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Medicina
Volume 58
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Medicina, Volume 58, Issue 3 (March 2022) – 129 articles

Cover Story (view full-size image): The most common abnormality of gait in ambulant children with cerebral palsy is toe walking, also known as equinus gait. Surgical management is effective in correcting the stance phase of gait, permitting the foot to be placed flat on the ground. However, the effects on swing phase, when the foot is moving through space, are not well understood. Poor swing phase function can cause foot drop gait, tripping, and falling, due to reduced function of the ankle dorsiflexor muscles. This study reviews the literature on ankle dorsiflexor function after surgery for equinus deformity. View this paper
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10 pages, 662 KiB  
Article
3D Master Toothguide Is Adequate to Subjective Shade Selection?
by Cristina Gómez-Polo, Miguel Gómez-Polo, Norberto Quispe López, Maria Portillo Muñoz and Javier Montero
Medicina 2022, 58(3), 457; https://doi.org/10.3390/medicina58030457 - 21 Mar 2022
Cited by 8 | Viewed by 2513
Abstract
Background and Objectives: To study the validity and the degree of representability of the toothguide 3D Master, with 26 physically shade tabs, on the natural tooth colour on a sample of the Spanish population. Materials and Methods: Natural tooth colour was measured in [...] Read more.
Background and Objectives: To study the validity and the degree of representability of the toothguide 3D Master, with 26 physically shade tabs, on the natural tooth colour on a sample of the Spanish population. Materials and Methods: Natural tooth colour was measured in a sample of 1361 Spanish participants of both genders distributed within an age range of 18 and 89 years of age. The colour coordinates were calculated and the frequency of the 26 physically shade tabs of the toothguide as well as the “intermediate shades” (without physical representation in toothguide) through the Easyshade Compact (Vita-Zahnfabrik) spectrophotometer using the 3D Master System nomenclature. The colour differences between the “intermediate shades” were calculated using the Euclidean formula (ΔEab*). The program used for the present descriptive statistical analysis of the results was SAS 9.1.3. Results: A total of 49 “intermediate shades” were registered in 816 participants (60%). The colour coordinates of the 49 ‘intermediate shades’ cover colour coordinates ranging from 0M1.5 (L* 100.0, C* 7.70, h* 112.2) to 5M2.5 (L* 56.8, C* 35.8, h* 78.5). Not all possible 3D Master System’s “intermediate shades” were registered in the population studied. 82.4% of the colour differences among the “intermediate shades” were clinically unacceptable (ΔEab* ≥ 5.5 units). Conclusions: Only 40% of the population studied presented a natural tooth colour belonging to the 3D Master Toothguide’s physical shade tabs. Full article
(This article belongs to the Section Dentistry and Oral Health)
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<p>Graphical representation of methodology.</p> Full article ">Figure 2
<p>The Easyshade compact spectrophotometer.</p> Full article ">
20 pages, 6011 KiB  
Review
Hidden in the Eyes—Recurrence of Systemic Hemopathies Reportedly “In Remission”: Six Cases and Review of Literature
by Margot Denier, Sarah Tick, Romain Dubois, Remy Dulery, Andrew W. Eller, Felipe Suarez, Barbara Burroni, Claude-Alain Maurage, Claire Bories, Johanna Konopacki, Michel Puech, Didier Bouscary, Alberte Cantalloube, Emmanuel Héron, Ambroise Marçais, Christophe Habas, Vincent Theillac, Chafik Keilani, Gabrielle R. Bonhomme, Denise S. Gallagher, Julien Boumendil, Wajed Abarah, Neila Sedira, Stéphane Bertin, Sylvain Choquet, José-Alain Sahel, Lilia Merabet, Françoise Brignole-Baudouin, Marc Putterman and Marie-Hélène Erreraadd Show full author list remove Hide full author list
Medicina 2022, 58(3), 456; https://doi.org/10.3390/medicina58030456 - 21 Mar 2022
Cited by 5 | Viewed by 3240
Abstract
Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients [...] Read more.
Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient’s progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient’s ocular symptoms after treatment. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Uveitis)
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<p>(<b>A</b>–<b>F</b>). Case 1. (<b>A</b>) Right eye color fundus (<b>B</b>) and red-free photographs showing a papilledema; (<b>C</b>) Early (on the left) and late (on the right) frame of fluorescein angiography showing dye leakage from the optic nerve; (<b>D</b>) Indocyanine green angiography early (on the left) and late (on the right) frames showing no obvious choroidal lesion; (<b>E</b>) Initial SD-OCT (Heidelberg) showing choroidal folds and localized subretinal fluid; (<b>F</b>) At two weeks, SD-OCT (Heidelberg) showing worsened choroidal folds and subretinal fluid. (<b>G</b>–<b>J</b>). Case 1. Histopathology and immunohistochemistry of a periocular biopsy; (<b>G</b>) Infiltration by lymphoblasts with round and irregular shaped nuclei (HES × 200); (<b>H</b>) Cd3 staining shows cytoplasmic positivity (CD3 clone NCL-L-CD3-565, ×200); (<b>I</b>) TdT staining highlights intense nuclear positivity (clone Novocastra NCL-L-TdT-339, ×200); (<b>J</b>) MIB1 antibody staining for Ki67 highlights very high proliferation rate (clone M7240, dako, ×200).</p> Full article ">Figure 2
<p>Case 2. (<b>A</b>) Slit-lamp photograph of the anterior segment of the left eye, showing anterior chamber involvement; (<b>B</b>) Ultrasound biomicroscopy of the left eye showing an iris mass with a tissular infiltrate at the base of the iris. (<b>C</b>) Brain IRM. Axial postcontrast fat-suppressed T1-weighted image (3T SIEMENS Skyra MRI scan) passing through the orbits and showing enhancement of the whole anterior chamber of the left eye. (<b>E</b>) Fine-needle aspiration biopsy of the lesion in the iris showing plasma cells producing IgG lambda (Immunohistochemistry) and (<b>D</b>) atypical plasma cells (May-Grünwald Giemsa).</p> Full article ">Figure 2 Cont.
<p>Case 2. (<b>A</b>) Slit-lamp photograph of the anterior segment of the left eye, showing anterior chamber involvement; (<b>B</b>) Ultrasound biomicroscopy of the left eye showing an iris mass with a tissular infiltrate at the base of the iris. (<b>C</b>) Brain IRM. Axial postcontrast fat-suppressed T1-weighted image (3T SIEMENS Skyra MRI scan) passing through the orbits and showing enhancement of the whole anterior chamber of the left eye. (<b>E</b>) Fine-needle aspiration biopsy of the lesion in the iris showing plasma cells producing IgG lambda (Immunohistochemistry) and (<b>D</b>) atypical plasma cells (May-Grünwald Giemsa).</p> Full article ">Figure 3
<p>Case 3. Brain MRI. (<b>A</b>) Coronal postcontrast fat-suppressed T1-weighted image passing through the orbits and showing rostral peri- and intra-optic nerve enhancement on the left side; (<b>B</b>) Axial postcontrast fat-suppressed T1-weighted image passing through the orbits and showing choroidoscleral and perioptic meningeal enhancements extending to the adjacent orbital fat on the left side; (<b>C</b>) Oblique sagittal postcontrast fat-suppressed T1-weighted image showing the whole left optic nerve, whose meninges are strongly enhanced in the intral conal space (on the right) compared with the right optic nerve (on the left); (<b>D</b>) SD-OCT (Heidelberg) showing thickened retina (inner and outer retina); (<b>E</b>) SD-OCT (Heidelberg) showing foveal intraretinal cysts and subretinal fluid; (<b>F</b>) B-scan ultrasonography revealed left optic nerve thickening in shell appearance in two parts; one focal hyper-reflective part (white arrow) surrounded by a hypo-reflective, exudative area (white arrow head). Vitreous sample; (<b>G</b>) Atypical lymphocytes, large cells with large vesicular nuclei, nucleolated with basophilic cytoplasma (May-Grünwald Giemsa, 400×); (<b>H</b>) The lymphoid cells are identified as CD20+ (CD20, 400×).</p> Full article ">Figure 3 Cont.
<p>Case 3. Brain MRI. (<b>A</b>) Coronal postcontrast fat-suppressed T1-weighted image passing through the orbits and showing rostral peri- and intra-optic nerve enhancement on the left side; (<b>B</b>) Axial postcontrast fat-suppressed T1-weighted image passing through the orbits and showing choroidoscleral and perioptic meningeal enhancements extending to the adjacent orbital fat on the left side; (<b>C</b>) Oblique sagittal postcontrast fat-suppressed T1-weighted image showing the whole left optic nerve, whose meninges are strongly enhanced in the intral conal space (on the right) compared with the right optic nerve (on the left); (<b>D</b>) SD-OCT (Heidelberg) showing thickened retina (inner and outer retina); (<b>E</b>) SD-OCT (Heidelberg) showing foveal intraretinal cysts and subretinal fluid; (<b>F</b>) B-scan ultrasonography revealed left optic nerve thickening in shell appearance in two parts; one focal hyper-reflective part (white arrow) surrounded by a hypo-reflective, exudative area (white arrow head). Vitreous sample; (<b>G</b>) Atypical lymphocytes, large cells with large vesicular nuclei, nucleolated with basophilic cytoplasma (May-Grünwald Giemsa, 400×); (<b>H</b>) The lymphoid cells are identified as CD20+ (CD20, 400×).</p> Full article ">Figure 4
<p>Fundus pictures, left eye; (<b>A</b>) showing vitritis before diagnostic vitrectomy; (<b>B</b>) showing infiltration of lymphoma cells into the retina causing a whitening of the retina nasally from optic nerve after vitreous biopsy.</p> Full article ">Figure 5
<p>Case 5. (<b>A</b>) Anterior chamber aspiration; High-power view shows the blast cells in the anterior aqueous humour sample (May-Grünwald-Giemsa staining); (<b>B</b>) Brain MRI; Axial postcontrast fat-suppressed T1-weighted image passing through the orbits and the brain, showing enhancement of the ciliary processes of the left eyeball associated with abnormal enhancements of the dorsal pre-and extraconal post-septal spaces.</p> Full article ">Figure 6
<p>Case 6. (<b>A</b>) Feature of lymphoid infiltration of the nasal and superonasal conjunctiva in right eye; (<b>B</b>) Three out of 4 fragments of 5 × 8 mm that were analyzed revealed a diffuse high-grade tumor infiltration by blast cells, some of them with apparent nucleoli. The immunostainings found positive markers CD45RB, CD68KP, MPO and Ki67 on 50% of the cells, and negative markers CD34-, CD3- CD20-. The arrows indicate some blast cells.</p> Full article ">
10 pages, 1033 KiB  
Review
Current Updates on Expanded Carrier Screening: New Insights in the Omics Era
by Iolanda Veneruso, Chiara Di Resta, Rossella Tomaiuolo and Valeria D’Argenio
Medicina 2022, 58(3), 455; https://doi.org/10.3390/medicina58030455 - 21 Mar 2022
Cited by 14 | Viewed by 4096
Abstract
Genetic carrier screening has been successfully used over the last decades to identify individuals at risk of transmitting specific DNA variants to their newborns, thus having an affected child. Traditional testing has been offered based on familial and/or ethnic backgrounds. The development of [...] Read more.
Genetic carrier screening has been successfully used over the last decades to identify individuals at risk of transmitting specific DNA variants to their newborns, thus having an affected child. Traditional testing has been offered based on familial and/or ethnic backgrounds. The development of high-throughput technologies, such as next-generations sequencing, able to allow the study of large genomic regions in a time and cost-affordable way, has moved carrier screening toward a more comprehensive and extensive approach, i.e., expanded carrier screening (ECS). ECS simultaneously analyses several disease-related genes and better estimates individuals’ carrier status. Indeed, it is not influenced by ethnicity and is not limited to a subset of mutations that may arise from poor information in some populations. Moreover, if couples carry out ECS before conceiving a baby, it allows them to obtain a complete estimation of their genetic risk and the possibility to make an informed decision regarding their reproductive life. Despite these advantages, some weakness still exists regarding, for example, the number of genes and the kind of diseases to be analyzed and the interpretation and communication of the obtained results. Once these points are fixed, it is expectable that ECS will become an ever more frequent practice in clinical settings. Full article
(This article belongs to the Special Issue Array Comparative Genomic Hybridization and Next Generation Sequencing in Molecular Diagnostics of Genetic Diseases: Novel Applications and Future Perspectives)
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<p>Pros and cons of ECS testing.</p> Full article ">Figure 2
<p>Indications for Expanded Carrier Screening (ECS) planning. ECS has potential benefits in different conditions if properly used. Who is admitted to the test, when it should be preferably carried out, and which kind of information it can provide are summarized herein, underlying its potential advantages in routine diagnostic settings.</p> Full article ">
10 pages, 819 KiB  
Article
The Effect of Scapular Fixation on Scapular and Humeral Head Movements during Glenohumeral Axial Distraction Mobilization
by Carlos López-de-Celis, Elena Estébanez-de-Miguel, Albert Pérez-Bellmunt, Santos Caudevilla-Polo, Vanessa González-Rueda and Elena Bueno-Gracia
Medicina 2022, 58(3), 454; https://doi.org/10.3390/medicina58030454 - 21 Mar 2022
Cited by 6 | Viewed by 2800
Abstract
Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of [...] Read more.
Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05–0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force. Full article
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<p>Experimental set-up. Axial traction glenohumeral joint mobilization technique. (<b>A</b>): Scapular fixation condition; (<b>B</b>): Non-scapular fixation condition.</p> Full article ">Figure 2
<p>(<b>A</b>) Transducer position. Ultrasound image at rest with the acromion and humeral landmarks identified. (<b>B</b>): Ultrasound image of humeral head position during at rest as baseline. Scapular fixation ultrasound image of humeral head position on low-force GADM (<b>C</b>), medium-force GADM (<b>D</b>) and high-force GADM (<b>E</b>). Non scapular fixation ultrasound image of humeral head position on low-force GADM (<b>F</b>), medium-force GADM (<b>G</b>) and high-force GADM (<b>H</b>).</p> Full article ">
11 pages, 2634 KiB  
Article
Effects of High Intensity Interval Training Rehabilitation Protocol after an Acute Coronary Syndrome on Myocardial Work and Atrial Strain
by Antonello D’Andrea, Andreina Carbone, Federica Ilardi, Mario Pacileo, Cristina Savarese, Simona Sperlongano, Marco Di Maio, Francesco Giallauria, Vincenzo Russo, Eduardo Bossone and Eugenio Picano
Medicina 2022, 58(3), 453; https://doi.org/10.3390/medicina58030453 - 21 Mar 2022
Cited by 7 | Viewed by 3256
Abstract
Background andObjectives: Current guidelines on cardiac rehabilitation (CR) suggest moderate-intensity physical activity after acute coronary syndrome (ACS). Recent report have shown that high-intensity interval training (HIIT) could be more effective than moderate-intensity continuous training (MCT) in improving cardiac performance. Our aim [...] Read more.
Background andObjectives: Current guidelines on cardiac rehabilitation (CR) suggest moderate-intensity physical activity after acute coronary syndrome (ACS). Recent report have shown that high-intensity interval training (HIIT) could be more effective than moderate-intensity continuous training (MCT) in improving cardiac performance. Our aim was to analyze the effects of HIIT protocol after ACS on advanced echocardiographic parameters of myocardial function. Materials and Methods: In total, 75 patients with recent ACS, with or without ST segment elevation, were enrolled and compared with a control group of 50 age- and sex-comparable healthy subjects. Patients were randomized to perform a MCT training or HIIT-based rehabilitation program. A complete echocardiographic evaluation, including left ventricular (LV) and left atrial (LA) global longitudinal strain (GLS) and myocardial work (MW) through speckle-tracking analysis, was performed for all patients, before and after cardiac rehabilitation training. A cardiopulmonary exercise testing (CPET) was also performed at the end of the rehabilitation program. Results: Patients who followed the HIIT rehabilitation program showed improved LV diastolic function compared to the MCT group (E/e’: 3.4 ± 3.1 vs. 6.4 ± 2.8, respectively, p < 0.01). Similarly, LV systolic function showed significant improvement in the group of patients performing HIIT (ejection fraction: 53.1 ± 6.4 vs. 52.3 ± 5.4%, p < 0.01; GLS: −17.8 ± 3.8 vs. −15.4 ± 4.3, p < 0.01). In addition, LA strain was improved. MW efficiency was also increased in the HIIT group (91.1 ± 3.3 vs. 87.4 ± 4.1%, p < 0.01), and was closely related to peak effort measurements expressed in peak VO2 by CPET. Conclusions: In patients with recent ACS, the HIIT rehabilitation program determined reverse cardiac remodeling, with the improvement of diastolic and systolic function, assessed by standard echocardiography. In addition, cardiac deformation index as GLS, LA strain and MW efficiency improved significantly after HIIT, and were associated with functional capacity during effort. Full article
(This article belongs to the Section Emergency Medicine)
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<p>Flowchart. Diagram demonstrating the study protocol. ACS = acute coronary syndrome; PCI = Percutaneous Coronary Intervention; MCT = moderate-intensity continuous training; HIIT = high-intensity interval training.</p> Full article ">Figure 2
<p>Panels (<b>A</b>–<b>C</b>): 17-segment bull’s-eye representation of LV strain (<b>A</b>), and myocardial work efficiency (<b>B</b>) and wasted work (<b>C</b>) in a patient after ACS performing rehabilitation. Both myocardial deformation (GLS −16%) and efficiency (90%) were moderately impaired. Panels (<b>D</b>–<b>F</b>): 17-segment bull’s-eye representation of LV strain (<b>D</b>), and myocardial work efficiency (<b>E</b>) and wasted work (<b>F</b>) in a healthy control. Both myocardial deformation (GLS −20%) and efficiency (97%) were within normal limits.</p> Full article ">
9 pages, 1266 KiB  
Case Report
The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report
by Ryunosuke Urata, Tatsuya Igawa, Akifumi Suzuki, Yutaka Sasao, Norihiro Isogai, Haruki Funao and Ken Ishii
Medicina 2022, 58(3), 452; https://doi.org/10.3390/medicina58030452 - 21 Mar 2022
Cited by 2 | Viewed by 4090
Abstract
Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This [...] Read more.
Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This is the first case report describing the improvement of both dropped head (DH) and cervical pain after the short and intensive rehabilitation (SHAiR) program in an ALS patient with DHS. Case Report: After being diagnosed with ALS in June 2020, a 75-year-old man visited our hospital in October 2020 to receive treatment for DHS. At the initial visit, the patient’s DH was prominent during standing and walking. The pain intensity of the neck was 9 out of 10 on the numerical rating scale (NRS), which was indicative of severe pain. The patient was hospitalized for 2 weeks and admitted into the SHAiR program. DH began to decrease one week after undergoing the SHAiR program and improved two weeks later. Neck pain decreased from 9 to 6 on the NRS. Results: The SHAiR program is a rehabilitation program aimed at improving DH in patients with idiopathic DHS. The program was designed to improve neck extensor and flexor function and global spinal alignment, and the program may have contributed to the improvement of DH and neck pain. Currently, reports of conservative therapies for this disease are limited to the use of cervical orthosis. Although further research is needed on the safety and indications of treatment, the SHAiR program may be a viable treatment option. Full article
(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)
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<p>Pre and post-rehabilitation posture. Before rehabilitation: (<b>a</b>) lateral view of the photograph and (<b>b</b>) standing radiograph. Two weeks after rehabilitation: (<b>c</b>) lateral view of the photograph and (<b>d</b>) standing radiograph.</p> Full article ">Figure 2
<p>Posture during exercises. (<b>A</b>) Training posture, (<b>B</b>,<b>C</b>) deep cervical flexor muscle exercise.</p> Full article ">Figure 3
<p>Timeline of patient’s treatment process. Abbreviation. NSAIDs, non-steroidal anti-inflammatory drugs; ALS, amyotrophic lateral sclerosis; SHAiR program, the short and intensive rehabilitation program; PT, physical therapist; OT, occupational therapist.</p> Full article ">
11 pages, 659 KiB  
Systematic Review
Diagnostic Criteria for Metabolic Syndrome in High-Altitude Regions: A Systematic Review
by Claudia Beatriz Villegas-Abrill, Rubén Vidal-Espinoza, Rossana Gomez-Campos, Vladimiro Ibañez-Quispe, Charles Mendoza-Mollocondo, Sara Ruth Cuentas-Yupanqui, José Fuentes-López, Camilo Urra-Albornoz and Marco Cossio-Bolaños
Medicina 2022, 58(3), 451; https://doi.org/10.3390/medicina58030451 - 21 Mar 2022
Cited by 3 | Viewed by 3965
Abstract
Background and Objectives: Metabolic syndrome (MS) has many risk factors that are important to investigate in populations living at sea level and in high-altitude geographic regions. The aim was to identify the components of MS that cross-sectional studies use to assess in [...] Read more.
Background and Objectives: Metabolic syndrome (MS) has many risk factors that are important to investigate in populations living at sea level and in high-altitude geographic regions. The aim was to identify the components of MS that cross-sectional studies use to assess in adult populations residing in high-altitude regions. Materials and Methods: A systematic review study was conducted. The Pubmed database was used. The search for original articles (cross-sectional) was performed from January 2013 to December 2020. The procedure was carried out by two researchers. The keywords used were metabolic syndrome, adults, and altitude regions. The search strategy considered the components of the PICOS tool. Results: Ten cross-sectional studies were identified in the Pubmed database from 2014 to 2020. Altitude levels varied between countries and regions, from 2060 to 4900 m above sea level. Three studies were conducted in both China and Peru, two studies in Ecuador, and one in Bolivia and India. The age ranges studied were from 18 to ~80 years of age, approximately. The components used to assess MS in most studies (between 9 to 10 studies) were body mass index (BMI), waist circumference (WC), blood pressure (BP), triglycerides (TG), high-density lipoproteins (HDL) and serum glucose (SG). Conclusions: This systematic review verified that the most commonly used domains in adult populations in various moderate- and high-altitude regions of the world are BMI, WC, BP, TG, HDL, and SG. These results suggest that in order to evaluate and/or investigate MS in subjects residing in high-altitude populations, at least four diagnostic domains should be considered in their protocols. Full article
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<p>PRISMA flow chart for the systematization of original articles 2014–2020.</p> Full article ">Figure 2
<p>Components of the metabolic syndrome used to assess adults living in high-altitude regions (BMI: Body Mass Index, WHiI: Waist hip index, WC: waist circumference, WHeI: waist height index, BP: blood pressure, SG: serum glucose, TC: total cholesterol, TG: triglycerides, %F: body fat percentage; HDL: high-density lipoprotein, LDL: low-density lipoprotein).</p> Full article ">
7 pages, 544 KiB  
Case Report
Thyroid Storm Superimposed on Gestational Hypertension: A Case Report and Review of Literature
by Yen-Hua Chen, Chan-Pin Liao, Cheng-Wei Lu, Tzu-Yu Lin and Ya-Ying Chang
Medicina 2022, 58(3), 450; https://doi.org/10.3390/medicina58030450 - 20 Mar 2022
Cited by 1 | Viewed by 3499
Abstract
A thyroid storm is an extreme manifestation of thyrotoxicosis, and is life threatening without an early diagnosis. Pregnancy or childbirth may worsen maternal hyperthyroidism or induce the development of a thyroid storm. Gestational hypertension, a disorder defined as new-onset hypertension, develops after 20 [...] Read more.
A thyroid storm is an extreme manifestation of thyrotoxicosis, and is life threatening without an early diagnosis. Pregnancy or childbirth may worsen maternal hyperthyroidism or induce the development of a thyroid storm. Gestational hypertension, a disorder defined as new-onset hypertension, develops after 20 weeks of gestation and shares symptoms with a thyroid storm. The diagnosis of a thyroid storm may be challenging in patients with gestational hypertension. To highlight the significance of early thyrotoxicosis-related gastrointestinal symptoms, we report a case of a 38-year-old woman with a twin pregnancy, who was diagnosed with gestational hypertension, and then developed a thyroid storm during the peripartum period. She complained of nausea and abdominal pain, followed by tachycardia, hypertension, and a disturbance of consciousness with desaturation. After emergency caesarean section, fever, diarrhea, and high-output heart failure, with pulmonary edema, were noted during the postoperative period in the intensive care unit. The diagnosis of a thyroid storm was confirmed using the Burch–Wartofsky point scale, which was 75 points. In this patient, the uncommon gastrointestinal symptoms, as initial manifestations of thyrotoxicosis, indicated the development of a thyroid storm. The distinguished presentation of thyrotoxicosis-induced cardiomyopathy and peripartum cardiomyopathy also helped in the differential diagnosis between a thyroid storm and gestational hypertension. Aggressive treatment for thyrotoxicosis should not be delayed because of a missed diagnosis. Full article
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<p>Intraoperative vital signs and postoperative chest radiography. (<b>A</b>) The patient had profound hypertension and tachycardia intraoperatively. (<b>B</b>) Chest radiography just after caesarean section showed bilateral pulmonary edema. (<b>C</b>) Pulmonary edema resolved after treatment on postoperative day 1. HR, heart rate; SpO<sub>2</sub>, oxygen saturation.</p> Full article ">
6 pages, 2804 KiB  
Case Report
Fulminant Giant Cell Myocarditis following Heterologous Vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19
by Dong-Hoon Kang, Joo-Young Na, Jun-Ho Yang, Seong-Ho Moon, Sung-Hwan Kim, Jae-Jun Jung, Ho-Jeong Cha, Jong-Hwa Ahn, Yong-Whi Park, Sang-Yeong Cho, Ho-Kyung Yu, Soo-Hee Lee, Mi-Yeong Park, Jong-Woo Kim and Joung-Hun Byun
Medicina 2022, 58(3), 449; https://doi.org/10.3390/medicina58030449 - 20 Mar 2022
Cited by 12 | Viewed by 7318
Abstract
A 48-year-old female patient underwent a heart transplantation for acute fulminant myocarditis, following heterologous vaccination with the ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19. She had no history of severe acute respiratory syndrome coronavirus-2 infection. She did not exhibit clinical signs or have laboratory findings [...] Read more.
A 48-year-old female patient underwent a heart transplantation for acute fulminant myocarditis, following heterologous vaccination with the ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19. She had no history of severe acute respiratory syndrome coronavirus-2 infection. She did not exhibit clinical signs or have laboratory findings of concomitant infection before or after vaccination. Heart transplantation was performed because her heart failed to recover with venoarterial extracorporeal oxygenation support. Organ autopsy revealed giant cell myocarditis, possibly related to the vaccines. Clinicians may have to consider the possibility of the development of giant cell myocarditis, especially in patients with rapidly deteriorating cardiac function and myocarditis symptoms after COVID-19 vaccination. Full article
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<p>The patient’s chest X-ray (<b>A</b>,<b>B</b>), electrocardiogram (<b>C</b>) and coronary angiography (<b>D</b>). Black arrow, trans-aortic LV venting catheters; white arrow, transseptal left atrium venting catheter; Blue arrow, venous drainage catheter of extracorporeal oxygenation support.</p> Full article ">Figure 2
<p>Pathologic findings of the heart. Diffuse cardiomyocyte necrosis and mixed inflammatory infiltration are noted (<b>A</b>; H&amp;E, ×100). Mixed inflammation including lymphocytes, macrophages, and frequent eosinophils are noted, and multinucleated giant cells are also noted (<b>B</b>; H&amp;E, ×200). T-lymphocytic infiltration is identified (<b>C</b>; CD3, ×100). Infiltration of CD68+ macrophages is identified, and multinucleated giant cells are positive for CD68 (<b>D</b>; CD68, ×200). Black and white arrows show multinucleated giant cells.</p> Full article ">
12 pages, 1204 KiB  
Article
Polarography Can Successfully Quantify Heavy Metals in Dentistry
by Bahareh Nazemisalman, Narges Bayat, Shayan Darvish, Saeedeh Nahavandi, Mehran Mohseni and Ionut Luchian
Medicina 2022, 58(3), 448; https://doi.org/10.3390/medicina58030448 - 20 Mar 2022
Cited by 2 | Viewed by 3254
Abstract
Background and Objectives: Due to the nutritional and behavioral patterns of children, their teeth can be a good indicator of heavy metal uptake from over the years. To determine the amount of Zn, Cu, Cd, and Pb accumulated in the body, primary [...] Read more.
Background and Objectives: Due to the nutritional and behavioral patterns of children, their teeth can be a good indicator of heavy metal uptake from over the years. To determine the amount of Zn, Cu, Cd, and Pb accumulated in the body, primary teeth of children in Zanjan, Iran, were examined with a polarography device. Materials and Methods: Samples were collected from dentistry clinics of Zanjan, Iran, and were prepared for acid digestion, and then were analyzed by a polarography device for determining the concentration of lead, copper, zinc, and cadmium. Results: Data were analyzed by a t-independent test to compare different groups (p < 0.05). Based on the results obtained from this study, the mean concentrations of zinc, lead, copper, and cadmium were 245, 7.66, 5.33, and 0.0879 µg/g, respectively, which shows that the amount of each of the four elements was more than the amounts that have been reported for different countries. The results showed no significant difference between age, tooth type, and jaw groups. Conclusions: We conclude that primary teeth are an important biological indicator to evaluate the concentration of heavy elements in the human body. The high concentrations of these elements in the primary teeth analyzed in this study could be attributed to the high concentrations of these elements in the environment of Zanjan. Full article
(This article belongs to the Special Issue Advances in Interdisciplinary Research in Medicine and Dentistry)
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<p>Determination of zinc, cadmium, lead, and copper in sample No. J1-5 and its polarographic curves according to DIN38406/16. Spiked concentrations were 0.1 mL of 10, 0.5, 0.1, and 2.5 mg/L of zinc, lead, cadmium, and copper, respectively.</p> Full article ">Figure 2
<p>The distribution of zinc, Cd, Pb, and Cu concentrations in each numbered sample after three replications.</p> Full article ">Figure 3
<p>Boxplot of Zn, Cd, Pb, and Cu concentrations in the samples. The minimum (0th percentile), maximum (100th percentile), median (50th percentile), first quartile (25th percentile), and third quartile (75th percentile), clearly show the data scatter in the first, second, third, and fourth quartiles. The most dispersion was shown in the fourth quartiles.</p> Full article ">
10 pages, 742 KiB  
Article
The Risk of Trigeminal Neuralgia Following Osteoporosis
by Yu-Feng Su, Chieh-Hsin Wu, Wei-Ting Wang and Ann-Shung Lieu
Medicina 2022, 58(3), 447; https://doi.org/10.3390/medicina58030447 - 18 Mar 2022
Cited by 4 | Viewed by 3047
Abstract
Background and objectives: Managing people with trigeminal neuralgia (TN) and osteoporosis is challenging due to their debilitating conditions. Currently, the exact association between TN and osteoporosis in patients remains unknown, although there is potential overlapping of pathophysiological mechanisms. In response, we calculated [...] Read more.
Background and objectives: Managing people with trigeminal neuralgia (TN) and osteoporosis is challenging due to their debilitating conditions. Currently, the exact association between TN and osteoporosis in patients remains unknown, although there is potential overlapping of pathophysiological mechanisms. In response, we calculated TN risk in patients who have osteoporosis. Materials and Methods: 45,393 patients aged over 50 years diagnosed with osteoporosis were matched with 45,393 non-osteoporosis patients aged over 50 years (1:1 ratio) who were used as the control group, using data from 1996 to 2010 from Taiwan’s National Health Insurance Research Database. The cumulative incidences of subsequent TN and the hazard ratio were estimated using Cox proportional hazards modeling and the Kaplan–Meier method, respectively. Results: Among the total sample, 333 patients were diagnosed with TN during the follow-up period: 205 in the osteoporosis cohort and 128 in the control cohort. Through covariate adjustment, the overall TN incidence showed a 1.80-fold increase in the osteoporosis cohort in comparison with the control cohort (0.60 vs. 0.18 per 1000 person-years, respectively). The High Charlson Comorbidity Index, hypertension, and migraines were risk factors of TN. Conclusions: Osteoporosis patients had a higher TN risk than that of the control cohort. Therefore, early recognition of pain and symptoms in osteoporotic people may help to identify possible TN patients who need prompt therapy. Full article
(This article belongs to the Special Issue Treatment of Bone Metabolic Disease)
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<p>Flow diagram of the study. LHID = Longitudinal Health Insurance Database.</p> Full article ">Figure 2
<p>Cumulative incidence of trigeminal neuralgia among people with osteoporosis and controls without osteoporosis.</p> Full article ">
9 pages, 572 KiB  
Article
Burnout Syndrome among Pediatric Nephrologists—Report on Its Prevalence, Severity, and Predisposing Factors
by Ewa Pawłowicz-Szlarska, Piotr Skrzypczyk, Małgorzata Stańczyk, Małgorzata Pańczyk-Tomaszewska and Michał Nowicki
Medicina 2022, 58(3), 446; https://doi.org/10.3390/medicina58030446 - 18 Mar 2022
Cited by 3 | Viewed by 2425
Abstract
Background and Objectives: Burnout is an occupation-related syndrome comprising emotional exhaustion, depersonalization, and reduced feelings of work-related personal accomplishments. There are reports on burnout among adult nephrologists and general pediatricians, but little is known about burnout among pediatric nephrologists. The aim of our [...] Read more.
Background and Objectives: Burnout is an occupation-related syndrome comprising emotional exhaustion, depersonalization, and reduced feelings of work-related personal accomplishments. There are reports on burnout among adult nephrologists and general pediatricians, but little is known about burnout among pediatric nephrologists. The aim of our study was to assess the prevalence and severity of burnout syndrome among Polish pediatric nephrologists. Materials and Methods: A 25-item study survey consisting of abbreviated Maslach Burnout Inventory and additional self-created questions about work-related factors was completed by 97 physicians affiliated with the Polish Society of Pediatric Nephrology. Women comprised 75.3%, with median time of professional experience in the study group was 15 years. Results: A high level of emotional exhaustion, depersonalization, and reduced feeling of personal accomplishments were observed in 39.2%, 38.1%, and 21.6% of the participants, respectively. At least a medium level of burnout in all three dimensions were observed in 26.8% of the participants and 8.2% of them presented high three-dimensional burnout. About 41.2% of the participants stated that they would like to take part in burnout prevention and support programs. According to the study participants, excessive bureaucracy in healthcare systems, rush at work, and overtime work were the main job-related problems that could influence burnout intensity. Conclusions: Burnout is an important factor in the professional landscape of pediatric nephrology. Actions aimed at reducing the risk of occupational burnout among pediatric nephrologists should be applied, both at the personal and institutional levels. Full article
(This article belongs to the Section Urology & Nephrology)
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<p>A word cloud presenting job-related issues influencing burnout intensity among pediatric nephrologists. The more a specific factor appeared in the database, the bigger and bolder it appears in the word cloud.</p> Full article ">
8 pages, 3559 KiB  
Article
Syndesmosis Changes before and after Syndesmotic Screw Removal: A Retrospective Radiographic Study
by Chien-Ting Huang, Peng-Ju Huang, Cheng-Chang Lu, Chia-Lung Shih, Yuh-Min Cheng and Shu-Jung Chen
Medicina 2022, 58(3), 445; https://doi.org/10.3390/medicina58030445 - 18 Mar 2022
Cited by 4 | Viewed by 5251
Abstract
Background and Objectives: In patients with ankle fractures complicated by syndesmotic injuries, no consensus has been reached on the best method of syndesmosis fixation using syndesmotic screws. One previous study revealed no difference in the tibiofibular overlap between two groups with or without [...] Read more.
Background and Objectives: In patients with ankle fractures complicated by syndesmotic injuries, no consensus has been reached on the best method of syndesmosis fixation using syndesmotic screws. One previous study revealed no difference in the tibiofibular overlap between two groups with or without syndesmotic screw removal. Other studies have indicated that distal tibiofibular diastasis exists after the removal of syndesmotic screws. In this study, we aimed to confirm the effect of syndesmotic screw removal on diastasis occurrence. We further analyzed the risk factors that may contribute to the widening of the tibiofibular syndesmosis. Materials and Methods: This retrospective study involved a review of the records of 63 patients with ankle fractures accompanied by syndesmosis injuries that required syndesmotic screw fixation. Anteroposterior radiographs were analyzed for each patient at various time points, from syndesmotic screw fixation to outpatient department follow-ups after screw removal. The changes in tibia–fibula overlap (OL), tibia–fibula clear space (CS), and medial clear space (MCS) were analyzed. Further analysis was performed to reveal potential factors that may have contributed to radiographic differences. Results: Compared with the postoperation radiographs following syndesmotic screw fixation, OL decreased (2.0 mm) and CS increased (0.8 mm) in the anteroposterior radiographs from outpatient department follow-ups. No significant changes were noted in OL or CS after syndesmotic screw removal. However, OL decreased (1.8 mm) and CS increased (0.5 mm) before syndesmotic screw removal. No significant change in MCS occurred during the whole observation period. Linear regression analysis did not reveal any significant correlations between potentially related factors and radiographic changes. Conclusions: Marked diastasis had occurred at final follow-up. Notably, the diastasis occurred before rather than after screw removal. This implies that screw removal does not significantly influence the radiographic outcomes of rotational ankle fractures. Full article
(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies)
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<p>Radiographic evaluation in the study. The tibiofibular clear space (CS) was defined as the distance between the lateral border of the posterior tibial malleolus and the medial aspect of the fibula, measured 1 cm proximal to the tibial plafond. The medial clear space (MCS) was defined as the distance from the lateral border of the medial malleolus to the medial border of the talus at the level of the talar dome. The tibiofibular overlap (OL) was measured from the lateral border of the anterior tibial prominence to the medial fibula 1 cm proximal to the tibial plafond.</p> Full article ">Figure 2
<p>Demonstration of serial images evaluation: (<b>a</b>) Patients who met the inclusion criteria were collected; (<b>b</b>) pre-SR anteroposterior radiographs were obtained; (<b>c</b>) last-FU anteroposterior radiographs were obtained. CS: tibiofibular clear space; last-FU: last follow-up; OL: tibiofibular overlap; pre-SR: presyndesmotic screw removal.</p> Full article ">
12 pages, 482 KiB  
Article
Prognostic Effect of Underlying Chronic Kidney Disease and Renal Replacement Therapy on the Outcome of Patients after Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study
by Won Yang, Jae-Guk Kim, Gu-Hyun Kang, Yong-Soo Jang, Wonhee Kim, Hyun-Young Choi and Yoonje Lee
Medicina 2022, 58(3), 444; https://doi.org/10.3390/medicina58030444 - 18 Mar 2022
Cited by 4 | Viewed by 2568
Abstract
Background and Objectives: This study assessed the prognostic value of underlying chronic kidney disease (CKD) and renal replacement therapy (RRT) on the clinical outcomes from out-of-hospital cardiac arrest (OHCA). Materials and Methods: This retrospective study was conducted utilizing the population-based OHCA data of [...] Read more.
Background and Objectives: This study assessed the prognostic value of underlying chronic kidney disease (CKD) and renal replacement therapy (RRT) on the clinical outcomes from out-of-hospital cardiac arrest (OHCA). Materials and Methods: This retrospective study was conducted utilizing the population-based OHCA data of South Korea between 2008 and 2018. Adult (>18 years) OHCA patients with a medical cause of cardiac arrest were included and classified into three categories based on the underlying CKD and RRT: (1) non-CKD group; (2) CKD without RRT group; and (3) CKD with RRT group. A total of 13,682 eligible patients were included (non-CKD, 9863; CKD without RRT, 1778; CKD with RRT, 2041). From the three comparison subgroups, data with propensity score matching were extracted. The influence of CKD and RRT on patient outcomes was assessed using propensity score matching and multivariate logistic regression analyses. The primary outcome was survival at hospital discharge and the secondary outcome was a good neurological outcome at hospital discharge. Results: The two CKD groups (CKD without RRT and CKD with RRT) showed no significant difference in survival at hospital discharge compared with the non-CKD group (CKD without RRT vs. non-CKD, p > 0.05; CKD with RRT vs. non-CKD, p > 0.05). The non-CKD group had a higher chance of having good neurological outcomes than the CKD groups (non-CKD vs. CKD without RRT, p < 0.05; non-CKD vs. CKD with RRT, p < 0.05) whereas there was no significant difference between the two CKD groups (CKD without RRT vs. CKD with RRT, p > 0.05). Conclusions: Compared with patients without CKD, the underlying cause of CKD—regardless of RRT—may be linked to poor neurological outcomes. Underlying CKD and RRT had no effect on the survival at hospital discharge. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)
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<p>Flow chart of patient inclusions and exclusions in this study. OHCA, out-of-hospital cardiac arrest; CKD, chronic kidney disease; RRT, renal replacement therapy; DOA, dead on arrival; DNR, do not resuscitate.</p> Full article ">
12 pages, 2177 KiB  
Article
Evolving Risk of Acute Kidney Injury in COVID-19 Hospitalized Patients: A Single Center Retrospective Study
by Fahad D. Algahtani, Mohamed T. Elabbasy, Fares Alshammari, Amira Atta, Ayman M. El-Fateh and Mohamed E. Ghoniem
Medicina 2022, 58(3), 443; https://doi.org/10.3390/medicina58030443 - 18 Mar 2022
Cited by 4 | Viewed by 2839
Abstract
Background and Objectives: Within a year, COVID-19 has advanced from an outbreak to a pandemic, spreading rapidly and globally with devastating impact. The pathophysiological link between COVID-19 and acute kidney injury (AKI) is currently being debated among scientists. While some studies have [...] Read more.
Background and Objectives: Within a year, COVID-19 has advanced from an outbreak to a pandemic, spreading rapidly and globally with devastating impact. The pathophysiological link between COVID-19 and acute kidney injury (AKI) is currently being debated among scientists. While some studies have concluded that the mechanisms of AKI in COVID-19 patients are complex and not fully understood, others have claimed that AKI is a rare complication of COVID-19-related disorders. Considering this information gap and its possible influence on COVID-19-associated AKI management, our study aimed to explore the prevalence of AKI and to identify possible risk factors associated with AKI development among COVID-19 hospitalized patients. Materials and Methods: A retrospective cohort study included 83 laboratory-confirmed COVID-19 patients hospitalized at the isolation department in a tertiary hospital in Zagazig City, Egypt between June and August 2020. Patients younger than 18 years of age, those diagnosed with end-stage kidney disease, or those on nephrotoxic medications were excluded. All study participants had a complete blood count, liver and renal function tests, hemostasis parameters examined, inflammatory markers, serum electrolytes, routine urinalysis, arterial blood gas, and non-enhanced chest and abdominal computer tomography (CT) scans. Results: Of the 83 patients, AKI developed in 24 (28.9%) of them, of which 70.8% were in stage 1, 8.3% in stage 2, and 20.8% in stage 3. Patients with AKI were older than patients without AKI, with hypertension and diabetes being the most common comorbidities. Risk factors for AKI include increased age, hypertension, diabetes mellitus, and a higher sequential organ failure assessment (SOFA) score. Conclusions: AKI occurs in a considerable percentage of patients with COVID-19, especially in elderly males, those with hypertension, diabetes, and a higher sequential organ failure assessment (SOFA) score. Hence, the presence of AKI should be taken into account as an important index within the risk spectrum of disease severity for COVID-19 patients. Full article
(This article belongs to the Special Issue Acute Kidney Injury: From Basic Findings to New Prevention and Therapy Strategies)
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<p>Non-enhanced chest CT scan demonstrates bilateral peripheral ill-defined patchy ground-glass opacities at both lower lung fields (<b>white arrow</b>).</p> Full article ">Figure 2
<p>The proportion of patients by stages (1–3) of acute kidney injury (AKI).</p> Full article ">Figure 3
<p>Non-enhanced abdominal CT scan demonstrates perinephric fat stranding (<b>white arrow</b>) with irregularity of the outer border of the kidney.</p> Full article ">Figure 4
<p>Independent risk factors for (AKI) among COVID-19 patients.</p> Full article ">
12 pages, 477 KiB  
Review
Neuromodulation of the Posterior Tibial Nerve for the Control of Urinary Incontinence
by Álvaro Astasio-Picado and María García-Cano
Medicina 2022, 58(3), 442; https://doi.org/10.3390/medicina58030442 - 17 Mar 2022
Cited by 3 | Viewed by 4032
Abstract
Urinary incontinence is considered a health problem that both elderly and young people can suffer, most often elderly women. This problem can lead to difficulties in establishing social relationships and dependence, negatively affecting the quality of life of the people who suffer from [...] Read more.
Urinary incontinence is considered a health problem that both elderly and young people can suffer, most often elderly women. This problem can lead to difficulties in establishing social relationships and dependence, negatively affecting the quality of life of the people who suffer from it. To evaluate and analyze the studies that demonstrate the efficacy of interventions based on the neuromodulation of the posterior tibial nerve as a treatment for the control of urinary incontinence. The search period for articles focused on those published between March 2011 to March 2021, in five databases (Pubmed, Cochrane Library, Scielo, Google Academic and WOS) based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT” and “OR”. The search was limited to publications from the last 10 years, in English and Spanish. After applying the selection criteria and evaluating the quality of the methodology, 5.28% (n = 27) of the 511 results were included with filters: 9 systematic reviews, 10 cohorts and 8 randomized controlled trials. After comparing the different articles, it was found that percutaneous stimulation of the tibial nerve is a suitable technique for treating overactive bladder. It is a promising technique in case of pelvic floor dysfunctions and effective for the control of urinary incontinence. Full article
(This article belongs to the Section Neurology)
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<p>Flow diagram.</p> Full article ">
10 pages, 1037 KiB  
Article
Adverse Events and Immunogenicity of mRNA-Based COVID-19 Vaccine among Healthcare Workers: A Single-Centre Experience
by Jolanta Sauserienė, Ida Liseckienė, Vitalija Neverauskė, Eglė Šepetauskienė, Danielius Serapinas, Šarūnas Mačinskas, Brigita Šitkauskienė, Ieva Bajoriūnienė, Rūta Vaičiūnienė and Leonas Valius
Medicina 2022, 58(3), 441; https://doi.org/10.3390/medicina58030441 - 17 Mar 2022
Cited by 3 | Viewed by 2655
Abstract
Background and Objectives: The safety and effectiveness of vaccines are among the key priorities in COVID-19 pandemic management. Moreover, evidence-based data regarding vaccine safety and immunogenicity can play an important role in building the trust of the community regarding vaccination. The aim [...] Read more.
Background and Objectives: The safety and effectiveness of vaccines are among the key priorities in COVID-19 pandemic management. Moreover, evidence-based data regarding vaccine safety and immunogenicity can play an important role in building the trust of the community regarding vaccination. The aim of this study was to investigate the safety and immunogenicity of Pfizer-BioNTech vaccine among healthcare workers in one hospital, 21 days after first dose. Materials and Methods: This study was conducted in the Hospital of the Lithuanian University of Health Sciences between February and March 2021. Hospital employees who arrived to receive the second dose of the Pfizer-BioNTech vaccine 21 days after the first one were invited to participate in the study: they were asked to complete an anonymous adverse events questionnaire and were offered a SARS-CoV-2 IgG/IgM rapid test. The study was performed at a single point, 21 days after the first dose of the vaccine. Results: Data of 4181 vaccine recipients were analysed. The first vaccine dose was associated with a 53.6% incidence of adverse events, mainly local reactions. Adverse events occurred more frequently in younger participants and women. Moderate adverse events were experienced by 1.4% of the vaccine recipients; 6.2% were incapacitated. Of the 3439 participants who performed a rapid IgG test, 94.5% were positive for IgG antibodies after the first vaccine dose. Seroconversion rates were lower in participants older than 47 years. Conclusions: Despite 1.4% moderate adverse events, no safety concerns or anaphylaxis were identified. The Pfizer-BioNTech vaccine induced an immune response in the overwhelming majority of recipients after a single dose. Younger participants experienced adverse events and were positive for IgG antibodies more frequently than older counterparts. It is important to mention that this study specifically considered short-term safety and reactions following vaccination and that long-term adverse effects were not investigated in the study. Thus, future research into both long-term adverse reactions and immune system programming is essential. Full article
(This article belongs to the Special Issue Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic)
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<p>Frequency of adverse events by symptoms.</p> Full article ">Figure 2
<p>Average score of adverse reaction intensity. ISP–injection site pain; ISS–injection site swelling; ISI–injection site itching; HA–headache; W/D–weakness, drowsiness; BP–body pain; F–fever; LNR–lymph node reaction; Anx–anxiety; Naus–nausea; Nerv–nervousness; DysO–disorientation; C/Dpn–cough, dyspnoea; Diar–diarrhoea; T/S–loss of smell or taste.</p> Full article ">
7 pages, 1808 KiB  
Review
Muscle-MRI and Functional Levels for the Evaluation of Upper Limbs in Duchenne Muscular Dystrophy: A Critical Review of the Literature
by Lara Cristiano, Claudia Brogna, Giorgio Tasca, Tommaso Verdolotti, Marika Pane and Eugenio Mercuri
Medicina 2022, 58(3), 440; https://doi.org/10.3390/medicina58030440 - 17 Mar 2022
Cited by 2 | Viewed by 2467
Abstract
Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association [...] Read more.
Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association between muscle MRI findings and motor function levels in the upper limbs of DMD patients. Ten studies with upper limb muscle MRI data were available. Four explored all upper limb segments, while six explored only the forearm. Functional assessments were performed in nine of the ten studies. All of the studies showed a significant correlation between muscle MRI changes and motor function levels in both ambulant and non-ambulant DMD patients. Full article
(This article belongs to the Special Issue Duchenne Muscular Dystrophy: MR Imaging and Genetic Findings)
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<p>Flow chart that shows the selection of the papers.</p> Full article ">
16 pages, 388 KiB  
Review
Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19
by Bogdan Huzum, Alexandrina Stefania Curpan, Bogdan Puha, Dragomir Nicolae Serban, Bogdan Veliceasa, Riana Maria Necoara, Ovidiu Alexa and Ionela Lacramioara Serban
Medicina 2022, 58(3), 439; https://doi.org/10.3390/medicina58030439 - 17 Mar 2022
Cited by 5 | Viewed by 2992
Abstract
The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here [...] Read more.
The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions. Full article
7 pages, 405 KiB  
Case Report
Mitigating the Risk of Adverse Effects Related to Augmentation Therapy for Resistant Major Depressive Disorder: A Case Report
by Collin J. Amundson, Robert Knight, Georgina M. Ybarra, Jacques Turgeon and Jennifer M. Bingham
Medicina 2022, 58(3), 438; https://doi.org/10.3390/medicina58030438 - 17 Mar 2022
Cited by 2 | Viewed by 3023
Abstract
Polypharmacy of psychotropic medications predisposes older adults to adverse drug events (ADEs). One contributing factor is inhibition of metabolic pathways between substrates (competitive inhibition) or between substrates and inhibitors of the same cytochrome P450 (CYP450) isoforms. The purpose of this case report is [...] Read more.
Polypharmacy of psychotropic medications predisposes older adults to adverse drug events (ADEs). One contributing factor is inhibition of metabolic pathways between substrates (competitive inhibition) or between substrates and inhibitors of the same cytochrome P450 (CYP450) isoforms. The purpose of this case report is to demonstrate observed sedation and difficulty concentrating from augmentation therapy for resistant major depressive disorder (MDD) and to highlight the value of clinical tools to identify opportunities for treatment optimization to reduce ADEs. The pharmacist identified significant medication burden and competitive inhibition of drug metabolism in the CYP450 system during a telehealth medication therapy management consultation with a 69-year-old male. The pharmacist recommended clinical monitoring and communicated concerns about medication-induced sedation, difficulty concentrating, and other medication-related problems (MRP) to providers. Several recommendations were implemented which helped improved patient’s outcomes. Individualizing MDD pharmacotherapy based on pharmacokinetic and pharmacodynamic drug interactions and geriatric dosage considerations may lead to better outcomes and tolerability among older adults. Full article
11 pages, 560 KiB  
Systematic Review
Effects of Non-Invasive Radiofrequency Diathermy in Pelvic Floor Disorders: A Systematic Review
by María Dolores González-Gutiérrez, Álvaro López-Garrido, Irene Cortés-Pérez, Esteban Obrero-Gaitán, Felipe León-Morillas and Alfonso Javier Ibáñez-Vera
Medicina 2022, 58(3), 437; https://doi.org/10.3390/medicina58030437 - 17 Mar 2022
Cited by 12 | Viewed by 5895
Abstract
Background and Objectives: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of this therapy among pelvic floor physiotherapists, little is known about its effects and [...] Read more.
Background and Objectives: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of this therapy among pelvic floor physiotherapists, little is known about its effects and effectiveness in pelvic floor disorders. For this reason, the aim of the present review is to assess the effects of non-invasive 300 kHz–1 MHz radiofrequency diathermy in the treatment of pelvic floor disorders. Materials and Methods: A literature search was performed in PubMed, Scopus and Web of Science, searching for any type of study that included pelvic floor disorder participants and an experimental group treated with non-invasive nor ablative radiofrequency diathermy. Results: There were a total of 578 studies after removing duplicates. The inclusion and exclusion criteria were applied, resulting in a total of 15 studies, which were methodologically assessed with PEDro and the Newcastle and Ottawa scale. Conclusions: Despite the low quality of most of them, the studies showed improvements in urinary incontinence, pelvic pain conditions, pelvic floor muscles strength and sexual function. These findings must be considered with caution until more randomized clinical trials are performed to solve the biases detected. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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<p>Flow diagram of the study search.</p> Full article ">
9 pages, 302 KiB  
Article
Comparison of the Efficacies of Direct-Acting Antiviral Treatment for HCV Infection in People Who Inject Drugs and Non-Drug Users
by Jui-Ting Hsu, Ping-I Hsu, Chang-Bih Shie, Seng-Kee Chuah, I-Ting Wu, Wen-Wei Huang, Sheng-Yeh Tang, Kun-Feng Tsai, Li-Fu Kuo, Supratip Ghose, Jui-Che Hsu and Chih-An Shih
Medicina 2022, 58(3), 436; https://doi.org/10.3390/medicina58030436 - 17 Mar 2022
Cited by 3 | Viewed by 3143
Abstract
Background and Objectives: Hepatitis C virus (HCV) is a major cause of liver disease worldwide. People who inject drugs (PWIDs) constitute the majority of patients with HCV infection in the United States and Central Asia. There are several obstacles to treating HCV [...] Read more.
Background and Objectives: Hepatitis C virus (HCV) is a major cause of liver disease worldwide. People who inject drugs (PWIDs) constitute the majority of patients with HCV infection in the United States and Central Asia. There are several obstacles to treating HCV infection in PWIDs because PWIDs are often accompanied by concurrent infection, low compliance, substance abuse, and risky behavior. The aim of the study is to compare the efficacies of direct-acting antiviral (DAA) therapy for HCV infection in PWIDs and those without opioid injection. Materials and Methods: In this retrospective cohort study, we included 53 PWIDs with HCV infections treated on site in a methadone program and 106 age- and sex-matched patients with HCV infections who had no history of opioid injection (ratio of 1:2). All eligible subjects received anti-HCV treatment by DAA agents in our hospital from March 2018 to December 2020. The charts of these patients were carefully reviewed for demographic data, types of DAA agents, and treatment outcomes. The primary outcome measure was sustained virological response (SVR). Results: PWIDs and non-drug users had different HCV genotype profiles (p = 0.013). The former had higher proportions of genotype 3 (18.9% vs. 7.5%) and genotype 6 (24.5% vs. 14.2%) than the latter. The two patient groups had comparable rates of complete drug refilling (100.0% vs. 91.1%) and frequency of loss to follow-up (3.8% vs. 0.9%). However, PWIDs had a lower SVR rate of DAA treatment than non-drug users (92.2% vs. 99.0%; p = 0.04). Further analysis showed that both human immunodeficiency virus (HIV) coinfection and history of PWID were risk factors associated with treatment failure. The subjects with coinfection with HIV had lower SVR rates than those without HIV infection (50.0% vs. 96.5%; p = 0.021). Conclusions: PWIDs with HCV infections have higher proportions of HCV genotype 3 and genotype 6 than non-drug users with infections. DAA therapy can achieve a high cure rate (>90%) for HCV infection in PWID, but its efficacy in PWID is lower than that in non-drug users. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
9 pages, 1214 KiB  
Article
Post-Operative Results of ACL Reconstruction Techniques on Single-Leg Hop Tests in Athletes: Hamstring Autograft vs. Hamstring Grafts Fixed Using Adjustable Cortical Suspension in Both the Femur and Tibia
by Lokman Kehribar, Ali Kerim Yılmaz, Emre Karaduman, Menderes Kabadayı, Özgür Bostancı, Serkan Sürücü, Mahmud Aydın and Mahir Mahiroğulları
Medicina 2022, 58(3), 435; https://doi.org/10.3390/medicina58030435 - 16 Mar 2022
Cited by 9 | Viewed by 3575
Abstract
Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL [...] Read more.
Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia (MAI) ACLR techniques. We aimed to compare the results of single-leg hop tests (SLHT) applied in different directions and limb symmetry indices (LSI) in athletes with a 6-month post-operative ACLR history. Materials and Methods: A retrospective cohort of 39 athletes from various sports branches who underwent MAI (n = 16) and ST/G (n = 23) ACLR techniques by the same surgeon were evaluated. The knee strength of the participants on the operated and non-operated sides was evaluated with five different SLHTs. The SLHT included the single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores in the post-operative leg for both techniques (p < 0.05) compared to the pre-operative levels. When there was a difference between the SH of the operative and the non-operative legs in the ST/G technique (p < 0.05), there was no significant difference in the other hop distance for both ST/G and MAI (p > 0.05). There was no difference between the techniques regarding the LSI scores. Conclusions: The fact that our research revealed similar LSI rates of the SLHTs applied in different directions in the ST/G and MAI techniques assumes that the MAI technique can be an ACLR technique which can be functionally used in athletes. Full article
(This article belongs to the Section Sports Medicine and Sports Traumatology)
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<p>Graphical illustration of the single-leg hop tests.</p> Full article ">Figure 2
<p>Comparison of pre-operative and post-operative levels of Lysholm, Tegner, and IKDC scores between techniques. * <span class="html-italic">p</span> &lt; 0.05.</p> Full article ">Figure 3
<p>Differences in the hop test between operative and non-operative leg. * <span class="html-italic">p</span> &lt; 0.05, ns = non-significant operative vs. non-operative.</p> Full article ">
10 pages, 2700 KiB  
Article
Odontogenic Effect of Icariin on the Human Dental Pulp Cells
by Guo Liu, Ying Yang, Kyung-San Min, Bin-Na Lee and Yun-Chan Hwang
Medicina 2022, 58(3), 434; https://doi.org/10.3390/medicina58030434 - 16 Mar 2022
Cited by 6 | Viewed by 3030
Abstract
Background and Objectives: Human dental pulp cells (HDPCs) can be used for dentin regeneration due to its odontogenic differentiation property. Icariin can induce osteogenic differentiation of stem cells. However, its potential to induce odontogenic differentiation of HDPCs remains unclear. Thus, the aim [...] Read more.
Background and Objectives: Human dental pulp cells (HDPCs) can be used for dentin regeneration due to its odontogenic differentiation property. Icariin can induce osteogenic differentiation of stem cells. However, its potential to induce odontogenic differentiation of HDPCs remains unclear. Thus, the aim of this study was to evaluate the capacity of icariin to induce odontogenic differentiation of HDPCs and investigate the underlying molecular mechanism. Materials and Methods: Cell viability assay was used to detect the cytotoxicity of icariin to HDPCs. Effect of icariin on HDPCs chemotaxis was measured by scratch migration assay. The mineralized and odontogenic differentiation of HDPCs was assessed by alkaline phosphatase (ALP) staining, alizarin red S (ARS) staining, real-time PCR, and Western blot of dentin matrix protein 1 (DMP 1) and dentin sialophosphoprotein (DSPP). In addition, Mitogen-activated protein kinase (MAPK) signaling pathway of icariin-induced biomineralization was investigated by Western blot. Results: Cells treated with icariin at all concentrations tested maintained viability, indicating that icariin was biocompatible. Icariin accelerated HDPCs chemotaxis (p < 0.05). Expression levels of related odontogenic markers were increased in the presence of icariin (p < 0.05). Icariin-induced odontogenic differentiation occurred via activation of the MAPK signaling pathway. Furthermore, MAPK inhibitors suppressed expression levels of DSPP and DMP 1 protein, ALP activity, and mineralization of HDPCs. Conclusions: Icariin can upregulate odontogenic differentiation of HDPCs by triggering the MAPK signaling pathway. Full article
(This article belongs to the Section Dentistry and Oral Health)
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<p>Effect of icariin on cytotoxicity and migration of HDPCs. (<b>A</b>) HDPCs were exposed to icariin at different concentrations for 24, 48, 72 h. Medium without icariin was used as a negative control (<span class="html-italic">p</span> &gt; 0.05). (<b>B</b>) HDPCs were cultured with or without 10 μM icariin. Images of HDPCs migration were captured at 0, 6, 12, and 24 h (scale bar = 1000μM). (<b>C</b>) Quantitative analysis of wound migration area was normalized to GM. Bars show means ± standard deviation (* <span class="html-italic">p</span> &lt; 0.05, ** <span class="html-italic">p</span> &lt; 0.01, *** <span class="html-italic">p</span> &lt; 0.001, HDPCs: human dental pulp cells, GM: growth medium, OM: odontogenic differentiation medium).</p> Full article ">Figure 2
<p>Mineralization of HDPCs after icariin treatment. (<b>A</b>,<b>B</b>) HDPCs were treated with different doses of icariin, displaying increased ALP activity at 10 days. (<b>C</b>,<b>D</b>) Treatment with icariin increased the capability of forming mineralized nodules on HDPCs at 14 days. Results were normalized to GM. Bars show means ± standard deviation (** <span class="html-italic">p</span> &lt; 0.01 and *** <span class="html-italic">p</span> &lt; 0.001 compared to GM; ## <span class="html-italic">p</span> &lt; 0.01 and ### <span class="html-italic">p</span> &lt; 0.001 compared to the OM without icariin treatment, ALP: alkaline phosphatase, ARS: alizarin red S).</p> Full article ">Figure 3
<p>Effect of icariin on odontogenic differentiation of HDPCs. (<b>A</b>,<b>B</b>) Effect of icariin treatment on the expression of odontogenic differentiation markers at mRNA level. HDPCs were treated with 10 μM of icariin for 3 or 5 days. Expression levels of <span class="html-italic">DSPP</span>, <span class="html-italic">DMP 1</span>, <span class="html-italic">ALP</span>, <span class="html-italic">BSP</span>, <span class="html-italic">OCN</span>, and <span class="html-italic">RUNX 2</span> mRNAs were measured by quantitative real-time PCR. Gene expression was normalized against <span class="html-italic">GAPDH</span> (* <span class="html-italic">p</span> &lt; 0.05, ** <span class="html-italic">p</span> &lt; 0.01, *** <span class="html-italic">p</span> &lt; 0.001). (<b>C</b>) DSPP and DMP 1 protein levels were upregulated after treatment with icariin at 3 or 5 days compared with both GM and OM. Bars show means ± standard deviation (<span class="html-italic">DMP 1</span>: dentin matrix protein 1, <span class="html-italic">DSPP</span>: dentin sialophosphoprotein, <span class="html-italic">RUNX2</span>: runt-related transcription factor 2, <span class="html-italic">OCN</span>: osteocalcin, <span class="html-italic">BSP</span>: bone sialoprotein and <span class="html-italic">GAPDH</span>: Glyceraldehyde-phosphate dehydrogenase).</p> Full article ">Figure 4
<p>MAPK signaling pathway involved in icariin-mediated odontogenic differentiation of HDPCs. (<b>A</b>) Icariin activated MAPK pathways in HDPCs, JNK, p38, and ERK total proteins and phosphorylated proteins were assayed by western blot for the indicated time points (0, 5, 10, 30, and 60 min). (<b>B</b>) MAPK inhibitors (SP600125, SB202190, and U0126) suppressed expression levels of DSPP and DMP 1 proteins. (<b>C</b>,<b>D</b>) Icariin induced ALP activities were significantly blocked by the presence of MAPK inhibitors. (<b>E</b>,<b>F</b>) Icariin enhanced calcium deposition of HDPCs by mainly restraining MAPK inhibitors. Results were normalized to OM. Bars show means ± standard deviation (## <span class="html-italic">p</span> &lt; 0.01 compared to OM; *** <span class="html-italic">p</span> &lt; 0.001 compared to OM with icariin treatment). (MAPK: Mitogen-activated Protein Kinase, SP600125: JNK inhibitor, SB202190: p38 inhibitor, and U0126: ERK inhibitor).</p> Full article ">
9 pages, 313 KiB  
Article
Serum NfL in Alzheimer Dementia: Results of the Prospective Dementia Registry Austria
by Daniela Kern, Michael Khalil, Lukas Pirpamer, Arabella Buchmann, Edith Hofer, Peter Dal-Bianco, Elisabeth Stögmann, Christoph Scherfler, Thomas Benke, Gerhard Ransmayr and Reinhold Schmidt
Medicina 2022, 58(3), 433; https://doi.org/10.3390/medicina58030433 - 16 Mar 2022
Cited by 7 | Viewed by 3059
Abstract
Background and Objectives: The neurofilament light chain (NfL) is a biomarker for neuro-axonal injury in various acute and chronic neurological disorders, including Alzheimer’s disease (AD). We here investigated the cross-sectional and longitudinal associations between baseline serum NfL (sNfL) levels and cognitive, behavioural [...] Read more.
Background and Objectives: The neurofilament light chain (NfL) is a biomarker for neuro-axonal injury in various acute and chronic neurological disorders, including Alzheimer’s disease (AD). We here investigated the cross-sectional and longitudinal associations between baseline serum NfL (sNfL) levels and cognitive, behavioural as well as MR volumetric findings in the Prospective Dementia Registry Austria (PRODEM-Austria). Materials and Methods: All participants were clinically diagnosed with AD according to NINCDS-ADRDA criteria and underwent a detailed clinical assessment, cognitive testing (including the Mini Mental State Examination (MMSE) and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD)), the neuropsychiatric inventory (NPI) and laboratory evaluation. A total of 237 patients were included in the study. Follow-up examinations were done at 6 months, 1 year and 2 years with 93.3% of patients undergoing at least one follow-up. We quantified sNfL by a single molecule array (Simoa). In a subgroup of 125 subjects, brain imaging data (1.5 or 3T MRI, with 1 mm isotropic resolution) were available. Brain volumetry was assessed using the FreeSurfer image analysis suite (v6.0). Results: Higher sNfL concentrations were associated with worse performance in cognitive tests at baseline, including CERAD (B = −10.084, SE = 2.999, p < 0.001) and MMSE (B = −3.014, SE = 1.293, p = 0.021). The sNfL levels also correlated with the presence of neuropsychiatric symptoms (NPI total score: r = 0.138, p = 0.041) and with smaller volumes of the temporal lobe (B = −0.012, SE = 0.003, p = 0.001), the hippocampus (B = −0.001, SE = 0.000201, p = 0.013), the entorhinal (B = −0.000308, SE = 0.000124, p = 0.014), and the parahippocampal cortex (B = −0.000316, SE = 0.000113, p = 0.006). The sNfL values predicted more pronounced cognitive decline over the mean follow-up period of 22 months, but there were no significant associations with respect to change in neuropsychiatric symptoms and brain volumetric measures. Conclusions: the sNfL levels relate to cognitive, behavioural, and imaging hallmarks of AD and predicts short term cognitive decline. Full article
(This article belongs to the Special Issue Biomarkers in Alzheimer Disease and Other Dementias: What’s Next into Pathophysiology to Support Clinical Practice and Drug Development)
15 pages, 2298 KiB  
Article
Publics’ Perceptions of Community Pharmacists and Satisfaction with Pharmacy Services in Al-Madinah City, Saudi Arabia: A Cross Sectional Study
by Amal A. El-Kholy, Khaled Abdelaal, Hussain Alqhtani, Basel A. Abdel-Wahab and Mohamed M. M. Abdel-Latif
Medicina 2022, 58(3), 432; https://doi.org/10.3390/medicina58030432 - 16 Mar 2022
Cited by 14 | Viewed by 5482
Abstract
Background and Objectives: Pharmacists play a major role in serving patients and delivering pharmaceutical services to the community. It is unclear whether the public fully appreciates what pharmacists can do as key health care providers. This study aims to examine public perceptions [...] Read more.
Background and Objectives: Pharmacists play a major role in serving patients and delivering pharmaceutical services to the community. It is unclear whether the public fully appreciates what pharmacists can do as key health care providers. This study aims to examine public perceptions of community pharmacists and levels of satisfaction with pharmacy services. Materials and Methods: A cross-sectional study was conducted on a randomly selected sample population (n = 1000) in Saudi Arabia over a period of six months from January through June 2019. A 40-item, structured, self-administered questionnaire was used, comprised of questions on the demographics characteristics of the respondents and their satisfaction with pharmacy services. Descriptive statistics were used to analyze the data. Results: The response rate of the survey was 76.92%. Public opinions were influenced by pharmacists’ availability and knowledge, service promptness, and counseling services. Overall, 80.5% of respondents agreed that community pharmacists treat them with respect. Doctors were identified as the preferred source of drug therapy consultation by 58.7% and pharmacists by 41.29%. About 72.8% of respondents agreed that pharmacists provided them with clear instructions about medication use, and 70.2% trusted pharmacists’ opinions about medications. About 62.5% of respondents expressed satisfaction with pharmacists, and 64.8% with pharmacy services. Conclusions: Customers’ opinions were influenced by pharmacists’ availability and knowledge, pharmacy service promptness, pharmacy location, waiting area, medication knowledge, and counseling. However, the public was greatly satisfied with community pharmacists’ professionalism and pharmaceutical services. This positive perception provides an opportunity for pharmacists to extend their roles as healthcare professionals. Full article
(This article belongs to the Special Issue Problems Related to Race and Ethnicity in Public Health and Epidemiology Research)
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<p>Customers’ views on pharmacy appearance (<b>A</b>), waiting area (<b>B</b>) and busyness (<b>C</b>).</p> Full article ">Figure 2
<p>Reasons for visiting the community pharmacy (<b>A</b>). Factors contributing to choosing a particular community pharmacy (<b>B</b>). Frequency of visiting a pharmacy (<b>C</b>).</p> Full article ">Figure 3
<p>The image of the community pharmacists among customers.</p> Full article ">Figure 4
<p>Perception of pharmacists. Customers’ views on societal respect of pharmacists (<b>A</b>). Customers’ preferences of doctor or pharmacist for the provision of drug therapy consultation (<b>B</b>).</p> Full article ">Figure 5
<p>Categorical distribution of respondents’ responses to question on buying medicines over the Internet (<b>A</b>) and home delivery of medicines (<b>B</b>).</p> Full article ">Figure 6
<p>Categorical distribution of respondents’ level of satisfaction with the pharmacy services (<b>A</b>) and their community pharmacist (<b>B</b>).</p> Full article ">
18 pages, 5994 KiB  
Review
Hypokalemia in Diabetes Mellitus Setting
by Lucas Coregliano-Ring, Kleber Goia-Nishide and Érika Bevilaqua Rangel
Medicina 2022, 58(3), 431; https://doi.org/10.3390/medicina58030431 - 16 Mar 2022
Cited by 19 | Viewed by 17320
Abstract
Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a consequence of disease progression or its treatment, in particular potassium disorders. The prevalence of hypokalemia in diabetic individuals [...] Read more.
Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a consequence of disease progression or its treatment, in particular potassium disorders. The prevalence of hypokalemia in diabetic individuals over 55 years of age is up to 1.2%. In patients with acute complications of diabetes, such as diabetic ketoacidosis, this prevalence is even higher. Potassium disorders, either hypokalemia or hyperkalemia, have been associated with increased all-cause mortality in diabetic individuals, especially in those with associated comorbidities, such as heart failure and chronic kidney disease. In this article, we discuss the main conditions for the onset of hypokalemia in diabetic individuals, briefly review the pathophysiology of acute complications of diabetes mellitus and their association with hypokalemia, the main signs, symptoms, and laboratory parameters for the diagnosis of hypokalemia, and the management of one of the most common electrolyte disturbances in clinical practice. Full article
(This article belongs to the Special Issue Advance in Type 2 Diabetes and Insulin Resistance)
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<p>Mortality according to serum potassium concentration in individuals with diabetes mellitus, associated or not with other comorbidities and distribution of serum potassium concentration in these populations. (<b>A</b>) Diabetes Mellitus versus Control Group. (<b>B</b>) Heart Failure, Chronic Kidney Disease, and Diabetes Mellitus versus Control Group. (<b>C</b>) Correlation between serum potassium levels and predicted probability of mortality according to each comorbidity and when comorbidities were combined. CKD: Chronic Kidney Disease; DM: Diabetes Mellitus; HF: Heart Failure. Adapted from [<a href="#B2-medicina-58-00431" class="html-bibr">2</a>].</p> Full article ">Figure 2
<p>Drawing of an ECG showing the main changes during hypokalemia: Extension of QT interval, T wave flattening with ST-T depression, and U waves.</p> Full article ">Figure 3
<p>Hypokalemia diagnostic flowchart. <span class="html-italic">UK</span>: Urinary Potassium; TTKG: Transtubular Potassium Gradient; <span class="html-italic">UCr</span>: Urinary Creatinine; BP: Blood Pressure; DKA: Diabetic Ketoacidocis; <span class="html-italic">PAldosterone</span>: Plasmatic Aldosterone; PRA: Plasmatic Renin Activity; RTA: Renal Tubular Acidosis; <span class="html-italic">UCl</span><sup>−</sup>: Urinary Chloride.</p> Full article ">
14 pages, 761 KiB  
Review
Metformin: Sex/Gender Differences in Its Uses and Effects—Narrative Review
by Ioannis Ilias, Manfredi Rizzo and Lina Zabuliene
Medicina 2022, 58(3), 430; https://doi.org/10.3390/medicina58030430 - 16 Mar 2022
Cited by 18 | Viewed by 6599
Abstract
Metformin (MTF) occupies a major and fundamental position in the therapeutic management of type 2 diabetes mellitus (T2DM). Gender differences in some effects and actions of MTF have been reported. Women are usually prescribed lower MTF doses compared to men and report more [...] Read more.
Metformin (MTF) occupies a major and fundamental position in the therapeutic management of type 2 diabetes mellitus (T2DM). Gender differences in some effects and actions of MTF have been reported. Women are usually prescribed lower MTF doses compared to men and report more gastrointestinal side effects. The incidence of cardiovascular events in women on MTF has been found to be lower to that of men on MTF. Despite some promising results with MTF regarding pregnancy rates in women with PCOS, the management of gestational diabetes, cancer prevention or adjunctive cancer treatment and COVID-19, most robust meta-analyses have yet to confirm such beneficial effects. Full article
(This article belongs to the Special Issue Modern Management and Treatment of Diabetes—Celebrating the 100th Anniversary of the First Diabetic Patient Who Received Insulin)
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Graphical abstract

Graphical abstract
Full article ">Figure 1
<p>Molecular responses that are elicited by MTF; some are influenced by sex hormones. Insulin-like Growth Factor-1, INS: Insulin, IGF-1-R: Insulin-like Growth Factor-1-Receptor, INS-R: Insulin Receptor, PI3K: Phosphoinositide 3-kinase, Akt: Serine/threonine protein kinase B, AMPK: AMP-activated protein kinase, SIRT1: Sirtuin 1, FOXO1: Forkhead box protein O1, FOXO2: Forkhead box protein O2, p53: Tumor protein p53, NFκB: Nuclear factor kappa-light-chain-enhancer of activated B cells, mTOR: Mammalian target of rapamycin, p21: Cyclin-dependent kinase inhibitor 1, ROS: Reactive oxygen species, E2: Estradiol, ERβ: Estrogen receptor β, (+): activation, (−): inhibition, drawn with data from [<a href="#B10-medicina-58-00430" class="html-bibr">10</a>,<a href="#B11-medicina-58-00430" class="html-bibr">11</a>,<a href="#B12-medicina-58-00430" class="html-bibr">12</a>,<a href="#B13-medicina-58-00430" class="html-bibr">13</a>].</p> Full article ">
9 pages, 1003 KiB  
Article
Efficacy of Listening to Music on Pain Reduction during Colposcopy-Directed Cervical Biopsy: A Randomized, Controlled Trial
by Lalita Pradit, Charuwan Tantipalakorn, Kittipat Charoenkwan, Prapaporn Suprasert, Jatupol Srisomboon and Tanarat Muangmool
Medicina 2022, 58(3), 429; https://doi.org/10.3390/medicina58030429 - 16 Mar 2022
Cited by 1 | Viewed by 2754
Abstract
Background and Objective: To investigate the efficacy of listening to music on pain reduction during colposcopy-directed cervical biopsy (CDB). Materials and Methods: From June 2020 to November 2021, 240 women undergoing CDB were enrolled. The participants were randomized into three groups: Group [...] Read more.
Background and Objective: To investigate the efficacy of listening to music on pain reduction during colposcopy-directed cervical biopsy (CDB). Materials and Methods: From June 2020 to November 2021, 240 women undergoing CDB were enrolled. The participants were randomized into three groups: Group 1, colposcopic examination while wearing headphones and listening to music; Group 2, colposcopy while wearing headphones but not listening to music; Group 3 (control group), colposcopy while neither listening to music nor wearing headphones. All participating women completed a 10 cm visual analog scale for subjective pain at three time points: baseline, immediately after cervical biopsy, and 15 min after the procedure. The primary endpoint was the biopsy pain score. Result: Of the 240 women, a sample size of 80 was randomly assigned per group. The clinical–pathological and procedure-related characteristics of the participants in all groups were similar. The mean baseline pain score between each group was not significantly different (2.83 in the music group, 2.54 in group 2, and 2.94 in the control group, p = 0.47). There were no significant differences between each group in terms of mean biopsy pain score (4.21 in the music group, 4.24 in group 2, and 4.30 in the control group, p = 0.98). The differences in changes between the baseline pain score and the biopsy pain score were not statistically significant (1.39 in the music group, 1.70 in group 2, and 1.36 in the control group, p = 0.69). In the multiple comparison analysis, the differences in changes between the biopsy pain score and the baseline pain score between each group were also not statistically significant. There were no complications with the intervention observed. Conclusion: This study demonstrated that there was no beneficial effect of listening to music on pain reduction during colposcopy-directed cervical biopsies. Full article
(This article belongs to the Special Issue Complementary and Alternative Medicine for Managing Pain)
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<p>Flow diagram for participating women.</p> Full article ">Figure 2
<p>Boxplot of pain scores for baseline, procedure, and post-procedure between study groups.</p> Full article ">
9 pages, 1179 KiB  
Article
Platelet-Rich Plasma-Releasate (PRPr) for the Treatment of Discogenic Low Back Pain Patients: Long-Term Follow-Up Survey
by Koji Akeda, Norihiko Takegami, Junichi Yamada, Tatsuhiko Fujiwara, Kohshi Ohishi, Satoshi Tamaru and Akihiro Sudo
Medicina 2022, 58(3), 428; https://doi.org/10.3390/medicina58030428 - 16 Mar 2022
Cited by 10 | Viewed by 3877
Abstract
Background and Objectives: Clinical studies of platelet-rich plasma (PRP) for the treatment of low back pain (LBP) have been reported; however, less is known about its long-term efficiency. Materials and Methods: This study was a long-term follow-up of a previous prospective clinical feasibility [...] Read more.
Background and Objectives: Clinical studies of platelet-rich plasma (PRP) for the treatment of low back pain (LBP) have been reported; however, less is known about its long-term efficiency. Materials and Methods: This study was a long-term follow-up of a previous prospective clinical feasibility study for the use of PRP releasate (PRPr) to treat discogenic LBP patients. Among 14 patients, 11 patients were evaluated for a long-term survey. The efficacy was assessed by a visual analogue scale (VAS) for LBP intensity and the Roland-Morris Disability Questionnaire (RDQ) for LBP-related disability. Radiographic disc height was evaluated for seven patients. Results: Improvements in VAS and RDQ were sustained at an average of 5.9 years after the intradiscal injection of PRPr (p < 0.01 vs. baseline, respectively). Clinically meaningful improvements (more than 30% decrease from baseline) in VAS and RDQ were identified in 91% of patients at final survey. The radiographic measurement of disc height of PRPr-injected discs showed a mild decrease (13.8% decrease compared to baseline) during the average 5.9 years. Conclusions: The results of this study with a small number of patients suggest that the intradiscal injection of PRPr has a safe and efficacious effect on LBP improvement for more than 5 years after treatment. Further large-scale studies would be needed to confirm the clinical evidence for the use of PRPr for the treatment of patients with discogenic LBP. Full article
(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)
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<p>Change in visual analogue scale (VAS). Values are shown as mean ± standard error of the mean (SEM). ** <span class="html-italic">p</span> &lt; 0.01 vs. baseline (BL).</p> Full article ">Figure 2
<p>Change in Roland-Morris Disability Questionnaire (RDQ). Values are shown as mean ± standard error of the mean (SEM). ** <span class="html-italic">p</span> &lt; 0.01 vs. baseline (BL).</p> Full article ">Figure 3
<p>Change in disc height. Disc height was represented as the rate of change in disc height index (DHI) compared to the baseline (BL) (%DHI). Values are shown as mean ± standard error of the mean (SEM). * <span class="html-italic">p</span> &lt; 0.05, ** <span class="html-italic">p</span> &lt; 0.01 vs. L3/L4 discs.</p> Full article ">
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