Medicine and Pharmacy Reports最新文献

Background: Polymorphous adenocarcinoma (PAC) is a type of salivary gland tumor that is rare and diverse in morphology. It is typically found in the minor salivary glands, with the palate being the most common location. However, this tumor is often misunderstood, underdiagnosed, and controversial in nomenclature. Its low-grade behavior may be unpredictable, making it challenging to manage.

Case report: In this paper, we detail a case of PAC that developed in the buccal mucosa, which is a less common anatomical location. We discuss the patient's clinical presentation, imaging findings, histological examination results, as well as the surgical treatment and follow-up outcomes. We also examine relevant literature related to the topic to provide a comprehensive understanding of this rare case.

Conclusions: Although complete surgical excision is the primary management for PAC, there is no gold standard treatment for it. It is crucial to follow up on patients with PAC in the long term, as recurrences, lymph nodes, and distant metastasis, even rare, may impair the prognosis in certain patients.

Background and aims: Exclusive enteral nutrition (EEN) is a well-established first-line therapy for inducing remission in mild-to-moderate pediatric Crohn's disease (pCD). While clinical remission (CR) and mucosal healing (MH) are widely accepted therapeutic goals, the concept of transmural healing (TH) has gained increasing recognition. This study aimed to evaluate the effectiveness of EEN in pCD patients from Romania, focusing on nutritional status, remission outcomes, and the impact of various factors on treatment efficacy.

Methods: We conducted a retrospective observational study of pCD consecutive patients who received EEN for induction of remission between 2007 and 2017 at a referral center in Cluj-Napoca, Romania. CR was defined as a weighted Pediatric Crohn's Disease Activity Index (wPCDAI) <12.5, MH as a fecal calprotectin level <250 microg/g, and TH as the combination of MH and imagistic remission assessed by intestinal ultrasonography. Statistical analyses included descriptive and comparative approaches, including logistic regression, with p <0.05 considered significant.

Results: Twenty patients with pCD, representing 45% of the cohort, were included. The median age at diagnosis was 14.2 years (9.9-18.4), and 65% were male. EEN was administered with a mean duration of 7.84±1.26 weeks. Body mass index Z-scores significantly improved following EEN (p=0.02). Hypoalbuminemia, detected in 55% of patients at diagnosis, resolved completely after EEN (p=0.00015). CR was achieved in 82% of patients with active clinical disease, MH in 26% of patients with microscopic activity, and TH in 20% of patients with imagistic activity. Age at diagnosis, disease behavior, location, activity, and anti-Saccharomyces cerevisiae antibody status were not significantly associated with CR or MH. Disease activity at initiation, measured by the wPCDAI, was inversely associated with TH (p=0.004).

Conclusions: This is the first study to report on EEN outcomes in pCD patients from Romania. EEN was effective in improving nutritional status and inducing CR, while MH was achieved in about one-quarter of patients. TH was also observed, though less frequently, and was negatively associated with higher baseline clinical disease activity. Regional factors may have influenced these outcomes.

Cancer remains one of the most significant global health challenges, requiring continuous exploration of novel therapeutic agents. Traditional medicine has long used Taraxacum officinale H.Wigg, commonly known as dandelion, for its diverse pharmacological properties. Recent studies have highlighted its potential anticancer effects attributed to a rich phytochemical profile containing flavonoids, terpenoids, phenolic acids, polysaccharides, and sterols. This review systematically examines the available scientific literature regarding Taraxacum officinale, focusing on its ethnomedical application, phytochemical composition, and anticancer mechanism demonstrated in vitro and in vivo models. Key bioactive compounds, such as taraxasterol, chlorogenic acid, chicoric acid, and taraxinic acid, have been identified as promising agents capable of inhibiting tumor cell proliferation and modulating oncogenic pathways. Additionally, the plant's safety profile and toxicological assessments are discussed to evaluate its therapeutic viability. Given its multi-target biological activity and low toxicity, Taraxacum officinale holds significant potential for integration into oncotherapy as an adjuvant treatment. However, further preclinical and clinical investigations remain essential to validate its efficacy and mechanism of action, paving the way for the development of cost-effective, plant-based cancer therapeutics.

Background: This study aims to investigate the effectiveness of steroids plus antivirals versus steroids alone in the treatment of Bell's palsy. Due to conflicting results in the existing literature, we conducted this meta-analysis to synthesize the available evidence and extract a more complete conclusion.

Methods: We searched electronic databases PubMed, CINAHL, ScienceDirect, MEDLINE, OVID, and Scopus. The last search was performed on March 2024. In this study, 7 randomized controlled trials were included. We used random and fixed effects for sensitivity analysis for each outcome, and we further proceeded to perform a Bayesian meta-analysis using priors and calculate the posterior distribution.

Results: Performing frequentist meta-analysis, both the random and fixed effects showed statistical significance, indicating the superiority of the combination treatment. The random log odds ratio was 0.5865 [95% CI: 0.0141 to 1.1589 and the Back-Transform Log Odds Ratio to Odds Ratio was 1.798 [95% CI: 1.014 to 3.186]. The fixed effect log odds ratio was 0.4377 [95%CI: 0.0819 to 0.7934] and the Back-Transform Log Odds Ratio to Odds Ratio was 1.549 [95% CI:1.085 to 2.211]. Neither the rank correlation nor the regression test in both models indicated any funnel plot asymmetry and publication bias.Performing Bayesian meta-analysis, in the posterior distribution the model-averaged log odds ratio was 0.26 [0.00 to 0.90], showing no statistically significant results, as the log odds ratio contains the zero. The inclusion Bayes Factor (BF) for the effect was 1.225 showing anecdotal supporting evidence for the combination treatment. The inclusion BF for the heterogeneity was 0.979, showing no support for its existence in the analysis and the inclusion BF for the publication bias was 0.622, a lower of 1, indicating evidence of its absence in the analysis.

Conclusions: The combination of steroids plus an antiviral agent, is more efficacious than steroid monotherapy in treating Bell's palsy. This conclusion is supported by frequentist analysis, but not by the Bayesian approach as the Bayesian meta-analysis was inconclusive, suggesting some uncertainty in the effect size but this could be due to priors influence. Further research with advanced syntheses such as network and Bayesian meta-analysis is needed as well as more double-blinded randomized controlled trials.

Background and aims: Diabetic peripheral neuropathy (DPN) is the most prevalent chronic complication of diabetes. Several risk factors have been identified in recent studies, in particular metabolic syndrome (MetS). However, this association remains unclear. We aimed to determine the prevalence of DPN and to study its associated factors, especially the MetS as a potential risk factor of DPN in patients with Type 2 diabetes mellitus (T2DM).

Methods: This was a retrospective and comparative study, with cross-sectional collected data, involving patients with T2DM from North Africa, followed up in the Department of Endocrinology-Diabetology-Nutrition at Mohammed VI University Hospital Center of Oujda, located in the eastern region of Morocco. Patients were grouped according to the presence (T2DM/DPN+, n = 110) or absence of DPN (T2DM/DPN-, n = 290). Data were collected from medical records and analyzed using SPSS software version 21.

Results: DPN was found in 27.5% of the patients. The mean age was similar between the two groups, at 58.96 ± 11.86 years in the T2DM/DPN+ group and 57.10 ± 13.29 years in the T2DM/DPN- group. Males comprised 40.9% of the T2DM/DPN+ group and 31.7% of the T2DM/DPN- group, but this difference was not statistically significant (p = 0.054). Patients with DPN had a significantly longer duration of diabetes (median 10 years vs. 5 years, p < 0.001). Both groups showed glycemic imbalance, with mean HbA1c values of 10.71 ± 2.31% for T2DM/DPN+ and 10.40 ± 2.87% for T2DM/DPN-, without a significant difference. MetS was a significant predictor of neuropathy presence. The prevalence of DPN was greater in individuals with hypertension (p = 0.013), abdominal obesity (p = 0.010), elevated triglyceride levels (p = 0.007), and low HDLc (p = 0.013). Male sex and the duration of diabetes were found to be significant risk factors for the development of DPN.

Conclusion: MetS and its components are strongly associated with the presence of DPN in patients with T2DM. Therefore, screening and optimal control of these risk factors may help prevent DPN in these patients. However, further intervention studies are needed to determine whether comprehensive multifactorial control in patients with T2DM and MetS can effectively prevent DPN.

Background and aim: Gastrointestinal bleeding (GIB) is one of the most common medical emergencies. Proton pump inhibitors (PPI) are among the most widely used drugs in gastroenterology to treat various types of acid-related disorders. We aim to investigate the safety of proton pump inhibitors (PPIs) when used concurrently with anticoagulants in patients with upper and lower gastrointestinal bleeding (GIB) and assess the risk of hospitalization, GIB, and mortality in patients receiving this combined treatment.

Methods: A retrospective multicenter study was conducted at two tertiary care hospitals. Patients were selected according to inclusion and exclusion criteria. Demographic data, vital signs, medical history, physical examinations, comorbid conditions, medications, laboratory investigations, endoscopy findings, management, and complications were retrieved from the medical records of all participants.Data obtained from all patients' medical records were reviewed. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms. Statistical analyses were performed using IBM SPSS version 25.0 software.

Results: Our results revealed a significant increase in acute GIB risk with the number of concurrent anticoagulants used, particularly in patients not using PPIs. Those using four anticoagulants along with PPIs had a lower likelihood of acute GIB at 6.3% (P = 0.0001). Patients taking two or three anticoagulants also experienced reduced GIB risk when PPIs were added (P ≤ 0.05). Age played a role, with a statistically significant difference between PPI users and non-users, especially in the 31-40 age group, where PPI users had a higher incidence of GIB (69.80%) compared to non-users (30.20%) (P < 0.05). Comparing patients on anticoagulants with or without PPIs, the study found a lower risk of hospitalization (adjusted hazard ratio, AHR: 1.02; 95% CI: 0.92-1.57) and mortality (AHR: 1.00; 95% CI: 0.84-1.11) in those using Rivaroxaban and PPIs concurrently. By contrast, patients using Rivaroxaban alone without PPIs faced an increased risk of hospitalization (AHR: 1.15; 95% CI: 0.98-2.35) and mortality (AHR: 1.12; 95% CI: 0.90-1.37).

Conclusions: Combining PPIs with anticoagulant drugs reduced the risk of GIB, hospitalization, and mortality, particularly in older adults, thereby mitigating potential complications.

Vaccination programs have had a pivotal part in the successful reduction of global morbidity and mortality of infectious diseases. Despite their undeniable success, vaccination rates among children with congenital heart disease (CHD) remain suboptimal. This article aims to address the challenges surrounding immunization in CHD patients and provide guidance for immunization practices within this population. Most experts advocate for adherence to standard immunization practices in CHD patients who are immunocompetent and in good health. Supplemental vaccinations against rotavirus, varicella, meningococcus, hepatitis A and influenza are recommended. RSV prophylaxis with palivizumab is advisable in patients with hemodynamically significant CHD during winter season. However, special considerations are warranted in specific situations, such as around cardiac surgery or in patients who are immunocompromised. Furthermore, adjustments to the vaccination schedule might be necessary for patients who require antithrombotic prophylaxis or blood transfusions. Lastly, special attention should be given to individuals at a high risk of decompensation after immunization, who might require close parental or medical monitoring for up to 72 hours post-vaccination.

Introduction: Renal arteriovenous malformations (AVMs) are rare vascular lesions mostly diagnosed when they become symptomatic. These lesions can be treated using a variety of endovascular techniques and devices.

Case report: We present a 51-year-old male who presented with acute onset right flank pain, hematuria and refractory hypertension. The patient was treated using a multi-plug flow control technique using multiple balloon catheters and microcatheters. Two operators worked synchronously during the procedure using two different dilutions of glue. The patient's symptoms resolved immediately after the embolization and at 1 month follow up the CT demonstrated complete obliteration of the AVM with little renal parenchymal loss. The patient remained clinically asymptomatic at the 6-months follow-up.

Conclusion: This case illustrates the feasibility and safety use of synchronous embolization in the treatment of complex renal AVMs.

Background/objectives: Genetic testing plays a critical role in breast cancer management by identifying individuals with high or moderate penetrance gene mutations. While clinical implications are well established, less is known about the psychological and quality-of-life impact of different genetic risk levels. This preliminary study aimed to explore whether breast cancer patients with high penetrance mutations experience different levels of distress compared to those with moderate penetrance mutations.

Methods: A total of 110 breast cancer patients treated at the Regina Maria Private Health Network in Cluj-Napoca, Romania, were included based on specific eligibility criteria. Participants completed a shortened version of the BREAST-Q questionnaire, focused on core dimensions such as emotional distress, self-concept, appearance, relationships, and financial burden. Descriptive statistics were calculated, and independent t-tests were performed to compare responses between the two genetic risk groups.

Results: Patients with high penetrance mutations reported significantly higher distress levels in several domains, including overall emotional distress (p = 0.039), concern for daughters or relatives (p = 0.043), changes in appearance (p = 0.038), and self-concept (p = 0.043). Other factors, such as fear of diagnosis, financial burden, and impact on sexuality, did not show statistically significant differences between groups.

Conclusions: This preliminary study suggests that genetic risk classification may influence the psychosocial experience of breast cancer patients, with high penetrance mutation carriers experiencing greater distress in specific areas. These findings highlight the need for personalized psychosocial support based on genetic profiles and warrant further investigation in larger, longitudinal cohorts.

Background: Pancreatic adenocarcinoma (PDAC) is a leading cause of cancer-related mortality due to its aggressive progression and late diagnosis. Despite advances in diagnosis and treatment, survival outcomes remain poor, with a median survival of 5.8 months.

Objective: The aim of the study is to evaluate the impact of diagnostic and therapeutic approaches on survival outcomes in patients with pancreatic adenocarcinoma, while also assessing the risk factors for PDAC.

Methods: This study is a retrospective analysis of 68 patients with suspected pancreatic tumors who underwent endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) between 2019 and 2022 at the Cluj-Napoca County Emergency Clinical Hospital. Patient demographics, risk factors, histopathological results, and treatment outcomes were analyzed using statistical methods.

Results: Of 68 patients, 35 were diagnosed with PDAC. Modifiable risk factors, such as alcohol and smoking, alongside non-modifiable factors like age and hereditary predisposition, were prominent. Among PDAC patients, 42.8% received palliative chemotherapy, while only 8.6% underwent curative surgical intervention due to advanced disease stages. Median survival varied significantly based on treatment: 2.4 months for untreated patients versus 8.1 months for those receiving oncological or surgical management (p=0.0082).

Conclusion: Modifiable and non-modifiable risk factors significantly raise the incidence of pancreatic cancer. Therefore, employing a multidisciplinary approach to detect the disease in its early stages and optimize personalized treatment plans can enhance patient outcomes. At the same time, traditional oncological treatments improve survival and quality of life, but newer approaches, such as immunotherapy combined with conventional radiotherapy, chemotherapy, molecular targeted therapy, and other diverse treatment modalities, have the potential to further extend survival.