Medicina

17 pages, 1912 KiB

Open AccessArticle

Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability

by Sujin Choi and Hyung-pil Jun

Medicina 2024, 60(7), 1187; https://doi.org/10.3390/medicina60071187 - 22 Jul 2024

Cited by 1 | Viewed by 1552

Abstract

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but [...] Read more.

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals. Full article

(This article belongs to the Special Issue Update on Orthopedic Surgeries of the Lower Extremity Diseases and Injuries: 2nd Edition)

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26 pages, 10447 KiB

Open AccessSystematic Review

Effects of Exercise Type on Muscle Strength and Body Composition in Men and Women: A Systematic Review and Meta-Analysis

by Ki-Woong Noh, Eui-Kyoung Seo and Sok Park

Medicina 2024, 60(7), 1186; https://doi.org/10.3390/medicina60071186 - 22 Jul 2024

Cited by 1 | Viewed by 1845

Abstract

Background and Objectives: There are typical differences in body composition and distribution of muscle fiber types between women and men. However, research investigating the effects of exercise based on sex differences is limited, and studies examining sex differences in physiological adaptations according to [...] Read more.

Background and Objectives: There are typical differences in body composition and distribution of muscle fiber types between women and men. However, research investigating the effects of exercise based on sex differences is limited, and studies examining sex differences in physiological adaptations according to exercise type are scarce. We aimed to compare the effects of exercise types on muscle strength and body composition in men and women through a meta-analysis. Materials and Methods: A systematic literature search was conducted using the PubMed/Medline, Web of Science, CINAHL, and EBSCO databases. Keywords included “endurance training”, “resistance training”, “concurrent training”, “muscle strength”, “body composition”, “sex characteristics”, and “men and women”. The standardized mean difference (SMD) was presented separately for men and women based on the pre- and post-intervention values for each exercise type. Results: Concurrent training showed the greatest effect on the increase in leg press muscle strength in men, and resistance training showed the greatest effect in women. Concurrent training showed the greatest effect size in both men and women in increasing bench press muscle strength. Resistance training and concurrent training showed a small effect size on lean mass reduction in both men and women. Endurance training and concurrent training significantly reduced fat mass in men. However, no significant changes in fat mass were observed in any exercise type among women. Conclusions: Concurrent training is the most efficient type of exercise for men, as it is effective in increasing upper- and lower-body muscle strength, increasing lean mass, and reducing fat mass. Resistance training is most effective in increasing muscle strength in females, whereas endurance training is most effective in reducing fat mass. However, it is difficult to corroborate these results because of the lack of study samples included in the analysis and the differences in exercise methods, participant age, and exercise duration. Full article

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

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15 pages, 1710 KiB

Open AccessArticle

Evaluating Therapy and Growth in Children with Phenylketonuria: A Retrospective Longitudinal Study from Two Romanian Centers

by Meda-Ada Bugi, Iulius Jugănaru, Iulia-Elena Simina, Delia-Maria Nicoară, Lucian-Ioan Cristun, Giorgiana-Flavia Brad, Delia Huțanu, Raluca Isac, Kinga Kozma, Daniela Cîrnatu and Otilia Mărginean

Medicina 2024, 60(7), 1185; https://doi.org/10.3390/medicina60071185 - 22 Jul 2024

Viewed by 1662

Abstract

Background and Objectives: Phenylketonuria (PKU) is a rare genetic disorder characterized by the inability to convert the essential amino acid phenylalanine into tyrosine. Early dietary treatment can successfully prevent complications, but controversies still exist regarding the attainment of normal growth in these [...] Read more.

Background and Objectives: Phenylketonuria (PKU) is a rare genetic disorder characterized by the inability to convert the essential amino acid phenylalanine into tyrosine. Early dietary treatment can successfully prevent complications, but controversies still exist regarding the attainment of normal growth in these patients. Materials and Methods: Eighteen patients with PKU from two Romanian reference centers were compared to eighteen non-PKU controls, matched for age and gender. The comparisons used weight-for-height, weight-for-age, height/length-for-age, and body mass index-for-age z-scores from birth to three years of age. Results: The PKU study group consisted of nine boys and nine girls, with a median follow-up period of thirty-six months (interquartile range = 9.75). While median values of all four growth metrics remained within the normal range across the entire study period, weight-for-age z-scores were significantly lower in PKU patients throughout most of the study (p < 0.001). Conclusions: The persistent lower weight-for-age z-scores of the PKU patients compared to controls indicate that ongoing monitoring and potential adjustments in dietary therapy may be necessary to further optimize growth outcomes. Full article

(This article belongs to the Special Issue Diagnosis and Therapy of Rare Diseases)

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12 pages, 515 KiB

Open AccessProject Report

Biomechanical Examination of Wrist Flexors and Extensors with Biodex System Dynamometer—Isometric, Isokinetic and Isotonic Protocol Options

by Marta Jokiel, Katarzyna Kazmierczak, Piotr Czarnecki, Aleksandra Bartkowiak-Graczyk, Anna Madziewicz, Ewa Breborowicz, Malgorzata Miedzyblocka, Michal Adamski, Krystian Kaczmarek, Leszek Kaczmarek and Leszek Romanowski

Medicina 2024, 60(7), 1184; https://doi.org/10.3390/medicina60071184 - 22 Jul 2024

Viewed by 1015

Abstract

Background and Objectives: Biodex System^® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation [...] Read more.

Background and Objectives: Biodex System^® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p < 0.05) between the three protocols in average pain intensity reported by study participants. All participants completed the isotonic protocol, but not all patients with symptomatic tennis elbow were able to complete the isometric and isokinetic protocols. The isotonic protocol was deemed “difficult but possible to complete” by study participants. Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants. Full article

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

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15 pages, 1438 KiB

Open AccessArticle

The Effect of Intravenous Tranexamic Acid on Perioperative Blood Loss, Transfusion Requirements, Verticalization, and Ambulation in Total Knee Arthroplasty: A Randomized Double-Blind Study

by Gordana Jovanovic, Mirka Lukic-Sarkanovic, Filip Lazetic, Teodora Tubic, Dajana Lendak and Arsen Uvelin

Medicina 2024, 60(7), 1183; https://doi.org/10.3390/medicina60071183 - 21 Jul 2024

Cited by 1 | Viewed by 1218

Abstract

Background and Objectives: Total knee arthroplasty (TKA) is sometimes associated with significant perioperative bleeding. The aim of this study was to determine the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss in patients undergoing primary TKA. The secondary objectives were to [...] Read more.

Background and Objectives: Total knee arthroplasty (TKA) is sometimes associated with significant perioperative bleeding. The aim of this study was to determine the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss in patients undergoing primary TKA. The secondary objectives were to assess the efficacy of TXA in reducing the need for blood transfusion in these patients and to determine its effect on verticalization and ambulation after TKA. Materials and Methods: This study included 96 patients who were randomly assigned to two groups, each containing 48 patients. The study group received intravenous TXA at two time points: immediately after the induction with doses of 15 mg/kg and 10 mg/kg 15 min before the release of the pneumatic tourniquet. The control group received an equivalent volume of 0.9% saline solution via the same route. Results: TXA markedly reduced (Z = −6.512, p < 0.001) the total perioperative blood loss from 892.56 ± 324.46 mL, median 800 mL, interquartile range (IQR) 530 mL in the control group, to 411.96 ± 172.74 mL, median 375 mL, IQR 200 mL, in the TXA group. In the TXA group, only 5 (10.4%) patients received a transfusion, while in the control group, 22 (45.83%) received it (χ2 = 15.536, p = 0.001). Patients in the study group stood (χ2 = 21.162, p < 0.001) and ambulated earlier postoperatively, compared to the control group (χ2 = 26.274, p < 0.001). Patients who received TXA had a better overall postoperative functional recovery. There was a statistically significant difference in all the above results. Conclusions: TXA is an effective drug for reducing the incidence of perioperative bleeding, decreasing transfusion rates, and indirectly improving postoperative functional recovery in patients undergoing primary TKA. Full article

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

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10 pages, 771 KiB

Open AccessArticle

Circulating Malondialdehyde Is a Potential Biomarker for Predicting All-Cause Mortality during Follow-Up by Reflecting Comprehensive Inflammation at Diagnosis in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

by Jihye Chung, Taejun Yoon, Hyunsue Do, Yong-Beom Park and Sang-Won Lee

Medicina 2024, 60(7), 1182; https://doi.org/10.3390/medicina60071182 - 21 Jul 2024

Viewed by 926

Abstract

Background and Objectives: To investigate whether circulating malondialdehyde (cMDA) at diagnosis could contribute to reflecting cross-sectional comprehensive inflammation or vasculitis activity and further predicting all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 78 [...] Read more.

Background and Objectives: To investigate whether circulating malondialdehyde (cMDA) at diagnosis could contribute to reflecting cross-sectional comprehensive inflammation or vasculitis activity and further predicting all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 78 patients with AAV. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were collected as indices reflecting cross-sectional comprehensive inflammation, whereas the Birmingham vasculitis activity score (bVAS), and the five-factor score (FFS) were reviewed as AAV-specific indices. All-cause mortality was considered to be a poor outcome during follow-up. cMDA was measured from stored sera. Results: The median age of the 78 patients (32 men and 46 women) was 63.0 years. The median BVAS, FFS, ESR, and CRP were 5.0, 0, 24.5 mm/h, and 3.4 mg/L, respectively. Six patients died during the median follow-up duration based on all-cause mortality at 26.7 months. At diagnosis, cMDA was significantly correlated with cross-sectional ESR but not with BVAS or FFS. Compared to patients with cMDA < 221.7 ng/mL, those with cMDA ≥ 221.7 ng/mL at diagnosis exhibited an increased relative risk (RR 12.4) for all-cause mortality and further showed a decreased cumulative patient survival rate. Cox analyses revealed that cMDA ≥ 221.7 ng/mL (hazard ratio 24.076, p = 0.007) exhibited an independent association with all-cause mortality during follow-up in patients with AAV. Conclusions: cMDA at diagnosis may be a potential biomarker for predicting all-cause mortality during follow-up by reflecting comprehensive inflammation at diagnosis in patients with AAV. Full article

(This article belongs to the Section Infectious Disease)

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10 pages, 22454 KiB

Open AccessCase Report

Large Peripheral Osteomas and Dental Implants: A Case Report

by Won-Bae Park, Wonhee Park, Joo-An Kim, Seungil Shin and Ji-Youn Hong

Medicina 2024, 60(7), 1181; https://doi.org/10.3390/medicina60071181 - 20 Jul 2024

Viewed by 1061

Abstract

Peripheral osteoma of the jaw is a rare, benign, slow-growing lesion, which usually appears as a unilateral, pedunculated, radiopaque mass protruding from the periphery and is generally solitary. Multiple osteomas without any syndromic involvement are rare. In the present case, a 75-year-old male [...] Read more.

Peripheral osteoma of the jaw is a rare, benign, slow-growing lesion, which usually appears as a unilateral, pedunculated, radiopaque mass protruding from the periphery and is generally solitary. Multiple osteomas without any syndromic involvement are rare. In the present case, a 75-year-old male patient underwent implant placement in the edentulous posterior ridges of the maxilla and mandible. Over 7 years, multiple masses gradually proliferated in the buccal bone of the implant in three different sextants of the posterior region, reaching a size of 2.0 cm. Clinically and radiologically, these lesions were presumed to be peripheral osteomas and were surgically removed because the large mass made self-performed oral hygiene and maintenance of peri-implant health difficult. The histopathological evaluation confirmed that peripheral osteomas were both compact and cancellous. The patient did not exhibit any other clinical manifestations of Gardner syndrome. Whether dental implant placement and loading are involved in the occurrence of peripheral osteomas is unclear, but they might have affected the consistent growth of the mass as a reactive mechanism. After resection, the functional abilities of chewing and self-cleansing significantly improved. No recurrence of peripheral osteoma was observed after 1 year of follow-up, and peri-implant health was well maintained. Within the limitations of the present case report, multiple peripheral osteomas can occur adjacent to dental implants without any syndromic issues, and a large mass of PO can harm peri-implant health which requires surgical removal. It is speculated that dental implants may be associated with the slow and consistent growth of PO. Full article

(This article belongs to the Special Issue Recent Advances in Periodontics and Dental Implantology: Part II)

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Preoperative examinations. Panoramic radiography (a) at the first visit, and (b) at one year after two additional dental implants at the maxillary left canine and mandibular right first molar. Ovoid-shaped radiopaque mass (white arrows) shown in the posterior ridges of both the maxilla and left mandible; (c,d) multiple proliferated round-shaped osteomas observed in the posterior ridges; (e) proliferated, well-circumscribed, and pedunculated masses observed in the 3-D images of CBCT; (f) a 3-D image of peripheral osteoma (PO) in the maxillary right posterior area; (g) a 3-D image of PO occurred in the upper and lower left posterior area; (h) an axial image of CBCT showing the proliferated bone mass in the buccal bone of the maxillary posterior implant (white arrow). Mass having external cortical layer and the internal radiolucent marrow space; (i) proliferated bone mass in the buccal bone of the mandibular posterior implant (white arrow). Full article ">Figure 2
Maxillary left posterior region. (a) A large mass of peripheral osteoma (PO) at the buccal alveolar bone adjacent to the first molar implant. Mucosal recession and plaque retention are shown at the implant; (b) flap reflection and exposure of the PO; (c) osteotomy and separation at the base of the pedunculated PO using a surgical round bur, and a bone chisel; (d) exposure of the implant thread with buccal bone dehiscence; (e) the removed specimen in a size of 1.8 × 2.0 cm; (f) maintenance after 1 year of follow-up. Full article ">Figure 3
Mandibular left posterior region. (a) Multiple masses of PO at the buccal alveolar ridge of the left mandibular posterior implants; (b) flap reflection and exposure of the PO; (c) osteotomy at the base of PO using a round bur and a bone chisel; (d) the specimens removed from the upper and lower jaws; (e) flap closure; (f) maintenance after 1 year of follow-up. Full article ">Figure 4
Histologic features (H-E stain). (a) Specimen from the maxillary left posterior region with cancellous-type PO. Oval-shaped mass composed of mature compact bone in the outer layer and fatty marrow space filled with adipose, vascularized connective tissue, and thin trabecular bones in the inner core; (b) specimen from the mandibular left posterior region with compact-type PO. Oval-shaped mass composed of thick, dense lamellar bone and a sparse fatty marrow space; (c) outer layer of mature lamellar bone commonly found in both specimens; (d) medullary space containing numerous adipose tissues and loosely arranged thin trabecular bone in the cancellous-type PO; (e) medullary space containing external lamellar bone proliferated inward rather than trabecular bone spicules in compact-type PO. Full article ">Figure 5
Maxillary right posterior region. (a) PO widely located on the buccal side of the ridge in the maxillary posterior area adjacent to the teeth and implants; (b) flap reflection and exposure of multiple isolated POs; (c) removal of the mass and smoothening of the bone surface; (d) the removed specimens in size approximately of 1.0–1.5 cm; (e,f) histologic features of cancellous-type PO in both specimens; (g) maintenance after 1 year of follow-up. Full article ">Figure 6
Examination after one year of the surgery. Panoramic view (a) and intraoral clinical view (b) showing no recurrence of PO. Full article ">

15 pages, 14119 KiB

Open AccessCase Report

Placenta Accreta Spectrum (PAS): Diagnosis, Clinical Presentation, Therapeutic Approaches, and Clinical Outcomes

by Filiz Markfeld Erol, Johanna Alena Häußler, Markus Medl, Ingolf Juhasz-Boess and Mirjam Kunze

Medicina 2024, 60(7), 1180; https://doi.org/10.3390/medicina60071180 - 20 Jul 2024

Cited by 1 | Viewed by 2065

Abstract

Placenta accreta spectrum (PAS) refers to the abnormal adhesion of the placenta to the myometrium, with varying degrees of severity. Placenta accreta involves adhesion to the myometrium, placenta increta invades the myometrium, and placenta percreta extends through the serosa to adjacent organs. The [...] Read more.

Placenta accreta spectrum (PAS) refers to the abnormal adhesion of the placenta to the myometrium, with varying degrees of severity. Placenta accreta involves adhesion to the myometrium, placenta increta invades the myometrium, and placenta percreta extends through the serosa to adjacent organs. The condition is linked to deficient decidualization in scarred uterine tissue, and the risk increases when placenta previa is present and with each prior cesarean delivery. Other risk factors include advanced maternal age, IVF, short intervals between cesareans, and smoking. PAS incidence has risen due to the increase in cesarean deliveries. Placenta previa combined with PAS significantly raises the risk of severe peripartum bleeding, often necessitating a cesarean section with a total hysterectomy. Recognizing PAS prepartum is essential, with sonographic indicators including intraplacental lacunae and uterovesical hypervascularization. However, PAS can be present without sonographic signs, making clinical risk factors crucial for diagnosis. Effective management requires a multidisciplinary approach and proper infrastructure. This presentation covers PAS cases treated at University Hospital Freiburg, detailing patient conditions, diagnostic methods, treatments and outcomes. Full article

(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy: Part II)

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14 pages, 342 KiB

Open AccessReview

Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients

by Francesca Ghirardini and Romeo Martini

Medicina 2024, 60(7), 1179; https://doi.org/10.3390/medicina60071179 - 20 Jul 2024

Cited by 1 | Viewed by 2176

Abstract

Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, [...] Read more.

Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality. Full article

(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)

11 pages, 310 KiB

Open AccessReview

Consultations for Poland Syndrome: The Essentials for a Thoracic Surgeon

by Małgorzata Edyta Wojtyś, Dawid Kordykiewicz, Janusz Wójcik, Periklis Tomos and Konstantinos Kostopanagiotou

Medicina 2024, 60(7), 1178; https://doi.org/10.3390/medicina60071178 - 20 Jul 2024

Viewed by 901

Abstract

Poland syndrome (PS) is a rare congenital musculoskeletal entity occurring in approximately 1 in 30,000 newborns that manifests with variable symbrachydactyly, ipsilateral costochondral deformities, an absence of pectoral muscles, and breast underdevelopment. These have potential impacts on social, somatic, and psychological functionality, often [...] Read more.

Poland syndrome (PS) is a rare congenital musculoskeletal entity occurring in approximately 1 in 30,000 newborns that manifests with variable symbrachydactyly, ipsilateral costochondral deformities, an absence of pectoral muscles, and breast underdevelopment. These have potential impacts on social, somatic, and psychological functionality, often leading affected individuals to seek expert opinions on corrective surgery. Due to phenotypic variability, strict management guidelines are lacking, with treatment decisions often based on the specialist’s personal experience rather than published evidence. Comprehensive imaging with CT and MRI with 3D reconstruction is crucial for providing a descriptive assessment of musculoskeletal defects. Management is multidisciplinary, involving thoracic, plastic, and pediatric surgeons and hand surgery specialists, as well as psychologists and developmental growth specialists. Surgery should achieve both structural and cosmetic correction to reverse the psychological and social impact and achieve patient satisfaction. We aim to provide thoracic surgeons the essential answers for sharing with affected adult individuals during consultations focusing on chest surgical correction. Full article

(This article belongs to the Section Surgery)

16 pages, 336 KiB

Open AccessReview

Laser-Induced Koebner-Related Skin Reactions: A Clinical Overview

by Emmanouil Karampinis, Konstantina-Eirini Georgopoulou, George Goudouras, Vicky Lianou, Elli Kampra, Angeliki Victoria Roussaki Schulze and Efterpi Zafiriou

Medicina 2024, 60(7), 1177; https://doi.org/10.3390/medicina60071177 - 20 Jul 2024

Cited by 2 | Viewed by 1253

Abstract

The Koebner phenomenon (KP), also known as the isomorphic response, describes the process by which new lesions that are clinically and histologically identical to a patient’s existing skin disease develop following trauma. Many skin diseases exhibit this characteristic, with variations that include possible, [...] Read more.

The Koebner phenomenon (KP), also known as the isomorphic response, describes the process by which new lesions that are clinically and histologically identical to a patient’s existing skin disease develop following trauma. Many skin diseases exhibit this characteristic, with variations that include possible, questionable, and pseudo-Koebner reactions, with the latter category occurring due to infectious agents seeding at a trauma site. Laser application, a type of controlled skin injury used for improving cutaneous lesions and skin rejuvenation, is also considered a form of trauma. This raises the question of whether controlled thermal injury can be regarded as a type of mechanical trauma capable of producing Koebner-related reactions. We conducted a literature review of cases or studies to identify laser-induced dermatoses that correspond to Koebner-related or pathergy reaction categories. As a whole, we identified nine case reports on true KPs, two cases on possible KPs, seventeen cases on laser-induced questionable KPs comprising cases of vasculitis, eczema or Meyerson reactions, and eruptive squamous atypia cases (ESA) as well as two pseudo-Koebner cases involving wart occurrences at laser application sites. Laser-induced Koebner reactions highlight several aspects of the KP. Firstly, the type of mechanical damage influences disease promotion, as different lasers are associated with different KPs. For example, hair removal lasers are linked with true and questionable KPs such as vasculitis while resurfacing lasers were found to be more connected with ESA occurrence. Secondly, the laser target is significant, with vascular laser application for port-wine stains tending to result in eczematous reactions, while hair follicle destruction can frequently lead to true KPs. Thirdly, the number of sessions matters; true KPs and eruptive squamous atypia questionable KPs typically appear after one to two sessions, whereas eczematous reactions require more sessions (at least four). Additionally, skin phototype is crucial, with darker phototypes showing a higher KP frequency as laser treatment for hypertrichosis relies on melanin absorption in the hair bulge or bulb for follicle destruction, as chromophore competes with the abundant melanin in the epidermis. Further research with larger-scale studies into trauma-specific Koebner reactions is vital for refining treatment protocols, minimizing post-laser adverse effects, and improving dermatological care outcomes. Full article

(This article belongs to the Special Issue Inflammatory Skin Diseases and Comorbidities)

10 pages, 294 KiB

Open AccessArticle

The Influence of Dental Status and Blood Parameters Characterizing Endogenous Intoxication on the Timing of Childbirth

by Maria Hakobyan, Gayane Manrikyan, Marina Markaryan, Izabella Vardanyan and Mikayel Manrikyan

Medicina 2024, 60(7), 1176; https://doi.org/10.3390/medicina60071176 - 19 Jul 2024

Viewed by 829

Abstract

Background and Objectives: Epidemiological and microbiological–immunological studies have led to the conclusion that periodontal disease may be a risk factor for preterm birth. The aim of this study was to investigate and identify the relationship of some hematological cellular biomarkers characterizing the [...] Read more.

Background and Objectives: Epidemiological and microbiological–immunological studies have led to the conclusion that periodontal disease may be a risk factor for preterm birth. The aim of this study was to investigate and identify the relationship of some hematological cellular biomarkers characterizing the chronic oral focus of infection with pregnancy outcomes and their impact on those outcomes. Materials and Methods: Clinical and laboratory tests were conducted on 100 pregnant women, grouped by full-term or preterm births, with the assessment of the following markers: DMF, CPI and PIRI, PHP, microbiological examination of periodontal pockets and amniotic fluid, WBS count, WBCSI, LGI, and NMR. A statistical analysis was carried out with SPSS Statistics version 19.0. Results: Women with preterm labor had higher-grade caries (CSL > 0.3), while women with full-term childbirth had moderate caries (CSL < 0.3). A satisfactory level of oral hygiene efficiency was found in 50% (group 1) and 38.1% (group 2) of the expectant mothers. The periodontal status by the PIRI showed tissue lesions in 20.7% (group 1) and 92.9% (group 2) of the women. The WBCSI was 2.27 ± 0.82 and 2.15 ± 0.68, the NMR was 9.29 ± 5.119 and 11.62 ± 7.78, and the LGI was 3.54 ± 1.1 and 3.73 ± 0.81 in groups 1 and 2, respectively. Comparative analysis of bacterial contamination of the amniotic fluid revealed the predominance of Fusobacterium nucleatum (64.3%), Tannerella forsythia (57.1%), Prevotella intermedia (50%), Porphyromonas gingivalis (57.1%), Staphylococcus aureus (45.2%), and Candida albicans (50%) in women with premature birth. Conclusions: In women with preterm birth, the values of the indices characterizing a chronic oral focus of infection evoke more significant correlations with the timing of delivery, which indicates the significant role of an oral focus of infection. The presence of microbial invasion of amniotic fluid may indicate the role of periodontopathogenic bacteria in pregnant women diagnosed with a risk of preterm birth. Full article

(This article belongs to the Special Issue Advances in Clinical Medicine and Dentistry)

11 pages, 2430 KiB

Open AccessArticle

Unveiling Bladder Cancer Prognostic Insights by Integrating Patient-Matched Sample and CpG Methylation Analysis

by Chanbyeol Kim, Sangwon Oh, Hamin Im and Jungsoo Gim

Medicina 2024, 60(7), 1175; https://doi.org/10.3390/medicina60071175 - 19 Jul 2024

Viewed by 1125

Abstract

Bladder cancer prognosis remains a pressing clinical challenge, necessitating the identification of novel biomarkers for precise survival prediction and improved quality of life outcomes. This study proposes a comprehensive strategy to uncover key prognostic biomarkers in bladder cancer using DNA methylation analysis and [...] Read more.

Bladder cancer prognosis remains a pressing clinical challenge, necessitating the identification of novel biomarkers for precise survival prediction and improved quality of life outcomes. This study proposes a comprehensive strategy to uncover key prognostic biomarkers in bladder cancer using DNA methylation analysis and extreme survival pattern observations in matched pairs of cancer and adjacent normal cells. Unlike traditional approaches that overlook cancer heterogeneity by analyzing entire samples, our methodology leverages patient-matched samples to account for this variability. Specifically, DNA methylation profiles from adjacent normal bladder tissue and bladder cancer tissue collected from the same individuals were analyzed to pinpoint critical methylation changes specific to cancer cells while mitigating confounding effects from individual genetic differences. Utilizing differential threshold settings for methylation levels within cancer-associated pathways enabled the identification of biomarkers that significantly impact patient survival. Our analysis identified distinct survival patterns associated with specific CpG sites, underscoring these sites’ pivotal roles in bladder cancer outcomes. By hypothesizing and testing the influence of methylation levels on survival, we pinpointed CpG biomarkers that profoundly affect the prognosis. Notably, CpG markers, such as cg16269144 (PRKCZ), cg16624272 (PTK2), cg11304234, and cg26534425 (IL18), exhibited critical methylation thresholds that correlate with patient mortality. This study emphasizes the importance of tailored approaches to enhancing prognostic accuracy and refining therapeutic strategies for bladder cancer patients. The identified biomarkers pave the way for personalized prognostication and targeted interventions, promising advancements in bladder cancer management and patient care. Full article

(This article belongs to the Section Oncology)

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16 pages, 2665 KiB

Open AccessArticle

The Role of Programmed Cell Death 1/Programmed Death Ligand 1 (PD-1/PD-L1) Axis in Sepsis-Induced Apoptosis

by Oana Coman, Bianca-Liana Grigorescu, Adina Huțanu, Anca Bacârea, Anca Meda Văsieșiu, Raluca Ștefania Fodor, Florin Stoica and Leonard Azamfirei

Medicina 2024, 60(7), 1174; https://doi.org/10.3390/medicina60071174 - 19 Jul 2024

Viewed by 910

Abstract

Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its [...] Read more.

Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its pathways, by assessing changes in PD-1 and PD-L1 serum levels, CD4+ and CD8+ T cells, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) severity scores. Materials and Methods: This prospective, observational, single-centre study enrolled 87 sepsis patients admitted to the intensive care unit at the County Emergency Clinical Hospital in Târgu Mureș, Romania. We monitored the parameters on day 1 (the day sepsis or septic shock was diagnosed as per the Sepsis-3 Consensus) and day 5. Results: Our study found a statistically significant variation in the SOFA score for the entirety of the patients between the studied days (p = 0.001), as well as for the studied patient groups: sepsis, septic shock, survivors, and non-survivors (p = 0.001, p = 0.003, p = 0.01, p = 0.03). On day 1, we found statistically significant correlations between CD8+ cells and PD-1 (p = 0.02) and PD-L1 (p = 0.04), CD4+ and CD8+ cells (p < 0.0001), SOFA and APACHE II scores (p < 0.0001), and SOFA and APACHE II scores and PD-L1 (p = 0.001 and p = 0.01). On day 5, we found statistically significant correlations between CD4+ and CD8+ cells and PD-L1 (p = 0.03 and p = 0.0099), CD4+ and CD8+ cells (p < 0.0001), and SOFA and APACHE II scores (p < 0.0001). Conclusions: The reduction in Th CD4+ and Tc CD8+ lymphocyte subpopulations were evident from day 1, indicating that apoptosis is a crucial factor in the progression of sepsis and septic shock. The increased expression of the PD-1/PD-L1 axis impairs costimulatory signalling, leading to diminished T cell responses and lymphopenia, thereby increasing the susceptibility to nosocomial infections. Full article

(This article belongs to the Special Issue Management of Septic Shock in ICU)

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Distribution by age. Full article ">Figure 2
SOFA score variation, for the entire amount of patients, between day 1 and day 5. Full article ">Figure 3
Statistically significant negative correlation between lymphocyte subtypes, Th CD4+ and Tc CD8+, on day 1—p < 0.0001 and day 5—p < 0.0001, after confirmation of either sepsis or septic shock. Full article ">Figure 4
SOFA score variation for septic patients between day 1 and day 5. Full article ">Figure 5
SOFA and PD-L1 score variation for septic shock patients between day 1 and day 5. Full article ">Figure 6
Receiver operating characteristic curve for Tc cells (CD8+) and septic shock (area under the curve: 0.64; p = 0.028). Full article ">Figure 7
SOFA score variation between day 1 and day 5 for survivor and non-survivor groups. Full article ">

18 pages, 808 KiB

Open AccessSystematic Review

The Complex Role of Mast Cells in Head and Neck Squamous Cell Carcinoma: A Systematic Review

by Sofia-Eleni Tzorakoleftheraki and Triantafyllia Koletsa

Medicina 2024, 60(7), 1173; https://doi.org/10.3390/medicina60071173 - 19 Jul 2024

Viewed by 1252

Abstract

Background and Objectives: Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous malignancy influenced by various genetic and environmental factors. Mast cells (MCs), typically associated with allergic responses, have recently emerged as key regulators of the HNSCC tumor microenvironment (TME). This [...] Read more.

Background and Objectives: Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous malignancy influenced by various genetic and environmental factors. Mast cells (MCs), typically associated with allergic responses, have recently emerged as key regulators of the HNSCC tumor microenvironment (TME). This systematic review explores the role of MCs in HNSCC pathogenesis and their potential as prognostic markers and therapeutic targets. Materials and Methods: A systematic search was conducted in the PubMed, Scopus and ClinicalTrials.gov databases until 31 December 2023, using “Mast cells” AND “Head and neck squamous cell carcinoma” as search terms. Studies in English which reported on MCs and HNSCC were included. Screening, data extraction and analysis followed PRISMA guidelines. No new experiments were conducted. Results: Out of 201 articles, 52 studies met the inclusion criteria, 43 of which were published between 2020 and 2023. A total of 28821 HNSCC and 9570 non-cancerous tissue samples had been examined. MC density and activation varied among normal tissues and HNSCC. Genetic alterations associated with MCs were identified, with specific gene expressions correlating with prognosis. Prognostic gene signatures associated with MC density were established. Conclusions: MCs have arisen as multifaceted TME modulators, impacting various aspects of HNSCC development and progression. Possible site-specific or HPV-related differences in MC density and activation should be further elucidated. Despite conflicting findings on their prognostic role, MCs represent promising targets for novel therapeutic strategies, necessitating further research and clinical validation for personalized HNSCC treatment. Full article

(This article belongs to the Section Oncology)

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10 pages, 2469 KiB

Open AccessCase Report

Mimicry of Rhabdomyosarcoma by Tonsillar Actinomycosis: Case Report

by John Fernando Montenegro Palacios, Shirley Vanessa Correa Forero, Gaby Alejandra Ordoñez Andrade, Jasbleidy Posu Barco, Luis Alvaro Melo Burbano and Yamil Liscano

Medicina 2024, 60(7), 1172; https://doi.org/10.3390/medicina60071172 - 19 Jul 2024

Viewed by 1007

Abstract

Actinomycosis is a rare infectious disease characterized by slowly progressive, chronic suppurative lesions, often mistaken for malignancies due to its ability to mimic them. It is caused by Actinomyces bacteria, which are part of the normal flora of the human oropharynx, gastrointestinal, and [...] Read more.

Actinomycosis is a rare infectious disease characterized by slowly progressive, chronic suppurative lesions, often mistaken for malignancies due to its ability to mimic them. It is caused by Actinomyces bacteria, which are part of the normal flora of the human oropharynx, gastrointestinal, and urogenital tracts. This case report describes a 51-year-old male with a history of mandibular rhabdomyosarcoma presenting with severe shoulder and hip pain, dysphagia, and headaches, initially suspected to be a cancer recurrence. However, after further investigation, including a PET-CT and tonsillectomy, the diagnosis of actinomycosis was confirmed through histopathological examination. The case highlights the diagnostic challenges of actinomycosis, especially in patients with complex clinical histories, emphasizing the importance of considering it as a differential diagnosis in similar presentations. The patient was treated with long-term antibiotic therapy, predominantly beta-lactams, demonstrating the necessity of a comprehensive diagnostic approach and the implications of a delayed diagnosis. This case underscores the critical need for high clinical suspicion and awareness among healthcare professionals regarding the potential for actinomycosis to mimic more common diseases, ensuring timely and accurate treatment. Full article

(This article belongs to the Section Infectious Disease)

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(A) Nodule in the right pharynx and palatoglossal arch measuring 22 × 10 mm, SUV 6.5 (red arrow). (B) Hypermetabolic nodular thickening of the right lateral pharyngeal wall, nonspecific, suspicious of neoplastic involvement (red arrows). Full article ">Figure 2
Magnetic resonance imaging of paranasal sinuses showing irregular enhancement forming a mass that involves the mucopharyngeal space and the right palatine tonsil (red arrows). Full article ">Figure 3
Contrast-enhanced magnetic resonance imaging of the neck: irregular enhancement, forming a mass that involves the mucopharyngeal space and the right palatine tonsil, extending to the tongue base, with a neoplastic appearance (red arrows). Full article ">Figure 4
Immunohistochemistry (Olympus CX33 microscope). Lymphoid tissue with follicles of various sizes and shapes at the level of the cortex. (A). Magnification 100×: Reactive germinal centers with marked phagocytosis and Actinomycosis filamentary bacteria on the surface of sulfur granules (red arrow). (B). Magnification of 200×: The germinal centers are surrounded by a mantle of mature lymphocytes cured in sulfur granules due to actinomycosis (red arrow). (C). Magnification of 50×: In the crypts, detritus and clusters of polymorphonuclear cells and colonies of filamentous bacteria are present, compatible with Actinomyces spp. As observed, the arrow on the left indicates the polymorphonuclear reaction and the arrow on the right shows colonies of filamentous bacteria. Full article ">

14 pages, 1925 KiB

Open AccessReview

Antimalarial Drugs at the Intersection of SARS-CoV-2 and Rheumatic Diseases: What Are the Potential Opportunities?

by Saule Abisheva, Kristina Rutskaya-Moroshan, Gulnaz Nuranova, Tansholpan Batyrkhan and Anilim Abisheva

Medicina 2024, 60(7), 1171; https://doi.org/10.3390/medicina60071171 - 19 Jul 2024

Viewed by 1125

Abstract

Background and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has posed a serious threat to humanity and is considered a global health emergency. Antimalarial drugs (ADs) have been used in the treatment of immuno-inflammatory arthritis (IIA) and coronavirus infection (COVID-19). The [...] Read more.

Background and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has posed a serious threat to humanity and is considered a global health emergency. Antimalarial drugs (ADs) have been used in the treatment of immuno-inflammatory arthritis (IIA) and coronavirus infection (COVID-19). The aim of this review is to analyze the current knowledge about the immunomodulatory and antiviral mechanisms of action, characteristics of use, and side effects of antimalarial drugs. Material and Methods: A literature search was carried out using PubMed, MEDLINE, SCOPUS, and Google Scholar databases. The inclusion criteria were the results of randomized and cohort studies, meta-analyses, systematic reviews, and original full-text manuscripts in the English language containing statistically confirmed conclusions. The exclusion criteria were summary reports, newspaper articles, and personal messages. Qualitative methods were used for theoretical knowledge on antimalarial drug usage in AIRDs and SARS-CoV-2 such as a summarization of the literature and a comparison of the treatment methods. Results: The ADs were considered a “candidate” for the therapy of a new coronavirus infection due to mechanisms of antiviral activity, such as interactions with endocytic pathways, the prevention of glycosylation of the ACE2 receptors, blocking sialic acid receptors, and reducing the manifestations of cytokine storms. The majority of clinical trials suggest no role of antimalarial drugs in COVID-19 treatment or prevention. These circumstances do not allow for their use in the treatment and prevention of COVID-19. Conclusions: The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for COVID-19. Furthermore, the need for high doses in the treatment of viral infections increases the likelihood of gastrointestinal side effects, the prolongation of QT, and retinopathy. Large randomized clinical trials (RCTs) have refuted the fact that there is a positive effect on the course and results of COVID-19. Full article

(This article belongs to the Section Infectious Disease)

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10 pages, 1867 KiB

Open AccessArticle

Short-Term Comparison of Switching to Brolucizumab or Faricimab from Aflibercept in Neovascular AMD Patients

by Akiko Kin, Takahiro Mizukami, Satoru Ueno, Soichiro Mishima and Yoshikazu Shimomura

Medicina 2024, 60(7), 1170; https://doi.org/10.3390/medicina60071170 - 19 Jul 2024

Viewed by 1526

Abstract

Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal [...] Read more.

Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. Materials and Methods: This observational clinical study included 20 eyes of 20 patients switched to brolucizumab and 15 eyes of 14 patients switched to faricimab from aflibercept in eyes with nAMD. We measured the structural outcome (central macular thickness (CMT)) and the visual outcome (best-corrected visual acuity (BCVA); logMAR) as follows: just before the most recent IVA injection (B0), one month after the most recent IVA injection (B1), just before the first IVBr or IVF injection (A0), one month after (A1) and three months after (A3) the first IVBr or IVF injection. Results: BCVA showed significant improvement at A1 (0.25 ± 0.34) and at A3 (0.19 ± 0.24) compared to A0 (0.38 ± 0.35) in the IVBr group (p = 0.0156, p = 0.0166, respectively). CMT (μm) was significantly thinner at A1 (IVBr: 240.55 ± 51.82, IVF: 234.91 ± 47.29) and at A3 (IVBr: 243.21 ± 76.15, IVF: 250.50 ± 72.61) compared to at A0 (IVBr: 303.55 ± 79.18, IVF: 270.33 ± 77.62) in the IVBr group (A1: p = 0.0093, A3: p = 0.0026) and in the IVF group (A1: p = 0.0161, A3: p = 0.0093). There was no significant difference in BCVA and CMT improvement observed between two groups at any time point (p > 0.05 for all). Conclusions: Switching from aflibercept to either brolucizumab or faricimab has a significant anatomical effect in eyes with nAMD and both treatments appear to be effective short-term treatment options. There is a trend towards greater visual improvements and reductions in CMT with brolucizumab. Full article

(This article belongs to the Section Ophthalmology)

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Timepoints evaluated in this study. Patients were evaluated at five time points: just before (B0) and one month after the most recent intravitreal aflibercept (IVA) injection (B1), and just before (A0), one month after (A1) and three months after (A3) the first intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injection. Full article ">Figure 2
The mean best-corrected visual acuity (BCVA) of the IVBr and IVF groups at each time point. Both groups showed no significant improvement in BCVA at B1 compared to at B0 (p > 0.05 for all). The IVBr group showed significant improvements in BCVA at A1 and at A3 compared to at A0 (A1, p = 0.0156; A3, p = 0.0166). No significant improvement in BCVA was observed in the IVF group at A1 and at A3 compared to at A0 (p > 0.05 for all). *: p < 0.05. Full article ">Figure 3
There was no significant difference in BCVA improvement observed at either A1 or A3 between two groups (p > 0.05 for all). Full article ">Figure 4
The mean central macular thickness (CMT (μm)) of the IVBr and IVF groups at each time point. No significant improvements in CMT were observed at B1 compared to B0 in either group (p > 0.05 for all). Both groups showed significant improvements in CMT at A1 (IVF, p = 0.0093; IVBr, p = 0.0161) and at A3 (IVF, p = 0.0026; IVBr, p = 0.0093) compared to at A0. *: p < 0.05. Full article ">Figure 5
There was no significant difference in CMT improvement observed at either A1 or A3 between the two groups (p > 0.05 for all). Full article ">Figure 6
A representative case of switching from IVA to IVBr in eyes with nAMD. Optical coherence tomographic scans going through the fovea at B0, B1, A0, A1 and A3. After switching to brolucizumab from aflibercept, decreases in CMT and the height of the pigment epithelial detachment were observed. N, nasal; T, temporal. Full article ">

18 pages, 736 KiB

Open AccessSystematic Review

Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers

by Kella L. Vangsness, Jonathan Juste, Andre-Philippe Sam, Naikhoba Munabi, Michael Chu, Mouchammed Agko, Jeff Chang and Antoine L. Carre

Medicina 2024, 60(7), 1169; https://doi.org/10.3390/medicina60071169 - 19 Jul 2024

Viewed by 1324

Abstract

Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but [...] Read more.

Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients. Full article

(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)

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9 pages, 1384 KiB

Open AccessArticle

Annual Trends of High Tibial Osteotomy: Analysis of an Official Registry in Italy

by Umile Giuseppe Longo, Alessandro Mazzola, Stefano Campi, Giuseppe Salvatore, Vincenzo Candela, Carlo Casciaro, Diana Giannarelli, Margaux D’Hooghe and Rocco Papalia

Medicina 2024, 60(7), 1168; https://doi.org/10.3390/medicina60071168 - 19 Jul 2024

Cited by 2 | Viewed by 1396

Abstract

Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high [...] Read more.

Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50–54, 55–59 showed the higher number of procedures. In pediatric patients (0–19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were “Varus knee” (736.42 ICD-9-CM code, 33.9%), “Osteoarthrosis, localized, primary, leg region” (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20–24 age class to the 50–54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients. Full article

(This article belongs to the Special Issue Current Updates and Future Perspectives on Orthopedic Trauma, Fracture Management and Rehabilitation)

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8 pages, 274 KiB

Open AccessArticle

Factors Associated with Postpartum Depression among Women in Eastern Sudan: A Cross-Sectional Study

by Khalid Nasralla, Saeed Omar, Ghusun Alharbi, Fai Aljarallah, Nadiah AlHabardi and Ishag Adam

Medicina 2024, 60(7), 1167; https://doi.org/10.3390/medicina60071167 - 19 Jul 2024

Viewed by 1209

Abstract

Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have [...] Read more.

Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have been conducted in Eastern Sudan. This study aims to evaluate the factors associated with postpartum depression among Sudanese women in Gadarif in Eastern Sudan. Materials and Methods: A cross-sectional study (using the systematic random sampling technique) of women presenting to Gadarif Maternity Hospital for postnatal follow-up within six weeks of childbirth was conducted. A questionnaire was used to collect sociodemographic information, and the Edinburgh Postnatal Depression Scale was used to assess postpartum depression. Results: Three hundred women were enrolled in the study. The median (interquartile) age and parity were 30.0 (25.0–34.0) years and 2 (1–4). Thirty-one (10.3%) of the women had postpartum depression. A univariate analysis showed that a past history of depression was the only factor associated with postpartum depression (OR = 3.04, 95% CI = 1.03–8.97). Other investigated factors (age, parity, educational level, occupation, history of previous miscarriage or intrauterine fetal death, a family history of depression, financial support, medical insurance, whether the pregnancy was planned or not, and if the gender of the newborn was known before delivery) were not associated with postpartum depression. Conclusions: The current study showed that 1 out of 10 women had postpartum depression that was associated with a past history of depression. Factors that have been reported to be associated with postpartum depression in African countries (age, parity, education, and occupation) were not found to be associated in this study. Mental health assessment needs to be employed for women in their antenatal and postpartum periods. Full article

(This article belongs to the Section Obstetrics and Gynecology)

9 pages, 988 KiB

Open AccessArticle

Barriers against Implementation of European Society of Gastrointestinal Endoscopy Performance Measures for Colonoscopy in Clinical Practice

by Giulia Gibiino, Leonardo Frazzoni, Andrea Anderloni, Lorenzo Fuccio, Alessandro Lacchini, Cristiano Spada and Carlo Fabbri

Medicina 2024, 60(7), 1166; https://doi.org/10.3390/medicina60071166 - 19 Jul 2024

Viewed by 877

Abstract

Background and Objectives: The implementation and monitoring of the European Society of Gastrointestinal Endoscopy (ESGE) performance measures for colonoscopy are suboptimal in clinical practice. Electronic reporting systems may play an important role in data retrieval. We aimed to define the possibility of systematically [...] Read more.

Background and Objectives: The implementation and monitoring of the European Society of Gastrointestinal Endoscopy (ESGE) performance measures for colonoscopy are suboptimal in clinical practice. Electronic reporting systems may play an important role in data retrieval. We aimed to define the possibility of systematically assessing and monitoring ESGE performance measures for colonoscopy through reporting systems. Materials and Methods: We conducted a survey during a nationwide event on the quality of colonoscopy held in Rome, Italy, in March 2023 by a self-administered questionnaire. Analyses were conducted overall and by workplace setting. Results: The attendance was 93% (M/F 67/26), with equal distribution of age groups, regions and public or private practices. Only about one-third (34%) and 21.5% of participants stated that their reporting system allows them to retrieve all the ESGE performance measures, overall and as automatic retrieval, respectively. Only 66.7% and 10.7% of respondents can systematically report the cecal intubation and the adenoma detection rate, respectively. The analysis according to hospital setting revealed no significant difference for all the items. Conclusions: We found a generalized lack of systematic tracking of performance measures for colonoscopy due to underperforming reporting systems. Our results underline the need to update reporting systems to monitor the quality of endoscopy practice in Italy. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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10 pages, 637 KiB

Open AccessArticle

Progranulin and Vaspin as Potential Novel Markers in the Etiology of Type 1 Diabetes in Children

by Katarzyna Jakubek-Kipa, Sabina Galiniak and Artur Mazur

Medicina 2024, 60(7), 1165; https://doi.org/10.3390/medicina60071165 - 19 Jul 2024

Viewed by 1005

Abstract

Background and Objectives: Diabetes is a significant health problem, prompting the search for new therapeutic strategies. Recently, researchers have focused on identifying novel markers for the progression of this condition. It is well established that adipokines, such as progranulin and vaspin, play crucial [...] Read more.

Background and Objectives: Diabetes is a significant health problem, prompting the search for new therapeutic strategies. Recently, researchers have focused on identifying novel markers for the progression of this condition. It is well established that adipokines, such as progranulin and vaspin, play crucial roles in regulating lipid and carbohydrate metabolism. Materials and Methods: This single-center cross-sectional study aimed to assess serum progranulin and vaspin levels in 80 children diagnosed with type 1 diabetes (T1D) and to examine their correlation with body mass index (BMI), glycated hemoglobin, and lipid profile. The cohort included 40 children newly diagnosed with diabetes, 40 children with long-term diabetes (20 well-controlled and 20 poorly controlled), and 14 non-diabetic children as a control group. Progranulin and vaspin levels were determined using a sandwich enzyme-linked immunosorbent assay. Results: There were no significant differences in the progranulin and vaspin concentrations in the studied groups (p = 0.246 and p = 0.095, respectively). No statistically significant differences were noted in the levels of both adipokines among boys and girls within the T1D, well-controlled T1D, and poorly controlled T1D groups. We did not find any differences in the progranulin and vaspin levels among all children with T1D and healthy controls when divided based on BMI percentiles. A negative correlation was observed between progranulin concentration and the age of children in the T1D, well-controlled T1D, and healthy groups. Furthermore, progranulin correlated negatively with BMI among children with T1D. In contrast, vaspin concentration correlated positively with age among healthy children. Conclusions: Our study provides novel insights into the status of progranulin and vaspin among pediatric participants with varying levels of type 1 diabetes control. However, further research involving larger patient cohorts and different stages of sexual maturation is warranted. Full article

(This article belongs to the Section Endocrinology)

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8 pages, 2502 KiB

Open AccessBrief Report

Handheld 6-Lead ECG for Early Detection of Acute Inferior Wall ST-T Segment Elevation Myocardial Infarction: HINT-MI Study Design and Rationale

by Sodam Jung, In-Sook Kang, Sanghoon Shin, Choongki Kim and Junbeom Park

Medicina 2024, 60(7), 1164; https://doi.org/10.3390/medicina60071164 - 18 Jul 2024

Viewed by 1113

Abstract

Background: ST-T segment elevation myocardial infarction (STEMI) is a critical condition that requires rapid diagnosis and treatment. Recently, various ECG recording devices have been developed. In this study, we aim to determine the utility of a 6-lead handheld ECG recording device to [...] Read more.

Background: ST-T segment elevation myocardial infarction (STEMI) is a critical condition that requires rapid diagnosis and treatment. Recently, various ECG recording devices have been developed. In this study, we aim to determine the utility of a 6-lead handheld ECG recording device to shorten the time taken for the diagnosis of inferior wall STEMI. Methods and Design: HINT-MI is an investigator-derived, observational, prospective study that will evaluate the ability of a handheld 6-lead ECG device to diagnose acute inferior wall STEMI. Patients who have undergone coronary angiography for STEMI or for other reasons will be enrolled in the study. This study aims to evaluate sensitivity and specificity of a handheld 6-lead ECG device by the level of agreement with a standard 12-lead ECG for diagnosing inferior wall STEMI. Further, we will determine whether the use of the handheld device can reduce the time needed for reperfusion treatment through faster diagnosis. Conclusions: This study aims to investigate the feasibility of a handheld 6-lead ECG device for diagnosing inferior wall STEMI to reduce the time required to diagnose inferior wall STEMI and to allow timely treatment. Full article

(This article belongs to the Special Issue Clinical Cardiology in a New Era: Navigating Challenges and Embracing Opportunities)

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3 pages, 188 KiB

Open AccessEditorial

Atypical Autism: Causes, Diagnosis and Support

by Rekha Jagadapillai

Medicina 2024, 60(7), 1163; https://doi.org/10.3390/medicina60071163 - 18 Jul 2024

Viewed by 1340

Abstract

Autism spectrum disorder (ASD) is a group of neurobehavioral disorders defined by persistent deficits in social communication and social interactions with repetitive behaviors, and it is typically diagnosed within the first three years of life [...] Full article

(This article belongs to the Special Issue Atypical Autism: Causes, Diagnosis, and Support)

14 pages, 994 KiB

Open AccessReview

Diagnostic Value of Cardiovascular Magnetic Resonance T1 and T2 Mapping in Acute Myocarditis: A Systematic Literature Review

by Karolina Gaizauskiene, Kamile Leketaite, Sigita Glaveckaite and Nomeda Valeviciene

Medicina 2024, 60(7), 1162; https://doi.org/10.3390/medicina60071162 - 18 Jul 2024

Cited by 1 | Viewed by 1216

Abstract

Background and Objectives: Over the past decade, there has been increasing attention paid to advanced and innovative cardiovascular magnetic resonance (CMR) modalities, such as T1 and T2 mapping, which play a major role in diagnosing diffuse myocardial disease. There is little data [...] Read more.

Background and Objectives: Over the past decade, there has been increasing attention paid to advanced and innovative cardiovascular magnetic resonance (CMR) modalities, such as T1 and T2 mapping, which play a major role in diagnosing diffuse myocardial disease. There is little data summarizing the current evidence regarding the diagnostic accuracy of T1 and T2 mapping, and extracellular volume (ECV) in acute myocarditis. The aim of our study was to select, analyze, and systematically review the recent scientific literature on the diagnostic value of CMR T1 and T2 parametric mapping in clinically suspected acute myocarditis. Materials and Methods: The literature search was performed in the PubMed database. Articles published in the years 2014–2024 were included in the analysis. At the initial stage, 458 articles were reviewed, and 13 exploratory research studies were further analyzed and presented in this systematic literature review. Results: The analysis included 686 patients with clinically suspected myocarditis and 372 subjects in the control group. The average age of patients with suspected myocarditis was 40.25 years; 26% of them were women. Prolonged native myocardial T1 relaxation time provides diagnostic accuracy in the setting of suspected acute myocarditis ranging from 69 to 99%, with sensitivity from 64 to 98% and specificity from 87 to 100%. Diagnostic accuracy of prolonged T2 relaxation time ranges from 47 to 87%, with sensitivity being from 48% to 94% and specificity from 60% to 92%. ECV alone showed moderate diagnostic performance, with diagnostic accuracy ranging from 62% to 76%, sensitivity from 47% to 73%, and specificity from 76% to 90%. T1 and T2 mapping and ECV, combined with the late gadolinium enhancement (LGE) technique, increases the probability of detecting myocardial inflammatory changes at various stages of the disease, improving the diagnostic accuracy to 96%. Conclusions: New quantitative CMR techniques, i.e., T1 and T2 mapping, have an advantage over conventional CMR sequences in detecting inflammatory myocardial structural changes and play an important role in diagnosing acute myocarditis. Incorporating these sequences in daily clinical practice increases the diagnostic value of CMR in acute myocarditis and becomes an alternative to endomyocardial biopsy, which has been considered the gold standard until now. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1227 KiB

Open AccessSystematic Review

The Application of Robotics in Cardiac Rehabilitation: A Systematic Review

by Aseel Aburub, Mohammad Z. Darabseh, Rahaf Badran, Ala’a M. Shurrab, Anwaar Amro and Hans Degens

Medicina 2024, 60(7), 1161; https://doi.org/10.3390/medicina60071161 - 18 Jul 2024

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Abstract

Background and Objectives: Robotics is commonly used in the rehabilitation of neuro-musculoskeletal injuries and diseases. While in these conditions, robotics has clear benefits, it is unknown whether robotics will also enhance the outcome of cardiac rehabilitation. This systematic review evaluates the use [...] Read more.

Background and Objectives: Robotics is commonly used in the rehabilitation of neuro-musculoskeletal injuries and diseases. While in these conditions, robotics has clear benefits, it is unknown whether robotics will also enhance the outcome of cardiac rehabilitation. This systematic review evaluates the use of robotics in cardiac rehabilitation. Methods: A systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus, and the Physiotherapy Evidence Database. Longitudinal interventional studies were included if they met specified criteria. Two reviewers independently conducted title, abstract, and full-text screening and data extraction. The quality assessment and risk of bias were conducted according to the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Four trials were included in this review out of 60 screened studies. The quality of the included studies was good with a low risk of bias. The trials used different robotic systems: Lokomat^® system, Motomed Letto/Thera Trainer tigo, BEAR, and Myosuit. It was found that interventions that included the use of robotic assistance technologies improved the exercise capacity, VO₂ max/peak, left ventricular ejection fraction, QOL, and physical functioning in people with cardiac diseases. Conclusions: Robotic assistance technologies can be used in cardiac rehabilitation programs. Further studies are needed to confirm the results and determine whether the use of robotics enhances intervention outcomes above standard interventions. Full article

(This article belongs to the Section Cardiology)

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19 pages, 8176 KiB

Open AccessArticle

Fatty Acid Synthase Promotes Hepatocellular Carcinoma Growth via S-Phase Kinase-Associated Protein 2/p27^KIP1 Regulation

by Antonio Cigliano, Maria M. Simile, Gianpaolo Vidili, Giovanni M. Pes, Maria P. Dore, Francesco Urigo, Eleonora Cossu, Li Che, Claudio Feo, Sara M. Steinmann, Silvia Ribback, Rosa M. Pascale, Matthias Evert, Xin Chen and Diego F. Calvisi

Medicina 2024, 60(7), 1160; https://doi.org/10.3390/medicina60071160 - 18 Jul 2024

Viewed by 1239

Abstract

Background and Objectives: Aberrant upregulation of fatty acid synthase (FASN), catalyzing de novo synthesis of fatty acids, occurs in various tumor types, including human hepatocellular carcinoma (HCC). Although FASN oncogenic activity seems to reside in its pro-lipogenic function, cumulating evidence suggests that FASN’s [...] Read more.

Background and Objectives: Aberrant upregulation of fatty acid synthase (FASN), catalyzing de novo synthesis of fatty acids, occurs in various tumor types, including human hepatocellular carcinoma (HCC). Although FASN oncogenic activity seems to reside in its pro-lipogenic function, cumulating evidence suggests that FASN’s tumor-supporting role might also be metabolic-independent. Materials and Methods: In the present study, we show that FASN inactivation by specific small interfering RNA (siRNA) promoted the downregulation of the S-phase kinase associated-protein kinase 2 (SKP2) and the consequent induction of p27^KIP1 in HCC cell lines. Results: Expression levels of FASN and SKP2 directly correlated in human HCC specimens and predicted a dismal outcome. In addition, forced overexpression of SKP2 rendered HCC cells resistant to the treatment with the FASN inhibitor C75. Furthermore, FASN deletion was paralleled by SKP2 downregulation and p27^KIP1 induction in the AKT-driven HCC preclinical mouse model. Moreover, forced overexpression of an SKP2 dominant negative form or a p27^KIP1 non-phosphorylatable (p27^KIP1-T187A) construct completely abolished AKT-dependent hepatocarcinogenesis in vitro and in vivo. Conclusions: In conclusion, the present data indicate that SKP2 is a critical downstream effector of FASN and AKT-dependent hepatocarcinogenesis in liver cancer, envisaging the possibility of effectively targeting FASN-positive liver tumors with SKP2 inhibitors or p27^KIP1 activators. Full article

(This article belongs to the Special Issue Advance in the Diagnosis, Treatment and Prognosis of Hepatocellular Carcinoma)

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12 pages, 283 KiB

Open AccessArticle

Post-Partum Clinical and Patient-Reported Outcome Changes in Mothers with Multiple Sclerosis: Findings from the NAPPREMS Study

by Dejan Jakimovski, Katelyn S. Kavak, Kara Patrick, Omid Mirmosayyeb, Svetlana P. Eckert, David Hojnacki and Bianca Weinstock-Guttman

Medicina 2024, 60(7), 1159; https://doi.org/10.3390/medicina60071159 - 18 Jul 2024

Viewed by 1056

Abstract

Background and Objective: Pregnancy in mothers with multiple sclerosis (MS) commonly results in significant changes in disease activity and changes in clinical care, including the discontinuation of disease modifying therapy (DMT). This study aimed at understanding the clinical and patient-reported outcomes (PROs) [...] Read more.

Background and Objective: Pregnancy in mothers with multiple sclerosis (MS) commonly results in significant changes in disease activity and changes in clinical care, including the discontinuation of disease modifying therapy (DMT). This study aimed at understanding the clinical and patient-reported outcomes (PROs) before, during and 1-year after delivery. Materials and Methods: A total of 30 pregnant mothers with MS were recruited as part of the study. Clinical (relapse activity and disability changes), PRO information and MRI outcomes were collected on four separate visits: one baseline visit—0–30 days post-delivery; and 3 follow-up visits at week 24, week 36 and week 52 from the baseline. PRO was assessed using a validated questionnaire called the Fatigue Scale for Motor and Cognitive Function (FSMC). The MRI scans were analyzed, and the count of new T2 lesions and/or contrast-enhancing lesions was determined. Results: The average time between delivery and the start of DMT was 142.5 days. Relapse activity before the pregnancy was numerically linked with the activity during the pregnancy, where up to 57.1% of the activity during pregnancy occurred in pwMS with previously active disease before conception (statistically trending with p = 0.073). The relapse activity after the pregnancy occurred twice as often in pwMS whose MS was clinically active before conception. All five pwMS who experienced a relapse prior to the pregnancy experienced worsening in their physical PRO domain. Conclusions: Pre-pregnancy activity is crucial in the screening of mothers with MS at risk for post-partum relapses, worsening of clinical disability and/or PRO measures. A post-partum MS period may benefit from the routine PRO utilization and screening for its worsening. The inflammatory activity during pregnancy was not associated with short-term disease progression. Full article

(This article belongs to the Section Neurology)

2 pages, 198 KiB

Open AccessReply

Reply to Saleh, C. Comment on “Bažadona et al. The Interconnection between Carotid Intima–Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations. Medicina 2023, 59, 1512”

by Danira Bažadona, Martina Matovinović, Magdalena Krbot Skorić, Hrvoje Grbavac, Andrej Belančić and Branko Malojčić

Medicina 2024, 60(7), 1158; https://doi.org/10.3390/medicina60071158 - 18 Jul 2024

Viewed by 470

Abstract

We would like to begin by expressing our gratitude for the interest shown in our research [...] Full article

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Medicina, Volume 60, Issue 7 (July 2024) – 171 articles

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