Clinics and Practice最新文献

Background and Objectives: The primary goal of the study is to analyze factors associated with spinal anesthesia-induced hypotension (SAIH), with a focus on ephedrine requirements in relation to patient characteristics and the type of intrathecal opioid used, reflecting real-world clinical practice in a Romanian secondary care hospital. Bolus ephedrine is often required during spinal anesthesia to maintain hemodynamic stability. We conducted a retrospective observational study of patients undergoing total hip arthroplasty. We analyzed the hemodynamic effects of spinal anesthesia to optimize management of spinal anesthesia-induced hypotension (SAIH). Materials and Methods: A total of 329 patients were included in the study, out of which 113 patients were without high blood pressure (60 cases needed Ephedrine) and 216 patients with high blood pressure were drug controlled (106 cases needed Ephedrine). Each group of patients was divided into two groups based on the type of spinal anesthesia: bupivacaine with morphine (Group M) and bupivacaine with fentanyl (Group F). The study explored perioperative factors associated with spinal anesthesia-induced hypotension and the ephedrine dose required to maintain hemodynamic stability. Results: We found that ephedrine dosage correlated with hypertension in 19% of cases and with patient age in 44.1% of cases. The type of anesthetic mixture did not significantly affect the need for intraoperative ephedrine administration. Conclusions: Ephedrine remains essential for ensuring hemodynamic stability and optimizing perioperative outcomes.

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics.

Background/objectives: Menopause leads to estrogen deficiency, which negatively affects bone density, skin integrity, and hair health in women. This study aimed to evaluate the effects of fish-derived collagen peptides, calcium, and vitamin D3 supplementation on body composition, bone turnover markers, skin condition, and hair loss in menopausal women.

Methods: Participants were randomized into four groups: placebo (G01), 1000 mg calcium + 400 IU vitamin D3 (G02), 5 g collagen (G03), and 1000 mg calcium + 400 IU vitamin D3 + 5 g collagen (G04). Participants received daily supplementation for six months. Body composition, biochemical bone markers (P1NP, BAP, osteocalcin), skin hydration, elasticity, transepidermal water loss (TEWL), and hair loss were assessed at baseline and follow-ups.

Results: No significant changes were observed in body composition or bone biomarkers including P1NP, BAP, and osteocalcin across groups. Serum creatinine, ALT, and AST levels remained within normal ranges. Serum calcium levels remained stable, and urinary calcium excretion slightly increased in calcium-supplemented groups, indicating no adverse effects on kidney or liver function. G02 and G04 exhibited slightly decreased serum calcium levels compared to G01 and G03. However, G04 showed significantly improved skin hydration by 23% and skin elasticity by 8.52% compared to baseline after six months, whereas the placebo group showed negligible changes. G03 also showed notable improvement in elasticity by 12.23%, indicating collagen's dominant role. The G02, G03, and G04 also significantly retarded hair shedding compared to the placebo (G01) group. TEWL did not significantly change in any group.

Conclusions: These findings suggest that six-month supplementation with collagen peptides, particularly when combined with calcium and vitamin D, improves skin hydration and elasticity in menopausal women.

Background and Objectives: Vitamin D deficiency and psychological distress have been linked to cancer biology, but their relevance to tumor differentiation in head-and-neck squamous cell carcinoma (HNSCC) is uncertain. Materials and Methods: In this cross-sectional study at the Department of Otolaryngology, County Hospital of Timișoara, Romania, we enrolled newly diagnosed HNC patients from October 2023 to December 2024, analyzing 199 SCC patients after exclusions. Vitamin D status was assessed using serum 25-OH-vitamin D levels, and distress was measured with the validated Romanian version of the Hospital Anxiety and Depression Scale (HADS). Tumor aggressiveness was defined by histological grade (G3 vs. G1-G2). Univariate, multivariate, and subgroup analyses were conducted, adjusting for confounders like smoking. Results: Vitamin D deficiency (<20 ng/mL) was prevalent (80.40%), with median 25-OH-vitamin D levels of 15.1 ng/mL. Univariate analysis revealed a modest association between vitamin D deficiency and poorly differentiated tumors (G3 vs. G1-G2; OR = 1.79, p = 0.055) and between clinically significant anxiety (HADS-A ≥ 8) and G3 tumors (OR = 1.71, p = 0.059). A weak negative correlation was observed between 25-OH-vitamin D levels and HADS-A scores (rho = -0.17, p = 0.052). In multivariate analysis adjusted for age, smoking, and tumor location, these associations weakened (vitamin D deficiency: OR = 1.55, p = 0.082; HADS-A ≥8: OR = 1.56, p = 0.113). Subgroup analysis suggested a trend toward higher odds of G3 tumors in patients with both vitamin D deficiency and high anxiety (OR = 1.72, p = 0.075). Conclusions: Univariate analyses indicated potential links between vitamin D deficiency, psychological distress, and tumor aggressiveness in HNSCC, but these did not reach statistical significance after adjustment for confounders. The observed trends, particularly in subgroups with combined deficiency and distress, suggest a possible interplay worth exploring further. To conclude, neither vitamin-D deficiency nor clinically significant distress independently predicted poor histological differentiation after adjustment; observed trends, including a possible distress-vitamin-D interaction, are hypothesis-generating and warrant testing in larger, longitudinal cohorts.

Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located in the brainstem, the sensorimotor cortex, the basal ganglia, and the cerebellum, but also peripheral nerves and swallowing muscles. Neurological diseases affecting either central or peripheral components of this system commonly result in dysphagia. Despite its clinical relevance, the management of neurogenic dysphagia remains challenging. While rehabilitative strategies such as swallowing therapy currently represent the main treatment option, emerging evidence suggests that non-invasive central and peripheral neuromodulation techniques may provide adjunctive beneficial effects. Further research is warranted to better define their efficacy, optimal protocols, and long-term outcomes.

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee's native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making.

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities.

Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter-defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy-defibrillator (CRT-D) therapies in remotely monitored patients following device replacement. Methods: Data from 134 patients who underwent ICD/CRT-D replacement or upgrade were analyzed. Kaplan-Meier estimates, as well as Cox proportional hazards regression, were used to present long-term outcomes and predictors of study endpoints, these being all-cause mortality, and appropriate and inappropriate ICD/CRT-D therapies. Results: Among the cohort, 51.5% of patients received ICDs and 48.5% received CRT-Ds; the median (quartile 1-quartile 3) LVEF at replacement was 23.0% (18.0-28.0%). In 11 (8.2%) patients, the LVEF at replacement was higher than 35%. During the median (Q1-Q3) follow-up of 3.0 (1.4-5.0) years, 32.1% experienced appropriate and 6.0% experienced inappropriate therapies. The all-cause mortality rate was 38.0%, and appropriate antitachycardia pacing (ATP), a reduced baseline LVEF, and no history of myocardial infarction were independent predictors of death (odds ratios of 1.87 for appropriate ATP, 0.88 per 1% of the LVEF and 0.54 for a history of MI, respectively). The rate of appropriate device therapies was numerically lower in patients whose LVEF improved (19.8% vs. 33.3% and 0% vs. 6.5%, for appropriate and inappropriate therapies). An LVEF of >35% at replacement did not influence the analyzed outcomes. Conclusions: In patients who underwent ICD/CRT-D replacement, an improvement in LVEF was not identified as either a predictor of improved survival or of a lower risk of needing device therapies. Further stratification models are needed to evaluate the arrhythmic risk in patients after generator replacements.

Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a specific focus on the neurotransmitters GABA and glutamate. Methods: In a prospective randomized study (2020-2023), 120 patients with coexisting MS and OSA were assigned to three groups: control (n = 36), diet therapy (n = 42), and diet therapy combined with probiotics (n = 42). Interventions lasted six months and included personalized dietary plans and probiotic supplementation. Outcome measures included BMI, visceral fat, HOMA index, lipid profile, oxygen saturation, and urinary GABA and glutamate levels. Unsupervised K-means clustering and principal component analysis (PCA) were applied to identify phenotypic response patterns based on delta values. Results: Diet therapy led to significant reductions in BMI (-15.7%, p = 0.001), visceral fat (-17.3%, p = 0.001), triglycerides (-14.6%, p = 0.003), uric acid (-9.5%, p = 0.011), and C-reactive protein (CRP) (-21.4%, p = 0.007). The combined intervention group exhibited further improvements in visceral fat (-22.8%, p = 0.001), glutamate (-18.2%, p = 0.002), and GABA levels (+19.5%, p = 0.001). Oxygen saturation improved across all groups, with the greatest increase in the probiotics group (+2.3%). Clustering analysis revealed three distinct response phenotypes-strong, moderate, and non-responders-highlighting inter-individual variability in treatment efficacy. Conclusions: Personalized dietary interventions, especially when paired with probiotics, effectively improve metabolic, inflammatory, and neurochemical profiles in patients with MS and OSA. Integrating clustering algorithms enables phenotype-specific stratification, offering a step toward precision lifestyle medicine. Future studies should explore long-term outcomes and refine microbiota-targeted approaches to optimize intervention efficacy.

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, n = 20) and a control group (n = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. Results: No statistically significant changes have been found regarding muscle tone (p = 0.162) and stiffness (p = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (p = 0.008). Decrement values decreased statistically significantly, both in Group 1 (p = 0.015) and in Group 2 (p = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (p = 0.027) lower pain intensity was observed in Group 1. Conclusions: It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS.