Journal Description
Medicina
Medicina
is an international, peer-reviewed, open access journal that covers all problems related to medicine. The journal is owned by the Lithuanian University of Health Sciences (LUHS) and is published monthly online by MDPI. Partner Societies are the Lithuanian Medical Association, Vilnius University, Rīga Stradiņš University, the University of Latvia, and the University of Tartu.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, MEDLINE, PMC, and other databases.
- Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.8 days after submission; acceptance to publication is undertaken in 2.5 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.7 (2023)
Latest Articles
Influence of Pain, Risk Factors, and Functional Ability on Physical Activity Levels in Women with Anterior Knee Pain: A Cross-Sectional Study
Medicina 2024, 60(9), 1467; https://doi.org/10.3390/medicina60091467 (registering DOI) - 7 Sep 2024
Abstract
Background and Objectives: Anterior knee pain (AKP) refers to chronic prepatellar pain and is one of the most common knee complaints in physically active women. This condition can significantly affect daily activities and overall quality of life. This study aims to assess
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Background and Objectives: Anterior knee pain (AKP) refers to chronic prepatellar pain and is one of the most common knee complaints in physically active women. This condition can significantly affect daily activities and overall quality of life. This study aims to assess the impact of pain, risk factors, and functional ability on different levels of physical activity (comparing low versus moderate activity) in women with AKP. Materials and Methods: This cross-sectional study involved fifty-six women diagnosed with AKP (aged 20–45 years) who were equally allocated into low and moderate physical activity groups. Their AKP and functional ability were assessed using the visual analog scale (VAS) and double squats and step-down tests, respectively. Possible risk factors were assessed using the Q-angle, modified Thomas test, sit and reach test, and patellar glide test. A person’s correlation coefficient and independent t-tests were used to determine the relationship and the differences between these variables while keeping the confidence interval level at 95%. Result: Women with moderate activity levels showed significantly higher scores on the VAS than those with low activity levels (p = 0.040). However, both groups had no significant difference in their functional ability or potential risk factors (p > 0.05). Additionally, their functional ability (double squat) showed a positive association with hamstring flexibility (Pearson correlation coefficient [r]:0.3; p = 0.006). Conclusions: Women with AKP who were engaged in moderate physical activity experienced higher levels of pain compared to those with low activity levels. These findings underscore the urgent need for further investigation into different levels of physical activity to develop appropriate prevention and treatment strategies for women with AKP.
Full article
(This article belongs to the Special Issue Advances in Orthopedics and Sports Medicine)
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Open AccessReview
Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis
by
Ana-Maria Balahura, Adrian-Gabriel Florescu, Teodora-Maria Barboi, Emma Weiss, Daniela Miricescu, Ciprian Jurcuț, Mariana Jinga and Silviu Stanciu
Medicina 2024, 60(9), 1466; https://doi.org/10.3390/medicina60091466 - 6 Sep 2024
Abstract
Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein
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Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger’s disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno–femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.
Full article
(This article belongs to the Special Issue The Challenges and Prospects in Clinical Cardiology and Angiology)
Open AccessReview
Hidradenitis Suppurativa in Elderly Patients: Clinical and Therapeutical Outcomes—A Review of the Literature
by
Fabrizio Martora, Nello Tommasino, Claudio Brescia, Luca Potestio, Teresa Battista and Matteo Megna
Medicina 2024, 60(9), 1465; https://doi.org/10.3390/medicina60091465 - 6 Sep 2024
Abstract
The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities. While HS typically affects the anogenital and intertriginous regions, elderly patients may exhibit atypical features such as the involvement of
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The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities. While HS typically affects the anogenital and intertriginous regions, elderly patients may exhibit atypical features such as the involvement of the neck, mammary area and gluteal region. The prevalence of HS in the elderly population is lower and the average age of disease onset is higher than in patients under 65. In contrast, it is unclear whether HS in the elderly has different clinical features. The elderly frequently present multiple comorbidities, including obesity, diabetes, and heart disease, which further complicate management decisions. Therapeutic interventions must consider the frailty and increased risk of multimorbidity and adverse events in elderly patients. While systemic antibiotics remain a mainstay of HS treatment, biologic agents such as TNFα inhibitors and secukinumab offer promising options for refractory cases. However, their safety and efficacy in elderly patients, particularly those with multiple comorbidities, require careful consideration. A comprehensive approach to managing HS in elderly patients involves not only pharmacological interventions but also lifestyle modifications and surgical options where appropriate. Multidisciplinary collaboration between dermatologists, geriatricians and other specialists is essential for tailoring treatment strategies and optimizing long-term outcomes and quality of life in special population.
Full article
(This article belongs to the Special Issue Chronic Inflammatory Skin Disease: Where We Are and Where We Are Going: 2nd Edition)
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Open AccessArticle
The Role of Repeated Surgical Resections for Recurrent Brain Metastases in Older Population
by
Maria Goldberg, Valeri Heinrich, Ghaith Altawalbeh, Chiara Negwer, Arthur Wagner, Jens Gempt, Bernhard Meyer and Amir Kaywan Aftahy
Medicina 2024, 60(9), 1464; https://doi.org/10.3390/medicina60091464 - 6 Sep 2024
Abstract
Background and Objectives: The impact of surgery for recurrent brain metastases in elderly patients has been the object of debate due to limited information in the literature. We analyzed clinical outcome and survival of elderly patients with recurrent brain metastases in order to
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Background and Objectives: The impact of surgery for recurrent brain metastases in elderly patients has been the object of debate due to limited information in the literature. We analyzed clinical outcome and survival of elderly patients with recurrent brain metastases in order to assess potentially beneficial role of surgery. Materials and methods: In total, 219 patients with recurrent brain metastases between 2007 and 2022 were identified, of which 95 underwent re-resection; 83 patients aged 65 and older were analyzed. A survival analysis was performed, and clinical outcomes were evaluated. Results: The median survival time after surgery for recurrent brain metastases was 6 months (95CI 4–10) in older patients and 8 (95CI 7–9) in younger patients (p = 0.619). Out of all the older patients, 33 who underwent surgical resection showed prolonged survival compared with patients who did not receive surgical resection (median: 14, 95CI 8–19 vs. 4, 95CI 4–7, p = 0.011). All patients had preoperative Karnofsky performance scores of >70, which did not deteriorate after surgery (87.02 ± 5.76 vs. 85 ± 6.85; p = 0.055). In the univariate analysis, complete cytoreduction was a favorable prognostic factor. The tumor volume, the number of metastases, extracranial disease progression, adjuvant radiation, and systemic therapy did not affect survival in this cohort. Conclusions: Patients aged 65 and older benefit from neurosurgical resections of recurrent brain metastases. Survival did not differ from that in younger patients, which can be explained by a better preoperative functional status. Moreover, independent of the extent of resection, older patients who underwent surgery showed better survival than patients who did not receive surgical treatment. Complete cytoreduction was a favorable prognostic marker.
Full article
(This article belongs to the Section Surgery)
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Open AccessArticle
Influence of Framework Material and Abutment Configuration on Fatigue Performance in Dental Implant Systems: A Finite Element Analysis
by
Meryem Erdoğdu, Mehmet Gökberkkaan Demirel, Reza Mohammadi, Neslihan Güntekin and Masoud Ghanbarzadeh Chaleshtori
Medicina 2024, 60(9), 1463; https://doi.org/10.3390/medicina60091463 - 6 Sep 2024
Abstract
Background and Objectives: This study uses finite element analysis to evaluate the impact of abutment angulation, types, and framework materials on the stress distribution and fatigue performance of dental implant systems. Materials and Methods: Three-dimensional models of maxillary three-unit fixed implant-supported
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Background and Objectives: This study uses finite element analysis to evaluate the impact of abutment angulation, types, and framework materials on the stress distribution and fatigue performance of dental implant systems. Materials and Methods: Three-dimensional models of maxillary three-unit fixed implant-supported prostheses were analyzed. Abutments with different angles and types were used. Two different framework materials were used. Conducted on implants, a force of 150 N was applied obliquely, directed from the palatal to the buccal aspect, at a specific angle of 30 degrees. The distribution of stress and fatigue performance were then assessed, considering the types of restoration frameworks used and the angles of the abutments in three distinct locations. The simulation aspect of the research was carried out utilizing Abaqus Software (ABAQUS 2020, Dassault Systems Simulation Corp., Johnston, RT, USA). Results: In all models, fatigue strengths in the premolar region were higher than in the molar region. Maximum stress levels were seen in models with angled implants. In almost all models with the zirconia framework, fatigue performance was slightly lower. Conclusions: According to the findings of this study, it was concluded that the use of metal-framework multi-unit restorations with minimum angulation has significant positive effects on the biomechanics and long-term success of implant treatments.
Full article
(This article belongs to the Special Issue Recent Advances in Periodontics and Dental Implantology: Part II)
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Open AccessArticle
The Influence of the Type of Breathing on the Masticatory Muscle Patterns in Children
by
Daniela Neves-Leal, Antonia M. Caleya, Andrea Martin-Vacas, Nuria E. Gallardo-López and Carlos Gallego
Medicina 2024, 60(9), 1462; https://doi.org/10.3390/medicina60091462 - 6 Sep 2024
Abstract
Background and Objectives: The aim was to compare the activity of the masseter muscles in children with different types of breathing. Materials and Methods: A cross-sectional study was conducted including patients aged 6–12 years with mixed dentition, who came for oral care at
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Background and Objectives: The aim was to compare the activity of the masseter muscles in children with different types of breathing. Materials and Methods: A cross-sectional study was conducted including patients aged 6–12 years with mixed dentition, who came for oral care at the Master’s Degree in Pediatric Dentistry program at the Complutense University of Madrid (UCM), according to inclusion and exclusion criteria. The sample was divided into three groups: nasal breathers without dental alterations (control group), oral breathers with dental malocclusion, and oral breathers with previous orthodontic treatment. An electromyography was performed, and statistic methods were conducted with a 95% confidence to contrast hypothesis. Results: A total of 122 children were analyzed and distributed into three groups. The electrical muscle activity of masseters was significantly different between the study groups (p < 0.001 for all comparisons). Pairwise comparisons revealed a significantly higher electrical muscle activity in the control group (nasal breathers) during chewing compared to both groups of oral breathers (p < 0.001 for both comparisons). Orthodontic treatment decreased electrical muscle activity during isometric contraction in oral breathers compared to nasal breathers (p < 0.001), but did not significantly affect electrical muscle activity during chewing. Higher decompensation values were obtained in oral breathers without previous orthodontic treatment compared the other study groups (p < 0.001 for both comparisons), although electrical muscle activity values were similar in both groups of oral breathers (p > 0.05 for both comparisons). Conclusions: Differences in electrical muscle activity between nasal and oral breathers can be confirmed. Oral breathers with and without orthodontic treatment showed lower electrical muscle activity of masseters during chewing than nasal breathers, while at isometric contraction, only oral breathers with previous orthodontic treatment showed lower electrical activity. Higher decompensation values were found in oral breathers without previous orthodontic treatment, in comparison to the control group and oral breathers with previous orthodontic treatment.
Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Oral Health)
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Open AccessArticle
Withdrawal/Withholding of Life-Sustaining Therapies: Limitation of Therapeutic Effort in the Intensive Care Unit
by
Ángel Becerra-Bolaños, Daniela F. Ramos-Ahumada, Lorena Herrera-Rodríguez, Lucía Valencia-Sola, Nazario Ojeda-Betancor and Aurelio Rodríguez-Pérez
Medicina 2024, 60(9), 1461; https://doi.org/10.3390/medicina60091461 - 6 Sep 2024
Abstract
Background/Objectives: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the
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Background/Objectives: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the characteristics of the patients, and their evolution. Methods: Retrospective observational study, including all patients to whom LTE was applied in a postsurgical ICU between January 2021 and December 2022. The LTE defined were brain death, withdrawal of measures, and withholding. Withholding limitations included orders for no cardiopulmonary resuscitation, no orotracheal intubation, no reintubation, no tracheostomy, no renal replacement therapies, and no vasoactive support. Patient and ICU admission data were related to the applied LTE. Results: Of the 2056 admitted, LTE protocols were applied to 106 patients. The prevalence of LTE in the ICU was 5.1%. Data were analyzed in 80 patients. A total of 91.2% of patients had been admitted in an emergency situation, and 56.2% had been admitted after surgery. The most widespread limitation was treatment withholding (83.8%) compared to withdrawal (13.8%). No differences were found regarding who made the decision and the type of limitation employed. However, patients with the limitation of no intubation had a longer stay (p = 0.025). Additionally, the order of not starting or increasing vasopressor support resulted in a longer hospital stay (p = 0.007) and a significantly longer stay until death (p = 0.044). Conclusions: LTE is a frequent measure in critically ill patient management and is less common in the postoperative setting. The most widespread measure was withholding, with the do-not-resuscitate order being the most common. The decision was made mainly by the medical team and the family, respecting the wishes of the patients. A joint patient-centered approach should be made in these decisions to avoid futile treatment and ensure end-of-life comfort.
Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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Open AccessArticle
Predictive Factors of Transient Urinary Incontinence Following Holmium Laser Enucleation of the Prostate (HoLEP): Single-Center Experience
by
Roxana Andra Coman, Thomas Bschleipfer, Nadim Al Hajjar and Bogdan Petrut
Medicina 2024, 60(9), 1460; https://doi.org/10.3390/medicina60091460 - 6 Sep 2024
Abstract
Background and Objectives: The aim of this study was to assess the predictive factors associated with transient urine incontinence (TUI) following holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A retrospective analysis was conducted on a prospectively maintained database
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Background and Objectives: The aim of this study was to assess the predictive factors associated with transient urine incontinence (TUI) following holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A retrospective analysis was conducted on a prospectively maintained database containing the first 149 consecutive HoLEP cases between June 2022 and December 2023. The study recorded several patient characteristics, and preoperative data such as IPSS score, total gland volume, preoperative catheterization, Qmax, and PVR volume were collected. During the operation, data on total operating time, enucleation time, morcellation time, and weight of enucleated tissue were recorded. Finally, postoperative data were also documented. TUI refers to a patient’s complaint of urine leakage, irrespective of type. Univariate and multivariate logistic regression analyses were performed to determine factors that predict TUI. Results: The study included 119 patients with BPH. Nineteen (15.96%) of them experienced postoperative TUI. Of those 19 patients, 15 (78.94%) recovered within three months from the date of the surgery. In the multivariate regression analysis, increased age (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.56~7.78; p = 0.002), prostate volume ≥ 100 mL (OR 1.86; 95% CI 1.54–2.13; p = 0.001), preoperative PVR volume ≥ 250 mL (OR 1.22; 95% CI 1.10–1.32; p = 0.02), preoperative catheterization (OR, 0.56; 95% CI 0.34–0.78; p = 0.003), increased operation time (OR, 3.87; 95% CI 1.62–4.19; p = 0.002), and resected tissue weight ≥ 40 g (OR, 1.032; 95% CI, 1.015–1.048; p = 0.002) were found to be independent predictors of TUI. Conclusions: The incidence of TUI following HoLEP was found to be 15.96% in patients, with a recovery rate of 78.94% within three months post-surgery. Predictive factors for TUI included age at surgery, prostatic volume, preoperative catheterization, high PVR, longer operative time, and resected tissue weight.
Full article
(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment)
Open AccessArticle
Changes in the Success and Characteristics of Tobacco Dependence Treatment before and during the COVID-19 Pandemic: Clinical Sample Comparisons
by
Lenka Stepankova, Kamila Zvolska, Alexandra Pankova, Jakub Rafl, Gleb Donin, Ales Tichopad and Eva Kralikova
Medicina 2024, 60(9), 1459; https://doi.org/10.3390/medicina60091459 - 6 Sep 2024
Abstract
Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy
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Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017–2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020–2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ2 (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist.
Full article
(This article belongs to the Special Issue Public Health in the Post-pandemic Era)
Open AccessReview
Epidemiology and Risk Factors of Dry Eye Disease: Considerations for Clinical Management
by
Alexis Ceecee Britten-Jones, Michael T. M. Wang, Isaac Samuels, Catherine Jennings, Fiona Stapleton and Jennifer P. Craig
Medicina 2024, 60(9), 1458; https://doi.org/10.3390/medicina60091458 - 5 Sep 2024
Abstract
Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients
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Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients with the condition. This review considers current knowledge surrounding its incidence and prevalence, as well as associated demographic, systemic, ocular, and iatrogenic, and lifestyle-related modifiable risk factors. Population-based prevalence estimates vary according to the diagnostic criteria used to define dry eye disease, as well as severity and demographic characteristics of the population. Considering recent data and variable population demographics, conservative prevalence estimates suggest that 10–20% of the population over 40 years of age report moderate to severe symptoms and/or seek treatment for dry eye disease. Individuals with specific non-modifiable demographic risk factors may be at increased risk of developing dry eye disease. Advanced age, female sex and East Asian ethnicity have been identified as key non-modifiable demographic features predisposing individuals to dry eye disease. Systemic conditions that have been associated with an increased risk of dry eye disease include migraine, Sjögren syndrome, connective tissue disorders, mental health disorders, diabetes mellitus and androgen deficiency. Medications that may contribute to this risk include antidepressants, antihistamines, and hormone replacement therapy. Ocular and iatrogenic risk factors of dry eye disease include blepharitis, Demodex infestation, ocular surgery, blink completeness, contact lens wear, and topical ophthalmic medications. A range of modifiable lifestyle factors that can increase the risk of dry eye disease have also been identified, including low humidity environments, digital screen use, quality of sleep, diet, and eye cosmetic wear. Dry eye is a common disease affecting millions globally. Increasing knowledge regarding its associated risk factors can better prepare the eye care practitioner to successfully manage patients with this ocular surface disease.
Full article
(This article belongs to the Special Issue Clinical Management of Ocular Surface Disease)
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Open AccessReview
Deciphering the Role of Maternal Microchimerism in Offspring Autoimmunity: A Narrative Review
by
Alexandra Mpakosi, Rozeta Sokou, Martha Theodoraki, Nicoletta Iacovidou, Vasileios Cholevas and Christiana Kaliouli-Antonopoulou
Medicina 2024, 60(9), 1457; https://doi.org/10.3390/medicina60091457 - 5 Sep 2024
Abstract
Feto-maternal microchimerism is the bidirectional transfer of cells through the placenta during pregnancy that can affect the health of both the mother and the offspring, even in childhood or adulthood. However, microchimerism seems to have different consequences in the mother, who already has
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Feto-maternal microchimerism is the bidirectional transfer of cells through the placenta during pregnancy that can affect the health of both the mother and the offspring, even in childhood or adulthood. However, microchimerism seems to have different consequences in the mother, who already has a developed immune system, than in the fetus, which is vulnerable with immature defense mechanisms. Studies have shown that the presence of fetal microchimeric cells in the mother can be associated with reduced fetal growth, pre-eclampsia, miscarriage, premature birth, and the risk of autoimmune disease development in the future. However, some studies report that they may also play a positive role in the healing of maternal tissue, in cancer and cardiovascular disease. There are few studies in the literature regarding the role of maternal microchimeric cells in fetal autoimmunity. Even fewer have examined their association with the potential triggering of autoimmune diseases later in the offspring’s life. The objectives of this review were to elucidate the mechanisms underlying the potential association between maternal cells and autoimmune conditions in offspring. Based on our findings, several hypotheses have been proposed regarding possible mechanisms by which maternal cells may trigger autoimmunity. In Type 1 diabetes, maternal cells have been implicated in either attacking the offspring’s pancreatic β-cells, producing insulin, differentiating into endocrine and exocrine cells, or serving as markers of tissue damage. Additionally, several potential mechanisms have been suggested for the onset of neonatal lupus erythematosus. In this context, maternal cells may induce a graft-versus-host or host-versus-graft reaction in the offspring, function as effectors within tissues, or contribute to tissue healing. These cells have also been found to participate in inflammation and fibrosis processes, as well as differentiate into myocardial cells, potentially triggering an immune response. Moreover, the involvement of maternal microchimeric cells has been supported in conditions such as juvenile idiopathic inflammatory myopathies, Sjögren’s syndrome, systemic sclerosis, biliary atresia, and rheumatoid arthritis. Conversely, no association has been found between maternal cells and celiac disease in offspring. These findings suggest that the role of maternal cells in autoimmunity remains a controversial topic that warrants further investigation.
Full article
(This article belongs to the Section Obstetrics and Gynecology)
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Open AccessOpinion
Technology beyond Biology; Isn’t It Time to Update WHO’s Definition of Health?
by
Maja Baretić, Dragan Primorac, David de Bruijn and Velimir Altabas
Medicina 2024, 60(9), 1456; https://doi.org/10.3390/medicina60091456 - 5 Sep 2024
Abstract
Technology is increasingly shaping human life, particularly in healthcare, where recent advancements have revolutionized patient care. Despite these advances, the World Health Organization’s (WHO) definition of health remains rooted in traditional notions, raising questions about its adequacy in light of technological progress. This
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Technology is increasingly shaping human life, particularly in healthcare, where recent advancements have revolutionized patient care. Despite these advances, the World Health Organization’s (WHO) definition of health remains rooted in traditional notions, raising questions about its adequacy in light of technological progress. This paper explores the conceptual and practical limitations of the current definition and argues for its revision to encompass the role of technology in health. This paper examines the evolving landscape of healthcare technology and its philosophical implications, drawing on theories such as the Extended Health Hypothesis and the Extended Mind Hypothesis. It claims that health extends beyond traditional biological boundaries and includes the influence of technology on well-being. This paper advocates for a re-examination of the WHO definition of health to reflect the integral role of technology in modern healthcare. Recognizing technology as part of health necessitates a broader conceptual framework that acknowledges the interconnectedness of biology, technology, and human well-being. Given technology’s transformative role in healthcare, this paper argues for a revaluation of the WHO’s definition of health to encapsulate the evolving relationship between technology and human well-being. At the end, we propose a new definition recognizing that health is a dynamic state of physical, mental, social, and technological well-being, wherein individuals can achieve optimal quality of life through the harmonious integration of biological, psychological, and technological factors. This state encompasses not only the absence of disease but also the effective utilization of advanced technologies.
Full article
(This article belongs to the Special Issue AI in Imaging—New Perspectives, 2nd Edition)
Open AccessArticle
Efficacy and Safety of Boldine Combined with Phyllanthus niruri and Ononis spinosa in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Single-Center, Retrospective Cohort Study
by
Ernesto Di Mauro, Pietro Saldutto, Roberto La Rocca, Giuseppe Sangiorgi, Gianluigi Patelli, Biagio Barone, Vittore Verratti, Roberto Castellucci, Luigi Napolitano, Fabrizio Iacono and Vincenzo Maria Altieri
Medicina 2024, 60(9), 1455; https://doi.org/10.3390/medicina60091455 - 5 Sep 2024
Abstract
Background and Objectives: This study aimed to compare the effects and safety of boldine combined with Phyllanthus niruri and Ononis spinosa plus tamsulosin vs. tamsulosin alone in medical expulsive therapy (MET) for distal ureteral calculi. Materials and Methods: This retrospective cohort
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Background and Objectives: This study aimed to compare the effects and safety of boldine combined with Phyllanthus niruri and Ononis spinosa plus tamsulosin vs. tamsulosin alone in medical expulsive therapy (MET) for distal ureteral calculi. Materials and Methods: This retrospective cohort study was conducted on 159 renal colic patients with distal ureteric stones (≤10 mm). Patients aged between 18 and 70 years or older with distal ureteral (below the sacroiliac joint) stones ≤10 mm (defined by the largest diameter in three planes) confirmed by urinary ultrasonography and/or native computed tomography (CT). Patients were divided into two groups: A and B. Patients in Group A received tamsulosin 0.4 mg plus boldine combined with Phyllanthus niruri and Ononis spinosa, while those in Group B received tamsulosin 0.4 mg. The rate of stone expulsion, duration of stone expulsion, the dose and the duration of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesic use, and adverse effects of drugs were recorded. Results: No differences were reported in demographic profiles between the two groups. The stone expulsion rate in Group A (84.8%) was higher in comparison to Group B (52.5%); the mean time of stone expulsion was 16.33 ± 4.75 days in Group A and 19.33 ± 6.42 days in Group B. The mean requirement time of analgesia was significantly less in Group A, 2.42 ± 2.56, than in Group B, 6.25 ± 3.05. Drug-related adverse effects (headache, dizziness, nausea, vomiting, postural hypotension, backache, and running nose) were comparable between the two groups. Conclusions: Tamsulosin plus boldine combined with Phyllanthus niruri and Ononis spinosa as medical expulsion therapy is more effective for distal ureteric stones with less need for analgesics and a shorter stone expulsion time than tamsulosin alone.
Full article
(This article belongs to the Section Urology & Nephrology)
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Open AccessArticle
Association of Dietary Inflammatory Index and Thyroid Function in Patients with Hashimoto’s Thyroiditis: An Observational Cross–Sectional Multicenter Study
by
Sanja Klobučar, Gordana Kenđel Jovanović, Jadwiga Kryczyk-Kozioł, Maja Cigrovski Berković, Jelena Vučak Lončar, Nikolina Morić, Katarina Peljhan, Dario Rahelić, Dunja Mudri, Ines Bilić-Ćurčić and Tatjana Bogović Crnčić
Medicina 2024, 60(9), 1454; https://doi.org/10.3390/medicina60091454 - 5 Sep 2024
Abstract
Background and Objectives: The available research suggests that dietary patterns with high inflammatory potential, as indicated by a high DII score, may exacerbate inflammation and potentially influence thyroid function. Therefore, the aim of this study was to investigate the associations between the inflammatory
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Background and Objectives: The available research suggests that dietary patterns with high inflammatory potential, as indicated by a high DII score, may exacerbate inflammation and potentially influence thyroid function. Therefore, the aim of this study was to investigate the associations between the inflammatory potential of a diet and thyroid function in adults with Hashimoto’s thyroiditis (HT). Materials and Methods: A total of 149 adults diagnosed with Hashimoto’s thyroiditis were enrolled in this observational, cross-sectional, multicenter study. The Dietary Inflammatory Index (DII®) was calculated using a 141-item food frequency questionnaire (FFQ). The serum levels of the thyroid-stimulating hormone (TSH), free thyroxine (fT4), thyroid peroxidase antibodies (TPO-Ab), and high-sensitivity C-reactive protein (hsCRP) were determined. Results: The DII® scores ranged from −3.49 (most anti-inflammatory) to +4.68 (most pro-inflammatory), whereas three DII® tertile ranges were defined as <−1.4, −1.39 to +1.20, and >+1.21, respectively. Participants in tertile 1 (more anti-inflammatory diet) had significantly higher levels of fT4 than those adhering to a more pro-inflammatory diet (p = 0.007). The levels of hsCRP and TSH appeared to increase with increasing the DII® score, but without statistical significance. A significant association was found between the DII® and TSH (β = 0.42, p < 0.001) and between DII® and free thyroxine (β = 0.19, p < 0.001). After adjustment for age, gender, energy intake, and physical activity, a significant positive correlation remained between the DII® and TSH (β = 0.33, p = 0.002) and between the DII® and body mass index (BMI) (β = 0.14, p = 0.04). Conclusions: Adherence to an anti-inflammatory diet appears to be beneficial in patients with Hashimoto’s thyroiditis, suggesting that dietary modification aimed at lowering DII® levels may be a valuable strategy to improve clinical outcomes in these patients.
Full article
(This article belongs to the Special Issue New Strategies for the Diagnosis and Treatment of Autoimmune and Autoinflammatory Diseases)
Open AccessArticle
Does Monopolar Electrocautery Affect the Fetus during Cesarean Section?
by
Sevki Goksun Gokulu, Hamza Yildiz, Ali Yildizbakan, Gorkem Ulger, Huseyin Durukan, Yalcin Celik and Hakan Aytan
Medicina 2024, 60(9), 1453; https://doi.org/10.3390/medicina60091453 - 5 Sep 2024
Abstract
Background and Objectives: This study aimed to assess the impact of monopolar electrocautery on the fetus during cesarean section. Materials and methods: A retrospective analysis was conducted with 552 patients delivered by cesarean section. Patients were grouped based on usage of monopolar electrocautery.
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Background and Objectives: This study aimed to assess the impact of monopolar electrocautery on the fetus during cesarean section. Materials and methods: A retrospective analysis was conducted with 552 patients delivered by cesarean section. Patients were grouped based on usage of monopolar electrocautery. In 272 patients, monopolar electrocautery was used to separate the tissues before the delivery. In 280 patients, no electrocautery was used. Newborn vital signs, Apgar scores, umbilical cord blood parameters, newborn serum parameters collected within 6th postpartum hour, and rate of newborn intensive care unit admission were compared. Results: The 1st and 5th minute Apgar scores were significantly higher in the electrocautery group; however, this difference lost its significance at the 10th minute. The median newborn pulse rate (148 (7) vs. 146 (6) beats per minute, p = 0.026), umbilical cord blood pH, and partial oxygen pressure were significantly higher in the electrocautery group compared to the no-electrocautery group (7.34 ± 0.06 vs. 7.31 ± 0.06, p < 0.001, and 25.5 (14.77) vs. 23 (16.08) mmHg, p = 0.025, respectively). The median umbilical cord blood serum calcium level was 1.51 (0.64) mmol/L in the electrocautery group, which was significantly lower than 1.9 (0.82) mmol/L in the no-electrocautery group (p = 0.002). The incidence of hypoglycemia was significantly lower in the electrocautery group than in the no-electrocautery group (2.2% vs. 5.7%, p = 0.035). Conclusions: Monopolar electrocautery during cesarean section affects the fetus, but it is safe to use it. Electrocautery is independently associated with umbilical cord blood pH and calcium level. Electrocautery may be associated with a lower incidence of hypoglycemia.
Full article
(This article belongs to the Section Obstetrics and Gynecology)
Open AccessArticle
Impact of Perioperative Lidocaine on Neutrophil Extracellular Trapping and Serum Cytokines in Robot-Assisted Radical Prostatectomy: Randomized Controlled Study
by
Dongho Shin, Jiheon Kim, Subin Lee and Min Suk Chae
Medicina 2024, 60(9), 1452; https://doi.org/10.3390/medicina60091452 - 5 Sep 2024
Abstract
Background and Objective: This randomized controlled trial investigated the influence of perioperative lidocaine administration on the postoperative inflammatory response in patients undergoing robot-assisted radical prostatectomy, with the results having potential implications for postoperative recovery and cancer recurrence via neutrophil extracellular trapping (NETosis). Materials
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Background and Objective: This randomized controlled trial investigated the influence of perioperative lidocaine administration on the postoperative inflammatory response in patients undergoing robot-assisted radical prostatectomy, with the results having potential implications for postoperative recovery and cancer recurrence via neutrophil extracellular trapping (NETosis). Materials and Methods: In total, 58 patients with localized prostate cancer were randomly assigned to receive an intravenous infusion of 2% lidocaine or a saline placebo intraoperatively. Serum levels of interleukin (IL)-6, IL-10, and IL-17, tumor necrosis factor(TNF)-α, interferon(IFN)-γ, neutrophil elastase (NE), citrullinated histone3 (CitH3), and myeloperoxidase (MPO) were determined preoperatively and at 24 h postoperatively. Biochemical recurrence (BCR) was assessed over a follow-up period of 2 years. Results: The lidocaine group showed a significant change in MPO, a greater reduction in IL-10 level, and a smaller increase in the NE level compared to the placebo group, suggesting a modulatory effect of lidocaine on certain anti-inflammatory and neuroendocrine pathways. No significant difference in the BCR rate was observed between the two groups. Conclusions: Perioperative lidocaine administration selectively modulates certain inflammatory and neuroendocrine responses after robot-assisted radical prostatectomy surgery, potentially influencing recovery outcomes. These findings highlight the need for further investigations of the role of lidocaine in Enhanced Recovery After Surgery protocols, particularly in oncologic surgeries.
Full article
(This article belongs to the Special Issue Advances in Radical Prostatectomy)
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Open AccessArticle
All-Polyethylene Tibial Component in Unicompartmental Knee Arthroplasty Offers Excellent Survivorship and Clinical Outcomes at Short-Term Follow-Up: A Multicenter Retrospective Clinical Study
by
Tommaso Bonanzinga, Federico Maria Adravanti, Umberto Vitale, Giuseppe Anzillotti, Francesco Iacono and Maurilio Marcacci
Medicina 2024, 60(9), 1451; https://doi.org/10.3390/medicina60091451 - 4 Sep 2024
Abstract
Background and Objectives: The ten-year survivorship of unicompartmental knee arthroplasty (UKA) is up to 96%, varying from implants and hospitals; however, most of registry studies do not distinguish between metal-back (MB) tibial implants and all-polyethylene (AP) tibial implants. The aim of the
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Background and Objectives: The ten-year survivorship of unicompartmental knee arthroplasty (UKA) is up to 96%, varying from implants and hospitals; however, most of registry studies do not distinguish between metal-back (MB) tibial implants and all-polyethylene (AP) tibial implants. The aim of the present retrospective clinical study was to analyze the clinical outcomes and survivorship of medial and lateral UKA with a newly designed all-polyethylene tibial plateau at short-term follow-up. Materials and Methods: A retrospective analysis of prospectively collected consecutive patients who underwent medial or lateral UKA with AP tibial plateau was conducted, with a minimum follow-up of 1 year. Primary outcomes were clinical score (VAS, OKS, and KOOS) variations from baseline up to the latest follow-up. Secondary outcomes were Likert scale variations from baseline to the follow-up, evaluation of the influence of demographic factors (age and BMI) at the time of surgery on the clinical outcomes, and evaluation of revision rate up to the last follow-up. Results: The final study population included 99 knees. The mean VAS score for the medial group significantly decreased from 7.61 ± 1.65 (pre-intervention) to 2.74 ± 2.26 (post-intervention). Similar improvements were registered for the OKS as well, for both the medial group (from 22.5 ± 12.6 to 36.6 ± 10.6, with a delta of 14.11 (10.05 to 18.17)) and the lateral group (from 22.6 ± 12.6 to 36.9 ± 11.8, with a delta of 14.24 (8.65 to 19.83)). Moreover, all the KOOS subscales reported an amelioration, both in medial UKA and lateral UKA. Furthermore, a logistic regression of delta VAS was performed in relation to the other clinical questionnaires and the demographic factors. For both medial and lateral UKAs, no statistically significant correlation was found between the VAS scale regression and the demographic factors. The survival rate free from any revision of the cohort at the latest follow-up was 96.32%. Conclusions: All-polyethylene tibial component in unicompartmental knee arthroplasty demonstrates significant improvements in clinical scores and a low failure rate at short-term follow-up.
Full article
(This article belongs to the Special Issue Recent Advancements in Total Knee Arthroplasty)
Open AccessArticle
Impact of Patient- and Surgeon-Related Factors on Weight Loss after Laparoscopic Sleeve Gastrectomy—A Single-Center Study
by
Mateusz Wityk, Natalia Dowgiałło-Gornowicz and Maciej Bobowicz
Medicina 2024, 60(9), 1450; https://doi.org/10.3390/medicina60091450 - 4 Sep 2024
Abstract
Background and Objectives: Surgical treatment for obesity is becoming increasingly popular. Surgeons have been trying to find a simple way to predict the type of surgical intervention that is best for a specific patient. This study aimed to determine the patient- and
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Background and Objectives: Surgical treatment for obesity is becoming increasingly popular. Surgeons have been trying to find a simple way to predict the type of surgical intervention that is best for a specific patient. This study aimed to determine the patient- and surgeon-related factors that affect weight loss after laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A total of 129 patients underwent LSG in one surgical department. The following factors were analyzed: gender; age; highest preoperative and 6-month postoperative weight; the occurrence of obesity-related diseases, such as type 2 diabetes and hypertension; the number of surgeons involved in the surgery; and who performed the surgery, a resident or specialist. The outcomes also included length of hospital stay, operative time and complications. Statistical significance was defined as p ≤ 0.05. Results: A total of 129 patients (94 female) with a median age of 43 years and BMI of 43.1 kg/m2 underwent LSG, while a total of 109 (84.5%) patients achieved ≥50% of excess BMI loss (%EBMIL). Preoperative weight loss had no impact on %EBMIL (p = 0.95), operative time (p = 0.31) and length of hospital stay (p = 0.2). Two versus three surgeons in the operating team had no impact on surgery time (p = 0.1), length of stay (p = 0.98) and %EBMIL (p = 0.14). The operative time and length of hospital stay were similar for specialists and surgeons in training. %EBMIL was higher in the residents’ surgery without statistical significance (p = 0.19). Complications occurred in 3.9% without mortality or leaks. Conclusions: Preoperative comorbidities, surgeons’ experience and the number of surgeons in the operating team do not impact the complication rate, length of hospital stay, operative time and postoperative weight loss after LSG.
Full article
(This article belongs to the Special Issue Current Status and Progress in Laparoscopic Surgery)
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Open AccessArticle
Impact of Central Sensitization on Clinical and Functional Aspects of Psoriatic Arthritis
by
Mehmet Nur Kaya, Duygu Tecer, Özlem Kılıç, Merve Sungur Özgünen and Sedat Yılmaz
Medicina 2024, 60(9), 1449; https://doi.org/10.3390/medicina60091449 - 4 Sep 2024
Abstract
Background/Objectives: Psoriatic arthritis (PsA) is an inflammatory rheumatic disease characterized by peripheral arthritis, enthesitis, spondylitis and psoriasis. The objective of this study was to examine the prevalence of central sensitization (CS) and its impact on the clinical and functional aspects of PsA.
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Background/Objectives: Psoriatic arthritis (PsA) is an inflammatory rheumatic disease characterized by peripheral arthritis, enthesitis, spondylitis and psoriasis. The objective of this study was to examine the prevalence of central sensitization (CS) and its impact on the clinical and functional aspects of PsA. Methods: Adult patients with PsA according to the Classification of Psoriatic Arthritis (CASPAR) criteria were included in this cross-sectional observational study. The Central Sensitization Inventory (CSI) was used to assess the presence of CS. The study evaluated the impact of CS on individuals by analyzing many factors including demographic information, laboratory findings, clinical features, disease activity, quality of life, severity of sleeplessness, frequency of depression and anxiety. The patients were categorized into distinct groups based on the existence and intensity of CS, and a comparative analysis was conducted on their respective outcomes. Results: A total of 103 PsA patients with a mean age of 43.2 (SD: 6.7) years and including 42 (40.8%) males were included. The mean CSI score was 45.4 (SD: 15.1), and 67 (65.1%) patients had CS. The logistic regression analysis revealed that the variables Psoriasis Area Severity Index (PASI), General Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) exhibit considerable predictive power in relation to the outcome variable CS (p < 0.05). PASI was observed as the most important variable in predicting CS (OR 9.70 95% CI: 1.52–62.21). Conclusions: CS has demonstrable efficacy in influencing laboratory, clinical, and functional markers among individuals with PsA. When assessing pain sensitivity in these patients, it is important to take into account the presence of CS.
Full article
(This article belongs to the Section Hematology and Immunology)
Open AccessCase Report
Successful Conservative Treatment of Maternal Spontaneous Unilateral Adrenal Hemorrhage Causing Severe Anemia in the Third Trimester of Pregnancy—A Case Report
by
Tomasz Skołozdrzy, Jan Wojciechowski, Mirosław Halczak, Sylwester Michał Ciećwież, Maciej Ziętek and Maciej Romanowski
Medicina 2024, 60(9), 1448; https://doi.org/10.3390/medicina60091448 - 4 Sep 2024
Abstract
We present the case of a 32-year-old pregnant woman in the 32 + 3 weeks of pregnancy who presented to the hospital with an exacerbation of pain in the right flank. The diagnostic evaluation revealed the presence of severe anemia and a spontaneous
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We present the case of a 32-year-old pregnant woman in the 32 + 3 weeks of pregnancy who presented to the hospital with an exacerbation of pain in the right flank. The diagnostic evaluation revealed the presence of severe anemia and a spontaneous adrenal hemorrhage (SAH) in the right adrenal gland. The patient was transferred to the Perinatology, Obstetrics and Gynecology Clinic with the intention of undergoing preterm childbirth. However, the doctors made a risky decision to wait until week 37 and to terminate the pregnancy at that point. The decision was right, as a cesarean section was performed without complications, and the patient gave birth to a healthy child. Spontaneous adrenal hemorrhage (SAH) is a rare condition, defined as spontaneous hemorrhage without trauma or anticoagulant therapy. Due to bleeding and damage to the adrenal cortex, SAH can lead to adrenal insufficiency. Because of its non-specific symptoms and potentially fatal outcomes for the patient and fetus, it should be considered during diagnostics.
Full article
(This article belongs to the Section Obstetrics and Gynecology)
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