Clinics and Practice最新文献

The aim of this study was to evaluate the factors associated with the occurrence of oral infection sources in patients scheduled for total hip or knee arthroplasty, with the purpose of establishing standardized preoperative dental triage criteria. Materials and Methods: A retrospective research was conducted on a study group of 89 patients diagnosed with hip osteoarthritis and knee osteoarthritis at the Clinical Rehabilitation Hospital (Iasi, Romania). Patients were divided according to the status of their oral cavity: study group (n = 51)-patients with diagnosed oral infection sites (oral foci of infection); control group (n = 38)-patients without oral foci of infection. The statistical analysis included a univariate stage followed by a multivariate binary logistic regression to identify demographic and clinical factors associated with the presence of oral foci of infection. Results: The strongest predictor of the presence of oral foci of infection was and Oral Hygiene Index (OHI) scorer of 2, which increased the risk 14.583-fold, followed by being aged between 50 and 65 years (OR = 4.038), tooth brushing once a day or less (OR = 3.488), and male sex (OR = 3.433). An OHI score of 2 raises the probability of oral infectious pathology to 30.3%, which increases to 85.1% when combined with being aged between 50 and 65 years. Conclusions: The risk factors for the presence or oral foci of infection in patients scheduled for total knee or hip arthroplasty support the inclusion of the preoperative assessment and management of these factors in order to reduce the risk of the postoperative periprosthetic joint infections.

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most often present with lower urinary tract symptoms (LUTS) or hematuria, though some cases are incidental findings. Associations with syndromic conditions such as Peutz-Jeghers, Beckwith-Wiedemann, Goldenhar, and Loeys-Dietz have been reported. Transurethral resection is the preferred treatment and has generally been curative. We report the first case in Germany-and the 16th worldwide-of urinary bladder hamartoma, occurring in a young adult male with bothersome LUTS. Because of its proximity to both ureteral orifices, only partial transurethral resection was performed, which provided durable symptom relief at 14 months of follow-up. This case highlights partial TUR as a pragmatic, organ-preserving alternative when complete resection is anatomically unsafe, while emphasizing that TURBT remains the standard of care. We provide a detailed discussion of the histopathological features, differential diagnosis, treatment considerations, and an updated narrative review of all reported cases.

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity and inflammation, they are promising candidates for assessing skin barrier disruption in CD.

Methods: Stratum corneum samples were collected by tape stripping from experimentally induced and chronic lesions, as well as healthy non-lesional skin. Biomarkers Cholesterol Sulfate (Chol-Sulf), Cholesterol Glucosyl (Chol-Glc) and their ratio were quantified. Data were analyzed using ANOVA, Pearson's correlation, logistic regression and ROC curves.

Results: Chol-Glc and the Chol-Glc/Chol-Sulf ratio differed significantly across the diagnostic groups, while Chol-Sulf did not. Logistic regression and ROC analyses revealed a limited standalone diagnostic accuracy for the individual biomarkers (all AUC < 0.6).

Conclusions: Chol-Glc and the ratio exhibit disease-specific patterns relevant for subtype discrimination. Although insufficient as independent diagnostic tools, these markers may contribute to future multivariate diagnostic models for CD diagnosis.

Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan-Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (-) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.

Background: Emergency contraception (EC), also known as postcoital contraception, is a method used to prevent an unintended pregnancy following unprotected or inadequately protected sexual intercourse. The available options include emergency contraceptive pills or the insertion of an intrauterine device (IUD). Emergency contraception pills contain either levonorgestrel (a single 1.5 mg dose, effective within 72 h) or ulipristal acetate (a single 30 mg dose, effective within 120 h), both of which are most effective when taken as soon as possible after unprotected intercourse. Another highly effective option is the insertion of a copper or levonorgestrel-releasing intrauterine device, although IUDs are not registered for EC use in all countries. The aims of this cross-sectional, comparative, observational study were to collect data on the emergency contraception methods used by adolescent girls and young women to examine their association with various factors, such as religious beliefs, and to evaluate the effectiveness of different emergency contraception methods, including hormonal options and intrauterine devices. Methods: Data were collected from 240 women who attended our Family Planning Clinic using a structured questionnaire that included items on their demographic characteristics, religious beliefs, medical history, lifestyle factors, contraceptive use and side effects, prior use of emergency contraception, method selected, and reasons for seeking emergency contraception. Descriptive statistics were used to summarize the data, comparisons between religious groups were conducted using chi-square tests, and factors related to the timing of emergency contraceptive use were investigated using multinomial logistic regression analysis. Results: Most of the reasons for emergency contraception use did not differ significantly between Christian and Muslim participants. However, Christians were significantly more likely to use emergency contraception due to missed contraceptive doses (20.9% vs. 6.7%, p = 0.004) or the failure to take a progesterone-only pill (19.1% vs. 3.3%, p = 0.001). Levonorgestrel was the most frequently used method in both groups (48.9% of Christians vs. 60% of Muslims, p = 0.132), followed by ulipristal acetate (30.9% vs. 40%, p = 0.180). Notably, 18.5% of Christian participants used an intrauterine device (IUD) for emergency contraception, while no Muslim participants reported IUD use (p < 0.001), indicating a significant difference potentially influenced by cultural or religious factors. Conclusions: Both religious and individual sociodemographic factors affect not only the choice of emergency contraception but also the urgency with which the emergency contraception is used. Interventions aimed at improving contraception education, addressing partner-related challenges, and promoting timely access could improve reproductive health outcomes.

Background/objectives: Previous studies have shown that hypothyroidism with myxedema may significantly affect the vocal folds. The aim of this study was to investigate thyroid dysfunction and other possible risk factors, including smoking, for the development of Reinke's edema (RE) in a group of men.

Methods: Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured in a group of men with first occurrence or recurrent RE and in age- and gender-matched control subjects without laryngeal pathology. All participants completed a questionnaire on other possible etiologic factors for the development of RE, especially smoking. Risk factors were compared between the two groups. Levels of TSH and thyroid hormones were also compared between patients with recurrent disease and those with a first occurrence of RE.

Results: A total of 53 men with RE (mean age 53.82 years) and 45 controls (mean age 57.71 years) completed the study protocol. TSH and thyroid hormone levels were within the normal limits in all participants. Serum fT3 levels were significantly higher in patients with RE compared to controls (p = 0.034). After univariate analysis, all risk factors were included in a multivariate regression model. Only smoking remained a significant variable. Thyroid hormone levels did not differ between patients with first-onset RE and those with recurrent RE.

Conclusions: An association between hypothyroidism and the development of RE was not confirmed. The significantly higher fT3 levels in patients compared to controls were still within the normal range and may reflect normal variation. Regression analysis of possible risk factors for RE showed the primacy of smoking.

Background/Objectives: An increasing number of older individuals require general anaesthesia for major non-cardiac surgery, with 20% displaying postoperative complications. Regional cerebral oxygen saturation (rSO₂) correlates with the gold standard of mixed venous oxygen saturation, indicating global perfusion. We hypothesised that rSO₂-based anaesthesia reduces organ dysfunction and morbidity after major non-cardiac surgery. Methods: In Singapore and Toronto, we conducted a prospective, double-blind, randomised controlled trial in elderly patients undergoing major non-cardiac surgery, after obtaining research ethics board permission and informed consent. This RCT followed the CONSORT guidelines. Patients received bilateral cerebral oximetry sensors, and the control group received standard care. In the intervention group, an algorithm restored rSO₂ if it dropped 10% below baseline for >15 s by adjusting cerebral perfusion pressure, inspired oxygen concentration, end-tidal carbon dioxide, depth of anaesthesia, haemoglobin, and cardiac index. Postoperative complications and outcomes were noted. Categorical data were analysed using Chi-square or Fisher's exact tests and continuous data using a t-test or a Mann-Whitney U test. The study was powered for 394 patients, but due to the COVID-19 pandemic and funding constraints, this study was terminated at 101 patients. Results: Of 101 patients, 49 were randomised to the control and 52 to the intervention group. A total of 31 (63%) patients in the control group and 30 (58%) in the interventional exhibited bilateral cerebral desaturation. Time of cumulative cerebral desaturation was longer in the control group (23 ± 48 min vs. 9 ± 15 min, respectively, p = 0.01). A total of 142 algorithm-based treatments were employed, restoring rSO₂ in 29 (86%) patients. Both groups displayed equal postoperative outcomes. Conclusions: In major non-cardiac surgery, cerebral desaturation is prevalent in over 85% of patients. Although algorithm-guided therapy restored rSO₂ in the majority of patients, it did not result in reduced postoperative morbidity.

Objectives: The aim of our study was to assess the efficacy and safety of two different labor induction methods in patients after fetal demise beyond 28 weeks, with an unfavorable cervix: misoprostol-prostaglandin E1 analog (PGE1) and dinoprostone-prostaglandin E2 analog (PGE2). Methods: This retrospective single-center cohort study included all labor cases after fetal demise (intrauterine fetal death or termination of pregnancy with feticide) from 28 to 40 weeks of gestation, where labor was induced by either PGE1 or PGE2. The primary outcome was the induction-to-delivery time interval. Secondary outcomes included the proportion of patients who delivered within 24 h, the failed induction rate, the length of labor, pain during induction, the adverse outcome rate, and the post-labor hospital stay. Results: The induction-to-delivery time interval was shorter in the PGE1 group (p = 0.048). There was no statistically significant difference in the proportion of patients who delivered within 24 h (p = 0.651) and failed inductions (p = 0.18) between groups. The duration of labor was longer in the PGE2 group (p = 0.01). Oxytocin augmentation was more common in the PGE2 group (p < 0.001). Pain during induction was greater in women in the PGE1 group (p < 0.001). There were no statistically significant differences in adverse effects between groups. There was no significant difference in induction to delivery interval between the two methods when comparing lower and higher gestational ages (28 to 34 weeks, p = 0.18; 35 to 40 weeks, p = 0.343). Conclusions: Our findings support the use of a PGE1 regimen for third-trimester labor induction after fetal demise, when no contraindications exist. This approach appears to improve the efficiency of induction and may enhance overall patient care by reducing intervention needs.

Background/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein-Barr virus (EBV)-positive NK/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. This report presents a case of an ASP-related HSR and reviews the incidence within our institutional cohort. Detailed Case Description: A 60-year-old female presented an immediate Grade 2 HSR during her second PEG-asparaginase infusion, with pruritus, vomiting, and presyncope. The infusion was discontinued, and she was subsequently transitioned to crisantaspase-an alternative formulation-which was well tolerated without further adverse events. She remains disease-free to date. A retrospective review of institutional records (2015-2025) identified six patients with NKTCL treated with ASP-containing chemotherapy. The incidence of HSRs in this cohort was 1 of 6 (16.7%). Conclusions: As in acute lymphoblastic leukemia, HSRs to asparaginase remains a major challenge in the management of NKTCL with potential implications for treatment safety and efficacy. The establishment of standardized, consensus-based criteria for the diagnosis, classification, and management of ASP-related HSRs is urgently needed to optimize patient outcomes.