Medicina-Lithuania最新文献

Background and Objectives: ST elevation myocardial infarction (STEMI), particularly when complicated by cardiogenic shock (CS), is a critical condition associated with high mortality rates. Identifying predictors of in-hospital mortality can enhance patient management and outcomes. Materials and Methods: This observational, retrospective case-control study included STEMI patients, both complicated and uncomplicated by CS. Additionally, demographics, clinical characteristics, laboratory data and in-hospital mortality rates were analysed for STEMI patients with CS and those without CS. Results: This study included a total of 101 patients with STEMI, of whom 51 (50.5%) had STEMI without CS and 50 (49.5%) had STEMI with CS. No significant differences were observed in demographic characteristics or STEMI risk factors between the two groups. Emergency coronarography was performed in 90.1% of the patients, with successful thrombolysis achieved in 24.5%. Patients with CS exhibited a significantly higher mortality (52%) than those without CS (11.76%). Univariate analysis identified white blood cell counts, CK-MB, CK levels, elevated creatinine and uric acid levels and a reduced left ventricular ejection fraction (LVEF) as predictors of mortality. Logistic regression analysis revealed that LVEF and CK-MB were independent predictors of in-hospital mortality in patients with STEMI and CS. Each 1% increase in LVEF was associated with a reduced mortality risk (HR = 0.89; 95% CI 0.81-0.98; p = 0.018), while elevated CK-MB levels were linked to an increased mortality risk (HR = 1; 95% CI 1-1.01; p = 0.014). Conclusions: Reduced systolic function and elevated CK-MB levels are key predictors of in-hospital mortality and outcomes in STEMI patients with CS. These findings underscore the importance of early identification and support the development of targeted management strategies aimed at improving outcomes in this high-risk population.

Background and Objectives: Studies investigating the types of dietary supplements associated with the atopic triad using large-scale data remain limited. We assessed the prevalence of the atopic triad, the types of dietary supplements used, and their associations in Korean adults using a 4-year national survey data. Materials and Methods: This cross-sectional study utilized data from the Korea National Health and Nutrition Examination Survey (2018-2021). Adults aged ≥ 19 years were included. Descriptive statistics were used to summarize participants' overall characteristics and estimate the national prevalence of the atopic triad, defined as a diagnosis of asthma, allergic rhinitis, or atopic dermatitis. Logistic regression analyses were conducted using each atopic condition as a dependent variable, with the types of dietary supplements currently used as independent variables. Covariates included socioeconomic status, lifestyle factors, frailty, and diet. Dietary supplements were categorized as multivitamins/minerals, vitamin C, vitamin D, vitamin A/lutein, propolis, omega-3, probiotics, red ginseng, calcium, or iron. Results: A total of 18,182 adults were analyzed, representing an estimated 52.8 million adults (mean age: 47 years; 50% male). Of these, 21% reported a history of any atopic triad, and 61% were current supplement users. Logistic regression showed significantly higher odds of all three atopic conditions among users of propolis (asthma: OR 1.90, 95% CI 1.04-3.47; allergic rhinitis: OR 1.64, 95% CI 1.25-2.17; atopic dermatitis: OR 2.04, 95% CI: 1.18-3.52), and higher odds of allergic rhinitis among users of probiotics (OR 1.21, 95% CI 1.06-1.38) and vitamin D (OR 1.43, 95% CI 1.16-1.75). Conclusions: A positive association was found between propolis use and all three atopic conditions. Also, a positive association was found between probiotics or vitamin D use and allergic rhinitis. We did not find significant associations with the other supplements. Further research in establishing causal relationships between the dietary supplements and atopic conditions are needed.

Background and Objectives: Stereotactic radiotherapy enhances local tumor control by delivering high doses directly to the tumor. It is thought to activate the immune system via T-cells, possibly creating a systemic response. This study aims to evaluate stereotactic body radiotherapy's (SBRT) impact on the immune system by measuring T-cell transcription factors, such as TBX21, GATA-3, FoxP3, and RORɣt. Materials and Methods: Peripheral blood samples were collected from 103 patients before SBRT and from 66 patients two months post-treatment. We measured transcription factors TBX21, GATA-3, FOXP3, and RORγt using ELISA, and performed a complete blood count and C-reactive protein analysis to rule out infections. Statistical analyses included paired t-tests and correlation analyses to assess changes before and after treatment. Results: Post-treatment, significant reductions were observed in TBX21 (Th1), GATA-3 (Th2), and FOXP3 (Treg), while RORɣt (Th17) remained stable but trended higher in lung cancer patients. No correlations were found with demographic factors. However, TBX21 levels were significantly related to the planning target volume (PTV) and biologically effective dose (BED10) in the lung region. Larger PTVs (≥16.5 cc) and higher BED10 doses (≥100 Gy) were linked to smaller reductions in TBX21 (p = 0.008, p = 0.04) and increased RORɣt levels (p = 0.01). Conclusions: Stereotactic radiotherapy reduces immunosuppressive markers like FOXP3 and GATA-3, indicating its potential to boost immune activation by suppressing Treg and Th2 cells. Larger target volumes and higher BED10 values may enhance Th1 responses through TBX21. These findings suggest that SBRT activates the immune system, and its combination with immunotherapy could be promising.

Background and Objectives: Gastric cancer (GC) remains a significant global health challenge with a poor prognosis. This study aimed to evaluate the association between Klintrup-Mäkinen (KM) inflammatory infiltrate grading and clinicopathological features in gastric cancer patients, investigating its potential as a prognostic marker. Material and Methods: This retrospective study analyzed 133 gastric adenocarcinoma patients diagnosed between 2020 and 2021 at County Clinical Hospital in Târgu Mureș, Romania. Patients were divided into two groups based on KM grades: low (grades 0-1, n = 62) and high (grades 2-3, n = 71). Clinicopathological characteristics and survival outcomes were compared between the groups. Results: Demographic characteristics were similar between the groups. Patients with low KM grades demonstrated significantly more aggressive tumor features, including a higher prevalence of Borrmann classification types III-IV (75.8% vs. 54.9%, p = 0.01), poorly differentiated histology (74.1% vs. 33.8%, p < 0.0001), advanced T stage (93.5% vs. 80.2%, p = 0.04), and lymph node involvement (87% vs. 60.5%, p = 0.0008). This group also exhibited higher rates of lymphatic invasion (79% vs. 50.7%, p = 0.001), venous invasion (51.6% vs. 30.9%, p = 0.02), perineural invasion (50% vs. 22.5%, p = 0.001), and positive surgical margins (32.2% vs. 15.4%, p = 0.02). Survival analysis revealed a hazard ratio of 1.642 (95% CI: 1.02-2.62) for patients with low KM grades compared to those with high KM grades. Conclusions: Low KM grades are associated with more aggressive tumor characteristics and poorer prognosis in GC patients. The KM score may serve as a valuable, cost-effective histological marker for assessing tumor aggressiveness and could aid in risk stratification when applied to routine H&E-stained slides. While it does not replace immunohistochemical or molecular analyses, integrating the KM score into pathological assessment may enhance prognostic accuracy and support identifying patients who might benefit from immunotherapy.

Glioblastoma (GBM) is the most prevalent and aggressive primary central nervous system (CNS) tumor in adults. GBMs exhibit genetic and epigenetic heterogeneity, posing difficulties in surveillance and being associated with high rates of recurrence and mortality. Nevertheless, due to the high infiltrating ability of glioblastoma cells, and regardless of the considerable progress made in radiotherapeutic, chemotherapeutic, and surgical protocols, the treatment of GBM is still inefficient. Conventional diagnostic approaches, such as neuroimaging techniques and tissue biopsies, which are invasive maneuvers, present certain challenges and limitations in providing real-time information, and are incapable of differentiating pseudo-progression related to treatment from real tumor progression. Liquid biopsy, the analysis of biomarkers such as nucleic acids (DNA/RNA), circulating tumor cells (CTCs), extracellular vesicles (EVs), or tumor-educated platelets (TEPs) that are present in body fluids, provides a minimally invasive and dynamic method of diagnosis and continuous monitoring for GBM. It represents a new preferred approach that enables a superior manner to obtain data on possible tumor risk, prognosis, and recurrence assessment. This article is a literature review that aims to provide updated information about GBM biomarkers in body fluids and to analyze their clinical efficiency.

Background and Objectives: A recent clinical trial has demonstrated that breast cancer with low-HER2 expression levels responds to trastuzumab deruxtecan treatment. This has prompted a re-evaluation of HER2-targeted therapies in the HER2-negative group. Further research is required in the form of more detailed information about HER2-negative breast cancers with HER2-null, HER2-ultralow, and HER2-low subgroups. This study represents a novel approach to this field. Materials and Methods: HER2-negative breast cancer patients were classified into three groups as HER2-null, HER2-ultralow, and HER2-low. A comparison of clinicopathological features was analyzed retrospectively. Results: Of 722 patients, 22.3% were HER2-null, 23.7% were HER2-ultralow, 54.0% were HER2-low. While two-thirds of all the patients were evaluated as having T2 tumors, T4 tumors constituted 2.4%. Among HER2-negative cases, 11.8% were triple-negative and 88.2% were hormone-positive. The mean tumor diameter was 0.57 cm larger in the HER2-ultralow group than in the HER2-null group and 0.34 cm larger in the HER2-low group than in the HER2-null group. HER2-null tumors tend to be smaller. The HER2-low group was more likely to relapse than the HER2-null group. There were no significant differences in the distribution of hormone positivity or negativity (TNBC) among the groups; they accounted for 89.2% and 10.8% of all cases, respectively. Conclusions: HER2-negative breast cancer is a heterogeneous disease and deserves a detailed review in terms of diagnosis and treatment. HER2-ultralow tumors are larger in size and have a prognosis comparable to HER2-null tumors. HER2-low tumors tend to recur much more frequently and with poorer outcomes. In this field, new therapeutic approaches may result in better outcomes.

Background and Objectives: Diabetes mellitus (DM) and hypertension (HTN) continue to increase and pose a significant burden on the health system worldwide. These patients comprise a significant portion of the hospitalized Oral and Maxillofacial Surgery (OMFS) department. Addressing and controlling DM and HTN during hospitalization should thus be one of the treatment goals. This study aims to investigate the management and outcomes of DM and HTN during the hospitalization period in the OMFS department. Materials and Methods: A retrospective analysis of patients with community-diagnosed DM and/or HTN admitted to the OMFS department between 2017 and 2019 was conducted at Rambam Healthcare Campus, Haifa, Israel. Linear regression analysis was used to determine trends in changes in blood pressure and blood glucose levels during hospitalization. The impact of consults from internal medicine experts and endocrinologists was tested using a paired-samples t-test. Results: A statistically significant reduction was observed in all systolic HTN patients categorized as stages 1 and 2, p = 0.012 and p = 0.001, respectively. A statistically significant (p = 0.012) reduction in blood glucose levels in all DM patients with initial values higher than 250 mg/dL was observed. A statistically significant reduction in blood glucose levels was observed in the DM group of patients who received endocrinologist consultations (p = 0.012). Conclusions: Addressing patients with systemic conditions during hospitalization in the OMFS department is mandatory. External medical consulting can be of great value for short-term treatment during hospitalization and may also have long-term benefits after discharge to the community. The main limitations of this study include retrospective data acquisition, a small sample size, and a lack of data regarding the impact of pain management on blood pressure and glucose levels.

Cancer medications can cause cardiac issues, which are difficult to treat in oncologic patients because of the risk of complications. In some cases, this may significantly impact their well-being and treatment outcomes. Overall, these complications fall under the term "drug induced cardiotoxicity", mainly due to chemotherapy drugs being specifically toxic to the heart, causing a decrease in the heart's capacity to pump blood efficiently and leading to a reduction in the left ventricular ejection fraction (LVEF), and subsequently possibly leading to heart failure. Anthracyclines, alkylating agents, and targeted therapies for cancer hold the potential of causing harmful effects on the heart. The incidence of heart-related issues varies from patient to patient and depends on multiple factors, including the type of medication, dosage, duration of the treatment, and pre-existing heart conditions. The underlying mechanism leading to oncologic-drug-induced cardiovascular harmful effects is quite complex. One particular group of drugs, called anthracyclines, have garnered attention due to their impact on oxidative stress and their ability to cause direct harm to heart muscle cells. Reactive oxygen species (ROS) cause harm by inducing damage and programmed cell death in heart cells. Conventional biomarkers alone can only indicate some degree of damage that has already occurred and, therefore, early detection is key. Novel methods like genetic profiling are being developed to detect individuals at risk, prior to the onset of clinical symptoms. Key management strategies-including early detection, personalized medicine approaches, and the use of novel biomarkers-play a crucial role in mitigating cardiotoxicity and improving patient outcomes. Identification of generated genetic alterations and the association to an increased likelihood of cardiotoxicity will allow treatment in a more personalized approach, aiming at decreasing rates of cardiac events while maintaining high oncological efficacy. Oncology drug-induced cardiotoxicity is managed through a combination of preventive strategies and therapeutic interventions from the union of cardiac and oncological knowledge.

Background and Objectives: Chlamydial infection is the most common asymptomatic infection worldwide. Despite all national programs, strategies and guidelines, chlamydial infection is still the leading infection worldwide, especially in young populations. We have tried to summarize the best diagnostic tools for its detection. Materials and Methods: In the study, 225 sexually active patients who were tested for chlamydial infection at the Institute of Public Health Kragujevac participated. Results: Combinations of direct immunofluorescence (DIF) and a rapid lateral immunochromatographic test (RT) and combinations of an RT and immunoglobulin G (IgG) do not improve diagnostic efficiency when compared to a rapid test that individually had the best parameters. In situations that require high specificity, the recommended combination is RT/IgA, which as a highly specific test has few false positive results, while the combinations of DIF + RT and RT + IgG, although showing a specificity of 100%, have low sensitivity (33.30%), due to which we prefer the RT/IgA combination. The combinations DIF + RT, DIF + RT + IgG and RT + IgG, although with low sensitivity, have the highest values of specificity, and the positive predictive value (PPV) and negative predictive value (NPV) show the highest values of the extended Youden index of 130.30% and the highest values of total diagnostic accuracy of 97.00%. Based on the results of the extended Youden index, taking into account PPV and NPV, the RT/IgA combination shows the highest value of 94.60%, as well as the highest value of total diagnostic accuracy of 93.00%. Conclusions: "Two or more positive tests" or "any test positive" did not improve the diagnostic efficiency compared to a single "rapid test".

Background and Objectives: As the world enters an aging society, it is necessary to focus on older individuals, especially those with disabilities. The latter must face two issues, their disability and their age; therefore, a lot of attention must be paid to their health. In this study, we aimed to explore the association between participation in leisure sports activities, health behaviors, and life satisfaction among older adults with disabilities. The research question we aimed to address was as follows: Can participation in leisure sports activities positively affect the health behaviors and life satisfaction of older adults with disabilities? Materials and Methods: Data were sourced from the 2023 Survey on the Status of Persons with Disabilities organized by the Korea Ministry of Health and Welfare. The collected data were analyzed using frequency analyses, chi-squared tests, and multivariate logistic regression analyses. Results: Multivariate logistic regression analyses revealed that regarding sex, the average odds ratio (OR) was 1.525 (p = 0.001) for males. Regarding efforts to control weight, the average OR was 1.808 (p < 0.001) for "tried to reduce", 1.893 (p < 0.001) for "tried to maintain", and 1.245 (p = 0.345) for "tried to increase". Regarding smoking, the average OR was 0.612 (p = 0.008) for "smoke daily", 0.947 (p = 0.889) for "smoke occasionally", and 1.175 (p = 0.255) for "smoked in the past but do not smoke now". Regarding health status satisfaction, the average OR was 2.014 (p = 0.022) for very satisfied, 1.846 (p = 0.013) for somewhat satisfied, and 1.347 (p = 0.220) for somewhat dissatisfied. Regarding friendship satisfaction, the average OR was 9.177 (p < 0.001) for very satisfied, 5.428 (p < 0.001) for somewhat satisfied, and 3.024 (p = 0.011) for somewhat dissatisfied. Namely, participation in leisure sports activities was significantly related to weight control efforts, smoking cessation, increased health status satisfaction, and increased friendship satisfaction among older adults with disabilities. Conclusions: Access to leisure sports activities should be increased to improve the health of older adults with disabilities. Furthermore, leisure sports activities should be considered in the establishment of policies and services to enhance the health of these individuals.