Medicina-Lithuania最新文献

Background and Objectives: The prevalence of and risk factors for immune checkpoint inhibitor-associated diarrhea and colitis (IMDC) in the Chinese population are unclear. This study aimed to estimate IMDC incidence and identify potential risk factors. Materials and Methods: We reviewed the electronic medical records from Beijing Friendship Hospital (2015-2022) to identify the patients treated with immune checkpoint inhibitors. The primary outcome was IMDC occurrence. The demographics, cancer type, baseline labs, and concurrent medications were analyzed. The univariable and multivariable analyses validated the associated factors. Results: Among 1186 patients (median follow-up: 217 days), the IMDC incidence was 4.6%, with colitis at 0.67%. Digestive system tumors increased the IMDC risk (OR 2.79, 95% CI 1.42-5.75, p = 0.004), while platinum agents decreased it (OR 0.41, 95% CI 0.21-0.78, p = 0.008). PPIs, antibiotics, NSAIDs, and glucocorticoids showed no significant association. Colitis was the third most common irAE, leading to ICI discontinuation (15.6%). Conclusions: IMDC prevalence is 4.6% in the Chinese population, the third most frequent irAE causing ICI discontinuation. Digestive tumors and platinum agents are risk and protective factors, respectively, while other medications show no significant impact.

Background and Objectives: It is unknown whether the tibial tuberosity-tibial intercondylar midpoint (TT-TIM) distance can be interchangeably measured on axial computed tomography (CT) and magnetic resonance imaging (MRI). The objective of this retrospective cross-sectional comparative study was to evaluate the intermethod agreement of the TT-TIM distance on axial CT and MRI and its bias towards tibial rotation (TR), age, sex, and body side. Materials and Methods: On axial CT and MRI of 15 consecutive knee pairs where each pair belonged to the same patient with no pathology affecting the tibial circumference and tibial tuberosity, TT-TIM distance and TR were measured by two blinded radiologists at 2-week intervals. Upon checking the symmetry of distributions (Shapiro-Wilk test), differences between matched knee pairs (Wilcoxon signed-rank test), intermethod (Bland-Altman plot) and interrater agreement (intraclass correlation coefficient [ICC]), and correlations (Spearman rank correlation) were assessed. Results: The mean intermethod difference in TT-TIM distance was not statistically significant (-0.4 mm [-1.82, 0.96]; p = 0.52). The TT-TIM distance did not differ between knee pairs (p = 0.68), its interrater agreement was almost perfect (ICC > 0.81), and no bias towards TR (p > 0.66), age (p > 0.14), sex (p = 0.66), and body side (p > 0.37) was found. Conclusions: The TT-TIM distance can be interchangeably measured on axial CT and MRI with almost perfect interrater agreement, unbiased towards TR, age, sex, and body side.

Background and Objectives: This study evaluated the safety and efficacy of long-term indwelling self-expandable covered metallic stents (UVENTA; Taewoong Medical Co., Ltd., Seoul, Republic of Korea) used to manage benign and malignant ureteral strictures. Materials and Methods: We retrospectively identified and analyzed the medical records of all patients who underwent metallic stent insertion at our institution since September 2012. Additionally, we evaluated the technical and clinical success rates and complications of patients who underwent follow-up for more than 36 months. Results: A total of 25 patients underwent metallic stent insertion for ureteral obstructions at our institution. Among them, 18 underwent follow-up for more than 36 months. A total of 21 ureters (15 unilateral and 3 bilateral) were ultimately included in this study. Metallic stents were successfully placed in all ureters using a retrograde approach, with a technical success rate of 100%. The mean follow-up duration was 58.6 months (range, 36-107 months). However, the clinical success rates were 85.7% (18/21 ureters) by 12 months, 61.9% (14/21 ureters) by 24 months, and 52.4% (11/21 ureters) after 36 months. During follow-up, obstructions could not be resolved using metallic stents in eleven ureters (median time to failure, 18.4 months; range, 2-40 months); therefore, they were treated with nephrectomy (three ureters because of a nonfunctional kidney) or percutaneous nephrostomy and double J stent placement (four ureters). Major complications included the encrustation of the metallic stent, flank pain, and gross hematuria. A uretero-enteric fistula occurred in one ureter. In two patients, existing metallic stents were removed and patency was maintained. In another two patients, new metallic stents were inserted without complications. Conclusions: Benign and malignant ureteral obstructions may be treated effectively and safely with metallic stents. However, the patency rate drastically decreased and major complications occurred during long-term follow-up. Therefore, careful patient selection is necessary to achieve better results.

Background and Objectives: Diabetes is a rapidly increasing global health challenge compounded by a critical shortage of diabetes care and education specialists. Robot-assisted diabetes care offers a cost-effective and scalable alternative to traditional methods such as training and dispatching human experts. This pilot study aimed to evaluate the feasibility of using robots for diabetes care consultations by examining their ability to elicit meaningful patient feedback, identify therapeutic issues, and assess their potential as substitutes for human specialists. Materials and Methods: A robot-assisted consultation programme was developed by selecting an appropriate robot, designing the programme content, and tailoring back-channel communication elements. Experienced diabetes care nurses operated the robot during the consultations. Patient feedback was collected through a 17-item questionnaire using a five-point Likert scale (evaluating functionality, impressions, and effects). Additionally, a five-item questionnaire was used to assess whether the programme helped patients reflect on the key therapeutic domains of diabetes knowledge, diet, exercise, medications, and blood glucose control. Results: This study included 32 participants (22 males; mean age, 69.7 ± 12.6 years; mean HbA1c, 7.2 ± 1.0%). None of the participants reported any discomfort during the consultation. Sixteen of the seventeen feedback items scored above the median of 3, as did all five therapeutic reflection items. The interview content analysis revealed the programme's ability to differentiate patients facing issues in treatment compliance from those effectively managing their condition. Robots can elicit valuable patient narratives like human specialists. Conclusions: The results of this pilot study support the feasibility of robot-assisted diabetes care to assist human experts. Future research should explore the programme's application with healthcare professionals with limited experience in diabetes care, further demonstrating its scalability and utility in diverse healthcare settings.

Background and Objectives: Type 2 diabetes (T2D), closely associated with obesity, contributes to increased morbidity and mortality due to complications such as cardiometabolic disease. This review aims to evaluate the effectiveness of metabolic and bariatric surgeries (MBS) and endoscopic bariatric therapies (EBTs) in achieving diabetes remission and to examine key predictors influencing remission outcomes. Materials and Methods: This review synthesizes data from studies on MBS and EBT outcomes, focusing on predictors for diabetes remission such as preoperative insulin use, diabetes duration, HbA1c, and C-peptide levels. Additionally, predictive scoring systems, including the Individualized Metabolic Surgery (IMS), DiaRem, Advanced-DiaRem, ABCD, and Robert et al. scores, were analyzed for their utility in forecasting remission likelihood. Results: Key predictors of T2D remission include shorter diabetes duration, lower HbA1c, and higher C-peptide levels, while prolonged insulin use, and higher insulin doses are associated with lower remission rates. Scoring models like IMS and DiaRem demonstrate that lower scores correlate with a higher likelihood of remission, especially for procedures such as Roux-En-Y gastric bypass (RYGB). RYGB generally shows higher remission rates compared to sleeve gastrectomy (SG), particularly among patients with mild disease severity, while EBTs like ESG and IGBs contribute 5-20% total weight loss (TWL) and moderate glycemic control improvements. Conclusions: Both MBS and EBTs are effective for T2D management, with predictive scoring models aiding in individualized patient selection to optimize remission outcomes. Further research to validate these predictive tools across diverse populations could enhance treatment planning for both surgical and endoscopic interventions.

Background and Objectives: Cigarette smoking is a widely prevalent risk factor in the global population, despite its well-recognized systemic impact. In this pilot study, an association was hypothesized between alterations in hemorheological and respiratory characteristics and damage at the chorioretinal level, considering that traditional cigarette smoking may increase oxidative stress, platelet activation, and thrombotic phenomena at the systemic level. Fundoscopy can provide information about the characteristics of the cerebral district and the entire circulatory system. Therefore, the aim of this research was to evaluate the impact of cigarette smoking on chorioretinal vascularization and pulmonary and blood parameters through investigations with optical coherence tomography angiography (OCTA), spirometry, and the total thrombus formation analysis system (T-TAS). Materials and Methods: Thirty subjects were recruited, divided into 20 traditional cigarette smokers (SMs) and 10 non-SMs, who underwent a comprehensive ocular examination, including OCTA. Spirometric evaluation and blood sampling were also performed on both groups to study pulmonary functional capacity, as well as T-TAS. Results: An analysis of the obtained data confirmed the systemic impact of smoking, evidenced by an increase in T-TAS and a decrease in forced expiratory volume in 1 s expressed in liters (FEV1 L) in SMs compared to the non-SMs group. Additionally, OCTA revealed a statistically significant alteration in macular vascular density (FD) in the right eye (RE) of the examined SMs. The other parameters evaluated did not show statistically significant differences. Conclusions: It is believed that FD, FEV1, and T-TAS may be promising values in correlating the alterations observed in SMs, as highlighted by the changes detected with OCTA, spirometry, and hemorheological data. Further research is needed to confirm and expand the results already obtained and to evaluate the systemic vascular damage and oxidative stress caused by tobacco consumption.

Coronary artery disease (CAD) is one of the leading causes of death worldwide, significantly contributing to mortality in both developed and developing nations. CAD arises from a combination of risk factors, including atherosclerosis, dyslipidemia, hypertension, diabetes, and smoking. In recent years, growing evidence has suggested a potential link between infectious agents and cardiovascular diseases. Among these, Helicobacter pylori (H. pylori) infection has been hypothesized for over a decade to play a role in the pathogenesis of CAD. This hypothesis is based on the bacterium's ability to trigger host inflammatory or autoimmune responses, potentially contributing to the progression of atherosclerotic plaques and coronary events. The association between H. pylori infection and CAD is of considerable interest as it opens new avenues for prevention and management strategies in cardiovascular health. Understanding this relationship could lead to innovative approaches to reducing the burden of CAD, particularly in populations with a high prevalence of H. pylori. In this review, we aim to provide a comprehensive overview of the most recent evidence on the involvement of H. pylori in the development and prognosis of CAD. By analyzing and synthesizing current findings, we seek to shed light on unresolved questions and clarify the ambiguous aspects of this potential connection. Our goal is to contribute to a deeper understanding of how H. pylori, may influence cardiovascular disease and to inspire further research in this critical area.

The global burden of cardiovascular disease (CVD) continues to pose a significant challenge to healthcare systems worldwide [...].

Background and Objectives: Brain fog, characterized by cognitive difficulties such as memory impairment, lack of focus, and mental fatigue, is a common symptom reported during recovery from COVID-19, particularly in long COVID cases. This study explores potential triggers such as sleep quality, mood, and gastrointestinal health and examines the link between adherence to the MIND diet and brain fog severity. Materials and Methods: A cross-sectional study was conducted between 1 July and 15 December 2022. The questionnaire assessed brain fog symptoms, dietary habits, sleep quality, mood, and gastrointestinal symptoms. Linear regression analysis examined the relationships between brain fog symptoms, demographic factors, sleep quality, MIND diet adherence, and gastrointestinal symptoms. Results: Brain Fog Scale (BFS) scores were significantly higher in individuals who had COVID-19 (p < 0.05) and even higher in those with reinfection. Women had higher BFS and Brain Fog Severity Score (BFSS), MIND Diet, The Gastrointestinal Symptom Rating Scale (GSRS), Brief Mood Introspection Scale (BMIS) Pleasant-Unpleasant scores (p < 0.05). BFS and BFSS were positively correlated with GSRS (p < 0.05), while no correlation was found with MIND diet adherence. A negative correlation was observed between BFS and Sleep Quality Scale (SQS) (p < 0.05), but this was not significant in regression (p = 0.367). GSRS, Pleasant-Unpleasant Dimension, and Arousal-Calm Dimension were significant predictors of BFS (R = 0.599, R² = 0.358, p < 0.01). Conclusions: This study identifies being female as a risk factor for brain fog symptoms, with women reporting higher BFS and BFSS scores. While sleep quality showed a negative correlation with brain fog symptoms, this relationship was not significant in the regression model, suggesting that other factors, such as mood and gastrointestinal symptoms, may play a more dominant role. However, adherence to the MIND diet showed no significant relationship with brain fog symptoms. These findings suggest that addressing mood and gastrointestinal health may be key to managing brain fog in long COVID.