Diseases (Basel, Switzerland)最新文献

Background/objectives: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in women with a short cervix. Vaginal dysbiosis has been associated with increased PTB risk. Progesterone (PR) and Arabin pessary (PE) are commonly used for PTB prevention, but their impact on vaginal microbiome composition is unclear. This study aimed to compare the effects of these interventions on the vaginal microbiome in women at risk of PTB.

Methods: In a secondary analysis of a randomized trial at Hospital das Clínicas, Universidade de São Paulo, 203 women with singleton pregnancies and cervical length ≤ 25 mm at the second trimester were assigned to daily vaginal PR (200 mg) or PE. Vaginal swabs from 44 participants (n = 22 per group) were collected at baseline and 4 weeks post-treatment and analyzed via 16S rRNA gene sequencing.

Results: From 88 samples analyzed, 80 showed a low-diversity, Lactobacillus-dominated microbiota, 42 classified into Lactobacillus iners-dominated community state type (CST-III), and 38 presented other Lactobacillus species dominance (termed CST-I/II/V). The remaining eight samples presented non-Lactobacillus dominance (CST-IV). Comparing the two groups, no significant changes in CST were observed between sampling timepoints (PE group, p = 0.368; PR group, p = 0.223). Similarly, Shannon alpha diversity did not change (PE group, p = 0.62; PR group, p = 0.30), and Bray-Curtis dissimilarity also did not change after treatment (p = 0.96, before; p = 0.87, after treatment).

Conclusions: Arabin pessary and vaginal progesterone maintain vaginal microbiome stability in women at high PTB risk, supporting the microbiological safety of both interventions.

Background/objectives: The long-term impact of the COVID-19 pandemic is not just limited to socioeconomic aspects; there are also important health issues to consider. Among these, one of the most important and obvious is long COVID. Despite a significant amount of scientific work having been published, this condition is still semi-unknown. The objective of this study was to collect useful information for the clarification of some epidemiological, clinical, and laboratory characteristics of this disease.

Methods: This was a single-center study carried out at the Infectious Diseases Clinic of the hospital "AUO delle Marche" on all patients hospitalized for COVID-19 between November 2021 and March 2022.

Results: From the data, it emerged that, following the resolution of the acute phase of SARS-CoV-2 infection, the majority of people experienced health problems that persisted for at least 6 months. The manifestations and outcomes affect different systems; therefore, long COVID, like COVID-19, has systemic involvement and the clinical manifestations may be residues of the damage caused by the disease during the acute phase, or new manifestations whose pathogenesis is still a matter of discussion.

Conclusions: The persistence of inflammation and the dysregulation of the immune system represent some of the pathogenetic hypotheses. Inflammation could therefore represent one of the physiopathogenetic mechanisms of long COVID, and it is possible that it is responsible for the clinical symptoms that appear in the months following the resolution of the acute phase of the disease.

A woman in her 40s with a history of ER/PR+, HER2-negative breast cancer presented with a seizure three years after mastectomy. Magnetic resonance imaging (MRI) revealed a right caudate head mass, which was concerning for either high-grade glioma or metastatic disease, but biopsy was deemed too high risk. Cerebrospinal fluid (CSF) tumor-derived DNA (tDNA) analysis by next-generation sequencing (NGS) was ordered, revealing a gain-of-function variant in PIK3CA, ERBB2 copy number gain, and high aneuploidy, findings consistent with breast cancer brain metastasis. Based on these results, the patient was treated with stereotactic radiosurgery (SRS) followed by trastuzumab deruxtecan, a HER2-targeted therapy. This case highlights the diagnostic and therapeutic value of CSF tDNA analysis in central nervous system (CNS) lesions when biopsy is not feasible. The report also illustrates how clonal evolution, such as acquired ERBB2 amplification, can occur in metastatic disease and influence treatment decisions.

Background: Metformin and proton pump inhibitors (PPIs) are independently associated with vitamin B12 deficiency. Despite frequent co-prescription, particularly in diabetics with gastroesophageal disorders, evidence regarding the combined risk of these medications on vitamin B12 deficiency remains limited. This study aimed to evaluate the real-world risk of vitamin B12 deficiency associated with metformin, PPIs, and their combinations using the United States Food and Drug Administration Adverse Event Reporting System (USFDA AERS) database.

Methods: We conducted a disproportionality analysis using USFDA AERS data from 2004 to 2024. We assessed whether metformin, PPIs, or their combinations were reported more often than expected with vitamin B12 deficiency and evaluated associated clinical outcomes, such as hospitalization and life-threatening events.

Results: Among 29,661,136 reports, 552 met inclusion criteria, with metformin monotherapy accounting for 274 cases. Positive safety signals were detected for both metformin and all PPIs individually. While statistical interaction measures were not conclusive, patients on metformin-pantoprazole combination therapy experienced significantly higher rates of hospitalization and life-threatening events compared to those on pantoprazole alone.

Conclusions: These findings suggest that patients receiving metformin and PPIs together, particularly the elderly, may face a higher risk of serious vitamin B12 deficiency-related complications. Clinicians should consider closer monitoring of vitamin B12 levels and supplementation when needed in patients on combination therapy.

Background: Cancer, type 2 diabetes mellitus (T2DM), and psychiatric comorbidities such as depression and anxiety frequently coexist, with shared mechanisms involving systemic inflammation and neuroinflammatory pathways. Understanding these interactions is critical for improving multidisciplinary oncological care. Methods: We conducted a monocentric cross-sectional study (n = 174). Beyond descriptive and univariate analyses, we fitted multivariable models: linear regressions (HADS-Anxiety/Depression) with robust HC3 errors and the predictors ECOG, T2DM, age, sex, and residence, and logistic regression for ECOG ≥ 3. We assessed collinearity and model fit, and performed sensitivity checks. Results: Psychiatric comorbidity was present in 58% of patients, while more than 80% of those with available HADS data (n = 136) exceeded the clinical threshold for anxiety or depression. No significant differences in ECOG status were observed between patients with and without T2DM (mean ECOG 2.5 in both groups). Higher ECOG remained positively associated with both HADS-Depression (adjusted β = 2.77, 95% CI -1.03-6.57, p = 0.149) and HADS-Anxiety (β = 1.62, 95% CI -2.76-6.00, p = 0.468), although not statistically significantly. T2DM showed no independent association with either outcome (Depression β = -2.91, p = 0.130; Anxiety β = -0.80, p = 0.595). In logistic regression, T2DM was not significantly associated with ECOG ≥ 3 (aOR = 3.58, 95% CI 0.23-56.66, p = 0.365). Conclusions: The psychiatric burden is high among Romanian cancer patients, irrespective of T2DM status, and strongly associated with functional decline. These findings support the relevance of a neuroinflammatory framework linking somatic comorbidities and psychological distress. Routine psychiatric screening, early intervention, and integration of psycho-oncology into multidisciplinary care are recommended. Future prospective studies should incorporate inflammatory biomarkers to better define underlying mechanisms.

Objectives: Rifaximin is a non-absorbable antibiotic that has an efficacy for hepatic encephalopathy (HE). We previously demonstrated that rifaximin improved liver functional reserve, but this was a single-center study with a limited number of cases, and there were few cases of long-term use. Here, we conducted a multicenter study to evaluate the efficacy of long-term rifaximin administration on the liver functional reserve.

Methods: A multicenter retrospective study was conducted on cirrhotic patients who received rifaximin for more than 12 months. We evaluated the efficacy of long-term rifaximin administration on the liver functional reserve.

Results: A total of 65 cirrhotic patients were enrolled. Administration of rifaximin for 12 months significantly improved the Child-Pugh score (CPS) and albumin-bilirubin (ALBI) score. Regarding the parameters of the CPS, albumin scores significantly improved in addition to HE scores at 12 months. Univariate and multivariate analysis revealed that high C-reactive protein (CRP) levels (>0.69 mg/dL) at baseline were the predictive factor for improvement in the liver functional reserve.

Conclusions: This study suggests that long-term rifaximin administration may improve the liver functional reserve in cirrhotic patients through improvement in albumin levels. CRP levels predict improvement in the liver functional reserve.

Introduction: Concussions are a growing concern in professional football due to their potential short- and long-term neurological consequences. Despite increasing global awareness, data on the epidemiology and clinical management of concussions in Portuguese football remain scarce. This preliminary exploratory study aimed to characterize the incidence, mechanisms, symptomatology, and medical response to concussions in Portugal's Professional Football Leagues during the 2023/2024 season, based on reported cases.

Methods: A retrospective observational analysis was conducted on head injuries reported by club medical teams during official matches in Liga Portugal First and Second Leagues. Collected variables included player position, time of injury, mechanism, symptoms, medical interventions and hospital referral.

Results: Only six concussions were reported during official matches, with an overall incidence of 0.60 per 1000 player-hours. Most occurred in defenders, primarily due to head-to-head collisions, followed by ball impact, falls, and maxillofacial trauma. Injuries were more frequent during the final third of matches. Common symptoms included loss of consciousness, headache, and amnesia. Half of the players were referred to hospital care and underwent cranial CT scans. Among all variables analyzed, a statistically significant association was found between mechanism of injury and occurrence of amnesia (p = 0.014), with non-head-to-head impacts more frequently associated with amnesia. However, given the extremely limited sample size, this finding should be interpreted with extreme caution and requires replication in larger cohorts.

Conclusions: This preliminary study suggests that defenders face a higher risk of head injuries, particularly from head-to-head impacts occurring late in matches. The prevalence of severe symptoms and the potential association between non-head-to-head impacts and amnesia highlight the need for more robust injury surveillance systems and underscore the importance of improved sideline assessment and return-to-play protocols. The findings emphasize the urgent need for comprehensive, standardized reporting mechanisms for concussions. Further research should explore long-term neurological effects and the effectiveness of preventive measures such as rule modifications, protective measures, and enhanced concussion management protocols, supported by more extensive and systematically collected data.

Background/Objectives: The interplay between asthma and COVID-19 raises critical clinical questions, particularly regarding the risk of hematological complications in patients affected by both conditions. While COVID-19 is known to cause coagulopathy and thromboembolic events, it remains unclear whether asthma independently influences these risks. This systematic review aimed to synthesize existing evidence on hematological abnormalities-including D-dimer elevation, thrombocytopenia, and venous thromboembolism (VTE)-in asthmatic patients with confirmed SARS-CoV-2 infection. Methods: A systematic search was conducted in PubMed and Web of Science databases for studies published between January 2020 and May 2025. Inclusion criteria were studies reporting hematologic outcomes in asthmatic patients with COVID-19. After duplicate removal, 139 unique articles were screened, with 40 studies meeting inclusion criteria. These included observational cohorts, retrospective analyses, and clinical investigations. Data were synthesized in a systematic review with qualitative synthesis due to heterogeneity in design and reporting. Results: The review identified variable patterns of D-dimer elevation and thrombotic events among asthmatic COVID-19 patients. Some studies reported a higher incidence of ICU admission, elevated inflammatory and coagulation markers, and increased thromboembolic risk in asthmatic individuals-particularly those with poor disease control or non-allergic phenotypes. However, findings were inconsistent and often limited by the absence of asthma stratification, standardized outcome measures, and prospective designs. Conclusions: Current evidence does not support a definitive link between asthma and increased thrombotic risk in COVID-19. Further research with prospective, phenotype-stratified methodologies and harmonized hematologic endpoints is needed to clarify whether asthma modifies the hematologic trajectory of SARS-CoV-2 infection.

Background/objectives: There are very few publications on unplanned excisions of great saphenous vein leiomyosarcomas (GSV-LMS), and their impact on the prognosis of the disease is not well known. The objective of this study is to present a series of nine new leiomyosarcomas of the great saphena vein (LMS-GSV) cases, with the aim of increasing diagnostic awareness and proposing guidelines for therapeutic management.

Methods: This is a prospective single-centre study of a series of nine GSV-LMS in thigh (stage IIIA AJCC), knee and proximal leg (IB, 1 II and 3 IIIA), and ankle (2 IIIB and 1 II). Eight patients were female, and the mean age was 72 years. All patients were surgically treated. Five (56%) were unplanned excisions. All these patients were reoperated on to attempt wide resection margins. In a patient, an infra-patellar amputation was performed. Another amputation was refused by another patient. Eight patients received adjuvant radiotherapy.

Results: One patient died 8 years after amputation for a reason other than LMS. The patient who refused amputation has been alive, disease-free, for 28 months. The mean follow-up of surviving patients was 39 months (6-78 months). In these patients, there were no local recurrences or metastases. The mean functional outcome according to the MSTS score was 28.9 (range: 24-30).

Conclusions: Unplanned excision of GSV-LMS can be prevented through clinical and imaging suspicion. Surgery and re-excision in case of inadequate previous margins and adjuvant radiotherapy lead to a good oncological and functional outcome.

Background: The impact of transfusion timing relative to endoscopy in upper gastrointestinal bleeding (UGIB) remains unclear.

Aim: To assess whether transfusion performed before versus after endoscopy affects 30-day mortality in UGIB.

Methods: We conducted a post hoc analysis of a multicenter cohort study including 3324 UGIB patients consecutively admitted in hospital. Propensity score matching adjusted for clinical and procedural variables.

Results: Among 2017 transfused patients, 34.7% received Red Blood Cells (RBC) before endoscopy. Patients who received transfusions before endoscopy were older, had more severe comorbidities, and presented with a worse physical and hemodynamic status. This study also explored whether transfusion timing relative to endoscopy affects clinical outcomes in patients stratified by baseline hemoglobin levels. While pre-endoscopy transfusion was not significantly associated with reduced 30-day mortality in the overall population, we observed an advantage in patients transfused before the endoscopy when the Hb value was <7 g/dL. Pre-endoscopy transfusion was associated with a 6% absolute reduction in 30-day mortality (p < 0.06), with a greater benefit observed in patients with Hb < 7 g/dL (-27%) and <8 g/dL (-21%). Moreover, for this group of patients more favorable outcome was observed when the endoscopy was performed between 6 and 12 h from admission. These findings suggest that transfusion timing should be integrated into individualized UGIB management and may impact future clinical guidelines.

Conclusions: In patients with severe anemia and UGIB, transfusion before endoscopy may reduce mortality. Timing to transfusion should be considered alongside hemodynamic and procedural factors in future guidelines.