Medicina-Lithuania最新文献

{"title":"The Influence of Mucinous Histology on the Prognosis of Stage II and III Colorectal Cancers.","authors":"İsa Caner Aydin, Mehmet Torun, Mehmet Reşit Sönmez, Serkan Ademoğlu, Ahmet Orhan Sunar, Orhan Uzun, Selçuk Gülmez, Erdal Polat, Mustafa Duman","doi":"10.3390/medicina61030456","DOIUrl":"10.3390/medicina61030456","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Mucinous adenocarcinoma (MAC) and mucinous components (MCP) in colorectal cancers (CRC) have shown conflicting results regarding their prognostic impact. This study aims to evaluate survival differences between MAC, MCP, and non-mucinous adenocarcinoma (nMAC) in stage II and III CRC patients. <i>Materials and Methods:</i> 224 CRC patients who underwent surgery between 2013 and 2021 were analyzed retrospectively. Patients were classified as nMAC, MCP, or MAC based on the percentage of extracellular mucin. Those who received neoadjuvant therapy, had stage I or IV TNM disease, and emergency cases were excluded. Survival analysis was performed using Kaplan-Meier curves and Cox regression models. <i>Results:</i> MAC patients showed worse survival outcomes compared to nMAC (<i>p</i> = 0.025). No difference in survival was found between MCP and nMAC (<i>p</i> = 0.055). Multivariate analysis identified MAC (OR: 2.814; <i>p</i> = 0.014) and perineural invasion (PNI) (OR: 2.283; <i>p</i> = 0.008) as independent factors associated with worse survival. Kaplan-Meier analysis revealed MAC's worse prognosis than nMAC (<i>p</i> = 0.027). <i>Conclusions:</i> MAC was shown to have a worse prognosis than nMAC in stage II and III CRC patients, while MCP survival rates were similar with nMAC. These findings suggest that MAC requires more careful treatment approaches, while MCP and nMAC have better survival rates. Further studies focusing on molecular and genetic profiles are needed to better understand these outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Role of SIRT-3 in the Acute Rejection Process of Kidney Transplantation and Its Effects on Graft Outcomes: Evaluation of Biomarker Potential.","authors":"Necip Altundaş, Eda Balkan, Murat Kizilkaya, Murat Altunok, Elif Demirci, Nurhak Aksungur, Salih Kara, Gürkan Öztürk, Abdullah Uyanik","doi":"10.3390/medicina61030457","DOIUrl":"10.3390/medicina61030457","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The aim of this study was to investigate the changes in the SIRT family, the effects of sirtuins on kidney graft function, and their potential as biomarkers in patients who develop rejection after kidney transplantation. <i>Materials and Methods</i>: Blood samples were collected from 45 kidney transplant patients before and after rejection. Some of these patients experienced T-cell-mediated early rejection (TCMR), while others presented antibody-mediated late rejection (ABMR). The mRNA expression levels of SIRT-1, SIRT-3, and SIRT-7 were measured via real-time PCR, while the protein levels of SIRT-1, SIRT-2, SIRT-3, SIRT-5, and SIRT-7 were assessed using ELISA. Patients were grouped based on rejection type and histological characteristics. Statistical analyses were performed using SPSS software (V23). <i>Results</i>: The mean age of the patient group was 42.22, while the control group had a mean age of 35.23 (<i>p</i> = 0.002). SIRT-1, SIRT-3, and SIRT-7 levels were significantly higher in patients with rejection (<i>p</i> < 0.001). In patients with late-stage rejection, SIRT-3 was found to be associated with interstitial fibrosis and C4d accumulation. SIRT-7 levels showed a weak correlation with potassium levels (<i>p</i> = 0.014). <i>Conclusions</i>: Our findings demonstrate significant changes in the SIRT family during both early- and late-stage rejection processes. Particularly, the role of SIRT-3 in the late stage is highlighted, suggesting the potential use of this gene as a biomarker for managing rejection processes. These findings could provide valuable insights for developing treatment strategies in organ transplantation.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of Dry Eye Disease for Primary Care Physicians.","authors":"Jeonghyun Kwon, Amirhossein Moghtader, Christie Kang, Zahra Bibak Bejandi, Sumaiya Shahjahan, Ahmad Alzein, Ali R Djalilian","doi":"10.3390/medicina61030460","DOIUrl":"10.3390/medicina61030460","url":null,"abstract":"<p><p>Dry eye disease (DED), also known as keratoconjunctivitis sicca, is a multifactorial ocular disease characterized by tear film insufficiency due to diverse etiologies including aging, incomplete and infrequent blinking, hormonal changes, medications, and systemic diseases. Classified into aqueous-deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed subtypes, DED presents with symptoms such as irritation, stinging, redness, foreign body sensation, sensitivity to light, and blurred or fluctuating vision. While rare, severe cases may lead to vision loss. With its rising global prevalence across age groups, DED poses a significant public health challenge. Primary care physicians (PCPs), often the first point of contact for DED patients, require timely screening and management strategies. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of DED, emphasizing practical approaches for PCPs. This narrative review was conducted by searching MEDLINE, PubMed, and Google Scholar databases for relevant articles. Diagnostic approaches, including detailed history taking, patient-reported questionnaires, differential diagnosis, and assessments are discussed alongside management strategies, including symptomatic ophthalmic treatment, risk factor mitigation (e.g., reduced digital device screen time), prevention, and nutrition. By providing a synopsis of early symptoms that PCPs are often the first to encounter, practical approaches to screening and managing DED in the primary care setting, and guidelines on when to refer to specialty care, this comprehensive review aims to equip PCPs with the knowledge to improve DED screening and optimize patient outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of CXCR2, MMP-2, and MMP-9 in the Pathogenesis of Placenta Accreta: A Molecular Expression Study.","authors":"Putri Mirani, Krisna Murti, Peby Maulina Lestari, Iche Andriyani Liberty, Cindy Kesty, Hana Andrina, Bella Stevanny","doi":"10.3390/medicina61030461","DOIUrl":"10.3390/medicina61030461","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The pathogenesis of placenta accreta spectrum disorder (PASD) is influenced by the inflammatory process. Therefore, the examination of biomarkers related to the inflammatory process, namely matrix metalloproteinase (MMP) and CXC motif chemokine receptor 2 (CXCR2), is expected to bring researchers to a bright spot regarding the pathogenesis of PASD. This study analyzes the role of CXCR2, MMP-2, and MMP-9 in the pathogenesis of PASD. <i>Materials and Methods</i>: An observational study with a case-control design was conducted to assess differences in the mean density of CXCR2, MMP-2, and MMP-9 immunostaining in placental and uterine tissue in 17 patients with PASD and 34 patients without PASD at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin Hospital Palembang. The expression of CXCR2, MMP-2, and MMP-9 was measured by immunohistochemistry analysis. The data were analyzed using STATA version 15. <i>Results</i>: There were no significant differences in the mean levels of MMP-2 expression in patients with and without PASD. There were significant differences in the expression of placental CXCR2 (<i>p</i> = 0.003), uterine CXCR2 (<i>p</i> < 0.001), and uterine MMP-9 (<i>p</i> = 0.018) in patients with and without PASD. <i>Conclusions</i>: CXCR2 and MMP-9 may play a role in the pathogenesis of PASD.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Complications in Radiofrequency Ablation for Hepatocellular Carcinoma: A Comprehensive Analysis of 1000 Cases.","authors":"Mohamed H Farag, Mohamed H Shaaban, Hamdy Abdelkader, Adel Al Fatease, Sara O Elgendy, Hussein H Okasha","doi":"10.3390/medicina61030458","DOIUrl":"10.3390/medicina61030458","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Primary liver cancer is a major cause of mortality, ranking third among the most fatal cancers. In Egypt, liver cancer constitutes 11.75% of gastrointestinal malignancies, with HCC representing 70.5% of cases. The landscape of HCC management was revolutionized by locoregional modalities, which offer a comparable alternative to conventional techniques, with low complications and minimal invasiveness. RFA is a technique that is suitable for early-stage lesions in the liver, with a high overall survival and low complication rates. However, the associated complications cause potential mortality and morbidity. The proper selection of patients may avoid such complications. This study presents a five-year experience of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in Egypt, analyzing the predictors of complications and the computed tomography (CT) features associated with complications post-ablation. <i>Materials and Methods</i>: The study included 1000 cases (84% males with a mean age of 60), with 90% having HCC. Exclusion criteria included prior chemoembolization and non-HCC primary hepatic tumors. Patients underwent RFA at Cairo University Hospital and two private centers from January 2014 to January 2019. The workup involved clinical assessments, lab tests, and CT scans. Complications were classified as major or minor. Statistical analysis was conducted via SPSS software Version 22.0, with associations evaluated using a chi-square test. A decision tree was employed to determine the predictive values for different variables associated with the complications. <i>Results</i>: Overall, the rate of complications was 4%, and mortality stood low at 0.1%. Subcapsular lesions were associated with complications, as well as the lesion size, site, Child-Pugh classification, and the number of RFA sessions. Decision tree analysis determined the size of a lesion to be the most predictive factor of major complications, whereas the site of the lesion predicted the occurrence of minor complications. <i>Conclusions</i>: RFA offers low complication rates; however, precise patient selection is critical. The approach and imaging modality choice influence the outcomes. Clinician experience enhances early complication detection, thereby allowing for effective treatments.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White Matter Microstructural Alterations in Type 2 Diabetes: A Combined UK Biobank Study of Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging.","authors":"Abdulmajeed Alotaibi, Mostafa Alqarras, Anna Podlasek, Abdullah Almanaa, Amjad AlTokhis, Ali Aldhebaib, Bader Aldebasi, Malak Almutairi, Chris R Tench, Mansour Almanaa, Ali-Reza Mohammadi-Nejad, Cris S Constantinescu, Rob A Dineen, Sieun Lee","doi":"10.3390/medicina61030455","DOIUrl":"10.3390/medicina61030455","url":null,"abstract":"<p><p><i>Background and objectives:</i> Type 2 diabetes mellitus (T2DM) affects brain white matter microstructure. While diffusion tensor imaging (DTI) has been used to study white matter abnormalities in T2DM, it lacks specificity for complex white matter tracts. Neurite orientation dispersion and density imaging (NODDI) offers a more specific approach to characterising white matter microstructures. This study aims to explore white matter alterations in T2DM using both DTI and NODDI and assess their association with disease duration and glycaemic control, as indicated by HbA1c levels. <i>Methods and Materials</i>: We analysed white matter microstructure in 48 tracts using data from the UK Biobank, involving 1023 T2DM participants (39% women, mean age 66) and 30,744 non-T2DM controls (53% women, mean age 64). Participants underwent 3.0T multiparametric brain imaging, including T1-weighted and diffusion imaging for DTI and NODDI. We performed region-of-interest analyses on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), orientation dispersion index (ODI), intracellular volume fraction (ICVF), and isotropic water fraction (IsoVF) to assess white matter abnormalities. <i>Results:</i> We observed reduced FA and ICVF, and increased MD, AD, RD, ODI, and IsoVF in T2DM participants compared to controls (<i>p</i> < 0.05). These changes were associated with longer disease duration and higher HbA1c levels (0 < r ≤ 0.2, <i>p</i> < 0.05). NODDI identified microstructural changes in white matter that were proxies for reduced neurite density and disrupted fibre orientation, correlating with disease progression and poor glucose control. In conclusion, NODDI contributed to DTI in capturing white matter differences in participants with type 2 diabetes, suggesting the feasibility of NODDI in detecting white matter alterations in type 2 diabetes. Type 2 diabetes can cause white matter microstructural abnormalities that have associations with glucose control. <i>Conclusions:</i> The NODDI diffusion model allows the characterisation of white matter neuroaxonal pathology in type 2 diabetes, giving biophysical information for understanding the impact of type 2 diabetes on brain microstructure. Future research should focus on the longitudinal tracking of these microstructural changes to better understand their potential as early biomarkers for cognitive decline in T2DM.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of SBDP Protein as a Potential Biomarker for Early-Onset Subarachnoid Hemorrhagic.","authors":"Ita M Sari, Selfy Oswari, Paulus A Ong, Achmad Adam, Nur Atik","doi":"10.3390/medicina61030454","DOIUrl":"10.3390/medicina61030454","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Cerebral vasospasm is the most common complication of subarachnoid hemorrhage (SAH) that is related to high mortality and morbidity. Early biomarkers predicting those conditions are still limited. This study aims to analyze spectrin degradation products (SBDPs) as potential biomarkers for SAH patients, which can be used to monitor clinical outcomes. <i>Materials and Methods:</i> We conducted a prospective observational study in acute SAH within 72 h of onset. All patients underwent placement of continuous cerebrospinal drainage, and liquor was taken four times and analyzed using ELISA to measure SBDP150, SBDP145, and SBDP120 levels and analyzed using Friedman test and post hoc Wilcoxon analysis. The relationship between SBDP levels and vasospasm, as well as functional outcomes (using the Glasgow Outcome Scale-Extended, GOSE), was assessed. <i>Results:</i> We enrolled thirty-five patients: thirty patients with lumbar drainage (LD) and five with extra ventricular drainage (EVD). Friedman's analysis showed significant changes over time for SBDP120 (<i>p</i> = 0.0001) and SBDP145 (<i>p</i> = 0.0001), but not for SBDP150 (<i>p</i> = 0.218). Levels of SBDP120 on day 3 (<i>p</i> = 0.001), SBDP120 on day 5 (<i>p</i> = 0.022), and SBDP145 on day 3 (<i>p</i> = 0.005) in EVD group were higher than in the LD group. SBDP145 on day 5 was significantly higher in patients with vasospasm (<i>p</i> = 0.041 in all patients, <i>p</i> = 0.028 in LD patients), indicating its potential as an early biomarker for vasospasm. SBDP145 on day 7 (<i>p</i> = 0.014) is the strongest predictor of unfavorable GOSE at 90 days in all patients. In LD patients, SBDP145 on day 7 (<i>p</i> = 0.002), SBDP120 on day 7 (<i>p</i> = 0.009), and SBDP120 on day 10 (<i>p</i> = 0.043) were significantly associated with poor GOSE at 90 days. <i>Conclusions:</i> A higher level of SBDP145 on day 5 can predict vasospasm risk, while an elevated level of SBDP145 and SBDP120 on day 7 is a potential predictor of poor functional outcomes. SBDPs may serve as valuable biomarkers for SAH management.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder-A Complex Relationship with a Difficult Management in the Acute Setting.","authors":"Matteo Zanchetta, Gian Luigi Adani, Giorgio Micheletti, Gianmario Edoardo Poto, Stefania Angela Piccioni, Ludovico Carbone, Ilaria Monteleone, Marta Sandini, Daniele Marrelli, Natale Calomino","doi":"10.3390/medicina61030452","DOIUrl":"10.3390/medicina61030452","url":null,"abstract":"<p><p>The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis.","authors":"Yueyang Xin, Pei Lu, Shaodi Guan, Shaomeng Si, Rao Sun, Wei Xia, Hui Xu","doi":"10.3390/medicina61030453","DOIUrl":"10.3390/medicina61030453","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benzodiazepine that offers many benefits. Our analysis aims to evaluate the effectiveness and safety of remimazolam during short endoscopic procedures. <i>Materials and Methods:</i> We conducted a comprehensive search of the PubMed, Web of Science, ClinicalTrials.gov, and Turning Research Into Practice databases up to 31 December 2023, for randomized controlled trials published in English. Statistical analyses were performed using Cochrane Review Manager 5.4.1 and Stata Software/MP. <i>Results:</i> The success rate of sedation with remimazolam was slightly lower than that with propofol (RR: 0.99, 95% CI: 0.98~1.00; <i>p</i> = 0.004; I² = 42%). As for anesthetic effect-related outcomes, remimazolam did not show advantages in onset time (MD = 12.72, 95% CI: 6.53~18.90, <i>p</i> < 0.001, I² = 94%), recovery time (MD = 0.86, 95% CI: -0.55~2.27, <i>p</i> = 0.23, I² = 98%), or intraoperative body movement (RR: 1.18, 95% CI: 0.60~2.32, <i>p</i> = 0.62, I² = 87%). However, compared to propofol, remimazolam significantly reduced the incidence of several adverse events, including injection pain (RR: 0.07, 95% CI: 0.03~0.14, <i>p</i> < 0.001, I² = 69%), intraoperative hypotension (RR: 0.38, 95% CI: 0.31~0.47, <i>p</i> < 0.001, I² = 65%), bradycardia (RR: 0.25, 95% CI: 0.15~0.45, <i>p</i> < 0.001, I² = 0%), and respiratory depression (RR: 0.34, 95% CI: 0.25~0.46, <i>p</i> < 0.001, I² = 50%). The incidence of postoperative nausea and vomiting (PONV) was slightly higher with remimazolam (RD: 0.01, 95% CI: 0.00~0.03, <i>p</i> = 0.04, I² = 33%). <i>Conclusions:</i> Remimazolam is a promising sedative for short endoscopic procedures due to its superior safety profile despite a slightly lower sedation success rate compared to propofol.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Topiramate Versus Acetazolamide in the Management of Idiopathic Intracranial Hypertension: ASystematic Review and Meta-Analysis.","authors":"Abdullah Almaqhawi, Alia Alokley, Reham Alamri, Razan Alabdulqader, Ahmad Alali, Ayat Aleid, Amani Alhejji, Maryam N ALNasser","doi":"10.3390/medicina61030450","DOIUrl":"10.3390/medicina61030450","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Primary pseudotumor cerebri syndrome, another name for idiopathic intracranial hypertension (IIH), is a neurological condition marked by elevated intracranial pressure (ICP) that can result in papilledema without a known etiology. The purpose of this study is to compare the efficacy of topiramate and acetazolamide as medical treatments for IIH and to evaluate the long-term outcomes of both medications. <i>Materials and Methods</i>: This systematic review and meta-analysis followed the PRISMA guidelines and was approved by the International Prospective Register for Systematic Reviews (PROSPERO). This study included randomized clinical trials, retrospective and prospective cohort studies, and patients with idiopathic intracranial hypertension (IIH). Data extraction was performed using the Rayyan application, and the risk of bias was assessed using the Critical Appraisal Skills Program (CASP). <i>Results</i>: The findings revealed a statistically significant 67% increase in the likelihood of improvement at 6 months compared to the baseline with the administration of acetazolamide and topiramate. After six months of the drug administration, there was a 3.6 times decrease in visual obscuration compared to the baseline. A significant advantage of topiramate in IIH is the added benefit of weight loss, since obesity is a modifiable risk factor. However, acetazolamide remains the conventional treatment. <i>Conclusions</i>: This study found that acetazolamide and topiramate are both effective therapies for idiopathic intracranial hypertension (IIH), improving visual metrics and decreasing cerebrospinal fluid pressure. Topiramate aids in weight reduction, while acetazolamide is recommended for its ability to lower CSF pressure and alleviate visual changes. A combination treatment of topiramate and acetazolamide is recommended for better results.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}