Medicina-Lithuania最新文献

{"title":"Effectiveness and Safety of Antibiotic Therapy Combined with NSAIDs or SAIDs in Osteomyelitis of the Oral and Maxillofacial Region: A Systematic Review.","authors":"Heilyn Joanna Nils, Cristina Arce Recatalá, Cosimo Galletti, Javier Flores-Fraile","doi":"10.3390/medicina61030499","DOIUrl":"10.3390/medicina61030499","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Osteomyelitis is a progressive bone infection requiring a combination of antimicrobial and anti-inflammatory therapies. While antibiotics remain the cornerstone of treatment, the role of NSAIDs and steroidal anti-inflammatory drugs (SAIDs) in modulating inflammation and improving clinical outcomes warrants further investigation. This systematic review evaluates the effectiveness and safety of combined antibiotic and NSAID/SAID therapy in osteomyelitis, aligning treatment strategies with disease stage and pathogenesis. <i>Materials and Methods:</i> A systematic search was conducted in Web of Science, Scopus, and PubMed from July 2024 to November 2024, following PRISMA and CARE guidelines. The studies were selected based on detailed pharmacological data, treatment outcomes, and follow-up analysis. The risk of bias was assessed using the Critical Appraisal Skills Programmed (CASP) tool. Statistical reliability between coders was evaluated using Cohen's kappa coefficient (κ = 0.636-0.909) and intra-class correlation coefficient (ICC = 1.0). <i>Results:</i> Four case studies, representing acute, chronic, recurrent, and SAPHO syndrome-associated osteomyelitis, demonstrated variable responses to combined therapy. Antibiotics alone were effective in acute cases, while NSAIDs/SAIDs significantly contributed to inflammatory control in chronic and immune-mediated osteomyelitis. Glucocorticoids (e.g., prednisolone, methylprednisolone) showed efficacy in reducing systemic inflammation, with no major adverse effects reported. The transition from intravenous to oral antibiotic therapy was observed in all cases, ensuring sustained infection control. <i>Conclusions:</i> This review highlights the critical role of NSAIDs/SAIDs in complementing antibiotic therapy, particularly in chronic and refractory osteomyelitis. Stage-specific pharmacological interventions improve treatment outcomes, and future research should explore bisphosphonates and immunomodulatory agents to refine therapeutic approaches. These findings reinforce the need for personalized osteomyelitis management based on pathogenesis, microbiology, and disease progression.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722310","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":"Graves' Disease: Is It Time for Targeted Therapy? A Narrative Review.","authors":"Nicola Viola, Alessandro Colleo, Mauro Casula, Chiara Mura, Francesco Boi, Giulia Lanzolla","doi":"10.3390/medicina61030500","DOIUrl":"10.3390/medicina61030500","url":null,"abstract":"<p><p>Current therapies for Graves' disease (GD) primarily aim to manage hyperthyroidism through synthetic antithyroid drugs, radioiodine, or surgery. However, these approaches are often limited by their incomplete efficacy and the risk of inducing hypothyroidism. The latest advances in understanding the autoimmune mechanisms driving GD have paved the way for novel therapies targeting the thyrotropin receptor (TSH-R) or immune pathways. Overall, key targets include cluster of differentiation 20 (CD20), cluster of differentiation 40 (CD40), protein tyrosine phosphatase non-receptor type 22 (PTPN22), cytotoxic T lymphocyte antigen-4 (CTLA-4), B cell-activating factor (BAFF), and the Fc receptor-like protein 3 (FcRL3). Recent preclinical studies and clinical trials testing targeted therapies have shown promising results in terms of efficacy and safety. Here, we present a narrative review of the literature on emerging therapeutic approaches for GD that are currently under investigation.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722136","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":"ECMO Support in Pediatric Populations with the Newborn ECMOLife Centrifugal Pump.","authors":"Carlo Pace Napoleone, Ignazio Condello, Maria Teresa Cascarano, Enrico Aidala, Licia Peruzzi, Isabella Molinari, Cristina Rivoldini, Maria Stella Di Carlo, Stefania Iannandrea, Enrico Bonaveglio","doi":"10.3390/medicina61030493","DOIUrl":"10.3390/medicina61030493","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Pediatric ECMO is a valid support mechanism for refractory cardiac and/or respiratory failure. Magnetic levitation technology applied to the centrifugal pump has reduced the hemolysis caused by this procedure, which can be particularly dangerous, especially in neonates and small children. ECMOLife, a new magnetic levitation centrifugal pump, has been introduced for these patients. <i>Materials and Methods</i>: Four patients were supported with the ECMOLife System in a newborn setting, with veno-venous application in two cases and veno-arterial in the other two. All parameters related to pump functioning, anticoagulation, hemolysis, and inflammation were recorded for the duration of the support. <i>Results</i>: All patients survived the procedure, in three cases achieving recovery, while one veno-arterial ECMO was switched to VAD, and then the patient underwent heart transplantation. All recorded parameters were compatible with clinical conditions. In particular, free haemoglobin was close to 0 g/L in all recorded samples. The possibility of monitoring pump functioning parameters, venous and arterial O2 saturation, and venous and arterial pressures creates an opportunity to check the adequacy of mechanical support for the clinical condition of the patient. <i>Conclusions</i>: This is the first reported experiment in a newborn setting with ECMOLife mechanical support. At present, ECMOLife represents the only system with a newborn and pediatric pump, allowing for the continuous monitoring of perfusion and hemodynamic parameters, with a large number of facilities for transportation available.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722202","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":"One-Stage Technique with Calcaneal Graft for the Treatment of Brachymetatarsia: A Case Report.","authors":"Mercedes Ortiz-Romero, Álvaro Fernández-Garzón, Rocío Caceres-Matos, Raquel García de la Peña, Ana M Rayo-Perez, Luis M Gordillo-Fernández","doi":"10.3390/medicina61030497","DOIUrl":"10.3390/medicina61030497","url":null,"abstract":"<p><p>Brachymetatarsia is a rare congenital anomaly characterized by the shortening of one or more metatarsals, which can lead to functional impairment, pain, and aesthetic concerns. This case report describes a 17-year-old female patient with brachymetatarsia affecting the third and fourth metatarsals of the right foot, which was unresponsive to conservative treatment and caused persistent pain while standing. To address this condition, a single-stage surgical approach was performed using an autologous calcaneal bone graft to lengthen the affected metatarsals. Additionally, the second and fifth metatarsals were shortened to restore a physiological metatarsal parabola and resolve chronic metatarsalgia. The procedure resulted in complete correction of the metatarsal parabola, full resolution of metatarsal pain, and satisfactory functional recovery. The use of an autologous calcaneal graft proved to be an effective and reliable surgical option due to its cortico-cancellous composition, high osteogenic potential, and low antigenicity. This case highlights the advantages of autologous bone grafting as a valuable technique in the surgical management of brachymetatarsia.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722226","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":"Comparison of Mortality Prediction Between the Model for End-Stage Liver Disease-3.0 (MELD-3.0) and the Model for End-Stage Liver Disease-Lactate (MELD-La) in Korean Patients with Liver Cirrhosis.","authors":"Seung-Kang Yoo, Jeong-Han Kim, Won-Hyeok Choe, So-Young Kwon","doi":"10.3390/medicina61030494","DOIUrl":"10.3390/medicina61030494","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The Model for End-Stage Liver Disease (MELD) score has widely been used for mortality prediction in liver cirrhosis (LC) patients and transplantation allocation. There have been recent modifications of MELD scores, such as MELD-Lactate (MELD-La) and MELD-3.0. The goal of this study was to compare MELD, MELD-La, and MELD-3.0 in predicting mortality among LC patients in Korea. <i>Materials and Methods</i>: This is a retrospective, single-centered study in which LC patients admitted to Konkuk University Hospital between January 2011 and December 2022 were enrolled and reviewed. Predictive values for 1- and 3-month mortality for MELD, MELD-La, and MELD-3.0 were calculated using the area under the receiver operating characteristic (AUROC) curve. Differences between AUROCs were statistically analyzed using DeLong's test. <i>Results</i>: A total of 1152 patients were initially included in this study. Among them, 165 (14.3%) patients died within one month, and 211 (19.7%) died within three months. The AUROCs for 1-month mortality of MELD, MELD-La, and MELD-3.0 were 0.808, 0.79, and 0.807, respectively. For the 3-month mortality of MELD, MELD-La, and MELD-3.0, the AUROCs were 0.805, 0.753, and 0.817, respectively. Multiple comparisons of ROC curves demonstrated that MELD and MELD-3.0 reflected the 3-month mortality prediction of LC patients better than MELD-La (<i>p</i> = 0.0018, <i>p</i> = 0.0003, respectively). <i>Conclusions</i>: This study demonstrated that MELD and MELD-3.0 outperformed MELD-La in predicting the 3-month mortality for LC patients. However, there was no significant difference between MELD and MELD-3.0 in predicting LC patient mortality.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722037","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":"Total Thyroidectomy with Harmonic Scalpel Combined with Gelatin Thrombin Hemostatic: A Focus on the Elderly Population-A Multicentric Study.","authors":"Simona Parisi, Claudio Gambardella, Roberto Ruggiero, Giovanni Docimo, Vincenzo Marotta, Adelmo Gubitosi, Federico Maria Mongardini, Valerio D'Orazi, Francesca Fisone, Luigi Brusciano, Salvatore Tolone, Ludovico Docimo, Francesco Saverio Lucido","doi":"10.3390/medicina61030496","DOIUrl":"10.3390/medicina61030496","url":null,"abstract":"<p><p><i>Background and Objectives</i>: With the increasing life expectancy, the frequency of total thyroidectomies in elderly patients has risen, raising concerns regarding hemorrhage and recurrent laryngeal nerve palsy compared to the general population. Therefore, considering the frequent alteration of the coagulation status in such patients, innovative methods able to reach an accurate hemostasis appear highly desirable. This retrospective multicentric study aimed to compare the postoperative outcomes of patients treated with conventional hemostasis with patients treated with the Harmonic Scalpel (HS) and gelatin-thrombin matrix (Floseal). <i>Materials and Methods</i>: Patients undergoing total thyroidectomy were retrospectively enrolled and categorized into two groups: Group A patients underwent surgery with the Harmonic Scalpel and Floseal, while Group B underwent traditional hemostasis surgery with ligations and monopolar electrocautery. The primary endpoint was the drain output after 24 and 48 h and the presence of significant blood loss. Secondary endpoints included the presence of seroma, wound infection, hematoma, laryngeal nerve palsy, surgery duration, and onset of post-surgical hypocalcemia. <i>Results</i>: From January 2014 to January 2024, 870 individuals participated in the study. Group A (gelatin-thrombin and HS) comprised 502 patients, while Group B (Standard Hemostasis-control group) comprised 368 patients. The 24 h drain output was 52 ± 25 mL in Group A vs. 113 ± 27 mL in Group B, <i>p</i> = 0.003, while the 48 h drain output was 95 ± 29 mL in Group A and 113 ± 27 mL in Group B (<i>p</i> = 0.002). Significant blood loss occurred in eight patients (2.2%) of Group B vs. three cases (0.6%) in Group A (<i>p</i> = 0.039). Also, neck hematoma (<i>p</i> = 0.012), seroma (<i>p</i> = 0.005), and reoperation (<i>p</i> = 0.052) values were significantly lower in Group A. <i>Conclusions</i>: Surgery aided with HS, and gelatin-thrombin was associated with lower major and minor complications compared to the conventional approach, guarantying reduced operative time, ensuring hemostasis, and preserving parathyroid glands, even in elderly patients.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721931","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":"Multidimensional Comparison of Microsurgical Clipping and Endovascular Techniques for Anterior Communicating Artery Aneurysms: Balancing Occlusion Rates and Periprocedural Risks.","authors":"Vanessa Magdalena Swiatek, Amir Amini, Claudia Alexandra Dumitru, Lena Spitz, Klaus-Peter Stein, Sylvia Saalfeld, Ali Rashidi, I Erol Sandalcioglu, Belal Neyazi","doi":"10.3390/medicina61030498","DOIUrl":"10.3390/medicina61030498","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The anterior communicating artery is a common location for intracranial aneurysms. Anterior communicating artery aneurysms (AcomA) pose a significant risk of rupture. Treatment options include microsurgical clipping and endovascular techniques, but the optimal approach remains controversial. This study aims to compare the outcomes of these two treatment modalities in a single-center patient cohort using a comprehensive matching process based on clinical and morphological parameters. <i>Materials and Methods</i>: A retrospective analysis was conducted on 1026 patients with 1496 intracranial aneurysms treated between 2000 and 2018. After excluding cases lacking 3D angiography or aneurysms in other locations or without treatment, 140 AcomA were selected. The study matched 24 surgically treated AcomA cases with 116 endovascularly treated cases based on 21 morphological and clinical criteria, including age, sex, Hunt and Hess score, and Fisher grade. <i>Results</i>: The microsurgical clipping group demonstrated a significantly higher rate of complete aneurysm occlusion compared to the endovascular group (<i>p</i> = 0.007). However, this was associated with a higher incidence of postoperative ischemic complications in the surgical group (13 out of 24 cases) compared to the endovascular group (2 out of 116 cases). Despite these complications, no significant differences were found in clinical outcomes at discharge or follow-up, as measured by the modified Rankin Scale (<i>p</i> > 0.999). Both groups had comparable rates of hydrocephalus, vasospasm, and delayed cerebral ischemia. <i>Conclusions</i>: Microsurgical clipping resulted in higher aneurysm occlusion rates but carried an increased risk of ischemic complications compared to endovascular treatment. Clinical outcomes were comparable between the two modalities, suggesting that treatment decisions should be individualized based on aneurysm characteristics and patient factors. Further prospective studies are warranted to optimize treatment strategies for AcomA.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722047","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":"Enhanced Recovery After Cardiac Surgery for Minimally Invasive Valve Surgery: A Systematic Review of Key Elements and Advancements.","authors":"Simon Goecke, Leonard Pitts, Martina Dini, Matteo Montagner, Leonhard Wert, Serdar Akansel, Markus Kofler, Christian Stoppe, Sascha Ott, Stephan Jacobs, Benjamin O'Brien, Volkmar Falk, Matthias Hommel, Jörg Kempfert","doi":"10.3390/medicina61030495","DOIUrl":"10.3390/medicina61030495","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. <i>Materials and Methods</i>: A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. <i>Results</i>: Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4-20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. <i>Conclusions</i>: ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722337","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 Probiotics, Prebiotics, and Symbiotic Supplementation in Cystic Fibrosis Patients: A Systematic Review and Meta-Analysis of Clinical Trials.","authors":"Freiser Eceomo Cruz Mosquera, Claudia Lorena Perlaza, Anisbed Naranjo Rojas, Saray Murillo Rios, Alejandra Carrero Gallego, Sara Isabel Fischersworring, Juan Sebastián Rodríguez, Yamil Liscano","doi":"10.3390/medicina61030489","DOIUrl":"10.3390/medicina61030489","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Cystic fibrosis (CF), caused by CFTR gene mutations, primarily affects the respiratory and gastrointestinal systems. Microbiota modulation through probiotics, prebiotics, or synbiotics may help restore microbial diversity and reduce inflammation. This study aimed to evaluate their efficacy in CF. <i>Materials and Methods:</i> A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2024 was conducted in Cochrane, ScienceDirect, Web of Science, LILAC, BMC, PubMed, and SCOPUS following PRISMA guidelines. Methodological quality was assessed using the Jadad scale, and RevMan 5.4^® estimated effects on pulmonary function (FEV₁), exacerbations, hospitalizations, quality of life, and inflammatory markers. <i>Results</i>: Thirteen RCTs (<i>n</i> = 552), mostly in pediatric populations, were included. Most examined probiotics (e.g., <i>Lactobacillus rhamnosus GG</i>, <i>L. reuteri</i>), while four used synbiotics. Several studies reported reduced fecal calprotectin and proinflammatory interleukins (e.g., IL-6, IL-8), suggesting an anti-inflammatory effect. However, no significant differences were observed regarding hospitalizations or quality of life. Additionally, none of the studies documented serious adverse events associated with the intervention. The meta-analysis showed no significant decrease in exacerbations (RR = 0.81; 95% CI = 0.48-1.37; <i>p</i> = 0.43) or improvements in FEV₁ (MD = 4.7; 95% CI = -5.4 to 14.8; <i>p</i> = 0.37), even in subgroup analyses. Sensitivity analyses did not modify the effect of the intervention on pulmonary function or exacerbation frequency, supporting the robustness of the findings. <i>Conclusions</i>: Current evidence suggests that probiotics or synbiotics yield inconsistent clinical benefits in CF, although some reduction in inflammatory markers may occur. Larger, multicenter RCTs with longer follow-up are needed for clearer conclusions. Until more definitive evidence is available, these supplements should be considered experimental adjuncts rather than standard interventions for CF management.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11944062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722311","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":"Factors Influencing Cyanoacrylate Tissue Adhesive Outcomes for Corneal Thinning and Perforation.","authors":"Anjali Om, Anjali Badami, Yuqing Wang, Xiangqin Cui, Soroosh Behshad, Joung Kim, Praneetha Thulasi","doi":"10.3390/medicina61030492","DOIUrl":"10.3390/medicina61030492","url":null,"abstract":"<p><p><i>Background and Objectives</i>: To report the outcomes of cyanoacrylate tissue adhesive (CTA) in patients with corneal perforations and thinning. <i>Materials and Methods</i>: A retrospective interventional study of 83 eyes treated with CTA for corneal thinning or perforation at a single institution between 2010 and 2020. Primary endpoints leading to CTA failure, visual acuity, and surgical outcomes were evaluated. <i>Results</i>: At presentation, 55 (66%) had frank perforations and 28 (34%) had thinning or desmetocele. Univariate analysis showed that only multiple CTA applications were associated with CTA failure (<i>p</i> = 0.047). Multivariate analysis did not show any statistically significant variables associated with CTA failure. No variables were associated with the need for future surgery at 30 days or any further point. Older patients (<i>p</i> = 0.005), use of topical steroids before gluing (<i>p</i> = 0.03), corneal thinning (vs. perforation) (<i>p</i> = 0.02), location of pathology (<i>p</i> = 0.048), and multiple CTA applications (<i>p</i> = 0.046) were associated with worse visual outcomes in univariate analysis. Multivariate logistic regression analysis showed that older age (OR 1.05) and use of topical steroids before gluing (OR 3.84) showed higher odds, and systemic immunosuppression (OR 0.08) and single (versus multiple) CTA application (OR 0.11) showed lower odds of worse visual acuity (BCVA ≥ 20/200). The presence of an anterior chamber prior to gluing was associated with spontaneous dislocation of CTA (<i>p</i> = 0.015). Spontaneous dislocation versus manual removal of glue was not associated with final visual acuity (<i>p</i> = 0.7), nor was duration of glue on the cornea (<i>p</i> = 0.2). <i>Conclusions</i>: CTA remains a mainstay of management in patients with corneal thinning or perforation. Only multiple CTA applications were associated with CTA failure, and duration of glue on the cornea was not associated with final visual acuity.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"61 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722011","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}