Medicina-Lithuania最新文献

{"title":"Cognitive and Neuropsychiatric Effects of 40 Hz tACS Simultaneously with Cognitive Exercises for Dementia: A Randomized, Crossover, Double-Blind, Sham-Controlled Study.","authors":"Maria Anabel Uehara, Sumeet Kalia, Mari Garcia Campuzano, Mohammad Jafari-Jozani, Brian Lithgow, Zahra Moussavi","doi":"10.3390/medicina61040757","DOIUrl":"https://doi.org/10.3390/medicina61040757","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Transcranial alternating current stimulation (tACS) at 40 Hz has shown potential to enhance cognitive function. However, research on its combination with cognitive exercises, particularly its long-term effects in a dementia population, remains limited. This study investigated the effects of 40 Hz tACS paired with simultaneous cognitive exercises on cognition, neuropsychiatric symptoms, and the depression status of individuals with dementia in a sham-controlled, double-blind crossover design. <i>Materials and Methods</i>: A total of 42 participants with dementia were randomized into two groups: (1) the R1S2 group received 40 Hz real tACS with cognitive exercises, followed by a ≥8-week washout period, and then sham tACS with cognitive exercises; (2) the S1R2 group received the reversed sequence. tACS was applied at 1.5 mA peak-to-peak with electrodes over the left dorsolateral prefrontal cortex and contralateral supraorbital area. Participants received two 30 min stimulation sessions per day, 5 days per week, for 4 consecutive weeks, paired with cognitive exercises using the MindTriggers app (2.9.1). The primary outcome was the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the secondary outcomes included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Neuropsychiatric Inventory Questionnaire (NPI-Q). All outcome measures were assessed before and after each treatment block. <i>Results</i>: Real tACS paired with cognitive exercises significantly improved ADAS-Cog scores post-treatment compared to pre-treatment (<i>p</i>-value = 0.019), whereas sham tACS did not. Furthermore, real tACS produced significant long-term improvements approximately 2-3 months post-treatment in ADAS-Cog scores compared to sham (<i>p</i>-value = 0.048). Both real (<i>p</i>-value = 0.003) and sham (<i>p</i>-value = 0.015) tACS significantly reduced NPI-Q scores post-treatment. MADRS scores significantly improved (<i>p</i>-value = 0.007) post-treatment for real tACS but not sham. <i>Conclusions</i>: The 40 Hz tACS paired with cognitive exercises improves cognition, neuropsychiatric symptoms, and depression post-treatment in dementia, with sustained cognitive effects. The findings highlight its potential as a non-invasive therapeutic intervention for dementia.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044827","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":"Effect of NT-proBNP on Serum Calcium: A Longitudinal Analysis.","authors":"Maria Rita Stancanelli, Giuseppe Restivo, Thea Corriere, Carmela Cannarozzo, Maria Gabriella Ferrara, Rosario Salemi, Maria Eva Sberna, Angelo Iraci, Ada Restivo, Valeria Furia, Elisa Longhitano, Domenico Santoro, Vincenzo Calabrese","doi":"10.3390/medicina61040755","DOIUrl":"https://doi.org/10.3390/medicina61040755","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Brain natriuretic peptide (NT-proBNP) is a biomarker widely used in diagnosing and monitoring heart failure. Its impact on electrolyte homeostasis is known, particularly for sodium. However, its relationship with serum calcium remains unclear. This retrospective observational study aimed to investigate the longitudinal association between NT-proBNP and serum calcium levels in a cohort of hospitalized patients with the goal of determining whether NT-proBNP could have a direct or indirect impact on calcium metabolism. <i>Materials and Methods</i>: We included 688 patients with 1022 repeated measurements of NT-proBNP and serum calcium collected during hospitalization from March 2022 to February 2025. Linear mixed models (LMMs) were employed to analyze longitudinal associations, adjusting for age, eGFR, estimated plasma volume status (ePVs), CRP, potassium, and albumin. <i>Results</i>: Baseline analysis revealed a negative correlation between NT-proBNP and serum calcium (r = -0.23, <i>p</i> < 0.001). Univariate LMM demonstrated a significant negative association (β = -1.3 × 10^-5, <i>p</i> < 0.001), which remained significant in multivariate analysis (β = -6.9 × 10^-6, <i>p</i> = 0.01), accounting for intrasubject variability. This suggests that as NT-proBNP increases, serum calcium levels decrease within individual patients, independent of confounders. This study's findings indicate that NT-proBNP may influence calcium excretion, possibly through mechanisms involving the sodium-calcium exchanger (NCX) in renal tubules, similar to its effects on sodium homeostasis. <i>Conclusions</i>: This is the first study to evaluate the longitudinal impact of NT-proBNP on serum calcium, highlighting a potential clinical relevance in patients with cardiac dysfunction. Limitations include a retrospective design and a lack of urine calcium data. Further research is warranted to validate these findings and elucidate the underlying mechanisms.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039663","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 Impact of Early Epidural Analgesia on the Course of Labor and Delivery.","authors":"Atene Simanauskaite, Gabriele Kavaliauskaite, Justina Kacerauskiene, Vilda Vilimiene","doi":"10.3390/medicina61040750","DOIUrl":"https://doi.org/10.3390/medicina61040750","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This study aimed to assess the impact of early epidural analgesia (EA) on the progression of labor and delivery outcomes among nulliparous women. <i>Materials and Methods</i>: A retrospective analysis was conducted utilizing data from the Birth Registry of the Department of Obstetrics and Gynecology at LUHS. The dataset encompassed women who underwent childbirth between 1 January 2021 and 31 December 2021 and who received EA for labor pain management. A total of 89 women with low-risk deliveries and EA were included in the study. The cohort was divided into two groups: Group I-parturients who underwent early EA with cervical dilatation ≤3 cm-and Group II-parturients who underwent EA with cervical dilatation >3 cm but <7 cm. The results were processed using IBM SPSS. <i>Results</i>: Group I consisted of 25 (28.1%) women and Group II consisted of 64 (71.9%). The prevalence of obesity was higher in Group II (<i>p</i> = 0.021). Bishop score was statistically elevated in Group II (<i>p</i> = 0.018). Upon hospital admission, Group II exhibited greater cervical dilation (<i>p</i> = 0.001). The rate of cervical dilation was higher in Group II at 1.54 cm/h (<i>p</i> = 0.033). Episiotomy was more frequently performed in Group II (<i>p</i> = 0.014). The average durations of the first stage of labor (<i>p</i> = 0.045), the second stage of labor (<i>p</i> = 0.033), and the overall labor (<i>p</i> = 0.023) were prolonged in Group I. <i>Conclusions</i>: The cervical dilation up to 10 cm occurs at a swifter pace when EA is administered following cervical dilation exceeding 3 cm. Notable associations were observed between EA and the incidence of episiotomy as well as the duration of labor stages. Early EA exhibited no impact on neonatal outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019992","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":"Folic Acid Mitigates Sertraline-Induced Liver Damage in Adult Female Albino Rats During Pregnancy and Postpartum: A Biochemical and Histological Study.","authors":"Ayman A Refai, Mohammad I Jumaa, Einas M Yousef, Ala M Aljehani, Rana Ahmed Alduraywish, Mohamed R Elkabary, Safaa M Hanafy, Hanan S Seleem, Eman S El-Roghy","doi":"10.3390/medicina61040751","DOIUrl":"https://doi.org/10.3390/medicina61040751","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is frequently prescribed during pregnancy to treat mood disorders. Studies indicate that chronic use of sertraline is associated with elevated liver enzymes, oxidative stress, and histological alterations in the liver. Folic acid, a recommended supplement currently used during the first trimester of pregnancy, has antioxidant and anti-inflammatory effects. Hence, folic acid might be a potential protective agent against sertraline-induced liver injury. The current study aimed to investigate the possible hepatotoxic effects of sertraline administration during pregnancy and early postpartum. In addition, we sought to evaluate the potential protective effects of folic acid supplementation in alleviating any sertraline-induced liver damage. <i>Materials and Methods:</i> Eighty pregnant albino rats were randomly divided into four groups: control, folic acid-treated, sertraline-treated, and folic acid-sertraline-treated. Each group was divided into rats euthanized immediately after giving birth (0 h) or 14 days postpartum. Biochemical, histological, and immunohistochemical evaluations of liver function and structure were conducted. <i>Results:</i> Administration of sertraline was associated with a significant increase in hepatic enzymes (ALT and AST) and disrupted lipid profile (elevated cholesterol, triglycerides, and LDL-c) compared to the control group. Increased apoptosis was evidenced by increased caspase 3 expression and histological alterations, including vacuolation and inflammatory infiltrates, in sertraline-treated rats. Folic acid supplementation effectively mitigated these effects by preserving liver architecture, normalizing biochemical markers (ALT, AST, and lipid profile changes), and reducing apoptotic activity (lower caspase 3 expression). <i>Conclusions:</i> Folic acid mitigated sertraline-induced hepatic damage in pregnant rats. This suggests the potential benefits of using folic acid during the whole duration of pregnancy in patients treated with sertraline.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024893","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":"A Comparative Longitudinal Study Analyzing Vaginal Microbiota Differences Between Term and Preterm Pregnancies in Korean Women.","authors":"Gina Nam, Kyung A Lee, Soo Jung Kim, Kwan Young Oh, Sunghee Lee, Hyun Chul Lee, So Yoon Kim, Mi Hye Park","doi":"10.3390/medicina61040752","DOIUrl":"https://doi.org/10.3390/medicina61040752","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, remains a significant public health concern due to its association with neonatal morbidity and mortality. Although studies have suggested that microbial factors in vaginal microbiota (VMB) influence PTB, longitudinal research on Korean women is limited. This study aimed to analyze VMB differences between term and preterm pregnancies in Korean women and their correlation with the cervical length (CL). <i>Materials and Methods</i>: A cohort of 60 pregnant Korean women (40 who had a term birth (TB) and 20 who had a PTB) was recruited. Vaginal samples were collected at five time points (first, second, and third trimester; 1-2 weeks postpartum; 1-2 months postpartum). Microbial DNA was extracted and analyzed using quantitative PCR targeting 12 bacterial species. The CL was measured in the second and third trimesters. <i>Results</i>: <i>Lactobacillus crispatus</i> was consistently dominant in the TB group, whereas PTB cases exhibited greater microbial diversity with elevated levels of <i>Prevotella salivae</i> and <i>Ureaplasma</i> species. The CL was significantly shorter in PTB cases, correlating with shifts in the VMB composition. <i>Conclusions</i>: A stable, <i>Lactobacillus</i>-dominant microbiome is protective in pregnancy, while increased diversity in PTB cases suggests microbial biomarkers for early risk prediction. Combining VMB profiling with CL measurement may enhance early, non-invasive PTB risk assessments.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024474","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":"3D CT-Based Preoperative Planning and Intraoperative Navigation in Reverse Shoulder Arthroplasty: Early Clinical Outcomes.","authors":"Elisa Troiano, Azzurra Masini, Giovanni Battista Colasanti, Caterina Drago, Stefano Giannotti, Nicola Mondanelli","doi":"10.3390/medicina61040749","DOIUrl":"https://doi.org/10.3390/medicina61040749","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. <i>Materials and Methods</i>: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24-108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. <i>Results</i>: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. <i>Conclusions</i>: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993783","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":"Tubeless Percutaneous Nephrolithotomy in the Barts 'Flank-Free' Modified Supine Position with 24-Hour Discharge: A Single-Center Experience.","authors":"Zoltán Kiss, Gyula Drabik, Mihály Murányi, Attila Nagy, Ioannis Kartalas Goumas, Tibor Flaskó","doi":"10.3390/medicina61040748","DOIUrl":"https://doi.org/10.3390/medicina61040748","url":null,"abstract":"<p><p><i>Background and Objectives:</i> To evaluate the effectiveness and outcomes of supine percutaneous nephrolithotomy (PCNL) using the Barts 'flank-free' position and ultrasound-guided puncture, assessing the feasibility of the tubeless technique for discharge within 24 h. <i>Materials and Methods:</i> We conducted a retrospective analysis of 208 patients across 220 renal units who underwent supine PCNL at a tertiary university hospital between May 2019 and December 2024. All procedures were performed by a single surgeon. Patient demographics, stone characteristics, and surgical outcomes were analyzed. The tubeless technique was applied in most cases, and outcomes were assessed in terms of operative time, complication rates, stone-free rates (SFRs), and length of hospital stay. <i>Results:</i> The mean operating time was 50.34 ± 30.80 min. Single-tract PCNL was performed in 94.55% of cases, with the tubeless technique used in 90% of patients. The overall complication rate was 9.55%, with no Clavien-Dindo grade IV-V complications observed. On the first postoperative day, 68.18% of patients were discharged, demonstrating 24 h discharge feasibility. SFR and complication rates aligned with existing literature. <i>Conclusions:</i> The Barts 'flank-free' position and ultrasound-guided puncture considerably improved surgical access and safety in supine PCNL. The tubeless technique facilitates faster recovery, making early discharge feasible, even with standard sheath sizes. Further research is warranted to validate these findings and optimize renal stone management outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022729","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 Mid-Trimester BUN and Creatinine Assessment in Predicting Preeclampsia: Retrospective Case-Control Study.","authors":"Ebru Celik Kavak, Cigdem Akcabay, Meryem Demircan, Ibrahim Batmaz, Cengiz Sanli, Ahmet Senocak, Mesut Ali Haliscelik, Miray Onat, Batuhan Tepe, Salih Burcin Kavak","doi":"10.3390/medicina61040746","DOIUrl":"https://doi.org/10.3390/medicina61040746","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Preeclampsia (PE) is a major cause of adverse perinatal outcomes. Early diagnosis of pregnant women at risk of PE can facilitate disease prevention and management. However, the presence of different phenotypes of the disease complicates its prediction. In particular, the challenges in the early diagnosis of term PE cases necessitate research on PE prediction in the second and third trimesters. This study aims to examine the association between PE development and mid-trimester blood urea nitrogen (BUN), serum creatinine, and the BUN/creatinine ratio in pregnant women. <i>Materials and Methods:</i> This retrospective case-control study was conducted on women diagnosed with PE. Pregnant women who underwent routine biochemical blood tests between the 18th and 24th weeks of gestation and subsequently gave birth at our hospital between January 2022 and May 2023 were categorized into three groups. Accordingly, healthy women who had term deliveries were classified as Group 1 (150 cases), women diagnosed with PE were classified as Group 2 (58 cases), and those diagnosed with severe PE were classified as Group 3 (44 cases). <i>Results:</i> There were no significant differences in age, gravidity, parity, body mass index, or gestational week at blood sampling between the patient and control groups (<i>p</i> > 0.05). When comparing the mean blood urea nitrogen, serum creatinine, and BUN/creatinine ratios, a significant difference was observed between the control group and those who developed PE (<i>p</i> = 0.001, <i>p</i> < 0.001, and <i>p</i> = 0.031, respectively). Univariate analysis revealed a significant association between BUN levels and PE development (OR 1.083; 95% CI, 1.031-1.139; <i>p</i> = 0.002). A stronger association was observed between serum creatinine levels and PE development (OR 112.344; 95% CI, 11.649-1083.416; <i>p</i> < 0.001). However, no significant association was found between the BUN/creatinine ratio and PE in univariate analysis (OR 1.003; 95% CI, 0.979-1.028; <i>p</i> > 0.05). Mid-trimester BUN and serum creatinine levels were significantly higher in patients who developed PE and severe PE. The AUC value for the BUN parameter in predicting PE was 0.614 (AUC 0.614; 95% CI, 0.539-0.689; <i>p</i> = 0.002). A BUN cut-off value of 16.2 mg/dL predicted disease development with a sensitivity of 52.9% and a specificity of 74%. Similarly, the AUC value for the serum creatinine parameter in predicting PE was 0.644 (AUC 0.644; 95% CI, 0.574-0.751; <i>p</i> < 0.001). A serum creatinine cut-off value of 0.58 mg/dL was able to predict disease development with 37.2% sensitivity and 88% specificity. No significant AUC value was obtained for the BUN/creatinine ratio (<i>p</i> > 0.05). <i>Conclusions:</i> Our findings indicate that elevated BUN and serum creatinine levels measured during the mid-trimester (18-24 weeks) are associated with an increased risk of developing preeclampsia.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046637","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":"Role of Nutritional Status in Acute Coronary Syndrome Patients with Diabetes.","authors":"Özlem Seçen, Muhammed Fuad Uslu","doi":"10.3390/medicina61040740","DOIUrl":"https://doi.org/10.3390/medicina61040740","url":null,"abstract":"<p><p><i>Background and Objectives:</i> This study aims to investigate the effect of Type 2 diabetes mellitus (DM) on nutritional status in acute coronary syndrome (ACS) patients and its relationship with various metabolic and hematologic parameters. <i>Materials and Methods:</i> A retrospective and cross-sectional design was used to analyze 485 acute coronary syndrome (ACS) patients who underwent angiography at Fethi Sekin City Hospital between 1 January 2020 and 1 January 2025. Clinical data, biochemical parameters (hemogram, glucose, creatinine, uric acid, lactate dehydrogenase (LDH), albumin, and cholesterol levels) were retrospectively analyzed. The Prognostic Nutrition Index (PNI) and CONUT score were calculated manually. <i>Results</i>: A total of 485 patients were included in this study. Patients were divided into two groups: patients with DM (n = 167) and patients without DM (n = 318). Glucose levels (<i>p</i> < 0.001) and triglyceride levels (<i>p</i> = 0.014) were significantly higher in patients with diabetes, while LDL cholesterol and total cholesterol levels were lower (<i>p</i> < 0.01). In addition, hemoglobin (<i>p</i> < 0.001), albumin (<i>p</i> = 0.010), and PNI scores (<i>p</i> = 0.014) were lower in patients with diabetes. Although CONUT scores were higher in patients with diabetes, this difference was not statistically significant (<i>p</i> = 0.267). Significant differences were observed in lipid profile and inflammation parameters in STEMI and NSTEMI subgroups, especially in patients with diabetes. In particular, triglyceride and neutrophil levels were found to be higher in NSTEMI patients among patients with diabetes. <i>Conclusions:</i> The PNI score may be a useful prognostic tool for predicting cardiovascular complications and determining treatment strategies in acute coronary syndrome patients with diabetes mellitus in whom nutritional status, inflammation, and lipid metabolism are significantly correlated.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039666","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":"Current Management and Future Challenges in the Management of Severe Traumatic Brain Injury.","authors":"Larissa Russo, Aasim Kazmi, Nasim Ahmed","doi":"10.3390/medicina61040738","DOIUrl":"https://doi.org/10.3390/medicina61040738","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Severe Traumatic Brain Injury (TBI) is one of the devastating injuries occurring in all ages across the globe. Despite many advancements in the management of severe TBI, mortality and morbidities remain high. Evidence-based management in severe TBI has reduced mortality. The purpose of this review is to discuss the current management and present the future challenges in this patient cohort. <i>Materials and Methods</i>: A literature review was conducted to identify the current practice patterns and guidelines of severe TBI. We examined the literature regarding medical and surgical managements of the severe TBI. <i>Results</i>: Initial management of severe TBI includes stabilization of the primary injury and prevention of secondary insult to brain. Hemodynamic, intracranial pressure and cerebral perfusion pressure monitoring, antiseizure prophylaxis, hyperosmolar therapy, sedation, medical induced coma, and nutritional and ventilatory support are part of the medical management. Operative intervention includes craniotomy and decompressive craniectomy. Most of the current practices are recommended by the Brain Trauma Foundation (BTF). These guidelines are based on the existing literature, however, some of the recommendations by the BTF lack level one evidence. <i>Conclusions</i>: BTF guidelines provide recommendations in the management of severe TBI. High quality prospective randomized trials are needed to further explore the new modalities and interventions in the field of severe TBI.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042126","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}