Search Results (1,169)

Background/Objectives: Renal cell cancer is a rare occurrence in patients with ulcerative colitis (UC), with no clearly demonstrated association between UC and an increased risk of renal malignancies. In this article, a case report concerning this relationship is presented. Methods: Our research group presented a case of clear cell renal carcinoma in a 56-year-old male with UC who had previously undergone ileorectal anastomosis and subtotal colectomy. Results: The patient developed a complex renal cyst that progressed to malignancy within one year while on immunosuppressive therapy with infliximab and then filgotinib. Previous ultrasound examinations of the kidney highlighted only simple cysts in the contralateral kidney in previous years. The neoplasm was promptly examined using contrast-enhanced ultrasound, confirming the diagnosis of a Bosniak IV cyst, which was corroborated by a subsequent computed tomography study. Conclusions: The patient underwent a nephrectomy and is currently scheduled for therapy with vedolizumab. Given the increasing use of biologics and small molecules in UC management, periodic ultrasound screening may be a valuable tool for the long-term monitoring of these patients. Full article

Biochemical markers can be used in addition to neuroimaging techniques to evaluate the extent of ischemic brain injuries and to enable earlier diagnosis and faster intervention following the ischemic event. Among the potential biomarkers of ischemic brain injuries during surgery, neuron-specific enolase (NSE) and S100B are the most frequently studied and were shown to be the most promising. The aim of this review was to summarize the role of NSE and S100B as biomarkers of ischemic brain injuries that occur during selected surgical procedures, predominantly carotid endarterectomy (CEA). Some other invasive interventions that cause ischemic brain injuries, like extracorporeal membrane oxygenation, were also included. We can conclude that these biomarkers can be useful for the evaluation of ischemic brain injuries that occur during various surgical procedures. They can help to determine the most optimal conditions for performing the surgery and therefore improve the procedures to consequently minimize brain damage caused during surgery. Because of a significant delay between sample collection and obtaining the results, they are not suitable for real-time assessment of brain injuries. Some improvement can be expected with the future development of laboratory methods. The association of the changes in NSE and S100B levels during surgery with potential consequences of ischemic brain injury have been described in numerous studies. However, even in a very homogenous group of surgical procedures like CEA, these findings cannot be summarized into a common final conclusion; therefore, the prognostic value of the two markers is not clearly supported at the present time. Full article

Background/Objectives: The coronavirus disease (COVID-19) pandemic was associated with an intense impact on health worldwide. Among the sequelae, it became necessary to clarify respiratory impairment related to lung function and aerobic capacity, as well as the treatment of curative and preventive measures of pulmonary involvement. In this context, this study aimed to compare vital signs, the sensation of dyspnea (Borg scale), lung function, and exercise tolerance before and after the use of non-invasive mechanical ventilation (NIV) in adults of both sexes after acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: A cross-sectional analytical clinical study was performed with the inclusion of individuals who had been diagnosed with COVID-19 at least three months before data collection. Individuals were evaluated for vital signs (heart rate and peripheral oxygen saturation), Borg scale, spirometry, and submaximal exercise protocol of two minutes of the step test before and after receiving NIV in ventilation mode by continuous positive airway pressure of 6 cm H₂O for 30 min. Results: A total of 50 participants were enrolled and grouped as a mild (N = 25) or severe (N = 25) clinical phenotype during SARS-CoV-2 infection according to the criteria of the World Health Organization. In our data, the forced vital capacity (p < 0.001), the ratio between the forced expiratory volume in the first one second to the forced vital capacity and the forced vital capacity (p = 0.020), and the two-minute submaximal step exercise protocol (number of steps—p = 0.001) showed a statistical improvement in the severe clinical phenotype group after NIV. In addition, forced expiratory volume in the first one second to the forced vital capacity (p = 0.032) and the two-minute submaximal step exercise protocol (number of steps—p < 0.001) showed a statistical improvement in the mild clinical phenotype group after NIV. No changes were described for vital signs and the Borg scale. Conclusions: This study allowed us to identify that NIV is a tool that promotes better exercise capacity by increasing the number of steps achieved in both clinical phenotype groups and improving lung function observed in the spirometry markers. Full article

Background: Ischemic heart disease is a major global health problem with significant morbidity and mortality. Several cardiometabolic variables play a key role in the incidence of adverse cardiovascular outcomes. Objectives: The aim of the present study was to apply a machine learning approach to investigate factors that can predict acute coronary syndrome in patients with a previous episode. Methods: We recruited 652 patients, admitted to the hospital for acute coronary syndrome, eligible if undergoing immediate coronary revascularization procedures for ST-segment-elevation myocardial infarction or coronary revascularization procedures within 24 h. Results: Baseline pulse wave velocity appears to be the most predictive variable overall, followed by the occurrence of left ventricular hypertrophy and left ventricular end-diastolic diameters. We found that the potential of machine learning to predict life-threatening events is significant. Conclusions: Machine learning algorithms can be used to create models to identify patients at risk for acute myocardial infarction. However, great care must be taken with data quality and ethical use of these algorithms. Full article

Introduction: About one in four people show an immunological reaction to an infection with Mycobacterium tuberculosis, which can remain latent or lead to active forms of the disease. Psoriasis is a chronic, immune-mediated skin disease that can be associated with numerous comorbidities. Biologic therapies have revolutionized psoriasis treatment but carry the risk of reactivating latent tuberculosis infection. However, the link between tuberculosis as a triggering factor for the onset of psoriasis remains unknown. Clinical Case: We present the case of a patient initially diagnosed with secondary pulmonary tuberculosis, who, two months after the diagnosis, showed a remarkable clinical evolution by developing lesions consistent with vulgar psoriasis, necessitating a multidisciplinary treatment approach. Discussions: This unique case highlights the shared immune mechanism of these diseases, particularly involving TNF-α, IL-17, and CD4+ T cells. Conclusions: The coexistence of these conditions raises critical questions about the interplay between infectious and autoimmune diseases and the impact of genetic susceptibility. Full article

Background: Streptococcal toxic shock syndrome (STSS) is a serious and potentially fatal complication of invasive Streptococcus pyogenes (Group A Streptococcus, GAS) infection, often stemming from severe soft tissue infections. While uncommon, tonsillitis can also lead to STSS, with lethality rates reported as high as 70%. Methods: We present three cases of patients diagnosed with tonsillitis who developed STSS. Point-of-care testing for GAS antigens was utilized to facilitate rapid diagnosis. Results: In all three cases, the characteristic clinical presentations, including scarlatiniform rash, strawberry tongue, and signs of shock with multi-organ dysfunction, were observed. Microbiological evidence confirmed ongoing GAS infections, and point-of-care testing for GAS antigens assisted in the diagnosis of tonsillitis in conjunction with STSS, enabling timely treatment interventions. Conclusions: Rapid diagnosis is crucial for the optimal management of STSS. The point-of-care testing for GAS may be useful for diagnosing STSS associated with tonsillitis. Full article

Background: To examine the changes in perceived tinnitus sound qualities following internet-based cognitive behavioral therapy (ICBT) for tinnitus. Method: This study was embedded within several clinical trials evaluating the efficacy of ICBT and used a quasi-experimental design (N = 152). Participants completed a series of online questionnaires, including measures of tinnitus sound qualities (Tinnitus Qualities and Impact Questionnaire; TQIQ), tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). Data were analyzed using a range of parametric and non-parametric statistics, and Cohen’s d effect sizes were reported. Results: There were no significant differences between the intervention and control groups in sociodemographic and clinical variables at baseline except for anxiety and depression symptoms, which were higher in the intervention group. A statistically significant reduction in tinnitus severity, anxiety, depression, and insomnia was noted post-intervention, with small-to-moderate effect sizes. Statistically significant improvements were also noted for the TQIQ (overall and all subscales) following ICBT compared to the no-intervention group (p ≤ 0.028), all with small-to-large effect sizes, except for the loud sounds subscale and for participants with a TQIQ < 38 at baseline, or “mild” perceived qualities of tinnitus (p ≥ 0.136). A significantly greater proportion of participants in the intervention group had minimum clinically important differences (38%) on the TQIQ compared to the no-intervention group (9%). Conclusions: ICBT can lead to changes in the perceived qualities of tinnitus sound in addition to reducing tinnitus severity and other aspects, such as anxiety, depression, and insomnia. While these findings are preliminary, they highlight that tinnitus distress and perception may be related. However, the study has several limitations including a lack of audiological variables and objective measures. For this reason, the study results must be viewed with caution and must be treated as preliminary. Full article

Background: Pregnancy induces hormonal, immunologic, and vascular changes that profoundly affect dermatologic health. This systematic review aimed to assess the impact of pregnancy on dermatological disorders in terms of disease incidence, severity, maternal-fetal outcomes, and optimal management strategies. Methods: A systematic search was performed in PubMed, MEDLINE, and Web of Science databases, following PRISMA guidelines. Studies evaluating pregnant women with dermatological disorders, pregnancy-related dermatoses, and pre-existing morbidities, were included. The collaboratively extracted data included patient demographics, disease severity, treatment approaches, and pregnancy outcomes. Results: A total of 8490 pregnant cases with dermatologic changes and conditions caused by pregnancy were studied. The dermatological conditions were divided into physiological changes, pregnancy-related exacerbation of pre-existing skin conditions, and pregnancy-specific dermatoses. Intrahepatic cholestasis of pregnancy and pemphigoid gestationis were associated with increased rates of adverse fetal outcomes in patients with specific dermatoses, including increased preterm birth and fetal distress rates. The atopic eruption of pregnancy and polymorphic eruption of pregnancy were highly relevant, but their effect on fetal health was minimal. The efficacy and safety of treatment modalities, including corticosteroids, antihistamines, and ursodeoxycholic acid, were variable. Conclusions: Pregnancy drastically affects dermatological health, but the nature of the impact depends on the condition. Optimal maternal and fetal outcomes rely on early diagnosis and individualized management strategies. More randomized controlled trials are required to develop standardized diagnostic and treatment guidelines to enhance the quality of dermatologic care during pregnancy. Full article

Background: The management of renal injuries in hemodynamically stable adult patients is moving toward more conservative methods, even in cases of severe grade and/or penetrating trauma. The objective of this study was to analyze the patterns of injury, management, and complications in renal trauma patients at a Polish trauma center. Methods: Patients diagnosed with renal trauma at the trauma center between January 2019 and December 2023 were identified based on the ICD-10 codes. The information was gathered from digitalized medical records, while imaging data were classified by Radiologists. Results: During a period of 4 years, a total of 81 patients with renal trauma were admitted to the trauma center. 76% of these patients were males, with a mean age of 44.61 ± 16.8 years. The most common concomitant conditions, both among men and women, included retroperitoneal hematoma, rib fractures, as well as chest and lung injuries. Surgical intervention within 8 h of admission was mainly performed on patients with grade IV and V kidney damage, which included a total of 22 people. In deferred treatment, 31 patients underwent surgical intervention. Conclusions: Hemodynamically stable patients, even with penetrating and/or high-grade blunt trauma, were mostly managed non-operatively, with a low rate of complications. Full article

Background: Lithium disilicate ceramic veneers are considered the gold standard in aesthetic dentistry due to their translucency, strength, and adhesive bonding properties. This clinical case report details the aesthetic rehabilitation of a patient through the use of pressed lithium disilicate veneers, highlighting the treatment workflow, material selection rationale, and the long-term functional and aesthetic outcomes achieved. Methods: A review was conducted to evaluate the long-term success of lithium disilicate. A case study is presented that involves a 32-year-old female patient with anterior tooth discoloration, minor morphological discrepancies, and a desire for smile enhancement. A conservative approach using pressed lithium disilicate was chosen to restore harmony and enhance natural aesthetics. The treatment involved minimally invasive tooth preparation, digital smile design, and adhesive cementation using a total-etch technique with light-cured resin cement. High-resolution intra-oral and extra-oral photographs documented the case, capturing the preoperative, preparation, and final restoration stages. These images highlight shade matching, margin adaptation, and smile transformation after veneering. Results: Postoperative evaluation showed excellent aesthetic outcomes, color integration, and marginal adaptation, with the patient expressing high satisfaction. The veneers exhibited optimal translucency and strength, ensuring long-term durability. A one-year follow-up revealed no debonding, marginal discoloration, or surface degradation, confirming the clinical reliability of lithium disilicate veneers. Conclusions: Lithium disilicate provides predictability, durability, and high aesthetic results, making it an ideal choice for minimally invasive smile enhancement. The use of photographic documentation emphasizes the importance of case planning, precise preparation, and adhesive bonding for successful outcomes. Future research should focus on long-term survival rates and complication prevention to further refine material selection and bonding protocols. Full article

Alpha-synuclein has been associated with neurodegeneration, especially in Parkinson’s disease (PD). This study aimed to review clinical, biochemical, and neuroimaging markers and management of prodromal synucleinopathies. The prodromal state of synucleinopathies can be better understood with PD pathophysiology, and it can be separated into premotor and pre-diagnostic phases. The incidence of PD in patients with prodromal phase symptoms ranges from 0.07 to 14.30, and the most frequently studied pathology is the REM behavioral disorder (RBD). Neuroimaging markers are related to dopamine denervation, brain perfusion changes, gross anatomy changes, and peripheral abnormalities. α-synuclein assays (SAA) in CSF revealed high sensitivity (up to 97%) and high specificity (up to 92%); in the last decade, there was the development of other matrices (blood, skin, and olfactory mucosa) for obtaining quantitative and qualitative α-synuclein. Other biomarkers are neurofilament light chain, DOPA decarboxylase, and multiplexed mass spectrometry assay. Regarding genetic counseling in α-synucleinopathies, it is an important topic in clinical practice to discuss with patients with high-risk individuals and should involve basic principles of autonomy, beneficence, and non-maleficence. Some of the themes that should be reviewed are the involvement of physical activity, diet (including alcohol, coffee, and vitamin supplementation), smoking, sleep, and stress in the pathophysiology of synucleinopathies. The number of trials related to prodromal symptoms is still scarce, and the number of studies evaluating intervention is even lower. Full article

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which the most known in dentistry is represented by the cone beam computed tomography (CBCT). Objectives: The purpose of the study is to obtain a quantitative analysis of bone mineral density changes in patients who underwent treatments of photobiomodulation (PBM), as complementary to a surgical approach in oral surgery and implantology. Methods: The study included the retrospective analysis of maxillary cone beam computed tomography of 28 patients without pathology or medication known to affect bone metabolism or its qualitative and quantitative properties. All patients from the study group followed the same laser PBM treatment protocol after placing dental implants; the PBM protocol implied the intraoral use of a gallium aluminum arsenide laser (GaAlAs) of 808 nm, 450 mW, in pulsed mode, administering an energy of 6 J in 3 points corresponding to each inserted dental implant—mesial, distal, and apical—totaling 18 J/implant. Treatment sessions were performed immediately postoperatively and at a subsequent distance of 48 h for 2 weeks (a total of eight sessions). For every patient, bone density was analyzed before and after PBM treatment, in the same areas of interest, within the same anatomical landmarks. A comparison was also made between the results obtained for the anterior maxilla and the posterior maxilla. All the measurements made were analyzed statistically, the results being presented in the dedicated section. Results: Based on the data analysis, the comparison between the lasered and non-lasered groups reveals that patients who underwent PBM showed a statistically significant improvement in bone mineral density, with the mean increasing from 530.91 HU before treatment to 842.55 HU after treatment (t-test: p < 0.001). In contrast, the non-lasered group showed no significant improvement, with a slight decrease in bone mineral density, as the mean dropped from 495.19 HU before treatment to 462.16 HU after treatment (t-test: p = 0.47). Conclusions: The study demonstrated results with statistical significance regarding the mineral bone density improvement of patients who underwent laser PBM treatment. This positive effect of laser therapy has been shown, both at the level of the vestibular cortical bone and at level of the trabecular bone, independent of the patient’s sex, for the anterior maxilla and at the lateral areas also. Full article

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months on pain, disability, quality of life, anxiety, depression and somatic symptom disorders (SSDs) in Greek backache patients and to evaluate the medium-term effects of a conservative physiotherapeutic approach (massage, ultrasound, transcutaneous electrical nerve stimulation, low-level laser and exercise program). Methods: A prospective cohort study of 145 volunteers receiving treatment for CLBP in a physiotherapy unit was conducted using random systematic sampling. The intervention was assessed by comparing pre-treatment, post-treatment and six-month measurements with Friedman’s test and the Bonferroni correction, using the pain numerical rating scale (PNRS), Roland–Morris disability questionnaire (RMDQ), EuroQol-5-dimension-5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale (HADS) and Somatic Symptom Scale-8 (SSS-8). Multiple linear regression analysis was carried out to determine the impact of demographics and pre-treatment scores with scores at six months. Results: The mean age was 60.6 years (±14.7). Post-treatment, statistically significant improvements were observed across all outcome measures, including PNRS, RMDQ, EQ-5D-5L and SSS-8 (all p ≤ 0.001), with anxiety showing a notable reduction (p = 0.002). After examining the multiple regression analysis, pre-treatment SSS-8 emerged as a predictor of elevated levels of pain, disability, anxiety and depression at 6 months. Conclusions: The findings yielded not only somatic symptom burden, greater age and pain intensity as prognostic indicators for poor outcomes at six months, but also reported favorable medium-term effects for a conventional physiotherapy regimen in CLBP management, as well. Full article

Background: Facial structures are critical to aesthetics and function. Deformities can cause significant problems. Advances in surgical techniques, including three-dimensional (3D) computer simulation and virtual surgical planning (VSP), have improved outcomes. VSP accurately predicts surgical outcomes, revolutionizing facial reconstruction. This article reviews VSP in facial bone reconstruction, highlighting its advantages and accuracy over traditional methods. Methods: A systematic search using Medline (PubMed), Web of Science, Scopus, and Google Scholar revealed 1645 articles that addressed the topic of this study. Results: The systematic search yielded 64 articles that were highly relevant to the study objective, underscoring the critical importance of virtual surgical planning (VSP) in enhancing surgical precision and patient satisfaction. VSP has become a key player in improving surgical interventions and reducing complications, reinforcing its role as the preferred method in modern reconstructive surgery and thus improving functional and aesthetic outcomes, significantly enhancing patient satisfaction, and ensuring accurate interpretation of treatment plans. When compared to traditional surgical planning (TSP), VSP offers increased accuracy, shorter operating times, and superior aesthetic outcomes. Conclusions: VSP has been shown to effectively manage the complex challenges of facial anatomy and has significantly enhanced the planning and execution of reconstructive surgeries. This has been achieved by leveraging advanced imaging and computer-aided design. Full article

Background: Dysphagia is a common complication in myopathy, significantly impacting patients’ quality of life (QoL) and overall health. Caregivers play a critical role in identifying and addressing swallowing difficulties in this population. The main purpose of this study was to assess the knowledge and experiences of professional caregivers of patients with myopathy regarding the recognition and management of dysphagia in Cyprus. Methods: The study was designed as an anonymous, cross-sectional descriptive survey and involved 10 professional caregivers of patients with myopathy in Cyprus. Results: The most common dysphagia symptoms reported in myopathy patients were coughing, chewing difficulties, choking on fluids, and challenges with swallowing boluses. Only one caregiver reported difficulty managing swallowing issues, particularly in cases of reluctance to eat. Approximately 60% had received relevant training, primarily through workplace programs. Overall, caregivers did not perceive dysphagia as a significant burden. Conclusions: Dysphagia is a prevalent phenomenon in myopathy. The study reveals that caregivers of myopathy patients, regardless of their professional backgrounds, face hidden challenges in managing complex neurogenic dysphagia. They often misjudge the severity of the condition and overestimate their own competencies. Providing caregivers of patients with myopathy with targeted education would help them effectively manage swallowing difficulties associated with the condition. Encouragingly, our study also suggests that focused dysphagia education could reduce caregiver stress and enhance their overall well-being. Future efforts should concentrate on ensuring access to well-trained professionals, establishing specialized clinics, and promoting education to enhance MND-related dysphagia management and patient care. Full article