Maedica最新文献

Background: Metabolic syndrome represented a clustering of abdominal obesity, dysglycaemia, dyslipidaemia and elevated blood pressure that together conferred an increased risk of type 2 diabetes and cardiovascular disease. The present study consequently examined the prevalence of metabolic syndrome among smokers versus non-smokers and characterised any differences in its constituent components and related risk profiles.

Methods: This was a hospital-based comparative cross-sectional study attending general medicine and preventive clinics. Smoking status was assessed by structured interview, while metabolic syndrome was defined based on standard criteria requiring at least three out of five components, consisting of central obesity, raised triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose.

Results: Smokers and non-smokers were similar in age, socio-economic status and overall adiposity, but smokers more frequently consumed alcohol and were predominantly male. Compared with non-smokers, smokers had higher mean levels of triglycerides and lower mean high-density lipoprotein cholesterol, while the differences in blood pressure and fasting glucose were smaller and did not reach statistical significance. The prevalence of metabolic syndrome was significantly higher in smokers than non-smokers; smokers more often had three or more clustered components, with higher frequency of raised triglycerides and reduced high-density lipoprotein cholesterol.

Conclusion: Current smoking was associated with a higher prevalence and greater clustering of metabolic syndrome components compared with non-smoking in this adult outpatient population, driven largely by a more adverse lipid profile and more frequent accumulation of three or more metabolic risk factors.

Background: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast condition. Accurate diagnosis is crucial for effective management. The present study aimed to evaluate the diagnostic accuracy of breast ultrasonography (US) parameters in IGM patients.

Methods: This cross-sectional study enrolled patients with IGM. Patients were first assessed by their pathology as a reference test, immediately followed by the breast US as an index test. The binary data of breast US parameters (parenchymal heterogeneity, irregular lesion border, axillary lymphadenopathy, fistula, hyperkeratosis and well-defined heterogeneous lesion) was assessed and reported with diagnostic parameters.

Results: Finally, 140 patients were enrolled in this study. Key US parameters for diagnostic accuracy were identified: irregular lesion border (sensitivity: 81.8%, specificity: 62.5%), fistula (predicitive positive value: 100%) and hyperkeratosis (predicitive positive value: 100%). Axillary lymphadenopathy and parenchymal Heterogeneity showed lower diagnostic value. The optimal ultrasound score cut-point was 1.5, with a Youden index of 0.81, sensitivity of 0.81, and specificity of 1.00. The area under the ROC curve was 0.95.

Conclusion: This study highlights the importance of specific US parameters in diagnosing IGM, providing valuable insights for clinicians and radiologists.

Background: Long COVID, a post-COVID-19 syndrome, has been linked to various musculoskeletal manifestations, particularly arthritic symptoms. This study aimed to evaluate the inflammatory markers associated with long COVID in patients diagnosed with COVID arthritis.

Methods: A cross-sectional prospective study was conducted in a tertiary care centre in Telangana, India, involving 139 PCR-confirmed COVID-19 patients diagnosed with arthritis. Eligible participants were COVID-free for one month to six months. Clinical histories, including severity of arthritis symptoms, levels of inflammatory markers (LDH, uric acid, serum ferritin, rheumatoid factor [RF] and CRP) and radiological investigations (radiographs and ultrasound) were recorded and analyzed. Follow-up assessments occurred at six months, with repeated measurements of inflammatory markers for statistical significance.

Results: The predominant clinical presentations included joint aches, restricted movement, swelling, myalgia and fatigue, with 95% of subjects relying on over-the-counter analgesics. Notably, all measured inflammatory markers decreased over the six-month follow-up, with statistically significant reductions being observed in LDH, RF and CRP levels.

Conclusion: COVID arthritis is a complication of long COVID that affects both men and women, with persistent elevation of inflammatory biomarkers. While levels decreased during the follow-up period, extended monitoring is necessary to determine the duration required for normalization. Further research is warranted to understand the long-term implications of these findings.

Background: Surgeon-performed point-of-care breast sonography (POCBS) offers immediate bedside ultrasound imaging that enhances the management of complex breast tumors by enabling real-time assessment and accelerating diagnosis and treatment decisions. This technique complements traditional imaging methods and improves clinical workflows by reducing delays and increasing diagnostic accuracy. Breast imaging reports incorporate BIRADS scores (0 to 6) indicating lesion suspicion levels and recommendations for further action, alongside ACR breast density categories (a to d) that influence imaging modality choice. Ultrasound complements mammography in lesion characterization and biopsy guidance. Five patient cases illustrate how surgeon-performed POCBS altered BIRADS and American College of Radiology (ACR) classifications compared to initial mammography, enabling timely biopsy and oncologic consultation, and highlighting the importance of immediate ultrasound assessment to prevent diagnostic delays. Surgeon-performed breast ultrasound (SPBU) improves diagnostic speed and accuracy by allowing surgeons to integrate clinical and imaging findings instantly, distinguish lesion types and perform biopsies or cyst aspirations during the same visit, reducing patient anxiety and streamlining care.

Myocardial infarction (MI) remains one of the leading causes of death worldwide. Currently, echocardiographic assessment focuses mainly on the function of the left ventricle, whereas the right ventricle is frequently overseen. This review aims to provide an overview of the current knowledge regarding right ventricular involvement in MI, as this is frequent, and carries prognostic significance. We also describe the currently available echocardiographic methods for RV systolic function assessment, including newer speckle tracking and 3D echocardiographic parameters, as well as their use in clinical practice, related to patient risk stratification and acute management.

Background: Implantation of intraocular lenses (IOLs) for full refractive correction at all distances is the ideal goal for cataract surgery. A comprehensive examination is pivotal to identify corneal pathology such as keratoconus, in order to achieve optimal outcomes with selection of premium or monofocal IOLs. Case report: A 57-year-old male presented for cataract surgery preoperative assessment. Ophthalmological examination indicated an unremarkable condition, while his files did not report any previous ocular pathology. The patient had high expectations for optimal refractive outcomes without spectacles and therefore, implantation of premium IOLs was considered. Preoperative biometric measurements using IOL Master 700 demonstrated a non-significant anterior corneal astigmatism in both eyes. The central corneal topography maps revealed an asymmetric colour appearance indicative of irregular astigmatism in the right eye, while colour gradation towards higher dioptres was present in the left eye. Despite not being pathognomonic for clinical ectasia, these visually relevant asymmetries warranted further investigation. Additional corneal tomography using Pentacam Scheimpflug imaging revealed an inferior symmetrical well-delineated mild keratoconus. Therefore, the selection of monofocal spherical IOL was decided. The patient had uneventful phacoemulsification bilaterally. At one month postoperatively, his unaided visual acuity at distance was 20/20 in both eyes, he could perform a Jaeger 2 scale for near vision, while subjectively had no complaints of unwanted photic phenomena. Conclusion: Our case highlights that a detailed corneal evaluation may add value to appropriate decision making concerning the selection of IOL implant for optimal visual outcomes. In addition, an enhance depth of focus might be provided postoperatively in selected mild keratoconic cases.

Introduction: Burns are the fourth cause of trauma worldwide, with a yearly death toll of 180,000. Multiple studies have investigated prognostic factors for the short-term and long-term evolution of burns, commonly citing age, percentage of total body surface area affected (BSA), percentage of third-degree burn, inhalation injury, surgery and overall depth of burn. The aim of our study is to review all cases managed in a tertiary emergency center and find factors associated with duration of hospital stay. Material and methods: The official reporting of burns from 2020-2023 "Bagdasar-Arseni" Emergency Clinical Hospital was reviewed, and clinical data regarding age, gender, burn severity and duration of hospitalisation, of Burns ICU time and mechanical ventilation was gathered and analysed using SPSS, version 26. Outcomes: A total of 337 cases were gathered, with a death rate of 14.54% (36.51% of inhalatory lesions are associated). 59.05% of patients were men, the majority (21.36%) were between 51 and 60 years old, most patients suffered burns on less than 10% of the total body area (50.45%). Most patients had third degree burns (60.2%), followed by second degree (39.2%). On average, patients were hospitalised for 16.5 days, of which approximately 8.5 were spent in the Burns ICU, and 3.3 days of mechanical ventilation were needed. The durations of hospitalisation, Burns ICU stay and mechanical ventilation were significantly higher in older patients, those with 31-40% BSA burns, subjects with third degree burns and those who died during the hospital stay. Conclusions: Of all managed cases, most patients were males, middle-aged, over half of them were suffering from small area burns and most of the burns were third degree. Regarding the duration of the required medical services, patients with severe burns (third degree) and those who did not survive required a longer duration of hospitalisation, more time in the Burns ICU and more time on mechanical ventilation.

Objectives: This study evaluated the diagnostic performance of two large language models (LLMs), ChatGPT and Google Gemini, to identify common retinal and optic nerve diseases benchmarked against an experienced ophthalmologist.

Methods: Thirty standardized case vignettes, each comprising a brief clinical history and a high-resolution fundus image, were independently evaluated by ChatGPT, Google Gemini and an ophthalmologist. Ten retinal and optic nerve diseases were included. Diagnostic accuracy was calculated against a gold standard defined by consensus of two retina specialists. Inter-rater agreement was assessed using Cohen's kappa (κ). Secondary outcomes included interpretation time and clarity of explanation.

Results: The ophthalmologist achieved the highest diagnostic accuracy (96.7%), followed by ChatGPT (90.0%) and Google Gemini (86.7%). Agreement between ChatGPT and Gemini was moderate (κ = 0.51, p = 0.004). ChatGPT showed moderate agreement with the ophthalmologist (κ = 0.47, p = 0.002), while Gemini demonstrated fair agreement with the ophthalmologist (κ = 0.36, p = 0.01). ChatGPT was the fastest (mean 21.7 seconds), followed by Gemini (25.7 seconds) and the ophthalmologist (149.8 seconds). Clarity of interpretation was highest for the ophthalmologist (mean 4.53/5), followed by ChatGPT (3.60/5) and Gemini (2.96/5), with significant differences between groups.

Conclusion: Ophthalmologists remain superior in diagnostic accuracy and clarity. However, ChatGPT and Google Gemini demonstrated strong performance in several retinal conditions. Their rapid evaluation times indicate potential utility as adjunct tools in triage, screening and education.

Background: A 34-year-old nulligravid lady was referred to the outpatient gynecology department with the symptoms of abnormal menstrual bleeding and mild anemia. A transvaginal ultrasound (TVS) revealed the presence of a hyperechoic lesion measuring 9.5x4.5 mm in the uterine cavity at the level isthmus (lower uterine segment), suggestive of an endometrial polyp. Consequently, a diagnostic hysteroscopy was performed. Transcervical hysteroscopic resection (TCR) and diagnostic curettage (D&C) were accomplished. A macroscopic analysis of the specimen exhibited a white, pale polypoid formation measuring 1x1 cm with a hard consistency. Histology analysis confirmed the diagnosis of an atypical polypoid adenomyoma (APA). All these findings were explained to the patient and the risk of potential progression to endometrial carcinoma was discussed in detail. A multidisciplinary meeting (MDT) was held and conservative management with levonorgestrel coil insertion or Methoxy progesterone administration per os, along with frequent hysteroscopies every three months, was offered. The patient decided to undergo a hysterectomy with preservation of the ovaries, despite the lack of childbearing. A laparoscopic-assisted vaginal hysterectomy with preservation of adnexa was performed. The pathology analysis confirmed the diagnosis of APA with coexistence of well-differentiated (low-grade) endometrioid carcinoma of the endometrium, stage Ia.

Methods: We performed a systematic review of systematic reviews with APA and quality assessment of the included studies. Furthermore, a flow-chart guideline for the management of APA in premenopausal and postmenopausal women is offered.

Conclusions: Atypical polypoid adenomyoma is a rare clinical entity. It occurs mainly during the reproductive period of a woman. It is associated with abnormal vaginal bleeding, infertility, nulliparity, obesity, metabolic syndrome, hyperprolactinemia and hyperestrogenism. It is a risk factor for the development of endometrial hyperplasia and subsequent endometrial cancer. Preoperative diagnosis is extremely difficult; there are no specific imaging landmarks in ultrasound and magnetic resonance imaging (MRI) assessment. In patients with a desire for fertility, the management is complicated and should be based on a four-step hysteroscopic transcervical resection of the lesion. Hysterectomy is the right option for post-menopausal women and for women not wishing to conceive.