their training course and social contacts [...] Read more.

Background and objectives: Stress is a common term used to describe various adverse psychological conditions. Students in the dentistry field face many negative psychological outcomes. The core factors for stress among dental students are related to their training course and social contacts with peers. This research aimed to assess the stress of dental students depending on their gender and study year. Materials and methods: We used the Perceived Stress Scale (PSS-10) and Mini-COPE questionnaire. The surveys were conducted among 446 dental students (320 women and 126 men) at the Faculty of Medical Sciences of the Medical University of Silesia in Katowice. Results: For the second-year and fifth-year students, the differences in scores were statistically significant, while in both cases, men had significantly lower values on the analysed scale. The results of the Kruskal-Wallis test indicated significantly lower values on the PSS-10 scale for the third-year and fourth-year students than in first-year students. The performed statistical analysis of the data obtained from the Mini-COPE questionnaire showed significant differences between men and women in individual years of study. In the first year, women chose more often the strategies related to turning to religion (p = 0.007), seeking emotional support (p = 0.046), seeking instrumental support (p = 0.045) and dealing with something else (p = 0.029) in coping with stress than men. Conclusions: The highest level of stress was found among first-year dental students. Moreover, women were characterised with higher stress levels than men. Men more often use psychoactive substances and resort to a sense of humour to cope with stress. On the other hand, women turn to religion, seek instrumental and emotional support. Full article

(This article belongs to the Section Dentistry and Oral Health)

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10 pages, 1055 KiB

Open AccessEditor’s ChoiceArticle

Non-COVID Diseases during the Pandemic: Where Have All Other Emergencies Gone?

by Veronica Ojetti, Marcello Covino, Mattia Brigida, Carmine Petruzziello, Angela Saviano, Alessio Migneco, Marcello Candelli and Francesco Franceschi

Medicina 2020, 56(10), 512; https://doi.org/10.3390/medicina56100512 - 1 Oct 2020

Cited by 53 | Viewed by 4815

Abstract

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it [...] Read more.

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February –31 March) in the last three years (2018–2019–2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality. Full article

(This article belongs to the Section Emergency Medicine)

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17 pages, 982 KiB

Open AccessEditor’s ChoiceReview

Effects of Equine-Assisted Therapies or Horse-Riding Simulators on Chronic Pain: A Systematic Review and Meta-Analysis

by Daniel Collado-Mateo, Ana Myriam Lavín-Pérez, Juan Pedro Fuentes García, Miguel Ángel García-Gordillo and Santos Villafaina

Medicina 2020, 56(9), 444; https://doi.org/10.3390/medicina56090444 - 31 Aug 2020

Cited by 16 | Viewed by 5573

Abstract

Background and objectives: Chronic pain is a complex global public health problem that affects the health status, quality of life, activities of daily living, and different work-related variables. Riding a horse may lead to some benefits in chronic pain patients through the improvement [...] Read more.

Background and objectives: Chronic pain is a complex global public health problem that affects the health status, quality of life, activities of daily living, and different work-related variables. Riding a horse may lead to some benefits in chronic pain patients through the improvement of postural control and other biopsychosocial processes. Therefore, this systematic review and meta-analysis aimed to evaluate the effects of horse riding (with real or simulated horses) on chronic pain. Materials and methods: A systematic literature search was carried out in accordance with PRISMA guidelines in Web of Science (WOS) and PubMed (Medline) electronic databases. Eleven articles (seven randomized controlled trials) were selected to be included in the review. Due to some risk of bias concerns, two meta-analyses (using postintervention or change-from-baseline measures) were conducted utilizing Review Manager Software (RevMan 5.3). Results: Horse-riding simulators significantly reduced the pain levels of patients with low back pain (p = 0.03, with a SMD of −1.14 and a 95% CI from −2.16 to −0.11) using change-from-baseline measures. However, the p-value in the meta-analysis with the postintervention measures was 0.06. Regarding interventions with real horses, it was not possible to conduct a meta-analysis due to the low number of studies. Conclusion: Horse riding could be a useful exercise to reduce pain, but more studies are needed to make evidence-based recommendations and to compare the effects of horse-riding with real and simulated horses. Full article

(This article belongs to the Special Issue Physical Activity and Chronic Diseases)

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30 pages, 1736 KiB

Open AccessEditor’s ChoiceReview

Probiotics: Versatile Bioactive Components in Promoting Human Health

by Javad Sharifi-Rad, Célia F. Rodrigues, Zorica Stojanović-Radić, Marina Dimitrijević, Ana Aleksić, Katarzyna Neffe-Skocińska, Dorota Zielińska, Danuta Kołożyn-Krajewska, Bahare Salehi, Selvaraj Milton Prabu, Francine Schutz, Anca Oana Docea, Natália Martins and Daniela Calina

Medicina 2020, 56(9), 433; https://doi.org/10.3390/medicina56090433 - 27 Aug 2020

Cited by 105 | Viewed by 14145

Abstract

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward [...] Read more.

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease’s diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control. Full article

(This article belongs to the Special Issue Modern Lifestyle, Anthropogens and Chronic Diseases from Myths to Reality)

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11 pages, 753 KiB

Open AccessEditor’s ChoiceArticle

Equal Opportunities for Stroke Survivors’ Rehabilitation: A Study on the Validity of the Upper Extremity Fugl-Meyer Assessment Scale Translated and Adapted into Romanian

by Nadinne Roman, Roxana Miclaus, Angela Repanovici and Cristina Nicolau

Medicina 2020, 56(8), 409; https://doi.org/10.3390/medicina56080409 - 13 Aug 2020

Cited by 13 | Viewed by 4378

Abstract

Background and objectives: The Upper Extremity Fugl-Meyer Assessment (UEFMA) is one of the most recommended and used methods of clinical evaluation not only for post-stroke motor function disability conditions but also for physiotherapy goal-setting. Up to the present, an official Romanian version has [...] Read more.

Background and objectives: The Upper Extremity Fugl-Meyer Assessment (UEFMA) is one of the most recommended and used methods of clinical evaluation not only for post-stroke motor function disability conditions but also for physiotherapy goal-setting. Up to the present, an official Romanian version has not been officially available. This study aims to carry out a translation, adaptation, and validation of UEFMA in Romanian, thus giving both patients and medical practitioners the equal opportunity of benefiting from its proficiency. Material and methods: The English version of the motor component of UEFMA was back and forth translated in the assent of best practice translation guidelines. The research was performed on a group of 64 post-stroke in-patients regarding psychometric properties for content validation and an exploratory and confirmatory factorial analysis was performed using the Bayesian model. To assess internal consistency and test–retest reliability, we used the Cronbach Alpha index and Intraclass Correlation Coefficient (ICC). We used Pearson correlation with the Functional Independence Measure (FIM) and Modified Rankin Scale (MRS) to determine concurrent validation. Standardized response mean (SRM) was applied to determine the responsiveness of the instrument used. Results: After performing the exploratory factor analysis, a single factor was extracted, with an Eigenvalue of 19.363, which explained 64.543% of the variation. The model was confirmed by Bayesian exploration, with Root Mean Square Residual (RMR) 0.051, Goodness-of-fit Index (GFI) 0.980, Normed-Fit Index (NFI) 0.978 and Relative Fit Index (RFI) 0.977. The Cronbach Alpha value was 0.981, the Intraclass Correlation Coefficient (ICC) index for average measures was 0.992, the Pearson correlation with FIM 0.789, and MRS −0.787, while the SRM was 1.117. Conclusions: The Romanian version of the UEFMA scale is a reliable, responsive and valid tool which can be used as a standardized assessment in post-stroke patients across Romania. Full article

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9 pages, 1102 KiB

Open AccessEditor’s ChoiceCommunication

UHPLC-HRMS and GC-MS Screening of a Selection of Synthetic Cannabinoids and Metabolites in Urine of Consumers

by Manuela Pellegrini, Emilia Marchei, Esther Papaseit, Magí Farré and Simona Zaami

Medicina 2020, 56(8), 408; https://doi.org/10.3390/medicina56080408 - 13 Aug 2020

Cited by 15 | Viewed by 3549

Abstract

Background and Objectives: The use of synthetic cannabinoids has increased around the world. As a result, the implementation of accurate analysis in human biological matrices is relevant and fundamental. Two different analytical technologies, ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) and high-sensitivity gas [...] Read more.

Background and Objectives: The use of synthetic cannabinoids has increased around the world. As a result, the implementation of accurate analysis in human biological matrices is relevant and fundamental. Two different analytical technologies, ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) and high-sensitivity gas chromatography-mass spectrometry (GC-MS) were used for the determination of three synthetic cannabinoids JWH-122, JWH 210, UR-144 and their metabolites in urine of consumers. Materials and Methods: Sample preparation included an initial hydrolysis with β-glucuronidase and liquid-liquid extraction. The UHPLC-HRMS method included a Kinetex 2.6 u Biphenyl 100A (100 × 2.1 mm, 2.6 μm) (Phenomenex, Italy) column with a gradient mobile phase consisting of mobile phase A (ammonium formate 2mM in water, 0.1% formic acid) and mobile phase B (ammonium formate 2mM in methanol/acetonitrile 50:50 (v/v), 0.1% formic acid) and a full-scan data-dependent MS2 (ddMS2) mode was used (mass range 100–1000 m/z). The GC-MS method employed an ultra-Inert Intuvo GC column (HP-5MS UI, 30 m × 250 µm i.d, film thickness 0.25 µm; Agilent Technologies, Santa Clara, CA, USA) and electron-impact (EI) mass spectra were recorded in total ion monitoring mode (scan range 40–550 m/z). Results: Both methods have been successfully used for screening of parent synthetic cannabinoids and their metabolites in urine samples of consumers. Conclusions: The screening method applied JWH-122, JWH-210, UR-144 and their metabolites in urine of consumers can be applied to other compounds of the JWH family. Full article

(This article belongs to the Special Issue Use of Medicinal Cannabis and Synthetic Cannabinoids)

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11 pages, 546 KiB

Open AccessEditor’s ChoiceArticle

Association between Breakfast Skipping and the Metabolic Syndrome: The Korea National Health and Nutrition Examination Survey, 2017

by JaeHun Jung, A-Sol Kim, Hae-Jin Ko, Hye-In Choi and Hee-Eun Hong

Medicina 2020, 56(8), 396; https://doi.org/10.3390/medicina56080396 - 7 Aug 2020

Cited by 14 | Viewed by 3272

Abstract

Background and Objectives: Recently, the prevalence of metabolic syndrome in Korea has increased rapidly. Current knowledge reflects the importance of dietary control in relation to the metabolic syndrome. The objective of this study was to evaluate the influence of skipping breakfast on the [...] Read more.

Background and Objectives: Recently, the prevalence of metabolic syndrome in Korea has increased rapidly. Current knowledge reflects the importance of dietary control in relation to the metabolic syndrome. The objective of this study was to evaluate the influence of skipping breakfast on the metabolic syndrome. Materials and Methods: We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey 2017 for the second year. A total of 3864 adults aged 20 to 64 were included in the study. We stratified the study population into three groups, based on breakfast patterns: the regular group, irregular group, and skipping group. Multiple logistic regression analysis was used to analyze the association between skipping breakfast and the presence of metabolic syndrome. Results: We noted an increase in the proportion of metabolic syndrome cases as follows: skipping group (3.3%), irregular group (5.4%), and regular group (8.5%) (p < 0.001). The multivariate-adjusted odds ratios of metabolic syndrome in the skipping and irregular groups compared with the regular group were 0.68 (95% CI; 0.35 to 1.35) and 0.81 (95% CI; 0.51 to 1.28), respectively. In the 40–65-year-old age group, which had a high prevalence of metabolic syndrome, the multivariate-adjusted odds ratios of metabolic syndrome in the skipping group compared with regular group were 0.78 (95%CI, 0.39 to 1.62). Conclusions: There was no significant correlation between skipping breakfast and risk factors of metabolic syndrome (after adjusting for risk factors), but a tendency of skipping breakfast to lower the risk of metabolic syndrome was observed. A rationale for these results is proposed through the association between skipping breakfast and intermittent fasting. Full article

(This article belongs to the Section Endocrinology)

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29 pages, 8309 KiB

Open AccessEditor’s ChoiceReview

Is Antioxidant Therapy a Useful Complementary Measure for Covid-19 Treatment? An Algorithm for Its Application

by María Elena Soto, Verónica Guarner-Lans, Elizabeth Soria-Castro, Linaloe Manzano Pech and Israel Pérez-Torres

Medicina 2020, 56(8), 386; https://doi.org/10.3390/medicina56080386 - 31 Jul 2020

Cited by 60 | Viewed by 8716

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes the corona virus disease-19 which is accompanied by severe pneumonia, pulmonary alveolar collapses and which stops oxygen exchange. Viral transmissibility and pathogenesis depend on recognition by a receptor in the host, protease cleavage of the [...] Read more.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes the corona virus disease-19 which is accompanied by severe pneumonia, pulmonary alveolar collapses and which stops oxygen exchange. Viral transmissibility and pathogenesis depend on recognition by a receptor in the host, protease cleavage of the host membrane and fusion. SARS-CoV-2 binds to the angiotensin converting enzyme 2 receptor. Here, we discuss the general characteristics of the virus, its mechanism of action and the way in which the mechanism correlates with the comorbidities that increase the death rate. We also discuss the currently proposed therapeutic measures and propose the use of antioxidant drugs to help patients infected with the SARS-CoV-2. Oxidizing agents come from phagocytic leukocytes such as neutrophils, monocytes, macrophages and eosinophils that invade tissue. Free radicals promote cytotoxicity thus injuring cells. They also trigger the mechanism of inflammation by mediating the activation of NFkB and inducing the transcription of cytokine production genes. Release of cytokines enhances the inflammatory response. Oxidative stress is elevated during critical illnesses and contributes to organ failure. In corona virus disease-19 there is an intense inflammatory response known as a cytokine storm that could be mediated by oxidative stress. Although antioxidant therapy has not been tested in corona virus disease-19, the consequences of antioxidant therapy in sepsis, acute respiratory distress syndrome and acute lung injury are known. It improves oxygenation rates, glutathione levels and strengthens the immune response. It reduces mechanical ventilation time, the length of stay in the intensive care unit, multiple organ dysfunctions and the length of stay in the hospital and mortality rates in acute lung injury/acute respiratory distress syndrome and could thus help patients with corona virus disease-19. Full article

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