Medicina-Lithuania最新文献

Background and Objectives: Scleral lenses are widely used for visual rehabilitation in keratoconus patients, but their long-term effects on corneal tomography remain unclear. This study aims to evaluate the impact of 12-month scleral lens wear on corneal tomography in keratoconus patients through a case-controlled design. Materials and Methods: This retrospective study included 220 keratoconus patients, of whom 10 eyes were treated with SoClear (Brighten Optix Corporation, Taipei, Taiwan) mini-scleral lenses for over one year (SL group). A control group of 14 eyes was matched using Mahalanobis distance matching based on anterior maximum keratometry (K_max) and age. Both groups were evaluated at baseline and 12 months. Corneal tomography was assessed using the Pentacam HR (Oculus, Wetzlar, Germany), analyzing parameters such as anterior and posterior corneal curvature, thinnest corneal thickness (TCT), and higher-order aberrations. Generalized estimating equations (GEEs) were employed to assess the time-by-treatment effect between the two groups. Results: The SL group included 10 eyes from eight patients (seven males, one female; mean age 30.40 ± 6.52 years), while the control group included 14 eyes from 11 patients (three males, wight females; mean age 27.43 ± 8.11 years). Best corrected visual acuity with spectacles improved significantly with scleral lenses (p = 0.011) and remained stable (p = 0.044) at 12 months. Significant interaction effects were found in Ambrósio relational thickness (p = 0.006), posterior radius curvature (p = 0.047), posterior mean keratometry (p = 0.019), posterior flat keratometry (p = 0.023), and thinnest corneal thickness angle (p = 0.023); the SL group demonstrated less progression in these parameters compared to the control group. Conclusions: This case-controlled study highlights the 12-month impact of scleral lenses on keratoconus, showing improved visual acuity compared to spectacles, stabilized posterior corneal curvature, and maintained corneal thickness. Further prospective studies with larger cohorts are needed to assess scleral lens effect on keratoconus progression.

Background and Objectives: Postoperative delirium (PODil) is a cognitive condition characterized by sudden fluctuations in consciousness and orientation after surgery. PODil following total knee arthroplasty (TKA) is associated with prolonged hospital stays and increased morbidity. Therefore, prevention of PODil is particularly important. Life's Simple 7 score, published by the American Heart Association, is a new measure of cardiovascular health (CVH). Better CVH is associated with a lower risk of cognitive impairment. Hence, this study aimed to determine whether Life's Simple 7 score is associated with PODil following TKA. Materials and Methods: This retrospective study included 973 patients who underwent TKA between January 2015 and January 2020. Patients were divided into two groups (group I: delirium group, n = 60; group II: non-delirium group, n = 913). Demographic data, use of analgesics, surgical factors, underlying diseases, laboratory results, and Life's Simple 7 score were evaluated. Results: Significant differences were observed between the two groups for Parkinson's disease, intraoperative hypotension, preoperative duloxetine administration, and Life's Simple 7 score. In the receiver operating characteristic (ROC) curve analysis, the optimal cut-off value for Life's Simple 7 score was determined to be 8 at the maximal Youden index, with an area under the curve (AUC) of 0.82, a sensitivity of 0.92, and a specificity of 0.58. Conclusions: Lower Life's Simple 7 score is an independent risk factor for the incidence of PODil after TKA. Given its ease of measurement, Life's Simple 7 score may be a useful measure for predicting PODil and will aid in preoperative risk assessment and post-operative patient management.

Background and Objectives: Multiple sclerosis (MS) is a chronic autoimmune condition that impacts the central nervous system and has a rising incidence globally, especially in Saudi Arabia. Materials and Methods: This study examines environmental, lifestyle, and familial risk factors associated with MS in the Aljouf Region by a cross-sectional analysis of 155 clinically diagnosed MS patients. Data were gathered using structured questionnaires and medical record examinations to evaluate sociodemographic characteristics, sun exposure, smoking, obesity, eating habits, and childhood infections. Results: Logistic regression research found insufficient daily sun exposure (<15 min/day), smoking, obesity, and childhood measles infection as significant risk factors, but substantial weekend sun exposure (>4 h/day), exclusive breastfeeding, and regular fish consumption were deemed protective. While familial history of MS was statistically significant (5.5%, p = 0.04), parental consanguinity (38.7%) did not show a significant association with MS risk (p = 0.07). Conclusions: The findings underscore the complex nature of MS and the pressing necessity for preventive efforts, such as advocating for vitamin D supplementation, smoking cessation, obesity prevention, and dietary adjustments. Mitigating these controllable risk factors may alleviate the prevalence of MS in Saudi Arabia.

Background and Objectives: Childhood obesity is a major problem in the nutritional aspect of childhood and is becoming increasingly important. The objective of this research was to examine the fluctuations in concentrations of asprosin and neuregulin 4, novel and significant adipokines, in obese pediatric individuals. Materials and Methods: In this study, comparisons were made between serum levels of asprosin and neuregulin 4, along with various anthropometric, biochemical, and hormonal parameters associated with obesity, among 40 children with obesity and 40 children with normal weight who sought medical attention at the Child Health and Diseases outpatient clinic of Kırşehir Training and Research Hospital between September 2021 and September 2022. Results: The study showed that of the 80 cases, 35 (43.8%) were male and 45 (56.2%) were female. The average BMI of the obese individuals was 27.27, with values ranging from 25.04 to 47.78. The serum levels of asprosin were similar between the two groups. Neuregulin 4 and HOMA-IR values exhibited statistically significant elevation in the obese group compared to the control group (p < 0.05). Conclusions: The research findings indicated that neuregulin 4 levels were greater in children with normal weight compared to those with children with obesity. Additional investigations are warranted to comprehensively grasp the impact of asprosin and neuregulin 4 on pediatric obesity.

Background and Objectives: Kaposi's sarcoma (KS) is a rare malignancy with limited prospective data. The aim of this study was to evaluate the clinical features and prognostic factors of KS in a cohort of patients treated at a single center. Materials and Methods: Records of 83 patients with KS were retrospectively analyzed. Patient demographics, clinical features, and treatments were analyzed. Univariate and multivariate analyses were performed to evaluate factors affecting overall survival (OS). Results: The median age of the cohort was 65 years, and 22.9% were female. The classical type of KS was the most common (84.3%), with the most common site of localization being the feet (30.2%). The 5-year and 10-year OS rates were 82.7% and 70.8%, respectively. Univariate analysis identified age, performance score (ECOG PS), lymph node involvement, and disease stage as significant prognostic factors. However, in multivariate analysis, only the ECOG PS remained a significant predictor of OS. Conclusions: KS is a condition that requires long-term follow-up, and performance status is particularly critical for patient survival. In addition to our findings, comprehensive prospective studies are still needed to better understand the factors influencing patient survival in KS.

Background and Objectives: Adolescence is a critical period of physical and mental development, yet allergic diseases are often poorly managed. Factors such as sleep deprivation, obesity, smoking, and mental stress can worsen allergic conditions and complicate treatment. This study examines the environmental, behavioral, and psychosocial factors influencing allergic diseases in Korean adolescents using data from the Korean National Health and Nutrition Examination Survey (KNHNES). Materials and Methods: From the 25,534 participants in the Fifth KNHNES, 1630 adolescents (aged 13-18 years) were selected. We analyzed demographic and lifestyle factors, including gender, age, housing type, family size, economic status, obesity, tobacco and alcohol use, sleep duration, and physical activity. Psychosocial factors such as stress perception, suicidal ideation, depressive symptoms, mental health counseling, and self-rated health were also examined. Results: The prevalence rates of allergic diseases were 23% for allergic rhinitis (AR), 11% for atopic dermatitis (AD), and 9.8% for asthma (AS), with 35.8% of adolescents having at least one allergic condition. Smoking was significantly associated with AS (odds ratio [OR] 1.753, p = 0.006), while shorter sleep durations increased AR risk (p = 0.000). Male adolescents had a lower risk of AD (OR 0.706, p = 0.046), and high economic status was inversely correlated with AD (OR 0.445, p = 0.006). Positive self-rated health was linked to lower AS risk (OR 0.447, p = 0.000). AR was significantly associated with male gender (OR 1.391, p = 0.045), high economic status (OR 1.784, p = 0.026), and high stress perception (OR 1.479, p = 0.013). Conclusions: Low self-rated health and high stress perception have been identified as risk factors for allergic diseases during adolescence. Integrating psychosocial counseling with medical treatment may improve management and outcomes.

The gut microbiota has emerged as a crucial player in cardiovascular diseases, including heart failure (HF). Recent studies have highlighted the bidirectional interaction between the gut and the heart, often referred to as the gut-heart axis. Dysbiosis, characterized by alterations in microbial composition and function, has been linked to systemic inflammation, metabolic disturbances, and impaired cardiovascular homeostasis. This review explores the mechanisms through which gut microbiota influences HF, including microbial metabolite production, inflammatory pathways, endothelial dysfunction, hormonal modulation, fluid retention, and sodium absorption. The potential therapeutic implications of microbiota modulation through diet, probiotics, and pharmacological interventions are also discussed. Understanding these mechanisms could pave the way for novel diagnostic and therapeutic strategies in the management of HF. Future research should focus on longitudinal studies to establish causality and the development of personalized microbiota-based interventions.

Background and Objectives: This is a retrospective study conducted at the Clinical County Hospital of Craiova, Romania, providing valuable insights into hemorrhagic transformation (HT) in thrombolyzed patients with acute ischemic stroke (AIS). Hemorrhagic complications remain a significant concern after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). This study aims to analyze clinical and biological factors associated with HT following thrombolysis. Materials and Methods: A retrospective analysis was conducted on 356 patients who received rt-PA at the Clinical County Hospital of Craiova between January 2020 and December 2024. Patients were divided into three groups based on CT findings at 24 h post-thrombolysis: no HT, minimal HT, and massive HT. Baseline characteristics were analyzed, including demographics, medical history, NIHSS scores, imaging findings, and laboratory parameters. Statistical analysis was performed using ANOVA and chi-square tests, with a significance threshold of p < 0.05. Results: HT occurred in 12.08% of patients (minimal HT: 8.15%, massive HT: 3.93%). Mortality was significantly higher in the massive HT group (71.43%) compared to minimal HT (41.38%) and non-HT (13.42%) (p < 0.001). Lower platelet count (p = 0.003), elevated blood glucose (p = 0.004), prolonged QT interval (p = 0.004), and reduced fibrinogen levels (p = 0.005) were significantly associated with HT. Other risk factors included atrial fibrillation (p = 0.001), hypertension (p = 0.005), delayed door-to-needle time (p < 0.001), diabetes mellitus (p = 0.007), dense ACM sign on CT (p = 0.003), older age (p < 0.001), obesity (p = 0.001), early neurological deterioration at 2 h/24 h (p < 0.001), elevated GOT (p < 0.001), elevated GPT (p = 0.002), lower LDL cholesterol (p < 0.001), lower total cholesterol (p = 0.001), and lower triglycerides (p < 0.001). Conclusions: Patients with HT had worse clinical outcomes, with massive HT associated with the highest mortality. Risk factors include age, nutritional status, hyperglycemia, and low platelet and fibrinogen levels, among others.

Background and Objectives: This meta-analysis compares the safety and efficacy of remimazolam and dexmedetomidine for sedation during regional anesthesia, focusing on respiratory and hemodynamic outcomes. Materials and Methods: A systematic search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to November 2024 identified randomized controlled trials (RCTs) comparing remimazolam with dexmedetomidine. Outcomes included respiratory depression (primary outcome), bradycardia, hypotension, hypertension, respiratory and heart rates, mean arterial pressure, sedation onset time, emergence time, and postoperative nausea and vomiting (PONV). Effect sizes were calculated as relative risks (RRs) or mean differences (MDs) using random-effects models. Results: Five RCTs involving 439 participants were included. Remimazolam did not significantly increase respiratory depression risk compared to dexmedetomidine (RR: 1.36, 95% CI [0.39, 4.71], p = 0.6305, I² = 44%). Bradycardia incidence was lower with remimazolam (RR: 0.15, 95% CI [0.06, 0.39], p = 0.0001, I² = 0%). Remimazolam showed faster sedation onset (MD: -6.04 min, 95% CI [-6.99, -5.09], p = 0.0000, I² = 68%). Both drugs demonstrated similar occurrences of hypotension and hypertension, respiratory rates, mean arterial pressures, emergence times, and incidences of PONV. Conclusions: Remimazolam offers comparable safety and efficacy to dexmedetomidine, with advantages such as lower bradycardia risk and faster sedation onset. These findings support remimazolam as a viable sedative option during regional anesthesia, although further large-scale studies are warranted to confirm these results and optimize sedation practices.

Background and Objectives: Aortic stenosis (AS) is a frequent valvular disease characterized by the obstruction of left ventricular outflow. The resulting hemodynamic and structural changes create an arrhythmogenic substrate, with sudden cardiac death (SCD) often caused by ventricular arrhythmias (VAs) being a feared complication. This review examines the relationship between severe AS and VA, detailing the epidemiology, pathophysiological mechanisms, risk factors, and management approaches prior to aortic valve replacement (AVR). Materials and Methods: We conducted a comprehensive narrative review of the historical and contemporary literature investigating ventricular arrhythmias in severe aortic stenosis. Literature searches were performed in PubMed, MEDLINE, and Scopus databases using keywords, including "aortic stenosis", "ventricular arrhythmia", "sudden cardiac death", and "aortic valve replacement". Both landmark historical studies and modern investigations utilizing advanced monitoring techniques were included to provide a complete evolution of the understanding. Results: The prevalence of ventricular ectopy and non-sustained ventricular tachycardia increases with AS severity and symptom onset. Left ventricular hypertrophy, myocardial fibrosis, altered electrophysiological properties, and ischemia create the arrhythmogenic substrate. Risk factors include the male sex, concomitant aortic regurgitation, elevated filling pressures, and syncope. Diagnostic approaches range from standard electrocardiography to continuous monitoring and advanced imaging. Management centers on timely valve intervention, with medical therapy serving primarily as a bridge to AVR. Conclusions: Ventricular arrhythmias represent a consequence of valvular pathology in severe AS rather than an independent entity. Their presence signals advanced disease and a heightened risk for adverse outcomes. Multidisciplinary management with vigilant monitoring and prompt surgical referral is essential. Understanding this relationship enables clinicians to better identify high-risk patients requiring urgent intervention before life-threatening arrhythmic events occur.