Medicine and Pharmacy Reports最新文献

Background: Brain metastases (BMs) are the most common intracranial tumors among adults, which exceed primary brain tumors by far. Surgery and radiotherapy represent the key local management of BM. However, the exact role of surgery is still under debate.

Objective: To comprehensively evaluate the safety and efficacy of surgical management in patients with brain metastases.

Methods: We searched four electronic databases from January 2023 until September 2024 (PubMed, Scopus, Web of Science, and Cochrane Library). All the studies assessing the role of surgery in managing BM were included. Our primary search targets were survival, mortality, and postoperative Karnofsky Performance Status (KPS). The results were reported as pooled mean or proportions with 95% confidence interval (CI) for continuous and dichotomous data, respectively.

Results: Eight observational studies comprising 1010 patients met our inclusion criteria. The pooled mean of overall survival was 10.482 with 95% CI [7.651, 13.314]. While the pooled proportion of one-year and two-year survival was (0.451, 95% CI [0.320, 0.582]) and (0.240, 95% CI [0.112, 0.367]), respectively. We found the pooled proportion of overall mortality to be 0.535 with 95% CI [0.278, 0.793]. Patients with immediate postoperative KPS improvement showed a pooled estimate of 0.463 with 95% CI [0.243, 0.683].

Conclusion: Surgical resection is an effective therapeutic option for patients with BMs. Yet, careful patient selection and surgical technique are crucial for reducing postoperative complications and death.

Background: High-frequency ultrasound (HFUS) at frequencies >20 MHz is a valuable non-invasive tool for high-resolution skin imaging, enabling quantitative assessment of epidermal and dermal morphology with an axial resolution of 21 μm. Such precision supports objective monitoring of dermatoses, including psoriasis.

Objectives: To compare epidermal and dermal measurements of psoriatic lesions using 75 MHz HFUS and histopathology.

Methods: Thirty psoriatic papules/plaques were imaged with 75 MHz HFUS (axial resolution: 21 μm) in patients who were referred for diagnostic biopsy, measuring epidermal thickness and subepidermal hypo-anechoic zone thickness. Lesions were marked for biopsy alignment, and histologic sections were evaluated along the same axis. Spearman's correlation analyzed agreement between methods.

Results: Mean epidermal thickness was 220 ± 33 μm (HFUS) vs. 215 ± 35 μm (histopathology; R = 0.82, p < 0.01). subepidermal hypo-anechoic zone thickness was 483 ± 97 μm (HFUS) vs. 448 ± 89 μm (histopathology; R = 0.88, p < 0.01). No significant inter-method differences were observed.

Conclusion: 75 MHz HFUS correlates strongly with histopathology in measuring psoriatic epidermal and dermal inflammatory changes, supporting its use as a non-invasive tool for therapeutic monitoring.

Objective and aim: Quality of life and quality of care are determinants that interact on the patients' health and satisfaction with care. The aim of the study is to investigate the satisfaction factors of day clinic cancer patients that influence their quality of life. The identification of the important health sectors and the improvement of the weak areas contribute to the amelioration of cancer patients' state of health as well as to the increase of their satisfaction with the day care unit.

Methods: The research is a cross-sectional, quantitative, descriptive and correlation study. It was conducted in a cancer day care unit of an oncology hospital in Greece, from January 2022 to July 2022. A convenient sample of 101 cancer outpatients with different diagnoses and disease progression completed the European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-EORTCQLQ-30 and a validated satisfaction questionnaire for ambulatory patients based on the SERVQUAL quality dimensions.

Results: Higher satisfaction regarding waiting (rho=0.20; p=0.041), medical care (rho=0.23; p=0.023), nursing care (rho=0.25; p=0.014) and overall satisfaction (rho=0.25; p=0.012) was significantly positively associated with better general health status. Accordingly, patients' satisfaction with reception (rho=0.21; p=0.039), waiting (rho=0.20; p=0.050), medical care (rho=0.24; p=0.019), nursing care (rho=0.25; p=0.013) and overall satisfaction (rho=0.25; p=0.014) were related positively to significantly better social functioning. Satisfaction with waiting was also significantly positively associated with better emotional functioning (rho=0.24; p=0.018), while satisfaction with medical care was correlated with better cognitive functioning (rho=0.21; p=0.041). Fatigue levels were significantly associated with patients' dissatisfaction with medical (rho=-0.23; p=0.021) and nursing care (rho=-0.23; p=0.024).

Conclusions: Cancer patients' satisfaction with the healthcare provided in the day clinic has a significant impact on their quality of life which is improved by prompt and effective medical and nursing interventions as well as by well organized health services.

Background and aim: Aneuploidies are rare diseases with great impact on an individual's life, as well as on their families, the reason why prenatal screening is performed, allowing families to take an informed decision. Initial prenatal screening includes the double test, triple test, non-invasive prenatal testing and ultrasonography. Among these, ultrasonography plays an important role giving information regarding an elevated risk for aneuploidies.

Methods: Eighty-four pregnant women who underwent prenatal screening were included in this study, of whom 9 cases were diagnosed with an aneuploidy. A statistical analysis was performed to identify possible associations between morpho-fetal characteristics, estimated fetal growth, and other parameters, such as maternal characteristics or gestational age.

Results: As expected, based on the data available in the literature, an advanced maternal age was observed in the high-risk group, compared to the low-risk one (the risk was evaluated after the initial screening and influenced the decision of a further amniocentesis). A good correlation was observed in this study between the fetal biometric parameters and gestational age, as well as between fetal biometric parameters and maternal weight gain in healthy pregnancies, while low or no correlations were found in the aneuploid pregnancies.

Conclusions: The results of our study highlight the importance of ultrasonography evaluation and reveal possible correlations of fetal parameters with maternal characteristics. These findings, together with already well-established parameters, might suggest stronger clusters of soft markers and bring supplementary information regarding the risk level of pregnancy, in order to perform a better assessment of cases where invasive diagnosis is required.

Background and aims: The "morning after pill" (oral emergency contraception (EC)) with the active ingredients ulipristal acetate (UPA) and levonorgestrel (LNG) may only be dispensed by community pharmacies (CPs) in Germany. Against the background of free pricing for oral EC as an over-the-counter medicine, German CPs bear a great responsibility with regard to pricing as an important criterion for unrestricted access. The aim was to investigate the pricing of oral EC nationwide. To our knowledge, this is the first study of this type in the world.

Methods: The cross-sectional design of the study was based on the simulated patient methodology (SPM) in the form of mystery calls, which is considered the "gold standard". Each of the 392 CPs as a representative random sample was called once by one of six trained mystery callers (MCs). At the beginning of the conversation, the MCs asked about the "morning after pill" without naming a specific oral EC. In the conversation about UPA (scenario-related appropriate outcome due to unprotected sexual intercourse four days ago) or LNG preparations (scenario-related inappropriate outcome), the MCs asked about the price of the respective preparation.

Results: The cheapest quoted prices for UPA preparations could be determined in 293 mystery calls and varied from EUR 17.00 to EUR 43.71 (Δ 157%) with a median of EUR 35.75 (interquartile range [IQR] EUR 6.07). The cheapest quoted prices for LNG preparations could be determined in 32 mystery calls and varied from EUR 13.99 to EUR 26.72 (Δ 91%) with a median of EUR 22.99 (IQR EUR 2.99).

Conclusions: The price of UPA preparations is much higher than that of LNG preparations. High price levels and wide price ranges, especially for UPA preparations, could restrict access to oral EC.

Background: The COVID-19 pandemic has significantly impacted health systems around the world. The healthcare burden was visible in all countries struggling with the pandemic. Pharmacists, who are at the frontline beating the COVID-19 pandemic, played a significant role in relieving the burden on healthcare systems. However, the role of pharmacists in the fight against the COVID-19 pandemic was not appreciated. Therefore, our goal was to create the Pharmacy Heroes initiative, which brings together pharmacists from around the world during the COVID-19 pandemic and promotes the role of pharmacists in the health care system.

Aim: The article aims to present the results of the Pharmacy Heroes campaign, mainly in terms of dissemination.

Results: 85 countries from six continents were involved in the Pharmacy Heroes campaign. Pharmacists who joined the campaign worked in both community and hospital pharmacies.

Conclusion: The Pharmacy Heroes campaign showed the significant commitment of pharmacists around the world. Being the third-largest group of medical professionals, pharmacists played a crucial role in fighting the COVID-19 pandemic.

Background and aims: Bacterobilia is associated with postoperative morbidity after pancreatico-duodenectomy (PD), mostly due to infectious complications. Investigating the frequency of bacterial species isolated from intraoperative biliary cultures and associated problems following PD was the goal of this study.

Methods: The frequency of isolated bacterial species and surgical complications were evaluated using an ANOVA test. The relationship between biliary cultures and each of the following complications: delayed gastric emptying (DGE), post-operative pancreatic fistula (POPF), biliary fistula and surgical site infectious (SSIs) were evaluated by using the odds ratio.

Results: In 340/513 (66%) of the PDs, positive biliary cultures were discovered. In patients with complications following surgery, different polymicrobial biliary cultures were shown to be more prevalent. A noteworthy incidence of biliary cultures confirming the presence of E. Coli, Klebsiella pneumoniae, and Enterococcus fæcalis (p < 0.001) was noted in SSIs (surgical site infectious). There was a strong correlation (p < 0.001) between the prevalences of polymicrobial biliary cultures containing Escherichia coli, Klebsiella pneumoniæ, Enterococcus fæcalis, and Enterococcus fæcium and POPF. Higher incidence of intra-abdominal collection and DGE was observed in biliary cultures positive for Escherichia coli, Enterococcus fæcalis, and Enterococcus fæcium (p < 0.001). Notably, as a distinct complication, Escherichia coli was substantially linked to DGE (p < 0.01).

Conclusion: While monomicrobial Escherichia coli bacterobilia is linked to DGE as a distinct consequence following PD, specific prevalences of polymicrobial bacterobilia are related with severe complications.

Background: Carcinoembryonic antigen (CEA/CEACAM5) is a well-established tumor-associated antigen overexpressed in epithelial malignancies, including colorectal cancer (CRC). While its diagnostic and therapeutic relevance is recognized, its immunological context and potential as a nanovaccine target remain underexplored.

Aim: This study aims to enable the rational design and refinement of CEA-based nanovaccines by integrating transcriptomic and spatial data to identify immunologically relevant co-expressed biomarkers and potential therapeutic targets.

Methods: We conducted an integrative bioinformatics analysis using transcriptomic data from TCGA-COAD, GEO, and spatial datasets (GSE207843, GSE226997), complemented by differential gene expression analysis (GSE245218). CEACAM5 expression was correlated with cytokine profiles (IL10, IFNG, TNF, IL1B, IL12A, IL4), immune cell infiltration (via xCell), and co-expression networks. Genes with Spearman ρ > 0.75 were prioritized as vaccine candidates and evaluated through oncofetal expression and literature curation.

Results: CEACAM5 expression was inversely correlated with IFNG, IL10, TNF, and IL1B, suggesting a potential immunosuppressive phenotype. xCell analysis revealed negative trends between CEACAM5 and effector immune populations including CD8⁺ T cells and NK cells. Spatial transcriptomics confirmed CEACAM5 compartmentalization in tumor epithelium with minimal cytokine overlap. Co-expression analysis identified EPCAM and ATP10B as high-confidence candidates. Embryonic vs. adult differential analysis (GSE245218) confirmed their oncofetal expression patterns. Gene ontology analysis revealed downregulation of antibacterial humoral immune pathways.

Conclusion: CEACAM5 defines a distinct immune-silent tumor phenotype and co-localizes with other vaccine-relevant genes such as EPCAM. This study provides a comprehensive immunogenomic rationale for CEACAM5-directed nanovaccine development and proposes EPCAM and ATP10B as co-targets based on tumor-specific and developmental expression profiles.

Background: Simulation based education and training (SBET) is an important part of formal medical education and training, with anesthesia and intensive care domains being among the first to use this teaching method. Implementation of SBET into anesthesia and intensive care training is included in the recommendations lists of the European Society of Anesthesia and Intensive Care, with Point of Care Ultrasound (POCUS) being on the list of procedures that residents should be trained in using SBET.

Objectives: In this study the objective is to assess the clinical use of POCUS by trainees in Anesthesia and Intensive Care that finished a simulation program on a high-fidelity simulator.

Methods: We developed a questionnaire comprised of seven sections that evaluates the use of POCUS in clinical practice related to airway, lung, cardiac ultrasound, the availability of POCUS, possible barriers that create limitations, as well as scoring and feedback regarding the simulation sessions and distributed it to trainees that finished the simulation sessions.

Results: Over 90% of respondents declare using POCUS in their daily clinical practice, with more use of pulmonary evaluations than cardiac evaluations. Most of the responders declared good or very good knowledge and ability to diagnose most of the critical conditions described in the curriculum for lung and cardiac POCUS.

Conclusions: Self-assessment methods may be used alongside traditional methods to offer a wider view on POCUS competency and maintenance of skills of trainees in anesthesia and intensive care.

Background: Irritable bowel syndrome (IBS) is a chronic functional disorder characterized by abdominal pain, bloating, and altered bowel habits. Post-infectious IBS (PI-IBS) develops after acute gastroenteritis, including Clostridioides difficile infection (CDI). While CDI has been shown to decrease in prevalence during the pandemic era, studies indicate a substantial risk of PI-IBS following CDI, data remaining limited. The aim of the present study was to evaluate the risk of PI-IBS following a CDI and a potential correlation between PI-IBS onset and the severity of CDI.

Methods: This cross-sectional study included 69 patients hospitalized with suspected CDI at a tertiary center for Infectious Diseases, in Romania. Inclusion criteria were: patients >18 years of age with confirmed CDI via polymerase chain reaction. The severity of CDI was assessed based on hospitalization, laboratory parameters, and clinical symptoms. PI-IBS was evaluated six months after CDI using the Rome IV IBS questionnaire and the Bristol Stool Form Scale. Relative risk (RR) was calculated using SPSS software and a p value <0.05 was considered significant.

Results: Among the 38 enrolled patients, 24/38 (63%) were males, while 14/38 (37%) were females. The CDI was confirmed in 14/38 (37%) patients by PCR and the infection was ruled out in 24/38 (63%) patients (control group). PI-IBS developed in 57% of the CDI group compared to 25% in the control group (RR=2.29, 95% CI 0.99-5.23, p=0.04). CDI severity correlated with higher PI-IBS risk, with 90% of hospitalized CDI patients developing PI-IBS (RR=2.72, p=0.0493).

Conclusion: PI-IBS occurred in over half of the patients six months after CDI, with disease severity increasing the PI-IBS risk. These findings highlight the need for proactive management in severe CDI cases to prevent long-term gastrointestinal complications.