Medical Science Monitor最新文献

BACKGROUND Accurate detection of endometrial polyps (EPs), a recognized cause of infertility, is essential prior to in vitro fertilization (IVF). This study compared the diagnostic performance of transvaginal sonography (TVS), hysterosalpingography (HSG), and saline infusion sonography (SIS) for EP detection. MATERIAL AND METHODS This retrospective study included 256 infertile women treated at Acıbadem Maslak Hospital IVF Unit between January 2022 and January 2024. All patients underwent TVS and HSG; SIS was performed in cases with suspected EP. Positive SIS findings were confirmed by diagnostic hysteroscopy, and excised specimens underwent pathological evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical comparisons were made using Cochran's Q test, McNemar's test, and receiver operating characteristic (ROC) curve analysis with DeLong's method. RESULTS The sensitivity and specificity were 60.6% and 52.6% for TVS, 66.8% and 32.0% for HSG, and 94.3% and 28.1% for SIS, respectively. SIS showed significantly higher sensitivity than TVS (P<0.01) and HSG (P<0.01). PPV/NPV were 81.2%/28.3% for TVS, 76.7%/22.0% for HSG, and 81.6%/59.3% for SIS. ROC analysis revealed area-under-the-curve values of 0.566 for TVS, 0.492 for HSG, and 0.612 for SIS, with SIS performing significantly better than HSG (P=0.018). Pathology confirmed that all polyps were functional, and no malignancy was detected. CONCLUSIONS SIS demonstrated the highest sensitivity and diagnostic accuracy, supporting its use as the most reliable non-invasive method for EP detection in infertile women prior to IVF.

BACKGROUND Working in healthcare imposes a significant psychological burden on professionals, affecting their attitudes and job satisfaction. The pivotal role in the effective functioning of the team is that of the leader, who must exercise effective management. In addition to managerial activities, the leader's role encompasses fostering a positive team atmosphere and ensuring the provision of adequate support. The main objective of this study was to measurably assess the impact of critical care team leaders' negative behaviors on the incidence of professional burnout among medical professionals. MATERIAL AND METHODS Online cross-sectional survey was sent via social media groups and channels to Polish medical professionals who are members of critical care teams (but not team leaders). We obtained 146 replies. The survey consisted of a consent form, demographic questions, a self-designed questionnaire concerning non-technical aspects of leadership in their critical care teams, and the Oldenburg Burnout Inventory (OLBI) questionnaire. RESULTS Principal Component Analysis (PCA) divided the self-designed questionnaire into 2 subscales: "unethical leadership" and "flurried leadership". The Cronbach's alpha of the questionnaire was 0.814. OLBI total score and exhaustion were positively correlated with results of our self-designed questionnaire: total and 'unethical leadership' subscale. CONCLUSIONS Unethical leadership in critical care teams can increase burnout among health professionals. Higher levels of exhaustion in the OLBI questionnaire were observed among participants who report lower level of leaders' ethics. There is a need for further studies concerning this subject. Educational efforts are needed to improve the level of ethics among healthcare team leaders.

BACKGROUND While the cardiac effects of SARS-CoV-2, the cause of COVID-19, are widely accepted, the long-term histopathological impact on pericardial tissue is still unclear. There are limited data on whether SARS-CoV-2 infection causes permanent structural changes such as inflammation or fibrosis in the pericardium, especially in patients undergoing open-heart surgery in which tissue samples can be directly evaluated. The aim of this study was to investigate whether a history of COVID-19 is associated with histopathological changes by examining pericardial tissues of patients undergoing elective isolated coronary artery bypass grafting (CABG). MATERIAL AND METHODS Pericardial tissue samples were prospectively collected from 93 patients undergoing their first isolated CABG. Patients were grouped according to documented SARS-CoV-2 PCR positivity within the previous 2 years. Histological and immunohistochemical analyses (CD3, CD4, CD8, CD68) were performed to assess inflammation, fibrosis, and immune cell infiltration. RESULTS Among 93 patients, 23 had previously confirmed SARS-CoV-2 infection. Chronic pericardial inflammation was more common in the PCR-negative group (54.3%) than in those with previous infection (30.4%), a statistically significant difference (P=0.047). No significant differences were found in pericardial fibrosis, immune cell infiltration, or expression of CD3+, CD4+, CD8+, and CD68+ markers. CONCLUSIONS Although SARS-CoV-2 infection can cause pericardial inflammation and fibrosis in the acute phase, our results did not reveal any lasting damage linked to COVID-19 in this patient group. However, larger studies are needed to verify these findings.

BACKGROUND We investigated the potential of the preoperative neutrophil-to-lymphocyte ratio (NLR) and soluble urokinase-type plasminogen activator receptor (suPAR) as predictive biomarkers for biochemical recurrence (BCR) following radical prostatectomy in prostate cancer (PCa). By examining these markers individually and in combination, we aimed to enhance risk stratification and improve postoperative management. MATERIAL AND METHODS A retrospective cohort of 245 patients with PCa who underwent laparoscopic radical prostatectomy were stratified into non-BCR (n=183) and BCR (n=62) groups based on a 2-year follow-up. We collected comprehensive clinical and pathological data, calculated preoperative NLR, and measured serum suPAR using ELISA. Cox regression analysis identified independent risk factors for BCR, while ROC curves evaluated the predictive power of NLR, suPAR, and their combination. Kaplan-Meier survival analysis assessed BCR risk associated with varying levels of these biomarkers. RESULTS Preoperative NLR and suPAR levels were significantly higher in the BCR group. Multivariate Cox regression identified several independent risk factors for BCR, including preoperative PSA ≥20 ng/mL, pathological T3-T4 stage, positive surgical margins, and elevated NLR and suPAR levels. ROC analysis showed NLR and suPAR combined (AUC: 0.943, 95% CI: 0.911-0.975) significantly outperformed the predictive accuracy of each marker alone, with standalone AUCs of 0.873 for NLR and 0.881 for suPAR. CONCLUSIONS Elevated preoperative NLR and suPAR are strongly associated with increased BCR risk after radical prostatectomy in patients with PCa. Combined assessment of these biomarkers offers a superior predictive tool, facilitating personalized risk stratification and potentially guiding tailored postoperative management strategies in PCa care.

Anhedonia is the inability to experience pleasure, often accompanying major depressive disorder (MDE) and schizophrenia. Despite growing interest in this issue in recent years, anhedonia continues to pose a challenge for both patients and clinicians. In recent years, it has been established that the mechanism leading to the development of anhedonia involves a variety of processes within the dopaminergic system. Despite the existence of a number of scales commonly used in the diagnosis of this symptom, such as the Snaith-Hamilton Pleasure Scale (SHAPS) and the Temporal Experience of Pleasure Scale (TEPS), the diagnosis should not be made solely on the basis of these scales without a comprehensive psychiatric examination. Anhedonia also poses a therapeutic challenge and is associated with a poorer response to classic treatments for depression and schizophrenia. Combination therapy with glutamatergic drugs, kappa opioid receptor (KOR) antagonists, or KCNQ channel activators, as well as neurostimulation and psychotherapy, offer great hope. The key to selecting an effective treatment is to identify the components of anhedonia as accurately as possible and to understand the exact functioning of the reward system. This article aims to review the causes, diagnosis, and treatment of anhedonia (loss of pleasure) in depressive disorders and schizophrenia.

BACKGROUND The COVID-19 pandemic significantly disrupted elective surgical services worldwide, especially in resource-limited settings, raising concerns about surgical safety and care quality. This study compared postoperative hospital mortality, day-of-surgery cancellations, and surgical reintervention rates before, during, and after the COVID-19 pandemic among elective surgeries scheduled at a tertiary public hospital in the Federal District, Brazil. MATERIAL AND METHODS This retrospective cohort study included all consecutive adult surgeries scheduled at a tertiary public hospital in the Federal District between January 2018 and December 2022. Trends in hospital mortality, day-of-surgery cancellations, and surgical reintervention rates were evaluated across the pre-pandemic (March 2018-February 2020), lockdown (March 2020-August 2020), and post-lockdown (September 2020-February 2022) periods using the Cochran-Armitage test for trend and multivariate logistic regression analysis. RESULTS Among 8806 scheduled surgeries, 5482 (62.3%) were elective. The number of elective procedures significantly decreased during the lockdown (P<0.001). Day-of-surgery cancellations decreased independently during the lockdown compared with the pre-pandemic period (odds ratio [OR]: 0.556; 95% CI: 0.448-0.691; P<0.001) and showed no significant difference with the post-lockdown period (OR: 0.828; 95% CI: 0.650-1.055; P=0.126). Surgical reintervention rates were unchanged during lockdown (OR: 0.888; 95% CI: 0.662-1.192; P=0.274) but declined significantly in the post-lockdown period (OR: 0.534; 95%CI: 0.390-0.733; P<0.001). No significant differences were found in postoperative hospital mortality across the 3 periods (P=0.847). CONCLUSIONS Reductions in cancellations and reinterventions, without an increase in mortality, were observed in the provision of elective surgical care during the pandemic.

BACKGROUND According to recent guidelines, the femoral vein is the second-line option for dialysis catheter placement in patients undergoing acute extracorporeal treatments. This study aimed to determine the incidence of catheter-related thrombosis (CRT) in intensive care unit (ICU) patients with temporary femoral vein dialysis catheters and evaluate the effect of catheter diameter on thrombosis. MATERIAL AND METHODS This prospective observational study was conducted in a university hospital ICU. Temporary femoral dialysis catheters were inserted by anesthesia residents. Doppler ultrasonography (DUSG) examinations were performed at 24 and 48 h and on days 7 through 10 after catheter placement, assessing the venous segment from the insertion site or inguinal ligament to the popliteal vein. Examinations were conducted by an intensivist and reviewed by a radiologist. Thrombosis and femoral vein diameters were recorded, along with demographic and laboratory data. RESULTS Among 262 ICU admissions during the study period, 37 patients who received temporary femoral dialysis catheters were included. CRT was detected in 7 patients (18.9%). In 5 cases, thrombosis occurred between days 7 and 10 post-insertion; in 2 cases, it was identified after catheter removal. All events were asymptomatic; no catheter dysfunction was observed. There were no significant differences between patients with and without thrombosis regarding body mass index, smoking status, mortality, or severity scores. CONCLUSIONS The incidence of asymptomatic CRT was 18.9% in ICU patients with femoral dialysis catheters. Routine DUSG may facilitate early detection of thrombosis, allowing timely intervention and potentially reducing the risk of thromboembolic events and catheter-related complications.

BACKGROUND Cryptocurrencies trade continuously on highly volatile markets and can elicit emotionally driven, gambling-like behaviors. Physicians experience high occupational stress and burnout, potentially predisposing them to risky financial activities. We examined whether hopelessness and perceived financial well-being are associated with problematic cryptocurrency trading among physicians. MATERIAL AND METHODS In a cross-sectional online survey, 300 licensed physicians from Diyarbakır, Turkey, completed the Beck Hopelessness Scale (BHS; score range, 0-20), Financial Well-Being Scale (FWBS; 0-100), and Problematic Cryptocurrency Trading Scale (PCTS; 16-80). Group differences were evaluated with t tests and chi-square tests, and multivariable linear regression models estimated PCTS predictors. RESULTS Participants' mean age was 39.8±7.2 years; 70% were male; mean practice duration was 14.1±6.9 years. Male physicians had higher PCTS scores than female physicians (33.0±6.8 vs 29.8±5.9; P=0.03); BHS and FWBS scores did not differ by sex. In regression models, older age (ß=0.32, P=0.04) and male sex (ß=1.45, P=0.02) predicted higher PCTS scores. Hopelessness was positively associated with PCTS (ß=0.80, P=0.001), whereas financial well-being showed a trend toward significance (ß=-0.03, P=0.067). The demographics-only model explained approximately 8% of PCTS variance; the psychosocial model R²=0.35 (P<0.001). CONCLUSIONS Among physicians, male sex, older age, and higher hopelessness are independently associated with problematic cryptocurrency trading, while perceived financial well-being is not clearly protective. Targeted institutional interventions (financial literacy and stress-management programs) may mitigate compulsive trading and support physician well-being.

BACKGROUND Spinal muscular atrophy (SMA) is a lower motor neuron disease characterized primarily by motor function impairment, as well as the development of contractures and scoliosis. MATERIAL AND METHODS A prospective study was conducted involving 38 children with SMA, including 8 with type 1, 20 with type 2, and 10 with type 3 SMA. Patients were categorized based on motor function into non-sitters (n=9), sitters (n=23), and walkers (n=6). Anthropometric measurements, including body mass index (BMI) and BMI z-scores, were recorded according to World Health Organization standards. Structural trunk parameters, the presence of contractures, and joint range of motion were assessed in all participants. RESULTS Changes in trunk parameters in all 3 groups showed no deterioration of structural elements. There was an increase in lower limb contractures measured at all 3 joints in the non-sitters and sitters groups. As BMI increased, the range of motion of the hips and right knee increased, while the left knee and feet remain unchanged. As body weight increased, the risk of trunk asymmetry increased in all patients. In the non-sitters group, there was an increase in hip and knee contractures regardless of BMI category. CONCLUSIONS As body weight increased, the risk of trunk asymmetry increased. As BMI increased, the neutral position of the hips changed (contracture increased), and the position of the knees did not change, while the neutral position of the feet improved. The measurement of contractures and range of motion should be introduced as a standard of practice in the evaluation of children with SMA.

BACKGROUND Neuropathic pain and polyneuropathy can affect the quality of life in patients receiving dialysis. The aim of this study was to assess quality of life and to compare electromyography (EMG) findings between patients screened positive and negative for neuropathic pain. MATERIAL AND METHODS This study was designed as an observational cross-sectional study in which 74 patients receiving hemodialysis were admitted. The Ferrans & Powers Quality of Life Index-Dialysis III Version, Neuropathic Pain Questionnaire (NPQ), and Brief Pain Inventory-Short Form were completed by all patients. Additionally, EMG was performed on all patients regardless of the presence of neuropathic symptoms. RESULTS According to the NPQ screening results, 51.4% of patients were identified as likely having neuropathic pain, whereas EMG findings revealed polyneuropathy in 89.2% (66 patients). Ferrans & Powers Quality of Life Index total and subgroup scores were compared between the NPQ-positive and NPQ-negative groups based on the screening results. Quality of life was found to be statistically significantly lower in the NPQ-positive group across all subgroups (P<0.001). No statistically significant differences were observed between NPQ-positive and NPQ-negative groups regarding any of the polyneuropathy types identified via EMG (P>0.05). CONCLUSIONS This study explores the association between screening-positive neuropathic pain and quality of life. Given the high prevalence of polyneuropathy on EMG even among patients without symptoms suggestive of neuropathic pain, it can be valuable to assess dialysis patients during the asymptomatic period as well.