Journal of Medicine and Life最新文献

Mixed phenotype acute leukemia (MPAL) represents approximately 3-5% of all acute leukemia cases and is defined by blast populations that co-express markers from more than one hematopoietic lineage. In most cases, blasts exhibit myeloid markers together with either B-cell or T-cell markers. The rarest subtype is mixed B/T acute leukemia. We report the case of a 7-year-old boy who presented with weakness and fatigue and was diagnosed with MPAL, not otherwise specified, B/T rare type, based on bone marrow examination and immunophenotyping. This case highlights the essential role of comprehensive immunophenotyping in establishing an accurate diagnosis of MPAL. Given the limited information in the literature, case series and prospective studies are needed for a better understanding and successful treatment.

Cochlear implantation is an established surgical intervention for patients with severe to profound sensorineural hearing loss. Although technological advancements have improved surgical outcomes, complications can still arise, affecting both short- and long-term postoperative results. Identifying and managing these complications is very important for optimizing patient outcomes. This review examined the key complications associated with cochlear implantation, discussing their mechanisms, clinical implications, and management strategies based on current literature. A comprehensive literature review was conducted using relevant studies from PubMed and other scientific databases. Key topics include intraoperative complications such as cerebrospinal fluid (CSF) leakage and electrode misplacement, as well as postoperative complications like intracochlear fibrosis, foreign body reactions, vestibular dysfunction, device extrusion, and infections, including otitis media and cholesteatoma. Despite being a generally safe procedure, cochlear implantation presents a range of complications, with incidence rates varying between pediatric and adult populations. Preoperative imaging and patient selection have an essential role in minimizing intraoperative risks such as CSF leakage, particularly in cases with inner ear malformations. Postoperative complications, including electrode migration, fibrosis, and vestibular dysfunction, can impact hearing outcomes and quality of life. Furthermore, late complications such as chronic infections and device extrusion require long-term follow-up and, in some cases, revision surgery. Cochlear implantation is a highly effective auditory rehabilitation technique with a favorable safety profile. However, complications-ranging from minor surgical site infections to major device failures-necessitate ongoing clinical vigilance. Future advancements in electrode design, surgical techniques, and biocompatible materials hold promise for reducing complications and improving patient safety.

Prolactinoma is the most common pituitary adenoma. This study aims to assess the clinical presentation, treatment modalities, and outcomes of patients with prolactinomas and to identify factors that predict remission. We conducted a retrospective single-center study including patients with prolactinoma. Data from medical records were analyzed to correlate patient demographics, clinical presentation, serum prolactin (PRL) levels, and adenoma size on MRI, both at diagnosis and after initiation of dopamine agonist (DA) therapy, with treatment outcomes. A total of 205 patients were included in the study. The mean age of the cohort was 34.8 ± 12.4 years, with a female-to-male ratio of 1.5:1. Oligomenorrhea/amenorrhea was the most common presenting symptom, occurring in 112 of 122 women (91.8%). Macroadenomas accounted for 117 of 176 adenomas (66.4%). Initial treatment consisted of DA therapy in 149 patients, transsphenoidal pituitary surgery in 41 patients, and gamma knife radiosurgery in five patients. A total of 148 patients continued DA therapy at our center. After one year of DA treatment, significant adenoma shrinkage (>30%) was observed in 23 patients (34.3%), while complete adenoma disappearance occurred in six patients (8.9%). At 24 months, 25 of 88 patients (28.4%) achieved remission. Baseline PRL <10,638.2 mIU/L (500 ng/mL) and the presence of microadenoma independently predicted remission. DA therapy remains the cornerstone of prolactinoma treatment in our region and is very effective in normalizing PRL levels, shrinking adenomas, and improving clinical symptoms; DA can be used even in cases of giant prolactinomas.

The aim of this systematic review and meta-analysis was to compare the impact of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) on cognitive function in patients with atrial fibrillation. In August 2024, multiple electronic databases were searched following a two-phase screening strategy. Meta-analyses were performed using RevMan version 5.4. Effect estimations were presented as risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes. Eleven studies published between 2018 and 2024 were included in this research. Cognitive function assessments show minimal changes between the groups. At 5 years, DOACs were associated with lower rates of intracerebral bleeding (0.9% vs 1.4%) and mortality (17.6% vs 25.1%), while the incidence of all-cause dementia was identical in both groups (3.9%). At 10 years, DOACs continued to demonstrate benefits, with a reduced incidence of vascular dementia (0.7% vs 1.2%), lower all-cause mortality (23.2% vs 34.2%), and a decreased incidence of all-cause dementia (3.3% vs 4.7%). Meta-analysis results indicate a significantly lower risk of stroke or systemic embolism with DOACs (pooled RR = 0.30; 95% CI, 0.26-0.34), while the pooled risk for all-cause death showed no significant difference between the groups (pooled RR = 0.44; 95% CI, 0.16-1.16). DOAC users exhibited a lower incidence of all-cause dementia and fewer adverse events, particularly in long-term follow-ups. As a result, DOACs may provide a safer profile and a minor cognitive advantage over VKAs.

The endocannabinoid system has been implicated in the pathophysiology of multiple sclerosis (MS), yet its role across different disease stages and under disease-modifying treatment remains incompletely understood. This study aimed to evaluate plasma levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in patients with MS at different clinical stages, and to explore their associations with disability, cognition, and quality of life, as well as the potential influence of teriflunomide therapy. Thirty participants were enrolled: ten healthy controls, ten newly diagnosed relapsing-remitting MS (RRMS) patients in acute relapse, and ten teriflunomide-treated RRMS patients in remission. Plasma AEA and 2-AG were measured by ELISA; clinical assessments included the Mini-Mental State Examination (MMSE) and the SF-36 quality-of-life questionnaire. No significant group differences were observed overall in 2-AG (P > 0.05). AEA showed a non-significant overall group effect (ANOVA, P = 0.0919) with a trend toward lower AEA in newly diagnosed patients compared to healthy controls (mean difference = -5.95 ng/ml, SE = 2.66; P = 0.098). In the teriflunomide group, AEA and 2-AG were strongly positively correlated (r = 0.882, P < 0.001). Additionally, SF-36 scores were positively associated with MMSE (r = 0.706, P = 0.023). Furthermore, SF-36 total scores were significantly lower in newly diagnosed patients compared to controls (post-hoc P = 0.044). These findings suggest possible early dysregulation of the endocannabinoid system in MS and indicate that teriflunomide treatment is associated with a strengthened AEA-2-AG relationship. Larger, longitudinal studies are warranted to confirm these observations and to assess clinical implications for disease progression and patient quality of life.

Discoid lupus erythematosus (DLE) is a chronic cutaneous form of lupus characterized by erythematous lesions, dyspigmentation, and scarring that may progress to systemic lupus erythematosus (SLE). This systematic review analyzed epidemiology, clinical patterns, immunologic features, progression rates, and treatment outcomes in 2,814 patients across 72 studies, including 626 pediatric/neonatal and 2,188 adult cases. Female participants predominated in both groups (68.5% in pediatrics; 74.2% in adults), with a higher prevalence among African/African American patients (29.6% in pediatrics and 33.8% in adults). The mean age at diagnosis was 11 years in children and 34 years in adults. Localized lesions were most common in pediatric patients (61.3%) and adult patients (58.7%). Progression to SLE occurred in 30.0% of pediatric cases and 25.4% of adults. Identified risk factors included early-onset disease (in children, <10 years; in adults, <20 years), ANA positivity (51% in pediatric; 48% in adult), high ANA titers (≥1:320), and a family history of rheumatic disease. Treatment relied mainly on topical corticosteroids (44.4% pediatric; 51.6% adult) and hydroxychloroquine (11.1% pediatric; 28.7% adult), while newer therapies such as lenalidomide and anifrolumab showed potential benefits. Overall, DLE demonstrates a strong female predominance and a substantial likelihood of progression to SLE, particularly in younger patients with autoantibody positivity.

Helicobacter pylori (H. pylori) is one of the world's most prevalent infections, being responsible for 90% of gastric MALT lymphomas along with multiple other extra-gastric manifestations. Its role in insulin resistance and glycemic metabolism has been debated in the last few years. The study included a retrospective analysis of 131 patients with dyspeptic symptoms who underwent gastroscopy with biopsies in two hospitals in Northwestern Romania. Our study analyzed the overall prevalence of H. pylori infection, its association with high glycemic values and glycosylated hemoglobin values, as well as histopathology results and their association with modified glycemic values. Fasting glucose levels were higher in patients with H. pylori than in patients without H. pylori (OR = 3.3; 95% CI, 1.6-6.8; P = 0.001). High HbA1c levels were associated with H. pylori infection (OR = 4.1; 95% CI, 1.9-8.7; P < 0.001). Histologically confirmed acute gastritis due to H. pylori was associated with high fasting glucose levels (OR = 8.3; 95% CI, 1-68; P = 0.028), and more specifically with antral acute gastritis (OR = 16.4; 95% CI, 1-290; P = 0.007), while no association between confirmed chronic gastritis and high fasting glucose values was found. Within the limitations of this study, our results support the findings that H. pylori infection represents a risk factor for prediabetes, highlighting the need for special attention to be given to those vulnerable patients. To fully understand the involved mechanisms and the potential therapeutic strategies and management implications, further investigations are required.

Conventional medicine has made significant advancements in the past century, yet the global burden of chronic degenerative diseases has continued to rise impressively. Are we healthier than we were a hundred years ago? A narrative review focusing on the direction global health has taken under modern medicine was conducted using PubMed, Google Scholar, WHO, and CDC databases. The retrieved studies yielded additional historical data, which was also included. The bigger picture emerging from these sources is presented in a narrative form. Our review of historical and current medical literature suggests an alarming worsening of health status in the overall population, with a shift from infectious diseases to chronic debilitating conditions, including serious immune, neurological, and psychiatric illnesses. The countries with well-established healthcare systems are experiencing a higher burden of chronic degenerative diseases. It appears that the healthcare approach has focused on specific aspects rather than considering the complete picture of human health. We propose that healthcare innovations should refocus on studying the individual in their environment as an integral entity and conduct research to understand the long-term effects of medicines and vaccines. Further, integrating complementary and alternative medicine systems that consider health and disease holistically is recommended for incorporation into healthcare. However, it is emphasized that theoretical scientific research in this area remains limited, and there is a growing call for research in complementary medicine healthcare innovations, which, if executed well, may benefit living beings.

Herpes simplex encephalitis (HSE) is a severe central nervous system (CNS) infection associated with cognitive decline, psychotic symptoms, and epilepsy. Despite aggressive antiviral and corticosteroid treatments, post-HSE complications remain challenging to manage. We report a case of a 33-year-old female patient with post-HSE neuropsychiatric symptoms who showed significant improvement following Cerebrolysin treatment. The patient was treated with acyclovir and dexamethasone in the acute phase, followed by Cerebrolysin administration in the post-acute phase. This case highlights the potential therapeutic role of Cerebrolysin in managing post-encephalitic cognitive dysfunction, underscoring the need for further studies.