Journal of Medicine and Life最新文献

Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is rare, and spinal cord infiltration as a presenting manifestation has only rarely been described. We present the case of a 65-year-old man with CLL, initially diagnosed at the age of 54, who had not received prior treatment. He presented with a six-week history of thoracic and epigastric pressure. Mild ataxia was found in the clinical exam. Clinical evaluation revealed leukocytosis (163 G/L; normal range: 4-10 G/L). MRI of the spine showed a mildly enhancing, T2 hyperintense central lesion extending between C3 and T8. There was a pleocytosis of 105 /micro/l consisting of neoplastic B-lymphocytes. The bone marrow biopsy diagnosed a relapse of CLL, and the patient was started on ibrutinib, which had a positive effect. This case highlights spinal cord infiltration as a rare initial manifestation of CLL relapse, presenting with non-specific symptoms such as thoracic and epigastric pressure and mild spinal ataxia.

Optical tweezers, which leverage the forces exerted by radiation pressure, have emerged as a pivotal technique for precisely manipulating and analyzing microscopic particles. Since Arthur Ashkin's ground-breaking work in the 1970s and the subsequent development of the single-beam optical trap in 1986, the capabilities of optical tweezers have expanded significantly, enabling the intricate manipulation of biological specimens at the micro- and nanoscale. This review elucidates the foundational principles of optical trapping and their extensive applications in the biomedical sciences. The applications of optical tweezers in biomedicine are vast, ranging from the investigation of cellular mechanical properties, such as cell stretching, membrane elasticity, and stiffness, to single-molecule studies encompassing DNA and protein mechanics, protein-DNA interactions, molecular motor functions, and pathogen-host interactions. Advancement of optical tweezers in this field includes their integration with holography, fluorescence microscopy, microfluidics, and enhancements in force sensitivity and positional accuracy. These tools have profoundly impacted the study of cellular mechanics, drug discovery processes, and disease diagnostics, providing unparalleled insights into the biophysical mechanisms underlying health and pathology.

Non-functioning pituitary adenomas (NFPAs) are hormonally inactive benign tumors, usually diagnosed as macro-adenoma. The aim of our research was to analyze the clinical and hormonal characteristics of NFPAs using Knosp and revised Knosp classifications. Furthermore, we aimed to assess the possibility of predicting surgical remission after surgery. This was a prospective descriptive-analytical study. We selected 30 patients with non-functioning pituitary adenomas by excluding all the clinical and biochemical evidence of hormone excess. Cavernous sinus invasion was evaluated by Knosp and revised Knosp classifications. The mean age was 50.8 ± 11.6 years, and 63.3% of the patients were women with a sex ratio F/M of 1.7. Patients with a Knosp grade greater than two experienced more symptoms, such as headaches (P = 0.014) and declining visual acuity (P = 0.095). Additionally, these patients were found to have a higher prevalence of growth hormone deficiency compared to those with a Knosp grade of two or lower (P = 0.037). The revised Knosp classification showed no significant difference between patients with invasive adenomas (grade ≥ 3B) and patients with non-invasive adenomas (grade ≤ 3A) regarding clinical and hormonal status. However, we noticed that patients with non-invasive adenomas (grade ≤ 3A) had significant surgical remission (P = 0.008). A preoperative description of cavernous sinus invasion in NFPAs provided by the Knosp and revised Knosp classifications is mandatory. Our report shows that the revised Knosp classification is superior in predicting surgical remission than the Knosp classification, with no significant difference in evaluating the clinical and hormonal status between the two classifications.

There is an increasing requirement for new therapeutic approaches to address lung inflammation caused by COVID-19. Recent evidence suggests that statins may reduce mortality in patients with respiratory infections. This study aimed to investigate the impact of statin use on COVID-19 outcomes among hospitalized patients at Ohud Hospital and King Salman Medical City (KSMC) in Madinah, Saudi Arabia. A retrospective cohort study was conducted, including 547 patients with confirmed COVID-19 diagnoses admitted between March 2020 and December 2022. Patients were classified into statin and non-statin users based on statin administration during hospitalization. Logistic regression analyses-including univariate, multivariate, and predictive stepwise models-were employed to assess associations between statin use and clinical factors. Among the 547 patients, 200 (36.5%) were prescribed statins upon admission. Statin users were predominantly men and older. The presence of low-density lipoprotein (LDL) levels ≥ 100 mg/dL, cardiovascular disease (CVD), and advanced age were identified as strong predictors of statin use, with odds ratios (ORs) of 11.1, 3.8, and 3.1, respectively. Furthermore, the odds of receiving statins were significantly higher in male patients, individuals with hypertension, those with HbA1c levels ≥ 8%, and patients with positive cultures and sensitivity results. Statin use was associated with an 18%% reduction in the risk of mortality, with an adjusted OR of 0.80 (95% CI, 0.30-2.32), and a 7% reduction in the risk of hospital stay > 10 days, although these findings did not reach statistical significance. Among patients with COVID-19, LDL ≥ 100 mg/dl, CVD, and patients older than 60 years were identified as strong predictors for statin prescription.

With advances in scientific and clinical knowledge, stroke has evolved from a major cause of death to a chronic condition affecting the daily lives of sufferers, their relatives, and society. Post-stroke cognitive impairment (PSCI) is common even among individuals with good neurological recovery. When deciding on interventions aimed to improve the life quality of post-stroke patients, identifying those at high risk of cognitive decline proves crucial. Given the complexity of PSCI assessment, this narrative review discusses the feasibility of developing standardized criteria for selecting cognitive instruments. Potential approaches for establishing harmonized procedures for post-stroke cognitive assessment are presented depending on how the cognitive impairment is defined, the cognitive domains examined, the methods used to generalize cognitive data by components/domains, and their normalization against standardized normative samples. The prognostic value of cognitive assessment to identify patients at high risk of PSCI, functional dependence, and poor survival is also discussed. Implementing harmonized criteria for assessing the cognitive status of stroke patients could reduce the now considerable heterogeneity between studies and serve as a reliable basis for determining the prevalence and predicting the occurrence/aggravation of PSCI.

The MACF1 gene (OMIM: 608271) encodes the Microtubule-Actin Cross-Linking Factor 1 protein. Existing medical research shows that genetic mutations in the MACF1 gene have been associated with neurodevelopmental and neurodegenerative disorders, with variants of unknown significance also linked to autism spectrum disorder (ASD). However, the number of reported autism disorder or epilepsy cases associated with MACF1 mutations remains limited. We present the case of a 7-year-old girl, a long-term patient at the Pediatric Neurology Clinic of Dr. Alexandru Obregia Hospital in Bucharest, followed since the age of 3. She initially presented with epilepsy characterized by generalized seizures, clinically resembling both spasms and myoclonus. Over time, she exhibited features of a pervasive developmental disorder and moderate cognitive delay. Genetic testing identified a missense point mutation in the MACF1 gene, c.16223C > T, p.(Pro504Leu). Her final diagnosis was epilepsy with generalized seizures of non-lesional origin, moderate cognitive impairment, pervasive developmental disorder, and a confirmed point mutation in the MACF1 gene. This case underscores the importance of incorporating genetic testing into the diagnostic process for patients with autism spectrum disorder and epilepsy.

Migraine is a burdensome primary headache disorder with a global prevalence ranging from 15-18%. Our study aimed to assess the knowledge among primary healthcare physicians regarding migraine and evaluate whether their management practices align with current advances. This descriptive cross-sectional study included 212 primary healthcare physicians working in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. Data were collected using a self-administered, validated questionnaire distributed at clinics, with participant consent, to ensure privacy. A total of 212 responses were collected, the majority were from men (53.8%) and participants less than 30 years old (43.9%). Most participants held a Bachelor of Medicine, Bachelor of Surgery (MBBS) qualification (general practitioners), accounting for 56.1% of the sample. The results revealed that 83.5% had a high level of knowledge about the diagnostic criteria for migraine. Factors associated with a higher level of knowledge were female gender and age group less than 30 years. However, most participants (62.3%) were not familiar with the new acute and preventive migraine treatments. The findings of this study indicate good knowledge, attitude, and practicing habits among our participants. However, there were clear deficiencies in understanding the latest advancements in migraine treatment. We recommend implementing continuous education programs regarding the advances in migraine treatment among primary care physicians in Al-Madinah Al-Munawarah.

This study explored the experiences of first-generation and non-first-generation medical students in Saudi Arabia regarding their education, career aspirations, attitudes toward medical school, and perceived stress. We aimed to provide insights into the struggles faced by first-generation medical students. This cross-sectional study was conducted with 485 participants, 77.9% of whom were first-generation students. Data were collected using a questionnaire adapted from the Association of American Medical Colleges (AAMC) and analyzed using chi-square and Mann-Whitney tests. First-generation students were less decisive about future specialties, showed greater interest in taking the United States Medical Licensing Examination and the Professional and Linguistic Assessments Board exams, and expressed less interest in teaching roles than their non-first-generation counterparts. No significant differences were found in attitude, career considerations, quality of life, or daily activities. This study aligns with global calls for robust support programs, mentorship initiatives, and systemic interventions to enhance diversity and inclusivity in medical education. The research highlighted the importance of recognizing the diverse career aspirations and challenges first-generation medical students face. Tailored support programs are essential for fostering inclusivity in medical education, addressing unique needs, and enhancing students' overall well-being. Future research should continue to explore the factors influencing the experiences of first-generation and non-first-generation medical students to contribute to ongoing efforts to improve medical education.

Apical periodontitis (AP) is a common dental condition that can be influenced by diabetes mellitus. This study aimed to investigate the impact of type 2 diabetes mellitus (T2DM) on the prevalence and severity of AP, considering the adequacy of endodontic treatments. A total of 180 patients selected based on specific dental criteria from a private clinic in Oradea, Romania, were included in this study. Clinical data were collected through medical records and panoramic radiographs. Statistical analyses were conducted using SPSS software, employing the Fisher test, Mann-Whitney test, and binary logistic regression to determine correlations between T2DM and AP in both endodontically treated and non-treated teeth. Additionally, we examined the relationship between diabetes and AP in teeth that received adequate root canal treatment (RCT), as well as the correlation of AP with the adequacy of endodontic treatment. Non-treated teeth were significantly more likely to have AP in patients with T2DM than in non-diabetic patients (OR = 5.3, P < 0.001). No significant difference in AP prevalence was observed between treated teeth in diabetic and non-diabetic patients. Inadequate RCT was associated with a higher incidence of AP, regardless of diabetes status (OR = 26.9, P < 0.001). The study concludes that DM significantly increases the risk of AP in untreated teeth, with diabetic patients showing a higher prevalence of AP than non-diabetic patients. However, this increased risk is not observed in adequately treated teeth. The quality of RCT is critical, as inadequate RCT is linked to a higher incidence of AP, regardless of diabetes status.

Amelogenesis imperfecta refers to a group of hereditary diseases that affect dental enamel, often leading to a wide range of clinical manifestations and aesthetic concerns. This case report describes a female patient diagnosed with amelogenesis imperfecta associated with a skeletal open bite. The treatment approach was multidisciplinary. Periodontal therapy was initiated, followed by orthodontic treatment using brackets on temporary crowns to expand and coordinate the maxillary and mandibular arches. Subsequently, orthognathic surgery, including a LeFort I osteotomy and genioplasty, was performed. The fixed prosthodontic rehabilitation performed with metal-ceramic crowns was the last step of the treatment. The final result was both functionally and esthetically satisfactory for the patient.