Medicina-Lithuania最新文献

Background and Objectives: Added sugar usage has become an important public health issue nowadays. Therefore, the interest in studying the cognitive and emotional effects associated with sugar consumption has increased. The present study aimed to investigate how the intake of added sugar affects participants' impulsivity and cognitive functions monitored during the performance of a computerized Go/NoGo task. Materials and Methods: This study included 20 subjects (10 men and 10 women). Quantitative data for this study were collected via self-report questionnaires, including demographics, the Dietary Fat and Free Sugar-Short Questionnaire (DFS), the Yale Food Addiction Scale (YFAS 2.0), and the Barratt impulsiveness scale-11 (BIS-11). Results: Event-related potentials (ERPs) were registered throughout this study. Comparing the results of psychophysiological and neuropsychological evaluations before and after the added sugar consumption reveals differences in ERPs. Specifically, the NoGo-P3 amplitude increased after the intake of added sugar. However, there were no behavioral differences between the two experimental sessions. Conclusions: Overall, the results of our study suggest that added sugar intake was associated with stronger neuronal firing in NoGo trials. One possible explanation for this could be the need for more cognitive endeavors for participants to successfully inhibit their response impulses after added sugar consumption.

In the original publication [...].

Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and poor prognosis. The aims of this scoping review are to present the etiology, bacteriology, clinical manifestations, and diagnostics, as well as treatment, in light of the research published in the last 5 years on deep neck infection associated with descending necrotizing mediastinitis. The most common primary sources of deep neck infection are odontogenic and tonsillar. The other sources that are involved in deep neck infection are salivary glands, foreign bodies, malignancies, and iatrogenic causes after endoscopic maneuvers. The bacteriologic aspect is polymorphic, including both aerobic and anaerobic species. Complications that may appear include jugular vein thrombosis, airway obstruction, acute respiratory distress syndrome, sepsis, and disseminated intravascular coagulation. Timely diagnosis is important for ensuring the positive evolution of a deep neck infection. A CT scan is important for characterizing the nature of a deep neck lesion and identifying the spaces involved, and this method represents the gold standard for diagnosis of these lesions. Following the establishment of a definitive diagnosis, antibiotic therapy is initiated empirically, and is modified according to bacteriological exam results. The administration of antibiotics is an essential part of the treatment strategy for patients with a deep neck infection. Based on CT results, different surgical methods are applied under general anesthesia. The surgical strategy involves opening and draining the cervical spaces and debriding the necrotic tissue. In the cases of odontogenic causes, drainage and extraction of the infected teeth are performed. It is especially important to follow up on the dynamic progression of the patient. In the management of a deep neck infection associated with descending necrotizing mediastinitis, a multidisciplinary team is necessary.

Background and Objective: Thrombophilia significantly increases the risk of complications like recurrent pregnancy loss, preeclampsia, IUGR, and stillbirth. Objective: This study aimed to evaluate the impact of inherited thrombophilic mutations on first-trimester screening outcomes, focusing on their relationship with maternal biomarkers and ultrasonographic parameters. Materials and Methods: A prospective observational study was conducted on 105 pregnant women during the first trimester (10-13 weeks of gestation). Genetic testing identified common thrombophilic mutations, including factor V Leiden, prothrombin G20210A, and MTHFR polymorphisms. First-trimester screening parameters, including PAPP-A, free β-hCG, and nuchal translucency (NT), were assessed. Maternal demographic and clinical characteristics, such as parity and smoking status, were recorded. Pearson correlation and risk estimates were calculated to explore associations between thrombophilic mutations, maternal factors, and screening results. Results: Lower parity (≤2) was significantly associated with a reduced risk of low PAPP-A levels (<1.0 MoM) (OR = 0.173; 95% CI: 0.044-0.676). Non-smokers showed a trend toward lower risk of low PAPP-A, although the association was not statistically significant. NT measurements <2.5 mm were consistent with normal fetal development, while maternal factors such as chronic hypertension and a history of small-for-gestational-age infants showed no significant correlations with screening markers. No significant association was observed between thrombophilic mutations and biomarker levels. Conclusions: Parity emerges as a significant factor influencing first-trimester screening outcomes, particularly PAPP-A levels, underscoring the need for tailored risk assessments in multiparous women. While smoking and thrombophilic mutations showed no definitive impact, their potential role in placental dysfunction warrants further investigation. These findings emphasize the importance of integrating maternal characteristics into screening protocols to enhance predictive accuracy and maternal-fetal outcomes.

Objectives: Spondyloarthritis (SpA) is a chronic inflammatory arthritis that mainly affects the sacroiliac joints and spine. Despite effective biological treatments, persistent pain is common in SpA patients, potentially due to central sensitization (CS), a condition of heightened central nervous system responsiveness. The purpose of this study was to investigate the link between disease activity and CS in SpA patients on biological therapy. Patients and Methods: One hundred and twenty SpA patients with at least six months of treatment with biological agents were included in this cross-sectional study. Patients' demographic, clinical, and functional information were collected. The assessment of CS was conducted using the Central Sensitization Inventory (CSI), whereas disease activity and quality of life were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and Ankylosing Spondylitis Quality of Life (ASQoL). Statistical analyses included correlation assessments and logistic regression to identify predictors of CS. Results: CS (CSI ≥ 40) was present in 40.8% of patients. Disease activity was significantly higher and quality of life was lower in patients with CS. BASDAI and ASQoL scores were strongly correlated with CS (r = 0.774 and r = 0.839, respectively). Logistic regression identified ASQoL and BASDAI scores as independent predictors of CS. ROC curve analysis demonstrated that ASQoL had the highest discriminative ability for predicting CS (AUC = 0.97). Conclusions: CS is significantly associated with higher disease activity and poorer quality of life in SpA patients receiving biological therapy. Incorporating CS assessment into routine clinical practice may enhance our understanding and management of persistent symptoms in SpA, improving patient outcomes.

Background and Objectives: An atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 min. This study aimed to evaluate whether neuron-specific enolase (NSE) levels, an indicator of neurological impact, could serve as a surrogate biomarker for silent neurological ischemia in patients with atrial high-rate episodes (AHREs). Materials and Methods: Patients with AHRE detected in a pacemaker analysis and a control group without any arrhythmias were included. Patients with AHRE were divided into subgroups according to AHRE duration-Group 1: AHRE < 5 min, Group 2: AHRE ≥ 5 min-<1 h, Group 3: AHRE ≥ 1 h-<24 h, Group 4: AHRE ≥ 24 h. Neuron-specific enolase (NSE) levels were measured using a double-antibody enzyme-linked immunosorbent assay (ELISA) with a sensitivity of 0.05 ng/mL. Imaging techniques were not employed in this study, and NSE was used as an indirect measure of potential neurological impact. Results: There were 160 patients, including 80 (50.0%) in the AHRE group and 80 (50.0%) in the control group. According to AHRE duration, there were 24 (30.0%) patients in Group 1, 33 (41.2%) in Group 2, 19 (23.8%) in Group 3, and 4 (5.0%) in Group 4. Patients with AHRE had statistically significant differences in age, sPAP, transmitral E/A ratio, and NSE levels. The mean NSE levels of all groups were significantly different (p < 0.001). A correlation analysis in patients with AHRE showed a very strong positive correlation between AHRE duration and NSE values as well as correlations with age, virtual CHA₂DS₂-VASc score, and LA diameter. NSE levels were positively correlated with AHRE duration and LA diameter. AHRE duration was an independent predictor of elevated NSE levels. Conclusions: It was shown that AHRE is associated with silent neurological ischemia and that NSE levels can be used to demonstrate these neurological effects. Future studies can contribute to the development of more effective treatment strategies based on these findings by investigating the neurological effects of AHRE in more detail.

Background and Objectives: This study aims to evaluate neurosurgery consultations for elderly patients during and following the COVID-19 pandemic. Materials and Methods: This study included patients aged 65 and older who were hospitalized in non-neurosurgery departments at Istinye University Gaziosmanpasa Medical Park Hospital and were referred for neurosurgery consultations between 1 April 2020 and 31 May 2024. Patients in the intensive care unit and emergency department were excluded. The period from 1 April 2020 to 30 April 2022 was defined as the pandemic period, and from 1 May 2022 to 31 May 2024 as the post-pandemic period. Results: A total of 123 patients were included in this study, with 57 from the pandemic period and 66 from the post-pandemic period. The average age during the pandemic period was 73.45 years (range: 65-93), compared to 71.09 years (range: 65-94) in the post-pandemic period. During the pandemic, 26.3% of patients were recommended for physical therapy and rehabilitation, 24.6% were advised to undergo surgery, 19.3% received neurology consultations, and 17.5% received medical treatment. In the post-pandemic period, 37.9% were recommended for surgery, 16.7% for neurology, 13.6% for physical therapy and rehabilitation, and 7.6% for medical treatment. Overall, 56.4% of patients accepted surgery. Conclusions: Despite the high prevalence of comorbidities in geriatric patients, appropriate neurosurgical referrals significantly improve treatment success, enhance quality of life and mobility, and reduce mortality. We therefore recommend earlier and more attentive referrals to neurosurgery for elderly patients with relevant symptoms to facilitate timely and effective interventions.

Caries is still one of the most prevalent diseases affecting children and adults worldwide [...].

Background and Objective: Ultrasound has become more popular and useful over the last few years in improving healthcare. While handheld devices offer portability and convenience, their diagnostic accuracy and clinical utility require further scrutiny. This study attempted to evaluate the non-inferiority of handheld portable ultrasound devices compared to standard ultrasound devices for common lung pathologies. Materials and Methods: Videos of various common lung pathologies from 20 patients were recorded by a single operator using both portable handheld and standard ultrasound devices in a single setting. These videos were then assessed via online questionnaires by clinicians of various levels of experience from respiratory and non-respiratory departments. A Likert scale was used, ranging from strongly disagree to strongly agree (ranging from 1 to 5) in terms of overall image quality, clear anatomical visualization, similar clinical interpretations/decisions, and the perception of non-inferiority. Median values with interquartile ranges were reported; a rating of 3 or above was defined as indicating non-inferiority. Results: Thirty participants completed the questionnaires, of which the majority were at trainee level (n = 20, 73%) and from a respiratory department (n = 20, 67%). The participants had mixed levels of experience in terms of the years and frequency of use of the ultrasound. Overall median ratings were 4.0 for overall image quality, clear anatomical visualization, and similar clinical interpretations/decisions, with slight variations in interquartile ranges. No significant differences were observed between subgroups. The portable ultrasound device was rated similarly for the overall perception of non-inferiority, but clinicians from respiratory departments and clinicians with less experience showed statistically significant variability in their assessments. Conclusions: The portable handheld device demonstrated potential as a reliable alternative to standard models in standard clinical settings without compromising clinical decision. Further evaluation is needed that includes a direct comparison of various types of handheld ultrasound devices, across different operators' levels of experience, to further solidify their suitability in patient care.