European review for medical and pharmacological sciences最新文献

OBJECTIVE: Percutaneous coronary intervention (PCI) is a non-surgical procedure that opens restricted or blocked coronary arteries to restore cardiac blood flow. The study's goal was to investigate the risk factors, complications, and mortality rates associated with PCI procedures in Western Sudan during conflict time. MATERIALS AND METHODS: This retrospective descriptive study was conducted at El-Obeid International Hospital (Aldaman), North Kordofan, Sudan, from April 2023 to April 2024. All data referring to patients who had PCI at El-Obeid International Hospital's catheterization laboratory during the period from April 2023 to April 2024 were retrieved. RESULTS: Approximately 38% of patients were hypertensive, with 15.7% developing complications, which included 33.3% femoral hematoma, 16.7% pulmonary edema, and 50% acute kidney injury (AKI). Approximately 17% were smokers, but none suffered complications. About 35% of the patients were diabetic, and three of them had complications, including 33.3% femoral hematoma, 33.3% pulmonary edema, and 33.3% AKI. Based on the type of PCI, approximately 50% of the patients underwent primary PCI, with only 2% developing pulmonary edema. Only 3% of patients successfully completed the standard pharmaco-invasive procedure without any complications. Approximately 27% of our treatments were for patients with chronic coronary syndrome (CCS), with four patients developing complications, including 50% femoral hematoma, 25% pulmonary edema, and 25% AKI. CONCLUSIONS: Despite Sudan's horrific situation, the outcome of PCI is positive, with few problems. The most common consequences of PCI at the western Sudan site were hematoma, pulmonary edema, and acute kidney injury.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/102-109.jpg.

OBJECTIVE: 5-Fluorouracil is a widely used antimetabolite in oncology but can be toxic, particularly in patients with dihydropyrimidine dehydrogenase deficiency. A plasma uracil level exceeding 16 ng/mL and a metabolic ratio (dihydrouracil/uracil) below 6 are indicators of DPD deficiency. This study compares different screening methods for dihydropyrimidine dehydrogenase deficiency. MATERIALS AND METHODS: One hundred and eighty-eight Algerian patients with colorectal cancer treated with 5-Fluorouracil were screened for dihydropyrimidine dehydrogenase deficiency using DPYD genotyping, phenotyping with uracil levels and metabolic ratio, and a multiparametric approach. Moderate-to-severe toxicities were investigated, and predictive performances of screening method was compared using likelihood ratios. RESULTS: No mutations were found except a heterozygous c.1905+ 1G>A (2A*) mutation in one patient. Uracil and metabolic ratio values ranged from [3.52-18.63] ng/mL and [4.33-30.74], respectively. The likelihood ratios for uracil, metabolic ratio, and multiparametric method were 5.7/0.13, 10.6/0.05, and 11.3/0.04, respectively. The multiparametric method reduced false-negative rates by more than half compared to uracil. Gender and weight significantly impacted toxicity (p=0.023 and p=0.013, respectively). CONCLUSIONS: The multiparametric method outperforms plasma uracil levels in predicting moderate-to-severe fluoropyrimidines toxicities. A more complex predictive model, considering factors like weight, sex, uracil, and metabolic ratio, is recommended. Further investigation into the DPYD gene in North African populations is needed.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/110-122-scaled.jpg.

OBJECTIVE: During the COVID-19 pandemic, communication between patients and their treatment teams was severely limited due to restriction laws, which had a devastating impact on both patients and their families. This study examined the adequacy of clinical communication and sufficiency between the treating physicians and relatives of patients with COVID-19 infection. MATERIALS AND METHODS: This is a descriptive, retrospective study using a validated questionnaire. The study targeted the relatives of patients admitted to King Saud University Medical City (KSUMS) in Riyadh from March 2020 to May 2022. The contact information of the patients' relatives was retrieved from the hospital's electronic admission system (e-SEHAI). A phone questionnaire was completed after contacting identified family members or relatives. RESULTS: The total number of completed questionnaire responses was 404. Of these, 216 (54%) of participants were males, and the remaining 46% were females. Participants comprised parents (41.3%), partners (17.4%), siblings (10%) and other relatives (31.2%). Forty-four percent of participants were satisfied with the quality of communication of the treating team, while 113 (28%) were not satisfied, and 113 (28%) preferred not to express their views. Sixty-nine percent of participants considered consultants the best way to communicate with relatives, while only 17% chose residents. One hundred and forty-seven (36%) of the participants believed that too much communication would not interfere with the clinical work of the physicians, while only 18% agreed it would, and 45% were undecided. CONCLUSIONS: While the authors found a moderate level of participants' satisfaction regarding physician communication during the COVID-19 pandemic, the study identified gaps and areas for potential improvement. The findings could guide more effective hospital communication strategies in the future and better approaches for patient care and family satisfaction.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphic-Abstract.jpg.

The interstitial lung disease (ILD) field is rapidly expanding as new insights highlight novel mechanisms and procedures that influence epidemiology, diagnosis, and treatment.  The aim of this review is to report on recent advancements and future perspectives in clinical management and research in ILD, particularly in idiopathic pulmonary fibrosis (IPF), for the most common ILD. Whilst high-resolution computed tomography (HRCT) remains the gold standard for diagnosis, we focus on newer diagnostic techniques, including IPF genome analysis and epigenetics, biomarkers, bronchoscope robotic navigation, and transbronchial lung cryo biopsy for improving diagnostic accuracy.  Further, we report IPF associated with pulmonary hypertension Group 3 and scores for defining disease progression. Positron emission tomography/computed tomography, treatment with prostacyclin and antifibrotic drugs, and lung transplantation as potential treatments for end-stage IPF are discussed. Lastly, we discuss contemporary perspectives on interstitial lung abnormalities (ILA), IPF associated with lung cancer, and the use of artificial intelligence (AI) for ILD diagnosis and monitoring.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/123-134.jpg.

Objective: The diagnosis of euthyroid sick syndrome (ESS) in several diseases has been associated with poor outcomes, and proximal femur fractures are among the most common injuries in elderly patients, representing a leading cause of disability and mortality. There are no studies evaluating the mortality rate in patients with proximal femur fractures and ESS. The aim of our study was to evaluate a potential higher mortality rate in geriatric patients with proximal femur fracture and affected by ESS.

Materials and methods: In this proof-of-concept study, all patients older than 65 years with a diagnosis of proximal femur fracture were included. They were all treated surgically. The main exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, and any thyroid or endocrine pathology.

Results: Thirty-six patients who met our criteria were enrolled: 20 of them had a diagnosis of ESS (Group A), while 16 had a normal thyroid function as control (Group B). The mortality rate was evaluated at one month, three months, six, and twelve months after surgery. The survival analysis of enrolled patients showed a higher mortality rate in patients with ESS (p = 0.049) regardless of baseline comorbidities.

Conclusions: The ESS could be included among the predictive factors of all-cause mortality in geriatric patients with proximal femur fracture.

Objective: MicroRNAs (miRNAs) are non-coding RNAs that participate actively in the post-transcriptional regulation of tumor suppressors, oncogenes, and DNA repair genes implicated in colorectal cancer (CRC). MiRNAs have been promising biomarkers for disease detection in recent years. The present study aimed to explore 16 candidate miRNAs in plasma samples as potential biomarkers for the detection and evolution of CRC.

Materials and methods: This study recruited 40 plasma samples of CRC patients [tumor-node-metastasis (TNM) stage III and IV] and 20 healthy controls. The expression of 16 miRNAs was evaluated by a quantitative Reverse Transcription-Polymerase Chain Reaction. The diagnostic value of miRNAs was evaluated by receiver operating characteristic analysis.

Results: The principal findings were that hsa-miR-31-5p was up-regulated in CRC patients vs. control group (p = 0.008), and by clinical stage TNM III and TNM IV (p = 0.011 and p = 0.018, respectively). This miRNA shows good diagnostic potential in CRC patients (AUC: 0.750, CI: 0.61-0.88, PPV: 62.5%, NPV: 100%) and in the clinical stage TNM III (AUC: 0.800, CI: 0.62-0.97, PPV: 83.3%, NPV: 100%) and TNM IV (AUC: 0.700, CI: 0.49-0.90, PPV: 71.4%, NPV: 100%). The hsa-miR-23a-3p was up-regulated in CRC patients with TNM stage III (p = 0.016), showing good potential as a diagnostic biomarker in this stage (AUC: 0.750, CI: 0.56-0.93, PPV: 76.9%, NPV: 100%), and in combined analysis with the hsa-miR-31-5p (AUC: 0.775, CI: 0.64-0.90, PPV: 66.6%, NPV: 100%). The hsa-miR-30a-5p and hsa-miR-126-3p were down-regulated in TNM IV (p = 0.03 and p = 0.047). Hsa-miR-126-3p miRNA showed good potential as a diagnostic biomarker in TNM IV stage (AUC: 0.850 CI: 0.69-1.00, PPV: 83.3, NPV: 100%); furthermore, in a combined analysis utilizing carcinoembryonic antigen (CEA), the outcome was superior (AUC: 0.907, CI: 0.78-1.00, PPV: 90.9%, NPV: 100%).

Conclusions: The significance of hsa-miR-31-5p and hsa-miR-23a-3p as oncomirs was evident in CRC TNM III, whereas hsa-miR-126-3p and hsa-miR-30a-5p were relevant as tumor suppressors in CRC TNM IV. The hsa-miR-30a-5p, hsa-miR-126-3p, hsa-miR-31-5p, and hsa-miR-23a-3p are good diagnostic and prognostic biomarkers in CRC.

Objective: Colorectal cancer continues to be a serious health problem in developed countries. Since the incidence of this cancer is constantly increasing, it is currently the subject of numerous studies. Researchers have begun to approach the treatment of patients in a more holistic way. For this reason, there are numerous studies analyzing the quality of life of patients, but also the degree of their acceptance of illness, as well as the severity of their levels of anxiety and depression.

Materials and methods: 102 patients surgically treated for colorectal cancer at the 4th Military Clinical Hospital in Wroclaw between May 2021 and November 2023 were examined. The standardized questionnaires [QLQ-C30, QLQ-CR29, Hospital Anxiety and Depression Scale (HADS), Acceptance of Illness Scale (AIS)] and an original questionnaire regarding the socioeconomic situation of patients were used for the assessment. The information was supplemented with clinical data obtained from patients' medical records.

Results: The study showed a strong relationship between the degree of acceptance of the disease and the quality of life of patients. The higher the degree of disease acceptance, the better the quality of life in the QL dimension (p=0.002, r>0). It has also been proven that feelings of anxiety and depression adversely affect the quality of life of patients (p=0.016 for anxiety, p<0.001 for depression, r<0).

Conclusions: This study proved that acceptance of the illness as well as levels of anxiety and depression were important components of patients' well-being and influence their quality of life. This knowledge should allow for even more effective treatments and more comprehensive care for oncological patients.

Background: Immunotherapy is a widely used and effective therapy for lung malignancy. However, its acting on the immune system can cause several adverse effects.

Case report: This is a case of a 74-year-old male who was admitted to the department of pulmonology due to bilateral pneumonia. The patient was treated with maintenance immunotherapy, pembrolizumab for a stage IV lung adenocarcinoma. Concomitant clinical manifestations were pleural effusion and respiratory failure, and the main comorbidities were hypertension and atrial fibrillation. The inflammatory indices, such as C-reactive protein and procalcitonin, were slightly altered, in contrast to a severely compromised clinical-radiological picture. Blood gas analysis test reported values indicative of altered gas exchange. T lymphocytopenia was found without an evident isolate of a bacterial agent. High-dose steroid treatment was initiated, and antibiotics such as cephalosporins have been administered.

Conclusions: The patient reported a good clinical response due to a poorly modified radiological picture.

Objective: The multidimensional dyspnea profile (MDP) is a self-reported instrument validated in several languages but not Arabic. The study aimed to translate and cross-culturally adapt the MDP into Arabic (A-MDP) and test its measurement properties in patients with chronic respiratory diseases.

Materials and methods: The MDP was translated and culturally adapted into Arabic based on published guidelines. A sample of 127 patients was recruited to assess the construct validity [correlating the A-MDP with the Arabic Numeric Pain Rating Scale (ANPRS), the Arabic version of the Chronic Obstructive Pulmonary Disease Assessment test (Arabic-CAT), and the Arabic Dyspnea-12 scale (D-12-A)] and structural validity (the exploratory and confirmatory factor analysis). Internal consistency [(Cronbach's alpha (α), corrected item-total correlation], test-retest reliability [Spearman's correlation (rho), Intraclass correlation coefficient (ICC2.1) with a 95% confidence interval (95% CI)], standard error of measurement (SEM), minimal detectable change (MDC95% and MDC%), the limit of agreement, and floor/ceiling effects were calculated. A-MDP responsiveness was assessed using the receiver operating characteristic curve.

Results: A-MDP's content validity was excellent. The scale showed highly significant positive correlations with the Arabic-CAT and ANPRS (rho = 0.83 and 0.78, respectively) and a moderately significant positive correlation with D-12-A (rho = 0.69). A model with a two-factor construct showed an acceptable fit (comparative fit index = 0.0.95). Excellent internal consistency (α = 0.93) and acceptable corrected item-total correlations (rho = 0.57-0.84) were found. The test-retest reliability was satisfactory (ICC2.1 = 0.94, 95% CI = 0.91-0.96, rho = 0.79). The SEM of the total score was 1.76 with an MCD95 of 4.8 (12.4%) with no systematic error or proportional bias. The area under the curve was 0.80. At the cut-off point of 40.5/110, specificity and sensitivity were 88% and 61%, respectively. No floor or ceiling effects were observed.

Conclusions: The MDP-A elaborated excellent measurement properties. It is recommended for its clinical utility.

Objective: Antithrombin (AT) has anti-inflammatory and anti-coagulant properties, but its role in COVID-19 and the rate of deficiency is unknown. We hypothesize that AT3 deficiency is common in COVID-19, and supplementing AT3 will impact COVID-19 coagulopathy.

Patients and methods: This is a prospective randomized control trial. Patients with plasma AT3<100% were randomized to either standard of care (SOC) or SOC+AT3 q48hr weight-based for a goal of 120% for up to 5 doses. An additional reference group with AT3>100% received SOC.

Results: 531 subjects were assessed for eligibility; 324 did not meet inclusion criteria, 151 did not consent, 6 withdrew consent, and 50 subjects completed the study. Enrollment AT3 (M±SD) was 91±13%.  AT3 levels were <100% in 38 (76%) and <80% in 11 (22%) patients. SOC+AT3, SOC only, and AT3>100% had a disseminated intravascular coagulation (DIC) score change (M±SD) of 0.4±1.5, -0.13±1.85 and 0±1.54, respectively, (p=0.63). Hospital length of stay was 11.7 [6-14], 6 [4.5-10], 8.5 [6-21] respectively, (p=0.176). Mortality occurred in 2 (11%), 3 (15%), and 3 (25%) patients, respectively (p=0.56). There was one bleeding event in a subject with AT3>100%, and no bleeding events were observed with exogenous AT3. There were no observed drug-related adverse events. Subjects received a median dose of 1,825.5 IU (IQR 794).

Conclusions: COVID-19 is associated with relative AT3 deficiency (22% of this cohort). No bleeding complications or drug-related adverse events with exogenous AT3 were observed. There were no significant differences in length of stay or mortality. Further studies should evaluate higher doses of exogenous AT3 and focus on higher-risk groups.

Clinicaltrials: gov: NCT04899232.