Medicina-Lithuania最新文献

Background and Objectives: With physiological aging, the pancreas is expected to decrease in size as in every organ. The objective of this study was to examine the correlation between pancreas volume (PV), nutritional status, and glycolyzed hemoglobin A1c (HbA1c) in elderly patients with and without type 2 diabetes mellitus (DM). Materials and Methods: Between July 2020 and April 2022, 109 patients aged ≥ 65 years who applied to geriatrics clinics and outpatient clinics were included in the study. PV was measured from available abdominal contrast-enhanced computed tomography (CT) scans. Patients were divided into two groups according to the presence of DM. The relationship between PV; biochemical parameters, especially HbA1c; and Mini Nutritional Assessment Short Form (MNAsf) score was analyzed between groups. p < 0.05 was considered statistically significant. Results: The mean age of all participants was M: 77.40, with SD: 7.32. A total of 54.1% of the participants were female, and 55 had DM. There were no significant differences in age and gender between those with and without DM. Glucose (p < 0.001), HbA1C (p < 0.001), and triglycerides (p < 0.001) were significantly higher, and HDL (p < 0.001) was significantly lower in patients with DM. PV was also significantly lower in those with DM (p = 0.028). A correlation analysis revealed significant positive correlations between PV, the MNAsf score (rho (109)) = 0.413, p = 0.003), and lipase (rho (109)) = 0.297, p = 0.002). Conclusions: PV, which is expected to decrease with age, was found to be lower in patients with DM in our study in which we evaluated elderly patients with and without DM. We also found that PV was associated with malnutrition. Our study highlights the importance of determining the clinical effects of pancreatic volume in the geriatric population where organ atrophy is expected. Therefore, we believe that more comprehensive studies are needed to clarify the clinical implications of pancreatic volume on our diagnostic and therapeutic decisions.

Background and Objectives: Axillary lymph node metastasis and the number of metastatic lymph nodes are important prognostic factors which are directly related to overall survival in women with breast cancer. Several factors have been identified to predict the likelihood of axillary lymph node metastasis in early-stage breast cancer. High PR expression is often more prevalent in the luminal A subgroup, which is associated with a better prognosis. The aim of this study was to determine the relationship between the percentage of PR expression and the likelihood of axillary metastasis in Her-2-negative, clinical T1-T2N0 luminal type breast cancer. Materials and Methods: A hundred and ninety-nine cases with luminal type, Her-2-negative, clinically and radiologically axilla-negative T1-T2 breast cancer who received radiotherapy were evaluated retrospectively. The pathological specimens were assessed by an experienced pathologist. Results: The statistical evaluation showed that tumor diameter greater than 2 cm, (p = 0.003), presence of lymphovascular invasion (p = 0.001), and PR expression level below 80% (p = 0.037) were identified as significant predictors of lymph node positivity in breast cancer patients. Conclusions: Percentage of progesterone receptor expression along with other molecular biological markers and clinicopathological parameters should be evaluated altogether when predicting axillary metastasis risk before surgery.

Background and Objectives: This study identified health-related factors that affect the happiness of Korean adults with disabilities based on the disability level. Materials and Methods: Data of 7581 adults with disabilities aged 20 or older were collected from the 2023 Survey on the Status of Persons with Disabilities. The collected data were analyzed using frequency and multivariate logistic regression analyses. Results: Among individuals with moderate disability, males were less happy than females. Those with elementary school or lower education levels were less happy than those with college or higher education levels. Those who experienced stress, sadness and despair, suicidal thoughts, or discrimination were less happy than those who did not. In contrast, married individuals were happier than unmarried individuals. Those who exercised, went out alone, engaged in paid work, or participated in social activities were happier than those who did not. Among individuals with severe disabilities, males were less happy than females. Those with lower levels of education were less happy than those with higher levels of education. Those who experienced stress, sadness and despair, suicidal thoughts, suicide attempts, difficulty in communication, or discrimination were less happy than those who did not. Those who perceived their body as very thin were less happy than those who perceived it as very obese. Those who suffered from chronic disease were less happy than those who did not. In contrast, those aged 20-29 were happier than those aged 80 years or older. Married individuals were happier than unmarried ones. Those who exercised, went out alone, engaged in paid work, or participated in social activities were happier than those who did not. Conclusions: Factors affecting the happiness of Korean individuals with disabilities differ depending on the disability degree. Therefore, health policies, plans, and support measures must be established based on the disability degree to support daily physical activities, along with health services facilitating physical activity.

Background and Objectives: Despite ongoing research and evolving diagnostic criteria, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) remain notoriously difficult to differentiate, largely due to their overlapping clinical presentations and the absence of definitive biomarkers. Materials and Methods: We provide a comprehensive review of cerebrospinal fluid (CSF) biomarkers, which have proven valuable in the diagnosis of other neurodegenerative conditions, and their application to PSP and CBS. Results: The most promising results derive from a combination of biomarkers associated with Parkinson's disease, Alzheimer's disease, and neurofilament light chain. Furthermore, CSF proteomics analysis offers valuable insights into the pathogenesis of PSP and CBS and could also contribute to accurate diagnosis. Conclusions: CSF biomarkers hold significant potential for improving the differential diagnosis of PSP and CBS. A stepwise combination approach-starting with CSF α-synuclein and neurofilament light chain, followed by amyloid-β42 and total and phosphorylated tau-may provide clinicians with a practical framework for distinguishing PSP and CBS from other neurodegenerative disorders. To advance this field, future efforts should prioritize large-scale, multicenter studies employing standardized methodologies to enhance the validity and reproducibility of biomarker-based diagnostics. Importantly, considering the frequent pathological overlap between PSP and CBS, future studies would greatly benefit from pathology-confirmed cohorts to ensure diagnostic accuracy and to better delineate biomarker profiles across these challenging conditions.

Background and Objectives: We aimed to assess the outcomes of upfront Optilume drug-coated balloon (DCB) dilation in patients after failed treatment for complex recurrent urethral stricture disease. All patients presented with acute urinary retention and were treated with DCB dilation regardless of stricture site and length. Materials and Methods: We retrospectively evaluated patients with acute urinary retention and known complex recurrent urethral strictures. Patients presented at the urology emergency room of our tertiary centre with an inability to void or a post-void residual (PVR) volume exceeding 400 mL between August 2021 and February 2024. Urethrography and/or endoscopic imaging confirmed the diagnosis. Patients with urinary tract infection/sepsis and those with neurological disease were excluded. Urethral dilation to 20 Fr was performed, followed by DCB dilation (30 Fr, 10 bar, 10 min). The primary endpoints were anatomical success (≥14 Fr by cystoscopy/calibration) at 12 months and freedom from repeat interventions. Results: Thirty-one consecutive male patients were evaluated, with twenty-six patients followed for ≥12 months (mean age 65 ± 16.8 years). The stricture sites included seven bulbopenile, seven bulbomembranous, seven anastomotic, three bladder neck, one penile, and one panurethral stricture. The median number of prior urethral/surgical interventions was 2 [IQR: 1-3] (range: 1-31). The median stricture length was 3 [IQR: 2-4] cm (range: 1-8). At 12 months, 65.4% (17/26) of subjects voided satisfactorily and were free of recurrence and reoperation. Conclusions: Timely DCB dilation may offer a viable treatment option for patients with complex recurrent urethral strictures and urinary retention, particularly those who are unable or unwilling to undergo surgical reconstruction and prefer to avoid indwelling catheters.

Background and Objectives: Quadratus lumborum block (QLB) is a regional anesthesia technique widely utilized in multimodal analgesia strategies for abdominal surgeries. While a few studies have investigated its efficacy in multiport total laparoscopic hysterectomy (TLH), its effectiveness in single-port TLH remains uncertain. This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH. Materials and Methods: This randomized, controlled, observer-blinded trial included 64 patients undergoing elective single-port TLH. Participants were randomly allocated to either the QLB group (n = 27) or the control group (n = 29). QLB was performed bilaterally under ultrasound guidance after surgery. The primary outcome was cumulative fentanyl consumption within 24 h postoperatively. Secondary outcomes included pain scores at predefined intervals, time to first opioid demand, the incidence of postoperative nausea and vomiting (PONV), and other complications. Results: The 24 h cumulative fentanyl consumption, which was the primary outcome, did not differ significantly between the QLB group, 342.8 [220, 651] mcg, and the control group, 470 [191.6, 648.1] mcg (p = 0.714). Similarly, cumulative fentanyl consumption at other time points, including 2 h, 4 h, 8 h, 12 h, 32 h, and 48 h, as well as in the PACU, also showed no significant differences between the two groups. Pain scores measured at these time points, along with the time to first bolus on demand, were comparable between groups. However, PONV occurred more frequently in the QLB group than in the control group (25.9% vs. 3.4%, p = 0.023). Conclusions: QLB did not significantly reduce opioid consumption, time to first opioid demand, or postoperative pain scores in single-port TLH. However, PONV occurred more frequently in the QLB group. These findings suggest that QLB may have limited analgesic benefits in single-port TLH.

Background and Objectives: CRC is one of the leading causes of cancer-related deaths worldwide. New biomarkers are needed to identify the high-risk patient population after primary treatment and to personalize and perfect treatment and follow-up. Indicators of cancer-associated systemic inflammatory response, such as the LMR, have been widely investigated and have yielded conflicting results. The aim of this study was to investigate the effect of preoperative LMR on the prognosis of recurrent CRC. Materials and Methods: We included 204 patients admitted to our center for recurrent CRC between January 2010 and January 2015. Retrospectively, we investigated the preoperative LMR data and its effect on RFS and OS. Results: The cut-off value of LMR was 24.72 and, according to this value, we created two groups: LMR-H and LMR-L. There were 104 (50.9%) patients in the H group and 100 (49.1%) patients in the L group. The median OS was 38.0 months (95% confidence interval (CI): 30.66-45.33) for the L group and 49.0 months (95% CI: 44.06-53.94) for the H group. Overall population median OS was calculated as 44.0 months (95% CI: 40.1-47.8, p = 0.004). Median RFS was 21.3 months (95% CI: 18.3-24.2) for the LMR-L group and 28.39 months (95% CI: 24.9-31.8) for the LMR-H group (p = 0.004). Conclusions: The association between the LMR at diagnosis and early recurrence, as well as survival outcomes, was investigated in patients with recurrent CRC. Higher preoperative LMR levels were found to correlate with improved OS and RFS.

Background and Objectives: Acute pancreatitis (AP) is an inflammatory disorder of the pancreas, with severe cases linked to a higher mortality rate. The prognosis of AP is influenced by factors such as necrosis, secondary infections, and organ failure. Tissue damage in AP is driven by the activation of leukocytes and the release of inflammatory mediators. Angiopoietin-like protein 8 (ANGPTL8), also known as betatrophin, is a recently discovered protein that regulates lipid metabolism. This study aimed to investigate the relationship between ANGPTL8 levels and disease severity in AP patients, and to explore the potential of ANGPTL8 as a biomarker. Materials and Methods: This prospective study included 50 patients diagnosed with AP who were admitted to the Department of Internal Medicine at Dr. Cemil Taşcıoğlu City Hospital between September 2021 and February 2022. Additionally, 39 healthy volunteers who underwent a check-up at the same hospital served as the control group. The Glasgow-Imrie (GI) score was used to assess the severity of pancreatitis. Results: ANGPTL8 levels were found to be significantly lower in the AP group compared to the control group, with a statistically significant correlation between ANGPTL8 levels and the severity of AP (p < 0.05). The cut-off level of ANGPTL8 based on the GI score was determined to be 70.9 ng/L. The GI score for ANGPTL8 was 0.749 (95% CI: 0.606-0.861) (p < 0.001). The overall cut-off value for ANGPTL8 was 179.2 ng/L, with an overall classification rate of 0.936 (95% CI: 0.864-0.977) (p < 0.001). Conclusions: This study demonstrates that ANGPTL8 levels vary between patients with and without AP, with lower levels observed in AP patients. Our research is the first to identify decreased ANGPTL8 levels as an independent predictor of AP severity. ANGPTL8 may play a crucial role in regulating inflammation or metabolic dysfunction in AP. However, further studies are needed to confirm these findings in larger populations and investigate ANGPTL8's mechanistic role in AP. Longitudinal studies could help determine whether ANGPTL8 levels act as a biomarker for disease progression or treatment response, potentially paving the way for targeted therapies to improve outcomes for AP patients.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a notable cause of morbidity and mortality worldwide and can become complicated by Type 2 respiratory failure. This study aimed to analyze the cardiological and metabolic comorbidities of patients admitted to the intensive care unit (ICU) due to COPD-related Type 2 respiratory failure and evaluate their effects on clinical outcomes. Materials and Methods: A retrospective analysis was conducted on 258 patients admitted to the secondary-level pulmonary disease intensive care unit between January 2022 and January 2024. Patients' demographic data, cardiological and metabolic comorbidities, laboratory parameters, and ICU-related variables were evaluated using statistical analysis methods. Results: The most common comorbidities were hypertension (57.0%), congestive heart failure (48.1%), diabetes mellitus (31.4%), and obesity (37.6%). Female patients had significantly higher rates of hypothyroidism, hypertension, obesity, and congestive heart failure compared to males. Patients diagnosed with chronic kidney disease (CKD) had markedly higher cardiothoracic ratios and proBNP levels. ICU length of stay was considerably longer in patients with acute kidney injury (AKI) and coronary artery disease (CAD). Cardiomegaly and obstructive sleep apnea syndrome (OSAS) were more frequently observed in obese patients. Additionally, in COPD patients, a body mass index (BMI) threshold of 25.5 was determined as a cutoff value for radiological cardiomegaly findings with a sensitivity of 69.9% and a specificity of 59.5%. Elevated pCO₂ and bicarbonate levels in patients receiving long-term oxygen therapy (LTOT) were associated with advanced-stage COPD. Conclusions: Metabolic and cardiological comorbidities notably impact the clinical prognosis and ICU management of patients diagnosed with COPD and Type 2 respiratory failure. This study, which aims to provide a snapshot of the comorbidities in patients requiring ICU admission due to COPD exacerbation-related Type 2 respiratory failure but without a fatal course, seeks to highlight the key areas where preventive and protective healthcare services should be focused in this patient group. Special attention should be given to monitoring female and obese patients. Future studies should explore how individualized and preventive follow-ups and treatment approaches can improve patient outcomes, with a particular emphasis on these identified areas.

Background and Objectives: In Kazakhstan, during the COVID-19 pandemic, older adults faced unique challenges, such as limited healthcare resources and prolonged periods of social isolation. The aim of our study was to evaluate the sociodemographic and health-related factors associated with loneliness and psychological distress in older adults during the COVID-19 pandemic in Kazakhstan. Materials and Methods: In this cross-sectional study, a total of 445 participants aged 60 and above were recruited from Kazakhstan during the COVID-19 pandemic. The Patient Health Questionnaire-4 (PHQ-4) was used to measure psychological distress, anxiety, and depression. Loneliness was assessed using the UCLA Loneliness Scale (UCLA-3). The sociodemographic and health-related variables of the tested participants were analyzed. Results: Mean values from the UCLA-3 (p < 0.001), PHQ-4 (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001) scores significantly differed between different categories of self-reported overall health. Significantly higher mean values were found in older adults with hypertension for UCLA-3 (p = 0.025), PHQ-4 (p = 0.001), anxiety (p = 0.001), and depression (p = 0.017); diabetes for UCLA-3 (p = 0.023), PHQ-4 (p = 0.029), and depression (p = 0.001); chronic heart failure for UCLA-3 (p = 0.005), PHQ-4 (p < 0.001), anxiety (p = 0.001), and depression (p < 0.001); cerebrovascular disease for UCLA-3 (p = 0.024), PHQ-4 (p = 0.002), anxiety (p = 0.001), and depression (p = 0.027); cardiovascular disease for UCLA-3 (p < 0.001), PHQ-4 (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001); dementia for anxiety (p = 0.046); being single for UCLA-3 (p = 0.009), PHQ-4 (p = 0.031), and depression (p = 0.028); other ethnic backgrounds for PHQ-4 (p = 0.004) and anxiety (p = 0.013); and living in an urban place for PHQ-4 (p = 0.043). Being single was shown to be a significant predictor for loneliness (OR 2.21; 95%CI 1.28-3.84), anxiety (OR 2.09; 95%CI 1.14-3.84), and depression (OR 4.23; 95%CI 1.95-9.15). Below-average (OR 5.79; 95%CI 1.09-30.90) self-reported overall health was shown to be a significant predictor of anxiety. Conclusions: Our study demonstrated that numerous sociodemographic and health-related factors were associated with loneliness, anxiety, and depression in older adults from Kazakhstan during the COVID-19 pandemic.