Medicina-Lithuania最新文献

Background and Objectives: Information on how psychomotor speed is associated with the risk of falling is scarce, even in older adults. Therefore, this study aimed to determine the relationship between falls and psychomotor speed in older adults with sarcopenia and frailty. Materials and Methods: A total of 204 subjects (aged 83 (77-87) years) participated in this study: 161 women (78.9%) and 43 men (21.1%). The history of falls was assessed by asking whether the subject had experienced a fall in the past 12 months. Psychomotor speed was evaluated by reaction time and frequency of movement. Sarcopenia was diagnosed based on the EWGSOP2 criteria. Frailty was confirmed if the participants met ≥3 criteria according to the Fried frailty criteria. The relationship between falls and psychomotor speed was measured using partial correlations. Binary logistic regression analysis was used to assess if psychomotor speed had an impact on falls. Results: Sarcopenia was confirmed in 93 (45.58%) and frailty in 91 (44.6%) subjects. Both sarcopenia and frailty were present in 62 (30.39%) participants. In the sarcopenia and frailty group, falls were related to simple reaction time (r = 0.444, p = 0.002), hand movement frequency in 10 s (r = -0.352, p = 0.014), and in 60 s (r = -0.312, p = 0.026). In women with sarcopenia and frailty, there were relationships between falls and simple reaction time (r = 0.68, p = 0.002), complex reaction time (r = 0.406, p = 0.004), hand movement frequency in 10 s (r = -0.614, p = 0.001), and in 60 s (r = -0.584, p = 0.001). In regression analysis, it was found that each millisecond increase in reaction time was associated with a 1.5% higher fall risk in the participants with sarcopenia (OR: 1.015 [1, 1.031], p = 0.048). Conclusions: This study demonstrates that slower psychomotor speed, particularly reaction time, is linked to a higher risk of falls in older adults with sarcopenia and frailty, especially in women.

Background and Objectives: Most patients with cardiovascular disease have limited health literacy and knowledge. The promotion of knowledge among patients with coronary artery disease is an integral part of health maintenance and the minimisation of secondary cardiac events. The aim of this study was to map the percent proportion of answers and scores obtained from them in the studied domains. Materials and Methods: In this cross-sectional study, a Coronary Artery Disease Education Questionnaire (CADE-Q II) was used to verify knowledge gaps in the five studied domains. In total, 253 patients with coronary artery disease completed the CADE-Q II, which targeted five domains: health status, risk factors, exercise, nutrition and psychosocial risk. Data were collected between June 2021 and November 2024. Results: An analysis of the data found a total mean CADE-Q II score of 61.05 ± 11.42 SD out of 93 points. Our research showed that the total mean score of a group of patients corresponded to an acceptable level of knowledge. Patients in the cohort provided a total of 7843 responses for the five study domains. In total, 46.8% of patients scored all answers correctly in terms of risk factors, 49.0% in terms of nutrition, 53.1% in terms of health status, 64.4% in terms of psychosocial risk, and 65.0% in terms of exercise. Conclusions: The use of the CADE-Q II questionnaire, with its focus on the studied domains, verifies patient knowledge and provides a foundation for education, the provision of effective information and the promotion of secondary prevention knowledge.

Background and Objectives: Glioblastoma (GBM) is among the most aggressive and lethal primary brain tumors, characterized by high heterogeneity, invasive growth, and resistance to conventional therapies. The 2021 WHO classification highlights the importance of molecular diagnostics, integrating genetic, transcriptomic, and epigenetic alterations alongside histological and immunohistochemical criteria. Materials and methods: Key molecular regulators, including ATRX, OLIG2, MGMT, and IDH2, play critical roles in chromatin remodeling, transcriptional reprogramming, DNA repair, and metabolic adaptation. However, their specific expression patterns and functional roles in GBM remain incompletely understood. This study utilizes publicly available data from The Cancer Genome Atlas (TCGA) to assess the transcriptional profiles of ATRX, OLIG2, MGMT, and IDH2 in GBM, aiming to identify potential biomarkers and therapeutic targets. Results: The expression analysis revealed that ATRX is downregulated at the gene level but overexpressed at the protein level, while OLIG2 is consistently overexpressed at both levels. MGMT showed no statistically significant changes in either gene or protein expression, whereas IDH2 was not significantly altered at the gene level but was downregulated at the protein level (p < 0.05). These discrepancies suggest potential post-transcriptional regulatory mechanisms influencing GBM molecular profiles. Notably, OLIG2 and MGMT expression correlated significantly with patient survival (p < 0.05), whereas ATRX and IDH2 did not reach statistical significance. Conclusions: Understanding these molecular relationships provides valuable insights into potential therapeutic strategies, paving the way for precision oncology approaches and combination therapies targeting multiple pathways simultaneously.

Background and Objectives: To summarize the evidence on in vivo uterine pelvic lymphatic drainage. Materials and Methods: A literature search was performed in multiple electronic databases from inception to December 2024. We included all the studies that compared two different uterine injection sites in the mapping of pelvic sentinel lymph nodes by injecting two different tracers into two distinct injection sites. The primary outcomes included the concordance and discordance rates in the mapped pelvic sentinel lymph nodes between the pairs of injection sites. The secondary outcomes were the detection rates per injection site and tracer. Four reviewers independently reviewed the records for inclusion, assessed the risk of bias, and extracted the data. Pooled concordance, discordance, and detection rates with 95% confidence intervals (CIs) were estimated using the random effects model. Heterogeneity was quantified using the I² tests. Results: Out of 2512 records, we included 4 studies (172 patients and 344 hemipelves). Three studies injected the cervix with the technetium-99m and the uterine corpus with methylene blue; one study injected the cervix with indocyanine green and the utero-ovarian ligament with methylene blue. Both tracers/injection sites successfully identified a sentinel lymph node in 132 hemipelves (132/344; 38.4%), identifying the same sentinel lymph node in 116 cases (116/132; 87.9%). The pooled concordance rate per hemipelvis was 91.8% (95% CI 0.665-1.000; I² = 92%; chi²p-value < 0.01). Two different sentinel lymph nodes were identified in the remaining 16 hemipelves, with a pooled hemipelvis discordance rate of 8.2% (95% CI 0.000-0.335; I² = 92%; chi²p-value < 0.01). The cervix and technetium-99m were the injection site and tracer with the highest pooled detection rate. Conclusions: Different uterine injection sites appear to share a common pelvic lymphatic pathway and sentinel lymph node in most cases, consistent with the current practice in endometrial cancer. Future research will confirm whether cervical injections might be proposed for pelvic sentinel lymph node mapping in all gynecological cancers.

Background and Objectives: Diagnostic imaging is essential for evaluating urinary tract disorders, offering critical insights into renal pathology. This review examines the strengths, limitations, and clinical applications of various imaging modalities, with a focus on pediatric populations. Materials and Methods: A narrative review was conducted, synthesizing current literature on ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and voiding cystourethrography (VCUG). Relevant studies were selected based on diagnostic accuracy, clinical utility, and safety considerations. Results: US is the preferred first-line imaging due to its safety, accessibility, and cost-effectiveness. CT excels in detecting renal calculi, trauma, and malignancies but is limited by radiation exposure. MRI offers superior soft tissue contrast without radiation but is costly and often requires sedation. Nuclear medicine evaluates renal function and scarring, while VCUG remains the gold standard for diagnosing vesicoureteral reflux and posterior urethral valves. Conclusions: Imaging modalities are vital for diagnosing and managing urinary tract disorders, with selection based on clinical needs, patient age, and safety. Ultrasound is the primary choice for its non-invasiveness and cost-effectiveness, while CT, MRI, nuclear medicine, and VCUG provide essential structural and functional insights. A balanced approach ensures accuracy while minimizing patient risk, especially in pediatrics.

Background and Objectives: KRAS genes are among the most prominent oncogenes that trigger tumor formation in colorectal cancer (CRC) and serve as predictive biomarkers for resistance to anti-EGFR therapies in metastatic colorectal cancer (mCRC) patients. However, the prevalence and mutation spectrum of the KRAS gene family in mCRC patients in Turkey have not been sufficiently analyzed. This study investigates the frequency and distribution of mutations in the KRAS gene family across different regions of Turkey and examines gender-related variations. Materials and Methods: This multicenter observational study included 2458 histologically confirmed mCRC patients collected from 52 centers across Turkey. In a central laboratory, KRAS mutations in codons 12 and 13 were analyzed using polymerase chain reaction (PCR). Statistical analyses were performed using chi-square tests and Monte Carlo simulations, with a significance threshold set at p < 0.05. Results: Depending on the region, KRAS mutations were detected in 45% of patients, ranging from 39.6% to 47.5%. The mutation rate was significantly higher in female patients (48.8%) compared to male patients (42.6%) (p = 0.002). Codon 12 mutations were more frequent than codon 13 mutations. G12D, G12V, and G13D mutations accounted for 80% of all detected mutations. The G12V mutation was prevalent in female patients (p = 0.007). Based on region, mutation diversity was similar, and no statistically significant difference was found (p > 0.05). Conclusions: This large-scale, multicenter study provides the most comprehensive dataset of KRAS mutations in mCRC patients in Turkey. This study revealed regional trends, as well as gender differences. The findings highlight the importance of routine KRAS genotyping in guiding personalized treatment strategies, especially regarding candidate selection for anti-EGFR therapies. Further research is required to elucidate the prognostic and therapeutic implications of specific KRAS mutations.

Anesthetic management of the pregnant patient undergoing non-obstetric surgery requires careful consideration of both maternal and fetal well-being. Key factors include appropriate drug selection to minimize fetal exposure, maintenance of uteroplacental perfusion, and management of physiological changes associated with pregnancy, such as altered respiratory function and increased blood volume. Regional anesthesia is often preferred to reduce the risks of general anesthesia, although considerations such as positioning, airway management, and monitoring are crucial. Multidisciplinary collaboration is essential to optimize outcomes, ensuring that both maternal health and fetal safety are prioritized throughout the perioperative period.

Background and Objectives: Ovarian cancer surgery requires multiple radical resections with a high risk of complications. The aim of this single-centre, retrospective study was to determine the best method for predicting Clavien-Dindo grade ≥ III complications using machine learning techniques. Material and Methods: The study included 179 patients who underwent surgery at the gynaecological oncology department of Antalya Training and Research Hospital between January 2015 and December 2020. The data were randomly split into training set n = 134 (75%) and test set n = 45 (25%). We used 49 predictors to develop the best algorithm. Mean absolute error, root mean squared error, correlation coefficients, Mathew's correlation coefficient, and F1 score were used to determine the best performing algorithm. Cohens' kappa value was evaluated to analyse the consistency of the model with real data. The relationship between these predicted values and the actual values were then summarised using a confusion matrix. True positive (TP) rate, False positive (FP) rate, precision, recall, and Area under the curve (AUC) values were evaluated to demonstrate clinical usability and classification skills. Results: 139 patients (77.65%) had no morbidity or grade I-II CDC morbidity, while 40 patients (22.35%) had grade III or higher CDC morbidity. BayesNet was found to be the most effective prediction model. No dominant parameter was observed in the Bayesian net importance matrix plot. The true positive (TP) rate was 76%, false positive (FP) rate was 15.6%, recall rate (sensitivity) was 76.9%, and overall accuracy was 82.2% A receiver operating characteristic (ROC) analysis was performed to estimate CDC grade ≥ III. AUC was 0.863 with a statistical significance of p < 0.001, indicating a high degree of accuracy. Conclusions: The Bayesian network model achieved the highest accuracy compared to all other models in predicting CDC Grade ≥ III complications following epithelial ovarian cancer surgery.

Background and Objectives: The objective was to assess ocular biometric measurements in relation to age and gender among patients scheduled for cataract surgery, utilizing an optical biometry device. Materials and Methods: The optical biometric parameters evaluated included axial length (AL), central corneal thickness (CCT), anterior chamber depth (AD), lens thickness (LT), horizontal corneal diameter (WTW), and keratometry values in the flat (K1) and steep (K2) meridians. Astigmatism (AST) was also measured as the difference between these keratometry values. Results: A total of 14,183 optical biometric measurements were included in the study. The average age of the participants was determined to be 56 (3-110) years. The average AL was 23.57 ± 1.45 mm, the average AD was 2.76 ± 0.42 mm, the average CCT was 518.13 ± 37.81 μm, the average WTW distance was 11.88 ± 0.59 mm, and the average LT was 4.19 ± 0.51 mm. The keratometry measurements were recorded as K1 = 43.39 ± 1.96 diopters (D), K2 = 44.51 ± 2.31 D, and AST = 1.12 ± 1.15 D. The average values for male eyes in terms of the AL, AD, WTW, and LT measurements were significantly higher than those for female eyes (p = 0.001). The average K1 and K2 values were flatter in males than in females, while the AST value was found to be higher in females (p = 0.001). As age progressed, the mean AL decreased, the CCT decreased, the AD narrowed, the WTW distance decreased, the LT increased, and the keratometric values K1, K2, and AST decreased until the age of 60, after which they increased again. Conclusions: Research indicates that the measurements of the bulbus oculi are generally larger in males than in females. Furthermore, each of the optical biometric measurements is interrelated. Over time, these measurements may change.

Background and Objectives: Associated mitral regurgitation (MR) is frequently observed during transcatheter aortic valve implantation (TAVI). The progression of moderate MR remains undetermined, given uncertain clinical significance and natural history. This study aims to assess the evolution of moderate MR following TAVI. Materials and Methods: Between 2018 and 2023, 1476 patients underwent TAVI. We excluded those with previous aortic or mitral valve interventions, endocarditis, concomitant percutaneous coronary intervention, or emergent procedures. Patients with severe aortic or tricuspid regurgitation or significant mitral stenosis were excluded. Ultimately, only patients with moderate MR were included, resulting in a final population of 154 patients. Results: Mean age was 81.4 ± 7.8 years, 48.1% (74/154) were female, and 48.1% (74/154) were functional MR. There was one surgical conversion due to annular rupture. Thirty-day mortality was 1.9% (3/154). Postoperative echocardiography showed 38 (24.7%) patients with none/trace MR, 91 (59.1%) with mild MR, 22 (14.3%) with moderate MR, and 3 (1.9%) with severe MR. Finally, according to the echocardiographic follow-up [median follow-up 1.0 (IQR: 0.1-1.2) years], 20.1% (31/154) had no/trace MR, 39.6% (61/154) had mild MR, 35.7% (55/154) had moderate MR, and 4.5% (7/154) had severe MR. Overall, 67 (43.5%) patients had any MR grade progression, 62 (40.3%) had stable disease, and 25 (16.2%) had any MR grade reduction at the last follow-up from the operation. No difference in MR evolution was seen between functional and primary MR. Conclusions: Concomitant moderate MR during TAVI has a variable evolution over time. A more detailed characterization of patients with preoperative moderate MR undergoing TAVI is necessary to identify those with a disease progression risk.