Medicina-Lithuania最新文献

Background and Objectives: Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is frequently prescribed during pregnancy to treat mood disorders. Studies indicate that chronic use of sertraline is associated with elevated liver enzymes, oxidative stress, and histological alterations in the liver. Folic acid, a recommended supplement currently used during the first trimester of pregnancy, has antioxidant and anti-inflammatory effects. Hence, folic acid might be a potential protective agent against sertraline-induced liver injury. The current study aimed to investigate the possible hepatotoxic effects of sertraline administration during pregnancy and early postpartum. In addition, we sought to evaluate the potential protective effects of folic acid supplementation in alleviating any sertraline-induced liver damage. Materials and Methods: Eighty pregnant albino rats were randomly divided into four groups: control, folic acid-treated, sertraline-treated, and folic acid-sertraline-treated. Each group was divided into rats euthanized immediately after giving birth (0 h) or 14 days postpartum. Biochemical, histological, and immunohistochemical evaluations of liver function and structure were conducted. Results: Administration of sertraline was associated with a significant increase in hepatic enzymes (ALT and AST) and disrupted lipid profile (elevated cholesterol, triglycerides, and LDL-c) compared to the control group. Increased apoptosis was evidenced by increased caspase 3 expression and histological alterations, including vacuolation and inflammatory infiltrates, in sertraline-treated rats. Folic acid supplementation effectively mitigated these effects by preserving liver architecture, normalizing biochemical markers (ALT, AST, and lipid profile changes), and reducing apoptotic activity (lower caspase 3 expression). Conclusions: Folic acid mitigated sertraline-induced hepatic damage in pregnant rats. This suggests the potential benefits of using folic acid during the whole duration of pregnancy in patients treated with sertraline.

Background and Objectives: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, remains a significant public health concern due to its association with neonatal morbidity and mortality. Although studies have suggested that microbial factors in vaginal microbiota (VMB) influence PTB, longitudinal research on Korean women is limited. This study aimed to analyze VMB differences between term and preterm pregnancies in Korean women and their correlation with the cervical length (CL). Materials and Methods: A cohort of 60 pregnant Korean women (40 who had a term birth (TB) and 20 who had a PTB) was recruited. Vaginal samples were collected at five time points (first, second, and third trimester; 1-2 weeks postpartum; 1-2 months postpartum). Microbial DNA was extracted and analyzed using quantitative PCR targeting 12 bacterial species. The CL was measured in the second and third trimesters. Results: Lactobacillus crispatus was consistently dominant in the TB group, whereas PTB cases exhibited greater microbial diversity with elevated levels of Prevotella salivae and Ureaplasma species. The CL was significantly shorter in PTB cases, correlating with shifts in the VMB composition. Conclusions: A stable, Lactobacillus-dominant microbiome is protective in pregnancy, while increased diversity in PTB cases suggests microbial biomarkers for early risk prediction. Combining VMB profiling with CL measurement may enhance early, non-invasive PTB risk assessments.

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. Materials and Methods: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24-108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. Results: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. Conclusions: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself.

Background and Objectives: To evaluate the effectiveness and outcomes of supine percutaneous nephrolithotomy (PCNL) using the Barts 'flank-free' position and ultrasound-guided puncture, assessing the feasibility of the tubeless technique for discharge within 24 h. Materials and Methods: We conducted a retrospective analysis of 208 patients across 220 renal units who underwent supine PCNL at a tertiary university hospital between May 2019 and December 2024. All procedures were performed by a single surgeon. Patient demographics, stone characteristics, and surgical outcomes were analyzed. The tubeless technique was applied in most cases, and outcomes were assessed in terms of operative time, complication rates, stone-free rates (SFRs), and length of hospital stay. Results: The mean operating time was 50.34 ± 30.80 min. Single-tract PCNL was performed in 94.55% of cases, with the tubeless technique used in 90% of patients. The overall complication rate was 9.55%, with no Clavien-Dindo grade IV-V complications observed. On the first postoperative day, 68.18% of patients were discharged, demonstrating 24 h discharge feasibility. SFR and complication rates aligned with existing literature. Conclusions: The Barts 'flank-free' position and ultrasound-guided puncture considerably improved surgical access and safety in supine PCNL. The tubeless technique facilitates faster recovery, making early discharge feasible, even with standard sheath sizes. Further research is warranted to validate these findings and optimize renal stone management outcomes.

Background and Objectives: Chondral and osteochondral lesions can lead to osteoarthritis if untreated, making accurate assessment of cartilage repair outcomes essential for optimizing treatment strategies. The objective of this study was to compare MOCART and MOCART 2.0 and to evaluate the clinical utility of both across different surgical cartilage repair techniques and various time points. Material and Methods: This study included 111 patients (age: 35 ± 10, 35% female) who underwent cartilage repair surgery of the knee between September 2015 and March 2022. A total of 188 postoperative magnetic resonance images were evaluated using MOCART and MOCART 2.0. The correlations between both scores, as well as to the change in Patient-Reported Outcome Measures (PROMs), were determined. Results: MOCART 2.0 scores (66 ± 13) were significantly higher than MOCART scores (58 ± 13, p < 0.001). Positive correlation was observed between scoring systems (r = 0.837, p < 0.001). There was no significant correlation between MOCART or MOCART 2.0 scores and the change in PROMs. Noticeably, there was a statistically significant correlation between both MOCART and MOCART 2.0 in the AutoCart subgroup across multiple timepoints for the change in PROMs. Conclusions: Based on radiographic-clinical outcome discordance, clinicians should not rely solely on MOCART or MOCART 2.0 scores when evaluating cartilage repair success but instead prioritize patient-reported functional improvements while using imaging as a complementary assessment tool.

Background and Objectives: Preeclampsia (PE) is a major cause of adverse perinatal outcomes. Early diagnosis of pregnant women at risk of PE can facilitate disease prevention and management. However, the presence of different phenotypes of the disease complicates its prediction. In particular, the challenges in the early diagnosis of term PE cases necessitate research on PE prediction in the second and third trimesters. This study aims to examine the association between PE development and mid-trimester blood urea nitrogen (BUN), serum creatinine, and the BUN/creatinine ratio in pregnant women. Materials and Methods: This retrospective case-control study was conducted on women diagnosed with PE. Pregnant women who underwent routine biochemical blood tests between the 18th and 24th weeks of gestation and subsequently gave birth at our hospital between January 2022 and May 2023 were categorized into three groups. Accordingly, healthy women who had term deliveries were classified as Group 1 (150 cases), women diagnosed with PE were classified as Group 2 (58 cases), and those diagnosed with severe PE were classified as Group 3 (44 cases). Results: There were no significant differences in age, gravidity, parity, body mass index, or gestational week at blood sampling between the patient and control groups (p > 0.05). When comparing the mean blood urea nitrogen, serum creatinine, and BUN/creatinine ratios, a significant difference was observed between the control group and those who developed PE (p = 0.001, p < 0.001, and p = 0.031, respectively). Univariate analysis revealed a significant association between BUN levels and PE development (OR 1.083; 95% CI, 1.031-1.139; p = 0.002). A stronger association was observed between serum creatinine levels and PE development (OR 112.344; 95% CI, 11.649-1083.416; p < 0.001). However, no significant association was found between the BUN/creatinine ratio and PE in univariate analysis (OR 1.003; 95% CI, 0.979-1.028; p > 0.05). Mid-trimester BUN and serum creatinine levels were significantly higher in patients who developed PE and severe PE. The AUC value for the BUN parameter in predicting PE was 0.614 (AUC 0.614; 95% CI, 0.539-0.689; p = 0.002). A BUN cut-off value of 16.2 mg/dL predicted disease development with a sensitivity of 52.9% and a specificity of 74%. Similarly, the AUC value for the serum creatinine parameter in predicting PE was 0.644 (AUC 0.644; 95% CI, 0.574-0.751; p < 0.001). A serum creatinine cut-off value of 0.58 mg/dL was able to predict disease development with 37.2% sensitivity and 88% specificity. No significant AUC value was obtained for the BUN/creatinine ratio (p > 0.05). Conclusions: Our findings indicate that elevated BUN and serum creatinine levels measured during the mid-trimester (18-24 weeks) are associated with an increased risk of developing preeclampsia.

Background and Objectives: Behçet's syndrome (BS) is a systemic inflammatory disorder characterized by recurrent oral and genital ulcers, uveitis, and vascular involvement. Serum uric acid (SUA) has been implicated in various inflammatory conditions, due to its antioxidant properties and role in oxidative stress. Abnormal SUA levels, particularly hypouricemia, may influence inflammatory processes, but their significance in BS pathophysiology remains unexplored. This study aimed to determine the prevalence of abnormal SUA levels among BS patients and investigate their associations with its clinical manifestations and laboratory parameters. Materials and Methods: A retrospective analysis was conducted on 436 patients with complete data who met the international criteria for Behçet's syndrome, including 420 patients classified as hypouricemic or normouricemic, for detailed evaluation. Patients were classified as hypouricemic (<3 mg/dL), hyperuricemic (>7 mg/dL), or normouricemic (3-7 mg/dL). Data on sociodemographics, laboratory findings, and clinical characteristics were collected. Mortality and malignancy associations were analyzed using logistic regression. Inverse probability weighting (IPW) was employed to adjust for confounding factors. Results: Initial unadjusted analysis showed that hypouricemic BS patients had significantly lower rates of acneiform lesions (7.3% vs. 14.4%, p = 0.020) and vascular involvement (3.8% vs. 11.6%, p = 0.038) compared to normouricemic patients. However, after adjustment for confounding variables using the IPW methodology, these associations lost statistical significance (p = 0.592 and p = 0.519, respectively). Both before and after adjustment, no significant differences were observed between groups regarding major organ involvement, disease severity, or activity markers. Conclusions: After controlling for confounding factors, hypouricemia in BS patients did not demonstrate significant associations with specific clinical manifestations or disease outcomes. While the unadjusted data initially suggested potential relationships with acneiform lesions and vascular involvement, these associations were not supported by comprehensive statistical analysis. Further prospective studies are warranted to elucidate the complex relationship between uric acid metabolism and BS pathophysiology.

Background and Objectives: This study aims to investigate the effect of Type 2 diabetes mellitus (DM) on nutritional status in acute coronary syndrome (ACS) patients and its relationship with various metabolic and hematologic parameters. Materials and Methods: A retrospective and cross-sectional design was used to analyze 485 acute coronary syndrome (ACS) patients who underwent angiography at Fethi Sekin City Hospital between 1 January 2020 and 1 January 2025. Clinical data, biochemical parameters (hemogram, glucose, creatinine, uric acid, lactate dehydrogenase (LDH), albumin, and cholesterol levels) were retrospectively analyzed. The Prognostic Nutrition Index (PNI) and CONUT score were calculated manually. Results: A total of 485 patients were included in this study. Patients were divided into two groups: patients with DM (n = 167) and patients without DM (n = 318). Glucose levels (p < 0.001) and triglyceride levels (p = 0.014) were significantly higher in patients with diabetes, while LDL cholesterol and total cholesterol levels were lower (p < 0.01). In addition, hemoglobin (p < 0.001), albumin (p = 0.010), and PNI scores (p = 0.014) were lower in patients with diabetes. Although CONUT scores were higher in patients with diabetes, this difference was not statistically significant (p = 0.267). Significant differences were observed in lipid profile and inflammation parameters in STEMI and NSTEMI subgroups, especially in patients with diabetes. In particular, triglyceride and neutrophil levels were found to be higher in NSTEMI patients among patients with diabetes. Conclusions: The PNI score may be a useful prognostic tool for predicting cardiovascular complications and determining treatment strategies in acute coronary syndrome patients with diabetes mellitus in whom nutritional status, inflammation, and lipid metabolism are significantly correlated.

Background and Objectives: Severe Traumatic Brain Injury (TBI) is one of the devastating injuries occurring in all ages across the globe. Despite many advancements in the management of severe TBI, mortality and morbidities remain high. Evidence-based management in severe TBI has reduced mortality. The purpose of this review is to discuss the current management and present the future challenges in this patient cohort. Materials and Methods: A literature review was conducted to identify the current practice patterns and guidelines of severe TBI. We examined the literature regarding medical and surgical managements of the severe TBI. Results: Initial management of severe TBI includes stabilization of the primary injury and prevention of secondary insult to brain. Hemodynamic, intracranial pressure and cerebral perfusion pressure monitoring, antiseizure prophylaxis, hyperosmolar therapy, sedation, medical induced coma, and nutritional and ventilatory support are part of the medical management. Operative intervention includes craniotomy and decompressive craniectomy. Most of the current practices are recommended by the Brain Trauma Foundation (BTF). These guidelines are based on the existing literature, however, some of the recommendations by the BTF lack level one evidence. Conclusions: BTF guidelines provide recommendations in the management of severe TBI. High quality prospective randomized trials are needed to further explore the new modalities and interventions in the field of severe TBI.

Background and Objectives: Dermal matrices have brought solutions for many problems, mainly in the treatment of burns and burn scar revisions. The objective of this study was to draw attention to the limits of a collagen-elastin dermal matrix (MatriDerm^®) in its 1 mm variant for the treatment of burn scars on the face and neck. Materials and Methods: A case series of four patients (three women and one man) with burn scars of the face (one case) and of the neck (three cases) treated with collagen-elastin matrices is presented. In all cases, the excision or release of the scars was performed, and the defects were covered with MatriDerm^® and thin split-thickness skin grafts in the same operative time. Results: In all cases, the graft take was very good but was followed by the important contraction of the graft to such an extent that the results were found to be poor by both the surgeons and the patients. The surface of the new scar was irregular, and the elasticity was low. The article points out some probable causes and draws attention to the need for more objective studies regarding the use of this dermal matrix in burn scars of the head and neck. Conclusions: This collagen-elastin 1 mm dermal matrix should be used with caution for the surgical treatment of burn scars of the head and neck area, and its indication should be carefully weighted.