Journal of Clinical Medicine
Journal of Clinical Medicine, an international, peer-reviewed Open Access journal.
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43 pages, 653 KiB

Open AccessReview

Common Mistakes in Managing Patients with Inflammatory Bowel Disease

by Javier P. Gisbert and María Chaparro

J. Clin. Med. 2024, 13(16), 4795; https://doi.org/10.3390/jcm13164795 (registering DOI) - 14 Aug 2024

Abstract

Introduction: Errors are very common in medical practice and in particular, in the healthcare of patients with inflammatory bowel disease (IBD); however, most of these can be prevented. Aim: To address common errors in the management of IBD. Methods: Our approach to this [...] Read more.

Introduction: Errors are very common in medical practice and in particular, in the healthcare of patients with inflammatory bowel disease (IBD); however, most of these can be prevented. Aim: To address common errors in the management of IBD. Methods: Our approach to this problem consists in identifying mistakes frequently observed in clinical practice (according to our experience) in the management of patients with IBD, then reviewing the scientific evidence available on the subject, and finally proposing the most appropriate recommendation for each case. Results: The most common mistakes in the management of IBD include those related to diagnosis and differential diagnosis, prevention, nutrition and diet, treatment with different drugs (mainly 5-aminosalicylates, corticosteroids, thiopurines, and anti-TNF agents), extraintestinal manifestations, anemia, elderly patients, pregnancy, and surgery. Conclusions: Despite the availability of guidelines for both disease management and preventive aspects of IBD care, a considerable variation in clinical practice still remains. In this review, we have identified common mistakes in the management of patients with IBD in clinical practice. There is a clear need for a greater dissemination of clinical practice guidelines among gastroenterologists and for the implementation of ongoing training activities supported by scientific societies. Finally, it is desirable to follow IBD patients in specialized units, which would undoubtedly be associated with higher-quality healthcare and a lower likelihood of errors in managing these patients. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease (IBD): Clinical Diagnosis and Treatment)

28 pages, 1639 KiB

Open AccessReview

Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review

by Naveen Jeyaraman, Filippo Migliorini, Shrideavi Murugan, Swaminathan Ramasubramanian, Sangeetha Balaji, Nicola Maffulli and Madhan Jeyaraman

J. Clin. Med. 2024, 13(16), 4794; https://doi.org/10.3390/jcm13164794 - 14 Aug 2024

Abstract

Metamizole, or dipyrone, has been used for decades as a non-narcotic analgesic, providing pain relief from musculoskeletal disorders and antipyretic and antispasmolytic properties. Despite being in use since the 1920s, its mechanism of action still needs to be discovered. Despite causing fewer adverse [...] Read more.

Metamizole, or dipyrone, has been used for decades as a non-narcotic analgesic, providing pain relief from musculoskeletal disorders and antipyretic and antispasmolytic properties. Despite being in use since the 1920s, its mechanism of action still needs to be discovered. Despite causing fewer adverse effects when compared to other analgesics, its harmful effects on the blood and lack of evidence regarding its teratogenicity make the usage of the drug questionable, which has led to it being removed from the drug market of various countries. This narrative review aims to provide a detailed insight into the mechanism of action and efficacy, comparing its effectiveness and safety with other classes of drugs and the safety profile of metamizole. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 1186 KiB

Open AccessArticle

Association of Lifestyle Behaviors with Quality of Life in Patients with COPD: A Cross-Sectional Study in Primary Care

by Izolde Bouloukaki, Antonios Christodoulakis, Katerina Margetaki and Ioanna Tsiligianni

J. Clin. Med. 2024, 13(16), 4793; https://doi.org/10.3390/jcm13164793 - 14 Aug 2024

Abstract

Background/Objectives: The association between healthy lifestyle behaviors and their effect on quality of life among patients with COPD remains unclear. Therefore, the aim of this study was to explore the lifestyle behaviors and their association with the disease-specific quality of life among [...] Read more.

Background/Objectives: The association between healthy lifestyle behaviors and their effect on quality of life among patients with COPD remains unclear. Therefore, the aim of this study was to explore the lifestyle behaviors and their association with the disease-specific quality of life among a primary care population with COPD in Greece. Methods: This cross-sectional study included 236 participants aged 40 years and older from the COCARE COPD study. The healthy lifestyle index (HLI) was created based on smoking, alcohol consumption, BMI, physical activity, and sleep duration, with each factor categorized as either healthy (1) or unhealthy (0). The HLI ranged from 0 (least healthy) to 5 (healthiest). COPD-specific quality of life was assessed using the COPD assessment test (CAT), where higher scores indicate poorer health status. Multiple logistic regression was used to analyze the association between HLI and CAT scores, adjusting for confounders. Results: Half of the participants were non-smokers or former smokers, while 92% reported consuming low levels of alcohol (less than 14 units per week). Additionally, 56% had a BMI below 30, indicating they were not obese. Surprisingly, only 32% engaged in regular exercise, with at least 150 min per week, and only 25% reported getting adequate sleep, ranging from 7 to 9 h per night. Importantly, poorer health status was inversely associated with non/former smoking (OR: 0.543, 95% CI: 0.282–1.049), physical activity (OR: 0.238, 95% CI: 0.122–0.463), and adequate sleep (OR: 0.337, 95% CI: 0.160–0.710). Patients with higher HLI scores were less likely to have poor health status. Conclusions: In conclusion, our findings indicate that a significant proportion of patients with COPD failed to adhere to a minimum of three out of five healthy behaviors. Additionally, a higher number of healthy lifestyle factors defined by a high HLI score were independently associated with a better disease-specific quality of life. This is particularly important for COPD where quality of life is in the epicenter of management. Therefore, healthcare providers could significantly improve the management of COPD and patient outcomes by targeting and improving these lifestyle behaviors with targeted and holistic intervention strategies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD))

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10 pages, 943 KiB

Open AccessArticle

Screening for RV Dysfunction Using Smartphone ECG Analysis App: Validation Study with Acute Pulmonary Embolism Patients

by Yoo Jin Choi, Min Ji Park, Youngjin Cho, Joonghee Kim, Eunkyoung Lee, Dahyeon Son, Seo-Yoon Kim and Moon Seung Soh

J. Clin. Med. 2024, 13(16), 4792; https://doi.org/10.3390/jcm13164792 - 14 Aug 2024

Abstract

Background: Acute pulmonary embolism (PE) is a critical condition where the timely and accurate assessment of right ventricular (RV) dysfunction is important for patient management. Given the limited availability of echocardiography in emergency departments (EDs), an artificial intelligence (AI) application that can [...] Read more.

Background: Acute pulmonary embolism (PE) is a critical condition where the timely and accurate assessment of right ventricular (RV) dysfunction is important for patient management. Given the limited availability of echocardiography in emergency departments (EDs), an artificial intelligence (AI) application that can identify RV dysfunction from electrocardiograms (ECGs) could improve the treatment of acute PE. Methods: This retrospective study analyzed adult acute PE patients in an ED from January 2021 to December 2023. We evaluated a smartphone application which analyzes printed ECGs to generate digital biomarkers for various conditions, including RV dysfunction (QCG-RVDys). The biomarker’s performance was compared with that of cardiologists and emergency physicians. Results: Among 116 included patients, 35 (30.2%) were diagnosed with RV dysfunction. The QCG-RVDys score demonstrated significant effectiveness in identifying RV dysfunction, with a receiver operating characteristic–area under the curve (AUC) of 0.895 (95% CI, 0.829–0.960), surpassing traditional biomarkers such as Troponin I (AUC: 0.692, 95% CI: 0.536–0.847) and ProBNP (AUC: 0.655, 95% CI: 0.532–0.778). Binarized based on the Youden Index, QCG-RVDys achieved an AUC of 0.845 (95% CI: 0.778–0.911), with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 91.2% (95% CI: 82.4–100%), 77.8% (95% CI: 69.1–86.4%), 63.3% (95% CI: 54.4–73.9%), and 95.5% (95% CI: 90.8–100%), respectively, significantly outperforming all the expert clinicians, with their AUCs ranging from 0.628 to 0.683. Conclusions: The application demonstrates promise in rapidly assessing RV dysfunction in acute PE patients. Its high NPV could streamline patient management, potentially reducing the reliance on echocardiography in emergency settings. Full article

(This article belongs to the Section Emergency Medicine)

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17 pages, 1456 KiB

Open AccessArticle

Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients

by Antonella Meloni, Laura Pistoia, Paolo Ricchi, Filomena Longo, Valerio Cecinati, Francesco Sorrentino, Zelia Borsellino, Sergio Bagnato, Vincenza Rossi, Priscilla Fina, Ada Riva, Stefania Renne, Giuseppe Peritore, Vincenzo Positano and Filippo Cademartiri

J. Clin. Med. 2024, 13(16), 4791; https://doi.org/10.3390/jcm13164791 - 14 Aug 2024

Abstract

Objectives: This multicenter, retrospective, population-based, matched-cohort study compared clinical characteristics and magnetic resonance imaging (MRI) findings, including hepatic, pancreatic, and cardiac iron levels and cardiac function, between 135 adult regularly transfused thalassemia intermedia (TI) patients (44.73 ± 12.16 years, 77 females) and [...] Read more.

Objectives: This multicenter, retrospective, population-based, matched-cohort study compared clinical characteristics and magnetic resonance imaging (MRI) findings, including hepatic, pancreatic, and cardiac iron levels and cardiac function, between 135 adult regularly transfused thalassemia intermedia (TI) patients (44.73 ± 12.16 years, 77 females) and 135 age- and sex-matched thalassemia major (TM) patients (43.35 ± 9.83 years, 77 females), enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Methods: The MRI protocol included the quantification of hepatic, pancreatic, and cardiac iron levels (R2* technique), the assessment of biventricular function parameters (cine images), and the detection of replacement myocardial fibrosis (late gadolinium enhancement technique). Results: Age, sex, frequency of splenectomy and chelation, and serum ferritin levels were not significantly different (p > 0.05) between the two groups, but TI patients started regular transfusions significantly later (p < 0.0001) and showed significantly lower pre-transfusion hemoglobin levels (p = 0.005). No difference was found in hepatic iron levels (p = 0.853). TI patients exhibited significantly lower pancreatic R2* values (p < 0.0001), also correcting for the duration of regular transfusions, and significantly lower cardiac R2* values (p < 0.0001). In the receiver operating characteristic analysis, pancreatic iron was the strongest discriminator between the two diseases. Left and right ventricular end-diastolic volume indexes were significantly higher in TI than in TM patients (p = 0.003 and p = 0.046, respectively), but the correction for the duration of regular transfusions removed the disease-specific differences (p > 0.05). Left ventricular (LV) mass index was significantly higher in TI (p = 0.049), while no difference (p > 0.05) was found in biventricular ejection fractions and replacement myocardial fibrosis. Conclusions: TI patients showed lower pancreatic and cardiac iron burden and more pronounced LV hypertrophy. These differences could not be explained by the different duration of the transfusional regimen. Full article

(This article belongs to the Section Hematology)

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11 pages, 1613 KiB

Open AccessReview

Reconstructive Surgery of the Head and Neck in Organ Transplant Recipients: A Case Report and a Review of the Literature

by Andrea Rampi, Lara Valentina Comini, Andrea Galli, Bright Oworae Howardson, Alberto Tettamanti, Paolo Luparello, Gabriele Redaelli, Davide Di Santo and Stefano Bondi

J. Clin. Med. 2024, 13(16), 4790; https://doi.org/10.3390/jcm13164790 - 14 Aug 2024

Abstract

The number of solid organ transplant recipients (SOTRs) is growing as a consequence of an increase in transplantations and longer survival; these patients, thus, frequently suffer various comorbidities and are subjected to the detrimental effects of immunosuppressive agents, which expose them to a [...] Read more.

The number of solid organ transplant recipients (SOTRs) is growing as a consequence of an increase in transplantations and longer survival; these patients, thus, frequently suffer various comorbidities and are subjected to the detrimental effects of immunosuppressive agents, which expose them to a higher risk of developing malignancies. These drugs also complicate the surgical treatment of neoplasms, as they can hinder wound healing, especially when associated with other unfavorable factors (e.g., previous radiotherapy, diabetes, etc.). We herein present our experience with a 74-year-old SOTR who underwent a radical extended parotidectomy and reconstruction with a submental island flap for a persistent cutaneous squamous carcinoma after radiotherapy; his complicated clinical course was characterized by incredibly slow wound healing. The current literature was reviewed to provide a succinct overview of the main difficulties of head and neck surgery in SOTRs. In particular, the immunosuppressive regimen can be tapered considering the individual risk and other elements should be carefully assessed, possibly prior to surgery, to prevent cumulative harm. New developments, including intraoperative monitoring of flap vascularization through indocyanine green fluorescence video-angiography and the prophylactic application of negative pressure wound therapy, when feasible, may be particularly beneficial for high-risk patients. Full article

(This article belongs to the Special Issue Current Perspectives and Future Directions in Oral and Maxillofacial Surgery)

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10 pages, 1186 KiB

Open AccessArticle

Impact of Baseline Anti-ABO Antibody Titer on Biliary Complications in ABO-Incompatible Living-Donor Liver Transplantation

by Se-Hyeon Yu, Hye-Sung Jo, Young-Dong Yu, Pyoung-Jae Park, Hyung-Joon Han, Sang-Jin Kim, Syahrul Hadi Kamarulzaman and Dong-Sik Kim

J. Clin. Med. 2024, 13(16), 4789; https://doi.org/10.3390/jcm13164789 - 14 Aug 2024

Abstract

Background: Although advancements in desensitization protocols have led to increased ABO-incompatible (ABOi) living-donor liver transplantation (LDLT), a higher biliary complication rate remains a problem. This study evaluated the effect of baseline anti-ABO antibody titers before desensitization on biliary complications after ABOi LDLT. Methods: [...] Read more.

Background: Although advancements in desensitization protocols have led to increased ABO-incompatible (ABOi) living-donor liver transplantation (LDLT), a higher biliary complication rate remains a problem. This study evaluated the effect of baseline anti-ABO antibody titers before desensitization on biliary complications after ABOi LDLT. Methods: The study cohort comprised 116 patients in the ABO-compatible group (ABOc), 29 in the ABOi with the low titer (<1:128) group (ABOi-L), and 14 in the high titer (≥1:128) group (ABOi-H). Results: Biliary complications occurred more frequently in the ABOi-H group than in the ABOi-L and ABOc groups (7 [50.0%] vs. 8 [27.6%] and 24 [20.7%], respectively, p = 0.041). Biliary complication-free survival was significantly worse in the ABOi-H group than in the other groups (p = 0.043). Diffuse intrahepatic biliary strictures occurred more frequently in the ABOi-H group than in the other groups (p = 0.005). Multivariable analysis revealed that the high anti-ABO antibody titer (≥1:128) is an independent risk factor for biliary complications (hazard ratio 3.943 [1.635–9.506]; p = 0.002). Conclusions: A high baseline anti-ABO antibody titer (≥1:128), female sex, and hepatic artery complications are significant risk factors for biliary complications. Full article

(This article belongs to the Special Issue Liver Transplantation: Current Challenges and New Perspectives)

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9 pages, 1093 KiB

Open AccessArticle

Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong

by Vivian Wai-Yan Ng and Vincent Yuk-Tong Cheung

J. Clin. Med. 2024, 13(16), 4788; https://doi.org/10.3390/jcm13164788 - 14 Aug 2024

Abstract

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms [...] Read more.

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms of menstrual pain, and quality of life were examined. Major and minor complications, together with re-intervention rates, were evaluated. Results: Eighty-one HIFU treatments were performed in seventy-nine premenopausal women. The follow-up period was up to 95 months. A total of 65 women underwent treatment for uterine fibroids and 14 were treated for adenomyosis. For patients with uterine fibroids, the baseline fibroid volume median was 190.1 cm3 (18.5–1729.4 cm3). Fibroid volume was reduced by 50.1% (−26.2–97.8, p < 0.0001) at 6 months and 66.9% (−33.7–98.3, p < 0.0001) at 12 months after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores had decreased by 43.5% (0–62.5%, p < 0.0001) at 6 months and 50% (0–73%, p < 0.0001) at 12 months after treatment. In the adenomyosis arm, the median baseline uterine volume was 97.7 cm3 (43.7–367.4 m3). Uterine volume was reduced by 19.6% (range: 1.2–42.0, p = 0.28) at 6 months and 41.9% (18.9–69.2, p = 0.04) at 12 months after treatment. UFS-QOL scores were reduced by 38.1% (6–66.7%, p < 0.0001) at 6 months and 40% (0–70%, p < 0.0001) at 12s month after treatment. Fourteen (21.5%) patients with uterine fibroid and five (35.7%) patients with adenomyosis required subsequent interventions. Conclusions: HIFU provides symptomatic relief to most patients with uterine fibroids and adenomyosis. It is a promising uterus-sparing treatment for patients with these conditions. Full article

(This article belongs to the Special Issue Advances in Gynecological Diseases)

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9 pages, 554 KiB

Open AccessArticle

Comparison of Ophthalmologists versus Dermatologists for the Diagnosis and Management of Periorbital Atypical Pigmented Skin Lesions

by Giovanni Rubegni, Marco Zeppieri, Linda Tognetti, Elisa Cinotti, Ernesto De Piano, Martina D’Onghia, Matteo Orione, Caterina Gagliano, Tommaso Bacci, Antonio Tarantello, Nicola Lo Russo, Niccolò Castellino, Giusy Miranda, Alessandra Cartocci, Gian Marco Tosi and Teresio Avitabile

J. Clin. Med. 2024, 13(16), 4787; https://doi.org/10.3390/jcm13164787 - 14 Aug 2024

Abstract

Background/Objectives: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are significant subtypes of melanoma, with an annual incidence of 1.37 per 100,000 people in the U.S. These skin tumors, often found in photo-exposed areas such as the face, are frequently misdiagnosed, leading to [...] Read more.

Background/Objectives: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are significant subtypes of melanoma, with an annual incidence of 1.37 per 100,000 people in the U.S. These skin tumors, often found in photo-exposed areas such as the face, are frequently misdiagnosed, leading to delayed treatment or unnecessary excisions, especially in the elderly. Facial melanocytic skin tumors (lentigo maligna—LM/lentigo maligna melanoma—LMM) and their simulators (solar lentigo, pigmented actinic keratosis, seborrheic keratosis and lichen planus-like keratosis) often affect the periocular region. Thus, their diagnosis and management can involve different medical figures, mainly dermatologists and ophthalmologists. This study aimed to evaluate the ability of ophthalmologists to diagnose and manage pigmented skin lesions of the periorbital area. Methods: A multicentric, retrospective, cross-sectional study on a dataset of 79 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected. The images were reviewed by six ophthalmologists and two dermatologists. Descriptive statistics were carried out, and the accuracy, sensitivity, and specificity, with their 95% confidence interval (95% CI), were estimated. Results: Ophthalmologists achieved a diagnostic accuracy of 63.50% (95% CI: 58.99–67.85%), while dermatologists achieved 66.50% (95% CI: 58.5–73.8). The sensitivity was lower for ophthalmologists in respect to dermatologists, 33.3% vs. 46.9%, respectively. Concerning the case difficulty rating, ophthalmologists rated as “difficult” 84% of cases, while for dermatologists, it was about 30%. Management was also consistently different, with a “biopsy” decision being suggested in 25.5% of malignant lesions by ophthalmologists compared with 50% of dermatologists. Conclusions: Ophthalmologists revealed a good diagnostic potential in the identification of periorbital LMs/LMMs. Given progressive population ageing and the parallel increase in facial/periorbital skin tumors, the opportunity to train new generations of ophthalmologists in the early diagnosis of these neoformations should be considered in the next future, also taking into account the surgical difficulty/complexity of this peculiar facial area. Full article

(This article belongs to the Section Dermatology)

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13 pages, 927 KiB

Open AccessArticle

Effectiveness of Noise Cancelling Earbuds in Reducing Hearing and Auditory Attention Deficits in Children with Autism

by Julien Zanin, Dani Tomlin and Gary Rance

J. Clin. Med. 2024, 13(16), 4786; https://doi.org/10.3390/jcm13164786 - 14 Aug 2024

Abstract

Background/Objectives: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterised by impairments in social communication, sensory abnormalities, and attentional deficits. Children with ASD often face significant challenges with speech perception and auditory attention, particularly in noisy environments. This study aimed to [...] Read more.

Background/Objectives: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterised by impairments in social communication, sensory abnormalities, and attentional deficits. Children with ASD often face significant challenges with speech perception and auditory attention, particularly in noisy environments. This study aimed to assess the effectiveness of noise cancelling Bluetooth earbuds (Nuheara IQbuds Boost) in improving speech perception and auditory attention in children with ASD. Methods: Thirteen children aged 6–13 years diagnosed with ASD participated. Pure tone audiometry confirmed normal hearing levels. Speech perception in noise was measured using the Consonant-Nucleus–Consonant-Word test, and auditory/visual attention was evaluated via the Integrated Visual and Auditory Continuous Performance Task. Participants completed these assessments both with and without the IQbuds in situ. A two-week device trial evaluated classroom listening and communication improvements using the Listening Inventory for Education-Revised (teacher version) questionnaire. Results: Speech perception in noise was significantly poorer for the ASD group compared to typically developing peers and did not change with the IQbuds. Auditory attention, however, significantly improved when the children were using the earbuds. Additionally, classroom listening and communication improved significantly after the two-week device trial. Conclusions: While the noise cancelling earbuds did not enhance speech perception in noise for children with ASD, they significantly improved auditory attention and classroom listening behaviours. These findings suggest that Bluetooth earbuds could be a viable alternative to remote microphone systems for enhancing auditory attention in children with ASD, offering benefits in classroom settings and potentially minimising the stigma associated with traditional assistive listening devices. Full article

(This article belongs to the Special Issue Current Advances in Assessment and Intervention for Hearing Loss and Cochlear Implantation)

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11 pages, 224 KiB

Open AccessArticle

Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study

by Agnieszka Drozdowska-Szymczak, Sabina Łukawska, Natalia Mazanowska, Artur Ludwin and Paweł Krajewski

J. Clin. Med. 2024, 13(16), 4785; https://doi.org/10.3390/jcm13164785 - 14 Aug 2024

Abstract

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies attacking fetal blood cell antigens. Despite routine antenatal anti-D prophylaxis, intrauterine transfusions (IUTs) are still needed in some HDFN cases. Methods: We conducted a retrospective cohort study on newborns [...] Read more.

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies attacking fetal blood cell antigens. Despite routine antenatal anti-D prophylaxis, intrauterine transfusions (IUTs) are still needed in some HDFN cases. Methods: We conducted a retrospective cohort study on newborns with HDFN born in the 1st Department of Obstetrics and Gynecology of the Medical University of Warsaw. We analyzed 274 neonates with HDFN, identifying 46 who required IUT due to fetal anemia and 228 who did not. The laboratory results, management, and outcomes were compared between these groups. Results: Comparative analysis showed that newborns treated with IUT were more likely to have significant anemia, hyperbilirubinemia, and iron overload, indicated by a high ferritin concentration. These neonates more often required top-up transfusions, phototherapy, intravenous immunoglobulin infusions, and exchange transfusions. The length of stay was longer for newborns who received IUT. Conclusions: HDFN requiring IUT is associated with a greater number of complications in the neonatal period and more often requires additional treatment compared to HDFN not requiring IUT. Full article

(This article belongs to the Special Issue Clinical Outcomes in Maternal–Fetal Medicine)

11 pages, 1313 KiB

Open AccessArticle

Changes in Circulating Adipokine Levels in COVID-19 Patients

by Tomasz Wikar, Mateusz Rubinkiewicz, Dominika Stygar, Elżbieta Chełmecka, Urszula Popiela, Wysocki Michał, Piotr Tylec, Barbara Maziarz and Michał Kukla

J. Clin. Med. 2024, 13(16), 4784; https://doi.org/10.3390/jcm13164784 - 14 Aug 2024

Abstract

Objective: The COVID-19 pandemic has posed significant global health challenges. Despite extensive research efforts, the inflammatory response triggered by SARS-CoV-2 remains to be further explored and understood. Our study aims to examine the changes in serum concentrations of pro-inflammatory adipokines—visfatin and leptin—in [...] Read more.

Objective: The COVID-19 pandemic has posed significant global health challenges. Despite extensive research efforts, the inflammatory response triggered by SARS-CoV-2 remains to be further explored and understood. Our study aims to examine the changes in serum concentrations of pro-inflammatory adipokines—visfatin and leptin—in COVID-19 patients in relation to a healthy control group. Patients/Materials/Subjects and Methods: The study consisted of forty COVID-19 patients and twenty-four healthy patients in the control group. Two serum samples were collected: upon admission and on the seventh day of hospitalization. Concentrations of visfatin and leptin in the serum, alongside routine biochemical parameters, were measured using enzyme immunoassay or enzyme-linked immunosorbent assay kits. The Shapiro–Wilk test was used to assess normality. Differences between independent groups were compared using the Mann–Whitney U test and Kruskal–Wallis ANOVA. Correlations were evaluated with Spearman’s rank correlation coefficient. Results: Our findings revealed significantly lower visfatin levels in COVID-19 patients compared to the control group upon admission (4.29 ng/mL, (3.0–6.88 ng/mL) vs. 37.16 ng/mL (24.74–50.12 ng/mL), p < 0.001 for visfatin 1 and 52.05 ng/mL, (31.2–69.66 ng/mL) vs. 37.16 ng/mL (24.74–50.12 ng/mL), p = 0.048 for visfatin 2). The visfatin level of COVID-19 patients returned to the normal levels, established in the control group. However, there was no significant difference in leptin levels between the two groups (p = 0.270 for leptin 1 and p = 0.129 for leptin 2). There was a positive correlation between BMI and leptin concentration (r = 0.66 and p = 0.00). Moreover, it was discovered that COVID-19 independently reduces visfatin levels during the first day of illness. Conclusions: The results of our research suggest that the onset of COVID-19 infection is correlated to visfatin levels. Association with leptin levels remains inconclusive. Further research is imperative to elucidate the intricate role of visfatin and leptin in SARS-CoV-2 infection and their potential as biomarkers for COVID-19 severity and prognosis. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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15 pages, 1440 KiB

Open AccessArticle

Enhanced Risk of Gastroesophageal Reflux Disease and Esophageal Complications in the Ulcerative Colitis Population

by Xiaoliang Wang, Omar Almetwali, Jiayan Wang, Zachary Wright, Eva D. Patton-Tackett, Stephen Roy, Lei Tu and Gengqing Song

J. Clin. Med. 2024, 13(16), 4783; https://doi.org/10.3390/jcm13164783 - 14 Aug 2024

Abstract

Background: Although heartburn and reflux are frequently reported in ulcerative colitis [UC], the correlation between UC and gastroesophageal reflux disease [GERD], and its complications, esophageal stricture and Barrett’s esophagus [BE], is not well understood. This study aims to examine the prevalence and [...] Read more.

Background: Although heartburn and reflux are frequently reported in ulcerative colitis [UC], the correlation between UC and gastroesophageal reflux disease [GERD], and its complications, esophageal stricture and Barrett’s esophagus [BE], is not well understood. This study aims to examine the prevalence and associated risk of GERD and its complications within the UC population. Methods: We analyzed the National Inpatient Sample (NIS) dataset, consisting of 7,159,694 patients, comparing GERD patients with and without UC to those without GERD. We assessed the degree of colonic involvement in UC and the occurrence of esophageal complications. Bivariate analyses were conducted using the chi-squared test or Fisher exact test (two-tailed). Results: A higher prevalence of GERD (23.0% vs. 16.5%) and GERD phenotypes, such as non-erosive reflux disease (NERD) (22.3% vs. 16%) and erosive esophagitis (EE) (1.2% vs. 0.6%), was found in UC patients (p < 0.01), including pancolitis, proctitis, proctosigmoiditis, left-sided colitis, and indetermined UC (with undefined colonic involvement). UC patients were more likely to develop GERD (1.421), NERD (1.407), and EE (1.681) (p < 0.01). A higher prevalence of esophageal stricture (16.9 vs. 11.4 per 10,000 patients) and BE without dysplasia (94.5 vs. 39.3 per 10,000 patients) was found in UC (p < 0.05). The odds of developing BE without dysplasia were higher (1.892) in patients with UC (p < 0.01), including ulcerative pancolitis, proctitis, and indeterminate UC (OR of 1.657, 3.328, and 1.996, respectively) (p < 0.05). Conclusions: Our study demonstrates an increased risk of developing GERD and its complications in UC. This highlights the importance of vigilant monitoring and early intervention to minimize associated GERD-related risks in patients with UC. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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12 pages, 615 KiB

Open AccessSystematic Review

Optimizing Diabetic Macular Edema Treatment: A Meta-Analysis of Subthreshold Micropulse Laser and Anti-Vascular Endothelial Growth Factor Combination Therapy

by Ching-Chih Ma, Po-Huang Chen and Yun-Hsiu Hsieh

J. Clin. Med. 2024, 13(16), 4782; https://doi.org/10.3390/jcm13164782 - 14 Aug 2024

Abstract

Background: Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this [...] Read more.

Background: Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this study aimed to investigate whether the addition of subthreshold micropulse laser (SML) to anti-VEGF therapy could reduce the requirement for anti-VEGF injections while maintaining the treatment efficacy for DME. Methods: Clinical trials retrieved from the databases of PubMed, EMBASE, and the Cochrane Library were evaluated to determine the effectiveness of combination treatment with SML and anti-VEGF medication compared with that of anti-VEGF treatment alone. The primary outcome measures were the changes in CMT, best-corrected visual acuity (BCVA), and the total number of intravitreal injections (IVIs). Results: The IVI + SML group revealed a substantial increase in the logarithm of the minimum angle of the resolution BCVA and a reduction in CMT at the 12-month follow-up (BCVA: random-effects; mean difference [MD], −0.05; 95% confidence interval [CI]: −0.10 to −0.01; p-value = 0.28, and CMT: random-effects; MD, −18.27; 95% confidence interval, −27.36 to −9.18; p-value = 0.20). The number of required IVIs in the IVI + SML group was lower than that in the IVI only group (random-effects; MD, −2.22; 95% CI: −3.13 to −1.31; p-value < 0.01). Conclusions: Combining SML therapy with anti-VEGF injections may reduce the total number of injections required, improve VA, and reduce CMT at the 12-month follow-up. Although the included studies used different SML regimens and anti-VEGF agents, this review indicates that the application of additional SML therapy results in positive clinical outcomes. Full article

(This article belongs to the Section Ophthalmology)

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8 pages, 558 KiB

Open AccessArticle

Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures

by Andy Ton, Jennifer A. Bell, William J. Karakash, Thomas D. Alter, Mary Kate Erdman, Hyunwoo Paco Kang, Emily S. Mills, Jonathan Mina Ragheb, Mirbahador Athari, Jeffrey C. Wang, Ram K. Alluri and Raymond J. Hah

J. Clin. Med. 2024, 13(16), 4781; https://doi.org/10.3390/jcm13164781 - 14 Aug 2024

Abstract

Introduction: Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT [...] Read more.

Introduction: Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT prescribing patterns in VCF patients, further assessing the impact of surgical interventions on these patterns. Materials and Methods: Patients with index VCFs between 2010 and 2021 were identified using the PearlDiver database. Diagnostic and procedural data were recorded using International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes. Patients under age 50 and follow-up <one year following index VCF were excluded. Patients were categorized based on whether they received AOT within one year, preceding and after index VCF, and were subsequently propensity-matched 1:3 based on age, sex, and Elixhauser Comorbidity Index (ECI) score to compare hip fracture incidence following index VCF. Sub-analysis was performed for operatively managed VCFs (kyphoplasty/vertebroplasty). Statistical tests included Chi-squared for categorical outcomes, and Kruskal–Wallis for continuous measures. Results: Of 637,701 patients, 72.6% were female. The overall subsequent hip fracture incidence was 2.6% at one year and 12.9% for all-time follow-up. Propensity-matched analysis indicated higher subsequent hip fracture rates in patients initiated on AOT post-index VCF (one year: 3.8% vs. 3.5%, p = 0.0013; all-time: 14.3% vs. 13.0%, p < 0.0001). Conclusions: The study reveals an unexpected increase in subsequent hip fractures among patients initiated on AOT post-index VCF, likely due to selection bias. These findings highlight the need for refined osteoporosis-management strategies to improve guideline adherence, thereby mitigating patient morbidity and mortality. Full article

(This article belongs to the Section Orthopedics)

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21 pages, 1391 KiB

Open AccessReview

Global Insights on Prehospital Stroke Care: A Comprehensive Review of Challenges and Solutions in Low- and Middle-Income Countries

by Elvan Wiyarta, Marc Fisher, Mohammad Kurniawan, Rakhmad Hidayat, Iskandar Purba Geraldi, Qaisar Ali Khan, I Putu Eka Widyadharma, Aliena Badshah and Jeyaraj Durai Pandian

J. Clin. Med. 2024, 13(16), 4780; https://doi.org/10.3390/jcm13164780 - 14 Aug 2024

Abstract

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the [...] Read more.

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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8 pages, 434 KiB

Open AccessReview

Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature

by Dan Bandea, Ramon Vilallonga, Anamaria Nedelcu, Laura Gabriela Gavril, Marius Nedelcu and Bogdan Andrei Suciu

J. Clin. Med. 2024, 13(16), 4779; https://doi.org/10.3390/jcm13164779 - 14 Aug 2024

Abstract

Background: The diet and physical activity of the world’s population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in [...] Read more.

Background: The diet and physical activity of the world’s population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease—heart failure (HF) and cardiac artery disease (CAD), types of revascularization—coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index—BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion—duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials. Full article

(This article belongs to the Section General Surgery)

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9 pages, 1952 KiB

Open AccessBrief Report

Cranioplasty after Decompressive Craniectomy (DC) in a Patient with Intracerebral Hemorrhage after SARS-CoV-2 Vaccination-Related Vaccine-Induced Thrombotic Thrombocytopenia (VITT)—Proposal of a Management Protocol for This Rare Pathological Condition

by Lennard Spanehl, Uwe Walter, Thomas Thiele, Daniel Dubinski, Bedjan Behmanesh, Thomas M. Freiman, Matthias Wittstock, Patrick Schuss, Hartmut Vatter, Matthias Schneider, Florian Gessler and Sae-Yeon Won

J. Clin. Med. 2024, 13(16), 4778; https://doi.org/10.3390/jcm13164778 - 14 Aug 2024

Abstract

The COVID-19 (coronavirus disease) pandemic had a severe impact on public health worldwide. A rare but serious complication after administration of adenoviral vaccines against SARS-CoV-2 (AstraZeneca–Oxford and Johnson & Johnson) is vaccine-induced immune thrombotic thrombocytopenia and thrombosis (VITT), which can lead to serious [...] Read more.

The COVID-19 (coronavirus disease) pandemic had a severe impact on public health worldwide. A rare but serious complication after administration of adenoviral vaccines against SARS-CoV-2 (AstraZeneca–Oxford and Johnson & Johnson) is vaccine-induced immune thrombotic thrombocytopenia and thrombosis (VITT), which can lead to serious complications such as cerebral venous sinus thrombosis (CVST). CVST itself can cause subarachnoid hemorrhage (SAH) and/or intracerebral hemorrhage (ICH), leading to high mortality due to herniation of brain parenchyma. In those patients, an emergent decompressive hemicraniectomy (DC) is regularly performed. Herein, the authors want to focus on the patients who survive DC following VITT-associated CVST and shed light on the neurosurgical considerations in those patients. We herein propose a treatment algorithm regarding the timing and the perioperative management of cranioplasty. We describe an exemplary case highlighting that special circumstances may result in a more urgent need for autologous cranioplasty than usual, based on individual risk assessment. Full article

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

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