Medicina

6 pages, 243 KiB

Open AccessEditorial

Editorial to the Special Issue “Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments, and Reliable Follow-Up”

by Dario Rusciano and Stefania Marsili

Medicina 2025, 61(4), 662; https://doi.org/10.3390/medicina61040662 (registering DOI) - 3 Apr 2025

Abstract

The Special Issue “Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments, and Reliable Follow-Up” brings together a diverse yet interconnected collection of research papers that collectively address the multifaceted challenges of retinal diseases [...] Full article

(This article belongs to the Special Issue Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments and Reliable Follow-Up)

8 pages, 518 KiB

Open AccessBrief Report

Hemodynamic Performance of a Self-Expanding Transcatheter Aortic Valve with an Intra-Annular Leaflet Position in Patients with a Small Aortic Annulus

by Matjaž Bunc, Gregor Verček and Ole De Backer

Medicina 2025, 61(4), 661; https://doi.org/10.3390/medicina61040661 (registering DOI) - 3 Apr 2025

Abstract

Background and Objectives: Transcatheter aortic valve implantation is associated with a higher risk for elevated trans-prosthetic gradients and prosthesis-patient mismatch in patients with a small aortic annulus. We aimed to assess the short-term hemodynamic performance of self-expanding transcatheter aortic valves with an [...] Read more.

Background and Objectives: Transcatheter aortic valve implantation is associated with a higher risk for elevated trans-prosthetic gradients and prosthesis-patient mismatch in patients with a small aortic annulus. We aimed to assess the short-term hemodynamic performance of self-expanding transcatheter aortic valves with an intra-annular leaflet position in patients with small aortic anatomies. Materials and Methods: Consecutive patients with small aortic annuli (annular area < 430 mm²), who underwent transcatheter aortic valve implantation with a self-expanding Portico or Navitor (Abbott Medical, St. Paul, MN, USA) transcatheter aortic valve between October 2017 and August 2024 at the University Medical Centre Ljubljana, Slovenia, were analyzed. The main endpoints were the post-procedural mean trans-prosthetic gradient, the presence of moderate or severe prosthesis-patient mismatch or paravalvular regurgitation. Results: Overall, 37 patients were included in the study (29 patients with a native aortic valve and 8 patients undergoing valve-in-valve transcatheter aortic valve implantation). The mean age was 81.6 ± 4.3 years, 32 patients (86.5%) were female. The median annular perimeter was 70.8 mm (interquartile range 67.3–74.1 mm) and the median annular area was 379 mm² (interquartile range 355–412 mm²). The post-procedural mean trans-prosthetic gradient was 9.0 ± 3.5 mmHg, with no cases with a mean gradient > 20 mmHg. Moderate and severe prosthesis-patient mismatch was observed in 21.2% and 3.0% of patients, respectively. Mild paravalvular regurgitation was noted in 44.1% of patients, there were no cases of moderate or severe paravalvular regurgitation. One patient (3.0%) had moderate valvular regurgitation. Conclusions: Self-expanding transcatheter aortic valves with an intra-annular leaflet position are associated with favorable hemodynamic performance in patients with a small aortic annulus. Full article

(This article belongs to the Section Cardiology)

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11 pages, 655 KiB

Open AccessReview

Significance of Demodex folliculorum and Demodex brevis in Pathogenesis of Dermatological Diseases—Current State of Knowledge

by Katarzyna Rychlik, Julia Sternicka, Roman J. Nowicki, Leszek Bieniaszewski and Dorota Purzycka-Bohdan

Medicina 2025, 61(4), 660; https://doi.org/10.3390/medicina61040660 (registering DOI) - 3 Apr 2025

Abstract

Demodex folliculorum and Demodex brevis are external parasites that reside in human hair follicles and sebaceous glands, most commonly on the cheeks, chin, nose, and eyelids, inhabiting the eyelash follicles. The prevalence of Demodex spp. varies with age. The highest concentration of mites [...] Read more.

Demodex folliculorum and Demodex brevis are external parasites that reside in human hair follicles and sebaceous glands, most commonly on the cheeks, chin, nose, and eyelids, inhabiting the eyelash follicles. The prevalence of Demodex spp. varies with age. The highest concentration of mites is observed in older people, being almost 100%, and the lowest is found in children. Although the presence of parasites does not directly lead to the development of pathological symptoms, their high density is associated with diseases such as rosacea or blepharitis. This manuscript delves into the biological characteristics of Demodex folliculorum and Demodex brevis with consideration of current diagnostic techniques for detecting Demodex mites. It also aims to provide an in-depth analysis of the role Demodex mites play in the development of various dermatological conditions, with a review of the current therapeutic approaches for managing Demodex-related diseases. Full article

(This article belongs to the Section Infectious Disease)

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31 pages, 3629 KiB

Open AccessSystematic Review

Systematic Review and Meta-Analysis of Transcendental Meditation for Post-Traumatic Stress Disorder

by David W. Orme-Johnson, Vernon A. Barnes, Brian Rees and Jean Tobin

Medicina 2025, 61(4), 659; https://doi.org/10.3390/medicina61040659 (registering DOI) - 3 Apr 2025

Abstract

Background and Objectives. Our recent systematic review and meta-analysis of all studies on meditation as treatment for PTSD (61 studies) found a moderate effect size of Hedges’s g = −0.67 for post-minus-pre change in symptom scores. Separate tests of the four meditation categories [...] Read more.

Background and Objectives. Our recent systematic review and meta-analysis of all studies on meditation as treatment for PTSD (61 studies) found a moderate effect size of Hedges’s g = −0.67 for post-minus-pre change in symptom scores. Separate tests of the four meditation categories found a large effect size of g = −1.13 for the Transcendental Meditation (TM) technique that is significantly greater than for each other category. The present follow-up used a different method, calculating effects relative to internal controls, to better characterize the effects of this meditation technique. Materials and Methods. Our study followed Prisma guidelines. Major databases, research anthologies, and bibliographies were searched for studies that used TM for treating PTSD, all military and civilian populations, and all age groups. Results. The searches located 15 controlled trials on TM that met the inclusion criteria (longitudinal and reporting sufficient statistics to calculate effect sizes), 1248 subjects total, mean age 40.5 years (range 20.6 to 54.4 years), and 46.9% males (range 0% to 100%). Using the random effects model, the pooled effect across all studies of TM compared to other treatments was g = −1.01, 95% CI = −1.29 to −0.74, p < 0.000000001. One-study removed analysis found that no study reduced the pooled effect to less than −1.0. Funnel plots indicated no risk of bias. TM was non-inferior to prolonged exposure therapy, p = 0.0001, and it worked significantly faster (p = 0.04 at week six). Conclusions. TM produced clinically meaningful reductions in PTSD for civilian and military personnel, young and older adults, and for both men and women. We recommend phase-III multisite studies comparing TM with known first-line treatments for PTSD. Full article

(This article belongs to the Special Issue Transcendental Meditation and Treatment for Stress)

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10 pages, 265 KiB

Open AccessArticle

The Management of Ischemic Priapism Due to Sickle Cell Disease and Other Etiologies: Treatment Strategies and Indications for Penile Prosthesis Implantation in an Endemic Region

by Eser Ördek, Sadık Görür, Fatih Gökalp, Duran Kuru and Ferhat Uçurmak

Medicina 2025, 61(4), 658; https://doi.org/10.3390/medicina61040658 (registering DOI) - 3 Apr 2025

Abstract

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile [...] Read more.

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in sickle cell disease (SCD) patients in an endemic region and compare it with ischemic priapism of other etiologies. Materials and Methods: Patients admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively reviewed. The patients were divided into two groups: ischemic priapism due to SCD and ischemic priapism due to other etiologies. Patient characteristics, treatment management, and the need for penile prosthesis (PP) were compared. Results: A total of 40 ischemic priapism patients were included in the study; 20 of them had SCD and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance imaging) were significantly (p < 0.05) higher than in the other priapism groups. The PP implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions: This study highlights the importance of early intervention and patient awareness in SCD-related ischemic priapism, recommending educational programs to improve symptom recognition and prevent complications. Full article

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

13 pages, 274 KiB

Open AccessArticle

Explaining the Link Between Alcohol and Homicides: Insights from the Analysis of Legal Cases in Lithuania

by Laura Miščikienė, Justina Trišauskė, Mindaugas Štelemėkas and Kristina Astromskė

Medicina 2025, 61(4), 657; https://doi.org/10.3390/medicina61040657 (registering DOI) - 2 Apr 2025

Abstract

Background and Objectives: Alcohol consumption has been a longstanding public health concern and known link to violence. The aims of this study were to analyze alcohol-related homicide cases in Lithuania, focusing on the prevalence of binge drinking among perpetrators and victims, the [...] Read more.

Background and Objectives: Alcohol consumption has been a longstanding public health concern and known link to violence. The aims of this study were to analyze alcohol-related homicide cases in Lithuania, focusing on the prevalence of binge drinking among perpetrators and victims, the situational and behavioral patterns leading to violence, and the legal outcomes of these cases. Materials and Methods: This study employed a retrospective analysis of court case law of criminal cases of the year 2019. The analysis was conducted by combining qualitative and quantitative analytical approaches. Results: The findings revealed that 84.6% of homicides occurred during binge drinking events. Alcohol intoxication was prevalent among both perpetrators (92.3%) and victims (86.5%), emphasizing the dual role of alcohol in homicide cases. Interpersonal violence was the primary pattern of homicide (78.8%), while planned homicides accounted for 21.2%. Thematic content analysis of the cases revealed that Lithuanian courts consistently regard alcohol consumption as an aggravating factor that contributes to the commission of violent crimes and influences the severity of criminal punishment. This reflects a judicial position that voluntary intoxication does not lessen legal responsibility, despite its effects on impairing judgment, heightening aggression and impulsivity, and escalating conflicts into deadly violence. Conclusions: Our findings revealed that the majority of alcohol-involved homicides occurred during binge drinking events, in a domestic environment, and because of unplanned acts of interpersonal violence. Targeted public health interventions should focus on strengthening alcohol control policies and enforcing stricter regulations to discourage binge drinking environments. Full article

(This article belongs to the Special Issue Advances in Health, Lifestyle and Environmental Risk Factors Monitoring)

16 pages, 2481 KiB

Open AccessReview

Quercetin as a Potential Therapeutic Agent for Malignant Melanoma—A Review of Current Evidence and Future Directions

by Teodora Hoinoiu, Victor Dumitrascu, Daniel Pit, David-Alexandru Schipor, Madalina Jabri-Tabrizi, Bogdan Hoinoiu, David Emanuel Petreuș and Corina Seiman

Medicina 2025, 61(4), 656; https://doi.org/10.3390/medicina61040656 - 2 Apr 2025

Abstract

Neoplastic disorders, particularly malignant carcinomas, are complex systemic diseases characterized by unregulated cellular proliferation, the invasion of adjacent tissues, and potential metastasis to distant bodily sites. Among the diverse spectrum of cancer subtypes, malignant melanoma is a highly aggressive form of cutaneous cancer [...] Read more.

Neoplastic disorders, particularly malignant carcinomas, are complex systemic diseases characterized by unregulated cellular proliferation, the invasion of adjacent tissues, and potential metastasis to distant bodily sites. Among the diverse spectrum of cancer subtypes, malignant melanoma is a highly aggressive form of cutaneous cancer originating in melanocytes, the pigment-producing cells resident in the skin. This malignancy is distinguished by its rapid and uncontrolled growth, as well as its propensity for metastasis to vital organs, thereby posing significant challenges to therapeutic intervention and prognostication. Early detection of melanoma is crucial for optimizing patient outcomes, as diagnosis at an advanced stage often yields a poor prognosis and limited treatment options. Diagnostic modalities for melanoma encompass comprehensive clinical evaluations by dermatologists; radiological imaging techniques such as ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT) scans; and excisional biopsies for accurate histopathological assessment. Malignant melanoma is typically treated with surgery to remove the tumor, followed by immunotherapy to enhance the immune response, targeted therapy for tumors with specific genetic mutations, chemotherapy for advanced stages, radiation therapy to manage metastasis, and other adjunct therapies. This review presents the properties and possible adjunct therapeutic effects against malignant melanoma of quercetin found in the literature and explores, based on the observed physicochemical properties and biological activity, its potential development as a topical formulation for cutaneous application. Quercetin is a naturally occurring flavonoid compound abundant in various plant-based food sources, including apples, onions, berries, and citrus fruits, and has exhibited promising antiproliferative, antioxidant, and anticancer properties. Its distinctive biochemical structure enables quercetin to effectively neutralize reactive oxygen species and modulate key carcinogenic pathways, thereby rendering it a potential candidate for therapeutic intervention in managing malignant tumors, including melanoma. Full article

(This article belongs to the Special Issue Advances in the Diagnosis, Prevention and Treatment of Skin Tumors)

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15 pages, 582 KiB

Open AccessArticle

Psychometric Validation of the Macedonian-Language Version of the Ultrashort Five-Item Oral Health Impact Profile in the North Macedonian Population (OHIP5-MAC)

by Saša Elenčevski, Asja Čelebić, Aleksandra Popovac, Sonja Apostolska, Julijana Nikolovska and Ivica Stančić

Medicina 2025, 61(4), 655; https://doi.org/10.3390/medicina61040655 - 2 Apr 2025

Abstract

Background and Objectives: Due to a lack of an ultrashort questionnaire for Oral Health-Related Quality of Life (OHRQoL) assessment in the North Macedonian population, the OHIP5 was translated into Macedonian language with aim to test its psychometrical properties. Materials and Methods: [...] Read more.

Background and Objectives: Due to a lack of an ultrashort questionnaire for Oral Health-Related Quality of Life (OHRQoL) assessment in the North Macedonian population, the OHIP5 was translated into Macedonian language with aim to test its psychometrical properties. Materials and Methods: Two types of reliability were tested: internal consistency by calculating Cronbach’s alpha coefficient (general population), and test-retest reliability by calculating intraclass correlation coefficients (ICC) in a convenient sample of dental students who answered the same questions twice. Two types of validity were also tested: convergent validity (via a Spearman rank correlation) and known-group validity (via a Mann–Whitney U test). Responsiveness was tested by calculating the significance of the differences between the pre-treatment and after-treatment scores and by calculating the effect sizes of different dental treatments. Results: The Cronbach alpha coefficient of 0.756 and inter-item correlations above 0.2 pointed out good internal consistency. The test-retest reliability was confirmed by high ICCs and no significant differences between the OHIP5-MAC scores in a period of two weeks as dental students had no oral health changes. The Spearman rank correlation of −0.88 (p < 0.01) between the OHIP5-MAC summary scores and one simple question scoring self-perceived oral health (1–5; 1-worst oral health; 5-excellent oral health) confirmed the convergent validity. Significant differences between subjects with natural teeth and those with removable dentures (p < 0.01) confirmed the know-group validity, as it was predicted that removable denture wearers would have more impairment of oral health than individuals with natural teeth. The sensitivity of a questionnaire to measure changes elicited by dental treatments, i.e., responsiveness, was confirmed in individuals who received different dental treatments and scored significantly better (lower scores) their OHRQoL one month after the treatment, compared to their pretreatment scores (p < 0.05). Conclusions: Generally good psychometric properties of the OHIP5-MAC justify the recommendation for its future use in clinical settings and research. Full article

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

10 pages, 2308 KiB

Open AccessArticle

Appropriate Distraction Strength for Metatarsophalangeal Joint Arthroscopy

by Jong-Kil Kim, Kwang-Bok Lee and Do-Yeon Kim

Medicina 2025, 61(4), 654; https://doi.org/10.3390/medicina61040654 - 2 Apr 2025

Abstract

Background and Objectives: To investigate the natural metatasophalangeal (MTP) joint distance, we studied the appropriate degree of distraction for arthroscopy and the associated factors, including age, gender, and body mass index (BMI). Materials and Methods: Sixty-seven patients who underwent MTP joint [...] Read more.

Background and Objectives: To investigate the natural metatasophalangeal (MTP) joint distance, we studied the appropriate degree of distraction for arthroscopy and the associated factors, including age, gender, and body mass index (BMI). Materials and Methods: Sixty-seven patients who underwent MTP joint arthroscopy or foot and ankle surgery from April 2013 to June 2020 were enrolled. Foot plain radiographs were taken using a mini-fluoroscan with no traction, manual traction, and traction of 5 pounds, 10 pounds, and 15 pounds to measure the MTP joint distance. Age, gender, and BMI were compared as associated factors. The minimum joint distance of MTP joint arthroscopy was defined as 2.8 mm, which was the sheath size of a 1.9 mm, 30° high-definition arthroscope. Results: Regarding natural MTP joint space sizes, the MTP-2 joint had the largest joint size (2.39 ± 0.37 mm). The MTP-5 joint had the smallest joint size (1.59 ± 0.34 mm). Traction of 10 lb was an appropriate distraction force for the MTP-1 joint (3.09 ± 0.03 mm) and MTP-4 joint (3.07± 0.47 mm) in arthroscopy. Traction of 5lb was an appropriate distraction force for the MTP-2 (3.32 ± 0.60 mm), MTP-3 (2.89 ± 0.50 mm), and MTP-5 (2.97 ± 0.49 mm) joints. For the MTP-1 and MTP-4 joints, males had significantly greater joint space sizes than females for no traction (p = 0.039), manual traction (p = 0.002), and traction of 5 pounds (p = 0.004), 10 pounds, (p = 0.013), and 15 pounds (p = 0.024). There was no statistically significant difference in joint space size according to age or BMI for any MTP joints (p > 0.05). Conclusions: Among natural joint spaces without traction, the MTP-2 joint had the largest joint size while the MTP-5 joint had the smallest joint size. In MTP joint arthroscopy, a traction power of 10 lb is sufficient for appropriate distraction of all MTP joints. Less distraction power is required for males than for females, especially for the MTP-1 and MTP-4 joints. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 2292 KiB

Open AccessSystematic Review

Efficacy of Long-Term Use of Azithromycin in the Management of Cystic Fibrosis in Pediatric Patients with or Without Pseudomonas aeruginosa: A Systematic Review and Meta-Analysis Article

by Hassan Al-shehri and Dana Albassam

Medicina 2025, 61(4), 653; https://doi.org/10.3390/medicina61040653 - 2 Apr 2025

Abstract

Background and Objectives: In the present systematic review and meta-analysis, we aimed to discover the overall efficacy of azithromycin in children with cystic fibrosis (CF) and with or without Pseudomonas aeruginosa infection, specifically regarding its effect on respiratory parameters such as forced expiratory [...] Read more.

Background and Objectives: In the present systematic review and meta-analysis, we aimed to discover the overall efficacy of azithromycin in children with cystic fibrosis (CF) and with or without Pseudomonas aeruginosa infection, specifically regarding its effect on respiratory parameters such as forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) in addition to its effect on exacerbations and the need to use additional antibiotics. Materials and Method: We conducted this systematic review and meta-analysis by searching for all eligible articles on PubMed, Web of Science, and Scopus published between inception and September 2024. We used the following search strategy for our searching process: “Cystic fibrosis” AND “Azithromycin” and “Children” OR “Pediatric” OR “Infant”. We conducted the meta-analysis by pooling the mean difference (MD) and comparing the continuous variables and odds ratio (OR) for dichotomous variables at 95% confidence intervals (CI), at a p-value of 0.05. Results: Azithromycin was observed to be associated with increased FEV1 compared with the control, showing an MD of 1.91 (95% CI: 1.09, 2.74, p < 0.00001) and non-significant heterogeneity. However, no significant difference was observed between azithromycin and control groups regarding FVC with MD = 0.62 (95% CI: −0.01, 1.25, p = 0.06). Compared with the control group, azithromycin was significantly associated with lower risk and a lower number of exacerbations, with OR = 0.48 (95% CI: 0.34, 0.67, p < 0.0001) and MD = −0.82 (95% CI: −1.32, −0.33, p = 0.001), respectively, with non-significant heterogeneity. Regarding the need for new antibiotic usage, azithromycin showed a significantly lower need, with OR = 0.35 (95% CI: 0.13, 0.94, p = 0.04), I² = 75%, p = 0.02. No significant difference was observed between both groups regarding hospitalization rate, with OR = 0.88 (95% CI: 0.55, 1.4, p = 0.59). Conclusions: This systematic review and meta-analysis showed the efficacy of azithromycin in pediatric patients with CF, as it improved lung function by increasing FEV1, reduced exacerbations of CF, which is the most common symptom of CF that leads to mortality, and reduced the number of antibiotics that needed to be administered to patients with CF, which reduces the risk of antibiotic resistance. Therefore, the long-term use of azithromycin is recommended for pediatric patients with CF as part of their treatment regimen. Full article

(This article belongs to the Special Issue Chronic Respiratory Diseases: Updates on Pathophysiology, Symptoms, Diagnosis and Treatment)

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8 pages, 249 KiB

Open AccessArticle

Routine Blood Examination Predicts the Course of Disease in Patients with Pseudoexfoliation

by Tatjana Sarenac Vulovic, Katarina Cupic, Nenad Petrovic, Jovana Srejovic, Tatjana Vulovic, Zeljko Todorovic, Jovan Rakic and Dusan Todorovic

Medicina 2025, 61(4), 652; https://doi.org/10.3390/medicina61040652 - 2 Apr 2025

Abstract

Background and Objectives: Is it possible to predict the course of disease in patients with pseudoexfoliation based on blood examination? Materials and Methods: This retrospective study included 800 patients recruited for cataract surgery in the Clinic of Ophthalmology, University Clinical Centre [...] Read more.

Background and Objectives: Is it possible to predict the course of disease in patients with pseudoexfoliation based on blood examination? Materials and Methods: This retrospective study included 800 patients recruited for cataract surgery in the Clinic of Ophthalmology, University Clinical Centre Kragujevac, Serbia. The patients were divided into four groups: pseudoexfoliation syndrome early stage group (n = 200 patients), pseudoexfoliation syndrome late stage group (n = 200 patients), pseudoexfoliation glaucoma group (n = 200 patients) and the control group (n = 200 patients). During the preoperative process, some blood examination must be performed. We retrospectively used the results for the blood cell counts that we obtained from the patients. We recorded the neutrophil, lymphocyte, platelet, monocyte and leucocyte numbers, as well as the lipid profile, and simply calculated the ratio of their values, which we considered through different stages of the disease. Results: Our results indicated that there were no significant differences between all the groups examined in terms of leucocyte, neutrophil and lymphocyte count, but we recorded significant differences in the monocyte and platelet count. It was interesting that the monocyte count increased in the late stage of pseudoexfoliation syndrome and pseudoexfoliation glaucoma, in comparison with the control group and patients with early stage pseudoexfoliation syndrome. The lipid profile analysis indicated only increased values of LDL in patients with pseudoexfoliation (syndrome/glaucoma) in comparison with the control group. Conclusions: Monocytes are the main source of various cytokines, so our results support the proinflammatory theory of pseudoexfoliation development. Monocytes are the main cells in chronic inflammation, which leads to pseudoexfoliation syndrome. Platelets play an important role in the differentiation and activation of monocytes, as well as in the process of chronic inflammation and fibrosis, which are significant for pseudoexfoliation material production. A disturbed lipid profile in patients with pseudoexfoliation is expected, as they are at higher risk for cardiovascular and cerebrovascular diseases. Full article

(This article belongs to the Section Ophthalmology)

13 pages, 2054 KiB

Open AccessArticle

Effects of Telehealth-Supervised Respiratory Exercise Training on Respiratory Function, Fatigue, Quality of Life, and Functional Capacity of Patients with Multiple Sclerosis

by Şeyda Öznur Ayçiçek, Abdulkadir Tunç and Cahit Bağcı

Medicina 2025, 61(4), 651; https://doi.org/10.3390/medicina61040651 - 2 Apr 2025

Abstract

Background and Objectives: Telerehabilitation (TR) offers an innovative approach to overcome accessibility challenges in managing multiple sclerosis (MS). This exploratory study evaluated the efficacy of integrating respiratory exercises into TR programs for improving respiratory function, fatigue, and quality of life. Materials and [...] Read more.

Background and Objectives: Telerehabilitation (TR) offers an innovative approach to overcome accessibility challenges in managing multiple sclerosis (MS). This exploratory study evaluated the efficacy of integrating respiratory exercises into TR programs for improving respiratory function, fatigue, and quality of life. Materials and Methods: A randomized controlled trial involving 48 MS patients randomized into TR and control groups was conducted. Both groups performed respiratory exercises over eight weeks. Pulmonary function, fatigue severity (FSS), quality of life (MSQOL-54), and functional capacity (6MWT) were assessed before and after the intervention. Results: Both groups demonstrated significant within-group improvements in FEV1 (L), PEF (L), FEF%25–75 (L), FSS, MSQOL-54 physical and mental subscales, and the 6MWT distance (p < 0.05). The TR group exhibited unique improvements in FEV1 (%) and slightly greater reductions in fatigue, although the intergroup differences were not statistically significant. Conclusions: Telerehabilitation incorporating respiratory exercises effectively enhances the respiratory function, fatigue, and quality of life of MS patients, suggesting a viable alternative to conventional rehabilitation. Future studies should focus on advanced-stage MS, long-term sustainability, and technological integration to optimize the potential of TR. Full article

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21 pages, 4127 KiB

Open AccessReview

Spontaneous Coronary Artery Dissection: A Narrative Review of Epidemiology and Public Health Implications

by Patrick Pender, Mithila Zaheen, Quan M. Dang, Viet Dang, James Xu, Matthew Hollings, Sidney Lo, Kazuaki Negishi and Sarah Zaman

Medicina 2025, 61(4), 650; https://doi.org/10.3390/medicina61040650 - 1 Apr 2025

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon but significant cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD is defined as a non-atherosclerotic, non-traumatic dissection of the coronary artery, leading to the formation of an [...] Read more.

Spontaneous coronary artery dissection (SCAD) is an uncommon but significant cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD is defined as a non-atherosclerotic, non-traumatic dissection of the coronary artery, leading to the formation of an intramural haematoma or intimal tear causing obstruction to blood flow and myocardial ischaemia. Unlike traditional atherosclerotic coronary artery disease, SCAD has unique pathophysiological mechanisms. SCAD is thought to arise secondary to a bleed and/or dissection within the arterial wall, linked to hormonal influences with potential triggers of physical or emotional stress and predisposition such as an underlying connective tissue disorder. Despite being increasingly recognised, SCAD remains underdiagnosed, and knowledge regarding SCAD epidemiology is limited. In addition, the impact of SCAD extends beyond the immediate cardiac event, encompassing psychological distress, the need for rehabilitation, and long-term surveillance. This has implications not just for the patient but also their family and the healthcare system. This narrative review summarises the current knowledge of SCAD epidemiology, including the affected population, its associated risk factors, and healthcare impact. By identifying current gaps in knowledge, this review aims to encourage targeted research, public awareness, and policy initiatives to improve outcomes for individuals affected by SCAD. Full article

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

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13 pages, 1043 KiB

Open AccessReview

The Pathophysiology of Sex Differences in Stroke Risk and Prevention in Atrial Fibrillation: A Comprehensive Review

by Ibrahim Antoun, Georgia R. Layton, Ahmed Abdelrazik, Mahmoud Eldesouky, Mustafa Zakkar, Riyaz Somani and André Ng

Medicina 2025, 61(4), 649; https://doi.org/10.3390/medicina61040649 - 1 Apr 2025

Abstract

Atrial fibrillation (AF) is the most common chronic arrhythmia and is a leading cause of stroke, with well-documented differences in pathophysiology, clinical manifestations, and prognosis according to the sex of the patient. This review provides an overview of known or hypothesized sex differences [...] Read more.

Atrial fibrillation (AF) is the most common chronic arrhythmia and is a leading cause of stroke, with well-documented differences in pathophysiology, clinical manifestations, and prognosis according to the sex of the patient. This review provides an overview of known or hypothesized sex differences in physiology and stroke risk for patients with AF. Women are reported to have more extensive fibrosis of the left atrium, different functional properties of the atria, and higher sensitivity to prothrombotic stimuli, especially after menopause. Variations in stroke risk with AF are linked to age, hypertension, diabetes, and chronic kidney disease; overall, women have worse outcomes. The widely clinically implemented CHA₂DS₂-VASc score no longer considers sex as a variable, and its propriety for women is still debated. However, women are usually under prescribed anticoagulation despite having a higher long-term risk of stroke compared to men, suggesting a lack of equity of treatment for certain patient groups. New AI-based risk stratification models and precision medicine approaches are potentially useful in reducing these gaps. Future work should also aim to improve sex-based predictive models, considering different gender categories, and understanding the part played by hormonal alterations, atrial structural alterations, and thromboembolic risk in the treatment of AF. Full article

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

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21 pages, 605 KiB

Open AccessReview

Cardiac Rehabilitation in TAVI Patients: Safety and Benefits: A Narrative Review

by Theodor Constantin Stamate, Cristina Andreea Adam, Radu Sebastian Gavril, Radu Ștefan Miftode, Andreea Rotundu, Ovidiu Mitu, Doina Clementina Cojocaru, Grigore Tinică and Florin Mitu

Medicina 2025, 61(4), 648; https://doi.org/10.3390/medicina61040648 - 1 Apr 2025

Abstract

Transcatheter aortic valve implantation (TAVI) has redefined the management of severe aortic stenosis, particularly in surgical high-risk patients. As the number of TAVI procedures increases, there is a growing need for effective post-procedural care. Cardiac rehabilitation (CR) has emerged as a critical component [...] Read more.

Transcatheter aortic valve implantation (TAVI) has redefined the management of severe aortic stenosis, particularly in surgical high-risk patients. As the number of TAVI procedures increases, there is a growing need for effective post-procedural care. Cardiac rehabilitation (CR) has emerged as a critical component of treatment in these patients. The most recent update of the European recommendations highlights the importance of including post-TAVI patients in CR programs. However, the benefits of CR in this particular patient group still need to be fully understood. The objective of this narrative review is to summarize the safety and benefits of post-TAVI CR by evaluating its impact on functional capacity, frailty, muscular strength, mental health, quality of life, and long-term survival. While emerging evidence supports its safety and effectiveness in the aforementioned outcomes, gaps remain regarding the optimal rehabilitation protocols, including the timing, duration, and intensity of CR as well as its long-term cardiovascular benefits. Further research is needed to develop personalized approaches for different patient groups. This article highlights the current knowledge, identifies critical gaps, and underlines the need for tailored rehabilitation strategies to improve post-TAVI recovery and patient outcomes. Full article

(This article belongs to the Special Issue Cardiovascular Disease: From Clinical Diagnosis to Management and Treatment)

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14 pages, 2710 KiB

Open AccessSystematic Review

Incidence and Prevention of Vaginal Cuff Dehiscence After Laparoscopic and Robotic Hysterectomy in Benign Conditions: An Updated Systematic Review and Meta-Analysis

by Pier Carlo Zorzato, Riccardo Vizza, Simone Garzon, Mariachiara Bosco, Anna Festi, Alberta Ricci, Irene Porcari, Giacomo Corrado, Rosa Maria Laterza and Stefano Uccella

Medicina 2025, 61(4), 647; https://doi.org/10.3390/medicina61040647 - 1 Apr 2025

Abstract

Background and Objectives: Vaginal cuff dehiscence (VCD) represents a rare but relevant complication that occurs following minimally invasive hysterectomy. With the rising frequency of this procedure, it is crucial to continuously evaluate VCD incidence, risk factors, and prevention strategies. This systematic review [...] Read more.

Background and Objectives: Vaginal cuff dehiscence (VCD) represents a rare but relevant complication that occurs following minimally invasive hysterectomy. With the rising frequency of this procedure, it is crucial to continuously evaluate VCD incidence, risk factors, and prevention strategies. This systematic review and meta-analysis aimed to update the evidence on VCD incidence and to assess the role of various surgical techniques and materials adopted for vaginal cuff closure. Materials and Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library for studies published up to January 2025. Eligible studies reported VCD rates after laparoscopic or robotic hysterectomy for benign conditions and compared different closure techniques. The primary outcome was the incidence of VCD across closure methods, while secondary outcomes included potential risk factors. A random-effects model estimated pooled VCD rates with 95% confidence intervals (CI), and heterogeneity was assessed using I² tests. Results: Twenty-six studies involving 10,039 patients were analyzed. The overall pooled incidence of VCD was 0.7% (95% CI: 0.4–1.1%), with higher estimates in randomized controlled trials (RCTs) (1.4%) compared to non-RCTs (0.5%). Robotic-assisted hysterectomy had a pooled VCD rate of 1.7%, compared to laparoscopic hysterectomy at 0.7%. Although not statistically significant, transvaginal closure showed a higher VCD risk than laparoscopic closure (2.3% vs. 1.16%; OR 0.97, 95% CI, 0.33–2.82; OR 2.53 (95% CI, 1.10–5.82) when considering only RCTs), and barbed sutures showed a lower VCD incidence (0.35%) than conventional sutures (1.52%) (OR 0.37, 95% CI, 0.13–1.02). Smoking was identified as a significant risk factor for VCD, while the impact of early postoperative sexual activity remains inconclusive. Conclusions: Laparoscopic closure rather than transvaginal cuff closure and barbed sutures were neither significantly associated with reducing VCD risk. Emphasizing smoking cessation preoperatively is essential for VCD prevention. Future studies should investigate the effects of postoperative sexual activity and refine surgical techniques to minimize VCD risk and improve outcomes. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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15 pages, 1659 KiB

Open AccessSystematic Review

Comparison of the Safety and Efficacy of Remimazolam and Propofol for Sedation in Adults Undergoing Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

by Bon-Wook Koo, Hyo-Seok Na, Sang-Hi Park, Seunguk Bang and Hyun-Jung Shin

Medicina 2025, 61(4), 646; https://doi.org/10.3390/medicina61040646 - 1 Apr 2025

Abstract

Background and Objectives: This meta-analysis evaluates the safety and efficacy of remimazolam versus propofol for sedation during colonoscopy, focusing on hemodynamic and respiratory outcomes. Materials and Methods: A comprehensive search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to [...] Read more.

Background and Objectives: This meta-analysis evaluates the safety and efficacy of remimazolam versus propofol for sedation during colonoscopy, focusing on hemodynamic and respiratory outcomes. Materials and Methods: A comprehensive search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to January 2025 identified randomized controlled trials (RCTs). Outcomes included hypotension (primary outcome), bradycardia, respiratory depression, injection pain, sedation onset time, emergence time, procedure success rate, and recovery room stay. Effect sizes were reported as relative risks (RR) or mean differences (MD) using random-effects models. Results: Fourteen RCTs with 3290 participants were included. Remimazolam significantly reduced the risk of hypotension (RR: 0.44, 95% CI [0.39, 0.51], p = 0.0000), bradycardia (RR: 0.36, 95% CI [0.25, 0.53], p = 0.0000), respiratory depression (RR: 0.32, 95% CI [0.22, 0.45], p = 0.0000), and injection pain (RR: 0.14, 95% CI [0.09, 0.24], p = 0.0000) compared to propofol. Remimazolam had slower sedation onset (MD: 15.97 s, 95% CI [8.30, 23.64], p = 0.0000) but allowed faster emergence (MD: −0.91 min, 95% CI [−1.69, −0.13], p = 0.023) and shorter recovery room stays (MD: −2.20 min, 95% CI [−3.23, −1.17], p = 0.0000). Both drugs had similar procedure success rates. Conclusions: Remimazolam demonstrates superior safety and efficacy compared to propofol, reducing risks of hypotension, bradycardia, respiratory depression, and injection pain while enabling faster recovery. These findings support remimazolam as a viable sedative for colonoscopy, though further large-scale studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

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15 pages, 1706 KiB

Open AccessArticle

Scapular Muscle Activation at Different Shoulder Abduction Angles During Pilates Reformer Arm Work Exercise

by Woo-Lim Mun, Eui-Young Jung, Shi Lei and Su-Yeon Roh

Medicina 2025, 61(4), 645; https://doi.org/10.3390/medicina61040645 - 1 Apr 2025

Abstract

Background and Objectives: Scapular muscles are crucial in controlling scapular movement, ensuring proper alignment, and preventing injuries during shoulder joint motion. The shoulder abduction angle is one of the most important factors when performing exercises to improve scapular movement control. The Pilates [...] Read more.

Background and Objectives: Scapular muscles are crucial in controlling scapular movement, ensuring proper alignment, and preventing injuries during shoulder joint motion. The shoulder abduction angle is one of the most important factors when performing exercises to improve scapular movement control. The Pilates reformer arm work (AW) movement can be performed with different shoulder abduction angles. Therefore, this study analyzed the differences in scapular muscle activation depending on the shoulder abduction angle during the AW movement. Materials and Methods: Twenty-six healthy adult males performed the AW movement under four shoulder abduction angle conditions (0°, 90°, 135°, 160°). When performing the AW in the four conditions, surface electromyography analyzed the muscle activation of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA), posterior deltoid (PD), and levator scapulae (LS), and the muscle activation ratios of the UT/LT, LS/LT, UT/SA, and LS/SA. Results: The UT, LT, and SA muscle activation increased proportionally with the increasing shoulder abduction angle (p < 0.001). The LT showed the highest muscle activity at the shoulder abduction angle of 135° (p < 0.001). The MT and PD showed the highest muscle activities at the shoulder abduction angle of 90° (p < 0.001). The muscle activity ratios of the UT/LT and LS/LT were the lowest at the shoulder abduction angles of 90° and 135° (p < 0.001). The muscle activity ratio between the UT/SA and LS/SA was the lowest at the 135° and 160° shoulder abduction angles (p < 0.001). Conclusions: Our findings highlight the impact of the shoulder abduction angle on scapular muscle activation, suggesting that different angles may be used to engage specific muscles during Pilates reformer arm work exercises selectively. This insight can guide exercise interventions for individuals aiming to improve their scapular control and stability. Full article

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

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16 pages, 2318 KiB

Open AccessReview

HER2-Low Breast Cancer—Current Knowledge and Future Directions

by Abeer M. Shaaban, Tanvier Kaur and Elena Provenzano

Medicina 2025, 61(4), 644; https://doi.org/10.3390/medicina61040644 - 1 Apr 2025

Abstract

The concept of binary classification of HER2 status has recently been challenged following the DESTINY-Breast trial data showing a clinically meaningful response to antibody–drug conjugates (ADCs) in invasive breast cancer expressing low levels of HER2. HER2-low breast cancer is defined as an immunohistochemistry [...] Read more.

The concept of binary classification of HER2 status has recently been challenged following the DESTINY-Breast trial data showing a clinically meaningful response to antibody–drug conjugates (ADCs) in invasive breast cancer expressing low levels of HER2. HER2-low breast cancer is defined as an immunohistochemistry (IHC) score of 1+ and 2+ without HER2 gene amplification. While HER2-low breast cancer does not represent a biological entity, it encompasses both hormone receptor-positive and triple-negative breast cancer. Differences exist between this group and HER2-null breast cancer. In this review, we provide an update on HER2-low and HER2-ultralow breast cancer, including background trial data, the evolution of HER2-low expression, current clinical guidelines, quality issues, and future directions. Full article

(This article belongs to the Special Issue Future Trends in Breast Cancer Management)

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