Medicine and Pharmacy Reports最新文献

The case is presented of an elderly patient (DCP) with extensive medical history, including osteoporosis, who developed hypocalcaemia and hypophosphataemia whilst treated with denosumab, while prescribed concomitant calcium and vitamin D therapies. The management of this complex case involved a multidisciplinary team (MDT) approach, incorporating the patient's wishes. It included discontinuation of denosumab and intravenous (IV) and oral mineral supplementation that yielded gradual amelioration of calcium and phosphate levels. This case demonstrates the importance of vigilant monitoring and appropriate management in patients receiving denosumab, particularly those with multiple comorbidities. It carries important considerations for using denosumab for osteoporosis treatment in patients with complex medical backgrounds. Ethical clearance waiver was granted by the Trust Research Ethics Committee on 18/01/2024.

Background: Despite advancements in congenital heart surgery, long-term outcomes remain challenging, with many patients developing heart failure and requiring transplants at a young age. Stem cell therapy, particularly using umbilical cord-derived mesenchymal stem cells, is emerging as a promising adjunct treatment. Adult studies suggest functional improvements, but pediatric research remains sparse. This pilot study aimed to establish surgical and anesthetic protocols for elective cesarean section in an ovine model to enable umbilical cord blood collection.

Methods: Three pregnant sheep aged 2-6 years and weighing 40-45 kg underwent elective cesarean section. Gestational age was confirmed using ultrasound and clinical signs. Preoperative preparation involved fasting, dexamethasone administration to prevent respiratory distress, and shaving surgical sites. Local anesthesia and mild sedation (medetomidine) minimized fetal exposure to anesthetics. Two umbilical cord blood collection methods were tested: active aspiration and gravitational collection.

Results: We established efficient anesthetic and surgical protocols for elective cesarean section and described a safe and easy method for umbilical cord blood collection with minimal risk. Elective cesarean section ensures a sterile environment, crucial for stem cell isolation. Local anesthesia with mild sedation proved safe and provided proper comfort for animals and operators. Accurate gestational estimation and effective postnatal care were critical.

Conclusions: This study provides a reliable protocol for elective cesarean section and umbilical cord blood collection in an ovine model, offering a valuable foundation for research in stem cell therapy. However, larger sample sizes are needed to validate these methods and enhance their applicability in translational research.

Background: The infection with SARS-CoV-2 in children usually manifests as a mild respiratory tract infection. The aim of this study was to evaluate the severity, outcome and vaccination status in children hospitalized for COVID-19 in a single center during two pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs).

Methods: A retrospective study on 656 consecutive pediatric patients was performed from September 1, 2021, to April 30, 2023. The study interval was divided into waves, according to official data on the circulation of Delta and Omicron VOCs. Data collected included sex, age, comorbidities, date of diagnosis, duration of hospitalization, vaccination status, clinical outcome.

Results: The Delta group consisted of 234 children with a mean age of approximately 9 years, while the Omicron group included 422 children with a mean age of around 2.5 years. Most cases were mild, although in the Omicron wave the hospitalization rate was higher and 41.7% of the cases were medium in severity. The presence of comorbidities was not linked to an increase in severity. Vaccination rates were low in both groups, with a mean of 4% for the total of eligible patients.

Conclusion: This pioneering study highlights the nature of COVID-19 in children, focusing on both clinical aspects and public health issues.

This review offers insight into the complex interplay between cytokines and vitamin D, with focus on its role in systemic lupus erythematosus (SLE) pathogenesis. It offers a helpful resource for researchers and clinicians seeking to better understand and treat SLE and related autoimmune conditions. The pathogenesis of SLE is complex and involves a wide range of cytokines, primarily of the Th2 type; these cytokines mediate hyperactivity in B lymphocytes and antibody production. Notably, vitamin D is found to suppress the activity of critical Th17-related cytokines like IL-23 and IL-6, which is pivotal for Th17 cell development and function. This ultimately leads to reduced IL-17 production, an increase in regulatory T lymphocytes, and subsequent secretion of IL-10. Supplementation with vitamin D is seen to have positive effects on SLE, leading to lower disease activity scores, decreased levels of autoantibodies, and a reduction of fatigue.

Introduction: The advent of Bruton's tyrosine kinase (BTK) inhibitors brought about a paradigm shift in the management of chronic lymphocytic leukemia (CLL), by offering a well-tolerated chemotherapy-free approach. Here, we share the experience with ibrutinib of a major Romanian regional cancer center.

Methods: We screened patients treated for CLL in our center over 6 years (2017-2022) and included those who were treated with ibrutinib either in the first line of therapy or in subsequent lines.

Results: We enrolled 61 patients, 40 with treatment-naïve (TN) CLL and 21 with relapsed/refractory (R/R) CLL, with a median age at treatment initiation of 65 years. Concerning the prognostic-predictive workup, IgHV mutational status was available for 78.7% of the patients, TP53 sequencing for 82%, assessment of 17p deletion for 82%, and CD38 marker analysis was performed for 70.5%. With a median follow-up period of 55 months, the overall response rate (ORR) was 90.2%, with a median progression-free survival (PFS) of 33 months and a median overall survival (OS) that has not been reached. In our cohort, albeit non-significant statistically, patients with TP53 mutation had a shorter OS and those with mutated IgHV, a shorter PFS. Rai 3-4 and Binet C stages at diagnosis were associated with a shorter PFS, but not OS. In our cohort, the correlation between survival and high Cumulative Illness Rating Scale (CIRS) index was not statistically significant. Ibrutinib was generally well tolerated in our cohort, as only 14.8% of our patients discontinued treatment due to adverse effects.

Conclusion: Our study suggests that ibrutinib is a valid therapeutic option for TN or R/R CLL patients, with a high ORR and a good safety profile.

Objective: The aim of our study was to evaluate the prevalence of cognitive decline in patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition.

Methods: In our cross-sectional study, we applied the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to determine cognitive function in 172 diabetic patients, in the clinical setting. We included 120 patients with type 2 diabetes (T2DM), 42 cases with type 1 diabetes (T1DM) and 10 patients with confirmed secondary diabetes (SDM). The mean age of the participants was 62.4 years (±1.01, min: 26 years, Max: 87 years), with median diabetes duration of 15±11.8 years.

Results: More than half (55.23%) of the subjects presented cognitive deterioration, which was diabetes type-specific (p<0.05). Mild forms affected mostly T1DM and SDM cases (31.5% and 30% vs. T2DM: 14.5%, p=0.00), whereas moderate cognitive decline was more predominant in T2DM (21.9% vs. T1DM: 7.1%, p=0.1). A higher prevalence of severe cognitive impairment was present in T1DM (14.5% vs. T2DM: 8.7%, p=0.1).The middle-aged category (40-64 years) was characterized by a more significant reduction of cognitive function in comparison with other age groups (p=0.02).No gender-related difference in the prevalence of cognitive decline was found (female: 45.83% vs male: 45.71%, p=0.98), although severe forms were significantly more suggestive for men (15.27% vs. 4.18%, p=0.04).Diabetic ketoacidosis (DKA) at admission was more frequently associated with cognitive deterioration, in comparison with hypoglycemic events (p=0.03).In T2DM, cognitive decline (p=0.006, r=-0.342) was associated with the presence of anemia.In T2DM women, treatment with calcium-channel blockers facilitated cognitive decrement (p=0.01, r=-0.339), whereas in men, therapy for distal symmetric polyneuropathy resulted in higher MMSE/MoCA test scores (p=0.00, r=0.72).In T1DM, a higher glycemic burden evidenced by increased HbA1c (p=0.03, r=-0.364) and glycemia at admission (p=0.01, r=-0.389) was suggestive to a more severe form of cognitive impairment. Distal symmetrical polyneuropathy (p=0.05, r=-0.305) and diabetic retinopathy (p=0.03, r=-0.102) was often co-occurring with cognitive decline.Cognitive deterioration was associated with insulin therapy (p=0.05, r=-0.232).

Conclusion: The prevalence of cognitive decline is high in the diabetic population. Risk stratification must start at diagnosis and physicians should follow disease progression periodically, with special attention attributed to T1DM and the middle-aged population.

Background and aim: Tacrolimus, a widely used immunosuppressive drug in kidney transplant recipients, exhibits a narrow therapeutic window necessitating careful monitoring of its concentration to balance efficacy and minimize dose-related toxic effects. Although essential, this approach is not optimal, and tacrolinemia, even in the therapeutic interval, might be associated with toxicity and rejection within range. This study aimed to identify specific urinary metabolites associated with tacrolimus levels in kidney transplant patients using a combination of serum high-precision liquid chromatography-mass spectrometry (HPLC-MS) and machine learning algorithms.

Methods: A cohort of 42 kidney transplant patients, comprising 19 individuals with high tacrolimus levels (>8 ng/mL) and 23 individuals with low tacrolimus levels (<5 ng/mL), were included in the analysis. Urinary samples were subjected to HPLC-MS analysis, enabling comprehensive metabolite profiling across the study cohort. Additionally, tacrolimus concentrations were quantified using established clinical assays.

Results: Through an extensive analysis of the HPLC-MS data, a panel of five metabolites were identified that exhibited a significant correlation with tacrolimus levels (Valeryl carnitine, Glycyl-tyrosine, Adrenosterone, LPC 18:3 and 6-methylprednisolone). Machine learning algorithms were then employed to develop a predictive model utilizing the identified metabolites as features. The logistic regression model achieved an area under the curve of 0.810, indicating good discriminatory power and classification accuracy of 0.690.

Conclusions: This study demonstrates the potential of integrating HPLC-MS metabolomics with machine learning algorithms to identify urinary metabolites associated with tacrolimus levels. The identified metabolites are promising biomarkers for monitoring tacrolimus therapy, aiding in dose optimization and personalized treatment approaches.

Background: Breast cancer treatment often involves mastectomy and adjuvant therapies such as radiotherapy, which can lead to complications in reconstructive procedures. Tissue expanders are commonly used for immediate breast reconstruction post-mastectomy, but radiation therapy increases the risk of complications like expander extrusion. Lipofilling has emerged as a promising technique to address tissue damage and improve reconstructive outcomes. This case illustrates the utility of ultrasonography in measuring fat thickness before and after the lipofilling procedure and calculating the resorption rate for managing complex post-radiation complications.

Case description: We report the case of a 38-year-old patient born and raised in Romania with a history of right breast cancer, who initially underwent mastectomy followed by immediate reconstruction with a subpectoral tissue expander. The patient subsequently received adjuvant radiotherapy, which led to the extrusion of the tissue expander and chronic pain with skin redness. Due to significant damage to the surrounding tissue and chest wall, lipofilling was employed as a reconstructive approach to enhance skin quality and support tissue regeneration. Fat grafting was performed in multiple sessions, with ultrasonographic evaluations conducted before and after each session to monitor volumetric changes in the reconstructed breast. Following lipofilling, the patient experienced marked improvements in skin texture and breast volume, with no recurrence of complications. Later that year we performed a DIEP flap.

Conclusions: This case demonstrates the efficacy of ultrasonography in measuring fat graft and fat resorption after lipofilling as a reconstructive strategy in patients who experience complications from tissue expander extrusion post-radiation. Lipofilling, in combination with thorough imaging assessments, can significantly enhance the outcomes of breast reconstruction following radiotherapy.

Background and aims: The purpose of this study is to analyze the sitting position and the park-bench position for intra-anesthesia complications in pediatric patients undergoing neurosurgery for posterior fossa lesions. Our goal is to highlight the risks associated with each of these positions under general anesthesia to aid in clinical decision making for optimal patient outcomes with regard to postoperative complications.

Methods: We retrospectively reviewed 41 pediatric patients (1 to 18 years old) undergoing posterior fossae surgery in the sitting (32) and park-bench (9) positions between January 2015 and December 2021. The majority of patients (15) who underwent surgery in the sitting position had fourth ventricular tumors (28.12%) and cerebellopontine tumors (18.76%) that required the sitting position.

Results: Of 32 patients operated on in the sitting position, 23 (71.78%) developed anesthetic complications, compared to 8 patients in the park-bench group (88.89%). Venous air embolism occurred in only 6.25% of patients in the sitting group. Compared to the sitting position, no cases of gas embolism were documented in the park-bench position. However, transient episodes of gas embolism cannot be excluded due to the higher incidence of hemodynamic instability (44.44%), need for additional fluid therapy (44.44%) and vasopressor support (11.11%), decreased CO2 (22.22%) and oxygen desaturation (22.22%). Patients who underwent surgery in the sitting position had a longer duration of surgery [247.5 min IQR (172.75 - 325.25)] and a longer duration of anesthesia [331 min IQR (237.5 - 423.25)]. Pneumocephalus (4, 12.5%) and postoperative hematoma (3, 9.38%) were the most common postoperative complications in patients who underwent surgery in the sitting position. In the park-bench group, three patients had postoperative complications, including postoperative hematoma (2, 25%) and hydrocephalus (1, 12.5%).

Conclusions: The incidence of anesthetic complications is lower in the sitting position compared to the park-bench position. Although there was no documented gas embolism in the park-bench position, the lower rate of venous air embolism in the sitting position may suggest a better control or a lower risk in this position. However, the sitting position has a less frequent occurrence of hemodynamic instability than the park-bench position.

Background: Hepatic disease represents a significant complication in children with cystic fibrosis (CF), yet its relationship with specific genetic factors, including CFTR (Cystic fibrosis transmembrane conductance regulator) mutations and SERPINA1 alleles, is not well understood. This study aims to clarify these associations within a Romanian pediatric CF population.

Methods: In this cross-sectional, prospective study, we examined 71 children with CF, comparing those with hepatic disease (n=25) to those without (n=46). We collected comprehensive clinical, biochemical, and genetic data, focusing on CFTR genotypes and SERPINA1 alleles. Key outcomes included the prevalence of hepatic disease in relation to specific genotypes, fibrosis markers, and liver function tests.

Results: The DF508/DF508 genotype was the most prevalent, occurring in 49% of the cohort. No significant associations were found between hepatic disease and specific CFTR genotypes or SERPINA1 alleles. However, children with hepatic disease exhibited significantly higher fibrosis scores (APRI and FIB-4), suggesting more advanced liver involvement. Additionally, a slight delay in CF diagnosis was observed in those with hepatic disease, though this difference did not reach statistical significance.

Conclusion: This pioneering study in Romania underscores the complexity of hepatic disease in CF. While specific CFTR genotypes and SERPINA1 alleles were not significantly associated with hepatic complications, the findings emphasize the importance of early diagnosis and monitoring using fibrosis markers to identify children at risk for liver involvement.