Clinics and Practice最新文献

Background: Intravenous protamine administration for heparin reversal after percutaneous hepatic chemosaturation intervention is generally recommended, but its effectiveness on coagulation parameters remains unclear.

Methods: In a single-center retrospective observational study, the effects of different postinterventional protamine doses on the activated partial thromboplastin time (aPTT), international normalized ratio (INR), prothrombin time (PT), fibrinogen, platelet count (PLT), and hemoglobin (Hb) were analyzed in consecutive patients who underwent high-dose heparin administration (>300 U/kg body weight) and extracorporeal circulation for chemosaturation treatment. Due to the multiple treatments of individual patients, linear mixed-effects models were applied.

Results: Thirty-one patients underwent 90 chemosaturation interventions, 68 (75.6%) of which involved heparin reversal with protamine. All investigated variables showed significant postinterventional alterations, while protamine use was associated with significantly lower aPTT, lower INR, higher PT, and higher fibrinogen levels, whereas PLT and Hb levels were comparable to those in procedures without protamine use. After adjustment for aPTT, significant independent effects of protamine remained for the INR and PT. Dose-dependent effects of protamine were observed for reductions in aPTT and an increase in fibrinogen levels, which were confirmed after adjustment for the heparin dose. A 10% higher protamine dose resulted in a 3% decrease in aPTT and a 4% increase in fibrinogen. An increase of 0.1 in the protamine-to-heparin ratio was associated with an increase of 9% in fibrinogen.

Conclusions: The present results suggest that protamine contributes to the normalization of the aPTT, INR, PT, and fibrinogen levels. Further prospective studies should be conducted to determine optimal dosing ratios.

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support during the perinatal period. An evaluation of the psychometric properties, validity, and reliability of the Fainareti mental health screening tool was carried out in Greek women in this study. Methods: The study participants consisted of 518 women retrospectively followed from pregnancy to their first year postpartum as part of a health intervention at the Day Center for Women's Mental Health Care (Perinatal Mental Health Disorders), operated by the non-profit organization Fainareti. Alongside the newly developed screening tool, this study utilized the Perinatal Anxiety Screening Scale (PASS), the Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Results: The assessment of the tool's internal reliability included computing two separate internal consistency indices, with both indicating its significant level of reliability. The correlation analysis between the tool and the scales included in this study demonstrated the tool's strong convergent validity, while factor analyses confirmed its satisfactory construct validity. Conclusions: Overall, these findings suggest that the one-factor Fainareti mental health screening tool is suitable for initial assessments of the mental health of Greek women.

Background: In heart failure with preserved ejection fraction (HFpEF) and decreased ejection fraction (HFrEF), LA strain, an indicator of the filling and discharge of the left atrium (LA), was recently identified as a sign of diastolic dysfunction. Our objective was to examine the significance of left atrial (LA) strain relative to tissue Doppler echocardiography and the left atrial volume index (LAVI) in evaluating left ventricular (LV) diastolic performance in individuals with chronic kidney disease (CKD). Methods: A prospective cross-sectional study was conducted on 220 outpatients with CKD who fulfilled the inclusion criteria and were referred to the cardiology clinic at Tanta University for routine echocardiographic assessment during a period of 6 months (April to September 2024). Based on their estimated glomerular filtration rate (eGFR), patients were divided into five groups: GFR ranges from 90 to 120 mL/min/1.73 m² in Group 1, 60 to 90 mL/min/1.73 m² in Group 2, 30 to 60 mL/min/1.73 m² in Group 3, 15 to 29 mL/min/1.73 m² in Group 4, and less than 15 mL/min/1.73 m² in Group 5. All participants were evaluated using echocardiographic measurements, such as the E/e ratio, left ventricular systolic and diastolic volumes, left atrial strain, left atrial volume index (LAVI), and ejection fraction (EF). Results: LA strain conduit and reservoir strain can significantly diagnose LV diastolic function in CKD patients (p < 0.001; AUC = 0.819 and 0.869, respectively) using cutoffs of ≤36 and ≥23, with 86% and 95.5% sensitivity, 65% and 60% specificity, 96.1% and 96% PPV, and 31.7% and 57.1%, NPV respectively. An AUC = 0.926 was observed with LAVI among grade 1 vs. grade 0 (0.9 is considered excellent in diagnosing patients with and without the disease). Other markers had AUC values of 0.5-0.6 among the grades of the diastolic function, suggesting no discrimination in diagnosing the disease. Conclusions: LA conduit strain and reservoir strain are independent markers that represent a superior and more sensitive approach than LAVI and tissue Doppler echocardiography for evaluating LV diastolic dysfunction in patients with CKD, even in the early stages.

Background: Ophthalmic emergencies are acute conditions that progress rapidly, posing a significant threat to a patient's vision and requiring urgent intervention to prevent permanent visual impairment. This study aimed to assess the general awareness of ocular chemical burns and the adequacy of the immediate response measures while also seeking to improve the understanding of these injuries and contribute to promoting a healthier society. Methods: A comprehensive literature review was performed, and the most frequently reported questions were incorporated into the original survey. An anonymous questionnaire, available both online and in print, was developed to conduct a cross-sectional study to assess the general knowledge of the causes, symptoms, and appropriate first aid measures to be applied in cases of chemical ocular trauma. Results: Between April and May 2024, 175 individuals completed the questionnaire and were included in the study. More than half (54%) of the tested population demonstrated a poor level of knowledge about chemical ocular injuries, and only 30.9% of the respondents correctly indicated the need for imminent treatment. Twenty percent of the respondents could not identify whether alkalis or acids are more hazardous. Additionally, 5.7% of the respondents falsely considered consultation with an emergency department a priority before thorough irrigation. Most of the respondents (60.6%) incorrectly indicated that the appropriate first aid measures and treatment depend on the substance involved, and 68.1% of the respondents stated that treatment in the emergency department should be delayed, allowing for anamnesis collection and thorough examination. Conclusions: Ocular chemical injuries can substantially impact an individual's quality of life. The present study found that the public knowledge concerning ocular chemical trauma, and the necessary immediate treatment is insufficient. Public education is vital, as delaying prompt and thorough irrigation at the chemical injury site may result in irreversible complications.

Background: Jugular foramen syndrome (JFS) is a rare condition characterized by the compression or impairment of one or more terminal cranial nerves passing through the jugular foramen. Although malignancies are the primary cause of JFS. Methods: In this report, we present the first documented case of JFS caused by acute otitis media in an adult patient. Results: A 74-year-old woman presented with ear pain, hoarseness, dysphagia, dizziness, tinnitus, and hearing loss. A physical examination revealed a reddish-bulging tympanic membrane, left-sided hearing loss, right uvula deviation, and cranial nerve palsies affecting the ninth and tenth nerves. Imaging studies confirmed temporal bone inflammation, thrombosis of the sigmoid sinus extending into the internal jugular vein, and signs of thrombophlebitis of the jugular vein. The patient underwent a cortical mastoidectomy, sigmoid sinus decompression, and ventilation tube insertion, along with antibiotic, steroid, and anticoagulant therapy. Postoperatively, the patient's condition improved significantly. Conclusions: This case highlights the importance of considering complicated acute otitis media in the differential diagnosis of neurological abnormalities associated with JFS. A thorough evaluation of the patient's medical history and radiological imaging can assist in identifying the cause of the symptoms and guide appropriate surgical or conservative treatment. Further research is essential to gain more comprehensive insights into the pathophysiology and therapeutic interventions of JFS affecting the ears.

Background/Objectives: Individuals diagnosed with schizophrenia are susceptible to constipation induced by antipsychotic medications. However, research investigating the prevalence of this adverse effect and its underlying mechanisms is limited. Methods: To address this knowledge gap, a narrative review was conducted on the subject of constipation in patients with schizophrenia. A comprehensive electronic search was conducted in the PubMed and J-Stage databases. Results: The prevalence of constipation in individuals with schizophrenia is high, ranging from 30% to 60%. The risk of constipation increases with high doses of antipsychotics and with the concomitant use of anticholinergics and mood stabilizers. The prevalence of constipation varies by sex, with women demonstrating a higher risk compared to men. Conclusions: Constipation is a prevalent complaint among individuals with schizophrenia, with women exhibiting a higher risk. The underlying pathophysiology of sex differences in constipation is attributed to variations in monoamines within the descending pain inhibitory pathway, which governs the neural circuitry associated with defecation. Constipation can lead to significant complications, underscoring the need for a multifaceted approach to treatment that considers the intestinal environment beyond the mere use of laxatives.

Background: Various types of dentures are applied in the treatment of missing teeth. The research carried out so far has proven that both the absence of teeth and the replacement of missing teeth with dentures affect the functional condition of masseter muscles. The purpose is, thus, to find out how the tone, elasticity, and stiffness of masseter muscles change after prosthetic treatment. Material and methods: The material for the study consisted of 137 individuals, who were divided into group 1, with dentures (n = 87) and undergoing prosthetic treatment, and group 2, without dentures (n = 50) with teeth preserved, and not undergoing prosthetic treatment. Additionally, group 1 was divided into subgroups, in accordance with the type of prosthetic treatment applied: group 1a-removable complete dentures (n = 14), group 1b-removable partial dentures (n = 48), group 1c-fixed partial dentures (n = 22), group 1d-fixed complete dentures (n = 3). The biomechanical properties of masseter muscles, namely: tone, stiffness, and elasticity were assessed by means of myotonometry. The measurements were taken under muscle relaxation and under maximum muscle contraction. Results: The values of the parameters of tone, stiffness, and elasticity were higher in group 2, without dentures, in comparison with group 1, with dentures, yet they did not differ with statistical significance. The type of prosthesis used affected the results obtained. Masseter muscles demonstrated the best biomechanical parameters in the case of applying fixed partial dentures. Conclusions: Prosthetic replacement of missing teeth contributes to maintaining the good condition of masseter muscles, which has been confirmed by the results of myotonometric measurements taken.

Background/Objectives: Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by muscle weakness and typical cutaneous rash. Dermatomyositis-specific antibodies, such as anti-TIF1γ, anti-SAE, anti-Mi2, anti-MDA5, and anti-NXP2, have been associated with specific clinical phenotypes. Our study aimed to describe the clinical profile of Moroccan patients with DM and clinical associations with myositis-specific antibodies. Methods: We recruited 54 adult patients with DM according to the Bohan and Peter criteria, admitted to the internal medicine and dermatology departments of the University Hospital Center Ibn Rochd of Casablanca from January 2020 to December 2023. Testing for myositis-specific autoantibodies (MSAs) was conducted using an Immunodot assay. Statistical analysis was performed using the Chi-square test. Results: Among our patients, 74% were female. The mean age of the patients at the time of diagnosis was 45.8 years (±12.95 years). The main clinical manifestations were a V-neck sign (70.4%), myalgia (70.4%), Gottron's papules (68.5%), heliotrope rash (63%), arthritis/arthralgia (48.1%), proximal muscle weakness (68.5%), periungual erythema (46.3%), and dysphagia (59.3%). Of the 54 patients, 37 (68.5%) showed dermatomyositis-specific antibody positivity. The most frequently found autoantibody was anti-Mi2 (22.2%), followed by anti-TIF1γ (14.8%), anti-NXP2 (9.2%), anti-MDA5 (7.4%), and anti-SAE (7.4%). The association between clinical manifestations and MSAs showed that anti-TIF1γ antibodies were associated with the V-neck sign (p < 0.05), and the MSA-negative group was protected from periungual erythema (p < 0.05). No other significant association was found. Conclusions: This study shows the autoantibody profile of Moroccan patients with DM and the associations of MSAs with clinical manifestations.

Aim: To compare caregiver satisfaction and children's acceptance of silver fluoride/potassium iodide (AgF + KI) treatment (Riva Star Aqua^®, SDI Limited, Victoria, Australia) and glass-ionomer cement (GIC) application (Ionostar Plus + Easy Glaze, VOCO, Germany) in reducing hypersensitivity in permanent molars affected by molar incisor hypomineralisation (MIH) with the MIH treatment need index (MIH-TNI) 3 and 4 immediately after its application and after 12 weeks. Materials and Methods: This prospective, comparative, clinical study recruited schoolchildren with at least one hypersensitive MIH molar with a Schiff cold air sensitivity score (SCASS) of 2 and 3. Caregivers in both groups (AgF + KI and GIC + glaze) answered a questionnaire (5-Point Likert Scale) regarding the perception of the treatment immediately (15 min post application) and in the 12 weeks follow-up. Children's behaviour during both applications was assessed using FBRS (Frankl Behaviour Rating Scale). Results: A total number of 47 children (n = 22 for AgF/KI and n = 25 for GIC) with a mean age of 8.6 ± 1.42 were recruited. A high proportion of the children in both arms (n = 40 out of 44; 90.1%) reported a reduction in hypersensitivity in the last 12 weeks. On average, children (n = 39; FBRS ≥ 3) in both groups showed positive behaviour, with a significantly more definitely positive behaviour in the GIC group (p < 0.05, independent student t-test). Caregiver satisfaction with both study procedures was high after immediate assessment (n = 19 out of 22, 86.4% for AgF/KI and n = 19 out of 25, 76.0% for GIC application) and in 12 weeks of follow-up (n = 17 out of 20, 85.0% for AgF/KI and n = 22 out of 24, 91.6% for GIC application). However, the taste AgF/KI is more frequently considered not acceptable for the child (n = 10; 45%) than smell (n = 2; 9%). Interestingly, there was a statistically significant difference in caregivers' preference toward alternative desensitisation treatment (tooth restoration coverage, desensitisation paste, stainless steel crown and fluoride varnish) in both treatment groups (p < 0.05, Mann-Whitney U test). Conclusions: Both GIC and AgF/KI applications can be considered acceptable approaches to reduce hypersensitivity in permanent molars affected by MIH both immediately and in long-term follow-up for schoolchildren based on caregivers' assessments.

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal issue, encompassing various shoulder conditions. While exercise typically forms the foundation of conservative treatment, there exists ongoing discourse regarding the effectiveness and role of passive treatments. International guidelines recommend initial conservative management, with surgery considered only after failed conservative treatment. However, recent studies reveal discrepancies between recommended practices and actual clinical management. The aim of the study was to assess current practices in managing RCRSP among Greek physiotherapists, with a focus on understanding the alignment of these practices with international guidelines for conservative treatment. Methods: A cross-sectional survey was conducted among Greek physiotherapists to assess current practices in managing RCRSP. The survey, adapted from previous studies, collected demographic data and assessed clinical reasoning through a vignette-based approach. Responses were analyzed for alignment with guideline-recommended care. Results: Out of over 9000 contacted physiotherapists, 163 responded. A majority expressed a specific interest in shoulder pain (85%). Patient education (100%) and exercise (100%) were widely endorsed, with limited support for imaging (44%), injection (40%), and surgery (26%). Younger respondents were less inclined towards surgical referral (p = 0.001). Additionally, adjunctive interventions like mobilization (66%) and massage therapy (58%) were commonly employed alongside exercise and education. Treatment duration typically ranged from 6 to 8 weeks, with exercises reviewed weekly. Conclusions: The study highlights a consistent preference for conservative management among Greek physiotherapists, aligning with international guidelines. However, there are variations in practice, particularly regarding adjunctive interventions and exercise prescription parameters. Notably, there is a disparity between recommended and actual use of certain modalities.