Medicina-Lithuania最新文献

Background and Objectives: Gender affirmation surgery significantly improves the quality of life and psychological well-being of transgender women. Among various techniques, sigmoid vaginoplasty is widely performed due to its ability to provide adequate vaginal depth and intrinsic lubrication. However, it carries risks, with neovaginal perforation being a serious yet underreported complication. Materials and Methods: This review examines the etiology, clinical manifestations, diagnosis, and management of neovaginal perforation. A literature review was conducted to analyze reported cases and treatment strategies. Additionally, we present a case from our institution to highlight diagnostic and therapeutic challenges. Results: Neovaginal perforation arises from mechanical trauma, ischemia, infection, or structural weaknesses in the sigmoid segment. Common risk factors include improper dilation, introital stenosis, and vascular compromise. Symptoms range from mild pelvic discomfort to peritonitis and sepsis. Computed tomography (CT) is the gold standard for diagnosis. Conservative management is effective in mild cases, whereas severe cases require surgical repair. Conclusions: Neovaginal perforation is rare but potentially life-threatening. Future research should refine surgical techniques, dilation protocols, and tissue engineering solutions. Standardized guidelines and patient education are essential for prevention and improved outcomes.

Background and Objectives: Robotic-assisted surgery (RS) has progressively emerged as a promising technology in modern thoracolumbar spinal surgery, offering the potential to enhance accuracy and improve clinical outcomes. To date, the benefits of robot-assisted techniques in thoracolumbar spinal surgery remain controversial. The objective of this study was to assess the efficacy and safety of RS compared to fluoroscopy-assisted surgery (FS) in spinal fusion procedures. Materials and Methods: In accordance with the PRISMA guidelines, a systematic review and meta-analysis was conducted, using REVMAN V5.3 software. The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) website with the following registration number: CRD42024567193. Results: Eighteen studies were included in the meta-analysis with a total of 1566 patients examined. The results demonstrated a worse accuracy in FS in cases with major violations of the peduncular cortex (D-E grades, according to Gertzbein's classification) [(odds ratio (OR) 0.47, 95%-CI 0.28 to 0.80, I² 0%]. In addition, a lower complication rate was shown in the RS group compared to the FS group, specifically regarding the need for surgical revision due to screw mispositioning (OR 0.28-CI 0.17 to 0.48, I² 98%). Conclusions: Advantages of robot-assisted techniques were demonstrated in terms of postoperative complications, revision surgery rates, and the accuracy of screw placement. While RS represents a valuable and promising technological advancement in thoracolumbar spinal surgery, future studies are needed to further explore its advantages in thoracolumbar spinal surgery and to identify which spinal surgical approach has greater advantages when using the robot.

Background and Objectives: Adolescent smoking is influenced by sociodemographic and psychological factors, including emotional and conduct problems. Understanding how sample size impacts the interpretation of these associations is critical for improving study design and public health interventions. This study examines the relationships between smoking behaviours, sociodemographic factors, and emotional and conduct problems, focusing on how sample size affects statistical significance and effect size interpretation. Materials and Methods: Data from the Latvian Health Behaviour in School-aged Children study was analysed. Chi-square tests and logistic regression were conducted to evaluate associations between smoking behaviours, sociodemographic factors, and emotional and conduct problems. Analyses were performed on both a large general sample and ten smaller generated subsamples to compare the impact of sample size on statistical outcomes. Results: Age and conduct problems emerged as the most consistent predictors of adolescent smoking behaviours across large and small samples, while other predictors, such as family affluence and family structure, showed weaker and less consistent associations. A large sample produced significant results even for weak predictors. Conclusions: This study highlights the importance of integrating effect size interpretation with statistical significance, particularly in large datasets, to avoid overstating findings. By leveraging real-world data, it provides practical recommendations for improving study design and interpretation in behavioural, medical, and public health research, contributing to more effective interventions targeting adolescent smoking.

Background and Objectives: Artificial intelligence has emerged as a transformative tool in healthcare, offering capabilities such as early diagnosis, personalised treatment, and real-time patient monitoring. In the context of rheumatoid arthritis, a chronic autoimmune disease that demands timely intervention, artificial intelligence shows promise in overcoming diagnostic delays and optimising disease management. This study examines the role of artificial intelligence in the diagnosis and management of rheumatoid arthritis, focusing on perceived benefits, challenges, and acceptance levels among healthcare professionals and patients. Materials and Methods: A cross-sectional study was conducted using a detailed questionnaire distributed to 205 participants, including rheumatologists, general practitioners, and rheumatoid arthritis patients from Romania. The study used descriptive statistics, chi-square tests, and logistic regression to analyse AI acceptance in rheumatology. Data visualisation and multiple imputations addressed missing values, ensuring accuracy. Statistical significance was set at p < 0.05 for hypothesis testing. Results: Respondents with prior experience in artificial intelligence perceived it as more useful for early diagnosis and personalised management of RA (p < 0.001). Familiarity with artificial intelligence concepts positively correlated with acceptance in routine rheumatology practice (ρ = 1.066, p < 0.001). The main barriers identified were high costs (36%), lack of medical staff training (37%), and concerns regarding diagnostic accuracy (21%). Although less frequently mentioned, data privacy concerns remained relevant for a subset of respondents. The study revealed that artificial intelligence could improve diagnostic accuracy and rheumatoid arthritis monitoring, being perceived as a valuable tool by professionals familiar with digital technologies. However, 42% of participants cited the lack of data standardisation across medical systems as a major barrier, underscoring the need for effective interoperability solutions. Conclusions: Artificial intelligence has the potential to revolutionise rheumatoid arthritis management through faster and more accurate diagnoses, personalised treatments, and optimised monitoring. Nevertheless, challenges such as costs, staff training, and data privacy need to be addressed to ensure efficient integration into clinical practice. Educational programmes and interdisciplinary collaboration are essential to increase artificial intelligence adoption in rheumatology.

Background and Objectives: Dental anxiety influences quality of life, causing emotional and physical discomfort. The aim of this study was to identify the prevalence of dental anxiety among young adults and how it influences the dimensions of quality of life, especially in terms of physical and psychological health. Material and Methods: This study was conducted between March and July 2024, within the Community Dentistry Discipline at the "Grigore T. Popa" University of Medicine and Pharmacy in Iași, on a group of 180 students to assess dental anxiety and its impact on their quality of life. Participants completed questionnaires using scales such as the IDAF, DAS-R CORAH, and WHOQOL-BREF. Results: Most participants presented a moderate level of dental anxiety, with 59.4% without anxiety and 6.1% with severe anxiety. Significant correlations were established between dental anxiety and physical and psychological dimensions of quality of life. In contrast, there were no significant correlations between dental anxiety and social relationships or the environment. Anxiety and fear were negatively correlated with perceived physical well-being, but positive correlations were also identified between sensitivity to dental stimuli and more favorable perceptions of physical and psychological health. Discussion: Dental anxiety has a significant impact on patients' physical and psychological health, especially on their perception of their well-being. This study confirms previous research showing that dental anxiety is related to certain dental procedures. Conclusions: Dental anxiety has a significant impact on psychological and physical perception but does not significantly affect social interactions.

This review focuses on the potential health risks of artificial food additives, especially their effects on lung health. Preservatives, synthetic colorants, and flavor enhancers, which are commonly used in processed foods, play roles in worsening respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD). These additives cause oxidative stress, systemic inflammation, and immune dysregulation, often through the gut-lung axis. The preservatives sodium nitrite and sulfites have the risk of causing bronchial hyper-responsiveness and allergic reactions. The synthetic colorant, Ponceau 4R, is also related to immune-mediated lung inflammation. Flavoring agents such as diacetyl contribute to occupational respiratory diseases like bronchiolitis obliterans. In animal models, prenatal exposure to additives, such as titanium dioxide (E171), might disrupt the development of respiratory neural networks, with long-term consequences. Ultra-processed foods (UPFs), which also contain a high concentration of additives, lead to systemic inflammation and impair lung function. Despite their wide usage, the use of these additives has become a warning sign due to their safety issue, particularly in sensitive people like children, pregnant women, and patients with pre-existing respiratory and chronic conditions. The review highlights the serious need for strict regulation and further research on the long-term effects of food additives on respiratory health. Policymakers should ban these food additives that are more harmful to human health. As an alternative to artificial additives, natural flavors and colors from fruits and vegetables, safe preservatives, and minimally processed ingredients can be used.

Background/Objectives: This study evaluated adherence to compression garments, their role in edema stabilization, and factors influencing patient compliance. Materials and Methods: This observational, descriptive, cross-sectional study evaluated adherence to compression garments in 92 patients with lymphedema treated at the University Hospital of Gran Canaria Dr. Negrín. In addition, sociodemographic, clinical, and design-related factors influencing adherence were analyzed. The evaluation was conducted via telephone questionnaires and a review of medical records. Results: The study revealed low adherence to compression garments in patients with lymphedema. Adherence was related to the garments' etiology, severity, and perceived comfort. Conclusions: The findings highlight the need to improve education strategies and personalize treatment recommendations to enhance adherence.

Guided bone regeneration (GBR) has represented a challenge for clinicians in the past 30 years, and the literature has well described many different surgical options such as d-PTFE membranes, titanium grids, or autogenous bone harvested from the posterior mandible. All of the previously mentioned techniques have shown a high rate of complications but, in the last decade, a new membrane made of xenogenic bone was introduced. Most of the publications regarding its application report very few and mild complications. In this article we will suggest a new application using segmented xenogenic bone sheets instead of autogenous bone to correct severe ridge deformity. Background and Objectives: Xenogenic bone sheets have been studied extensively over the past decade and have proven effective, with a very low rate of complications when used to reconstruct bone atrophies. The technique presented in this paper aims to reduce morbidity, avoid the need for intra-oral graft harvesting, and minimize both surgical time and post-operative discomfort. Materials and Methods: Xenogenic bone sheets of equine origin were used to reconstruct severe 3D bone defects in five patients requiring dental implants. The segmentation of the sheet allowed the operator to rebuild the missing bone walls and achieve optimal anatomy without compromise. Furthermore, using different sizes and thicknesses of the bone sheets allowed safe procedures preventing early exposure of the membranes. CBCT of the defects before and after 8 months of healing were measured with Exocad software to assess the volumetric gain. Histological analysis performed on one site showed integration of the bone lamina and live bone underneath. Results: In all five cases evaluated the ridge deformities were successfully corrected and all patients' implants have functioned for more than two years to date. The average horizontal bone gain in these five cases was 6.18 mm (±1.19 mm) while the vertical gain was 9.70 mm (±2.39 mm). Conclusions: This new application of flex cortical sheets simplifies the surgical procedure for both operator and patient, reduces morbidity and post-operative complications, and shows promising signs for resolving complex 3D bone reconstructions.

Background and Objectives: Serotonin modulates platelet aggregation and secretion, but its role in hemostasis remains controversial. This study hypothesized that the 5-HT₃ receptor antagonist palonosetron may inhibit platelet function and aimed to evaluate its effects on blood coagulation using thromboelastography (TEG). Materials and Methods: Blood samples from 11 healthy volunteers were treated with palonosetron at concentrations of 25, 250, and 2500 ng/mL. Untreated samples served as controls. Coagulation parameters were assessed using global hemostasis (citrated kaolin, citrated rapid TEG, citrated kaolin with heparinase, and citrated functional fibrinogen) and PlateletMapping (adenosine diphosphate [ADP], arachidonic acid, and others) assays. Results: In the global hemostasis assay, maximum amplitude values, reflecting clot strength, decreased with increasing palonosetron concentrations in all tests, including citrated kaolin (p = 0.031), citrated rapid TEG (p = 0.001), citrated kaolin with heparinase (p = 0.033), and citrated functional fibrinogen (p = 0.011). The PlateletMapping assay showed significant reductions in ADP-induced platelet aggregation (p = 0.001), with the largest inhibition observed at 2500 ng/mL (p = 0.007). Despite these changes, all values remained within normal reference ranges. Conclusions: Palonosetron induces hypocoagulable trends in vitro by inhibiting platelet function and fibrinogen-mediated clot strength. However, these changes are unlikely to result in clinically significant hemostatic impairment when used within therapeutic doses. Further research is warranted to confirm these findings and explore their clinical relevance.

Background and Objectives: Atherosclerotic cardiovascular disease is one of the most common causes of death and disability around the world. Hypercholesterolemia is an established and widely prevalent risk factor; however, the prevalence of severe hypercholesterolemia (which is characteristic for familial hypercholesterolemia) has been studied far less. The aim of this study was to determine the prevalence of severe hypercholesterolemia among patients with acute coronary syndrome. Materials and Methods: A retrospective study of patients hospitalised at Vilnius University Hospital Santaros Klinikos due to acute coronary syndrome was performed. Data were attained from an electronic medical history database. Data such as sex, age, cardiovascular risk factors (hypertension, diabetes) and low-density cholesterol results were collected. Severe hypercholesterolemia was defined as low-density lipoprotein cholesterol levels ≥ 4.9 mmol/L. Results: A total of 34,669 patients were included in this study (12,115 females (34.9%) and 22554 (65.1%) males, p < 0.001). The median age of the entire study population was 67 years. A total of 3434 patients (9.9%) had severe hypercholesterolemia, 371 (1.1%) patients met the criteria for phenotypically probable familial hypercholesterolemia, and 36 (0.1%) patients presented with phenotypically definite familial hypercholesterolemia. The most common concomitant risk factor in this study was arterial hypertension, which was found in 48% of patients. Conclusions: Based on the results of this study, severe hypercholesterolemia is prevalent among patients with acute coronary syndrome, with as many as 9.9% of patients presenting with severe hypercholesterolemia at the time of hospitalisation. The definite familial hypercholesterolemia phenotype is scarcer, with prevalence reaching 0.1% of patients with acute coronary syndrome.