Medical principles and practice : international journal of the Kuwait University, Health Science Centre最新文献

{"title":"Letter Regarding the Published Article \"Population Pharmacokinetics and Dose Optimization of Valganciclovir and Ganciclovir in Lung Transplant Recipients\".","authors":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1159/000550866","DOIUrl":"10.1159/000550866","url":null,"abstract":"","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"496-497"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Manifestations in Children with Celiac Disease - Part II: Salivary Changes, Immunological Markers, and their Correlation with Oral Health Status.","authors":"Sibel Acar, Güzide Aksu, Elif Esin Hameş, Miray Karakoyun, Sema Aydoğdu","doi":"10.1159/000549623","DOIUrl":"10.1159/000549623","url":null,"abstract":"<p><p><p>Objectives: Celiac disease (CD) is a systemic autoimmune disorder associated with various oral manifestations, including dental enamel defects (DED). This study aimed to investigate the correlation between enamel defects, other oral health-related factors, and salivary immunological markers in children with CD.</p><p><strong>Subject and methods: </strong>A total of 128 children, comprising 97 patients diagnosed with CD and 31 healthy controls, were included in this cross-sectional study. All participants underwent a thorough oral examination to assess for DED, caries experience, and recurrent aphthous stomatitis (RAS). Saliva samples were collected to measure stimulated salivary flow rate, buffer capacity, saliva pH, the levels of mutans streptococci and lactobacilli, anti-tissue transglutaminase (tTG) IgA, and anti-gliadin antibody (AGA) IgA.</p><p><strong>Results: </strong>Children with CD showed a significantly higher prevalence of DED and RAS compared to the healthy control group (p < 0.05). Serum IgA and tTG IgA levels positively correlated with salivary IgA and tTG IgA levels (p = 0.02, p = 0.00). A statistically significant positive correlation was found between the presence of enamel defects and the salivary levels of both tTG IgA and AGA IgA (p < 0.05). No significant difference was observed in caries experience between the groups.</p><p><strong>Conclusion: </strong>CD is associated with significant oral health disadvantages in children, including a higher prevalence of enamel defects. The correlation between these defects and salivary immunological markers suggests that saliva analysis could serve as a promising, noninvasive tool for monitoring disease-related oral manifestations in pediatric patients. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"181-189"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter regarding the Article \"Association between D-Dimer and Long-Term Major Adverse Cardiovascular Outcomes in Patients with Masked Hypertension\".","authors":"Ugur Köktürk","doi":"10.1159/000550378","DOIUrl":"10.1159/000550378","url":null,"abstract":"","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"299-300"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Predictive Value of the Endothelial Activation and Stress Index in Determining the Severity and Prognosis of Acute Pulmonary Embolism.","authors":"Orhan Karayiğit, Muhammet Cihat Çelik, Murat Gök, Ahmet Balun, Burcunur Karayiğit, Funda Başyiğit, Zehra Güven Çetin","doi":"10.1159/000550677","DOIUrl":"10.1159/000550677","url":null,"abstract":"<p><p><p>Objectives: The endothelial activation and stress index (EASIX) has gained growing recognition as a potential marker for evaluating endothelial dysfunction and survival outcomes across diverse clinical conditions. This research aimed to assess the utility of the EASIX score in predicting disease severity and prognosis in patients diagnosed with acute pulmonary embolism (APE).</p><p><strong>Methods: </strong>A retrospective analysis was carried out on 364 consecutive patients diagnosed with APE at our hospital between 2022 and 2025. The cohort included 193 female (53%), with an average age of 64.8 ± 15.8 years. Based on clinical severity, patients were stratified into three categories: low-risk, intermediate-risk, and high-risk APE. Calculation of the EASIX score was performed using the following formula: lactate dehydrogenase (U/L) × serum creatinine (mg/dL)/platelet count (109/L).</p><p><strong>Results: </strong>Higher EASIX scores independently predicted both the high-risk APE and in-hospital mortality. Additionally, the EASIX score showed positive correlations with the simplified Pulmonary Embolism Severity Index (sPESI), troponin, and N-terminal pro-brain natriuretic peptide. Receiver operating characteristic (ROC) curve analysis identified an optimal EASIX cutoff value of 1.18 for predicting high-risk APE, offering a sensitivity of 77.5% and a specificity of 72.1%, with an area under the curve (AUC) of 0.816. Comparative ROC curve analysis revealed that the EASIX score (AUC = 0.835) exhibited a higher discriminative ability for in-hospital mortality compared to both the sPESI (AUC = 0.710) and Wells (AUC = 0.592) scores.</p><p><strong>Conclusion: </strong>The EASIX score appears to be a reliable and easily obtainable marker for assessing both disease severity and prognosis in APE. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"285-293"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactate, a Spearhead of Cancer Aggressiveness: Metabolic Reprogramming, Immune Suppression, and Metastatic Progression.","authors":"Yunus A Luqmani","doi":"10.1159/000552146","DOIUrl":"10.1159/000552146","url":null,"abstract":"<p><p><p>Reprogramming of cellular energy metabolism is a defining feature of malignancy, characterized by sustained glucose conversion to lactate under aerobic conditions. Once viewed as metabolic waste or a consequence of mitochondrial dysfunction, lactate is now recognized as a multifunctional metabolite that actively drives malignant progression. This review advances the concept of lactate as a spearhead of malignancy that coordinates metabolic adaptation with microenvironmental conditioning, immune suppression, epigenetic regulation, and metastatic dissemination. Beyond its role in metabolism, lactate functions through receptor-mediated signaling and histone lactylation, linking metabolic state to transcriptional programs associated with epithelial-mesenchymal transition, stemness, immune modulation, and therapeutic resistance. Lactate also reshapes the tumor microenvironment by promoting angiogenesis, stromal activation, immune suppression, and invasive behavior, including effects that cannot be explained solely by extracellular acidosis. Together, these observations support lactate as a critical effector of metastatic competence and a strategic target for disrupting multiple cancer hallmarks. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"301-322"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Burden in Mild Autonomous Cortisol Secretion: A Cross-Sectional Comparative Study.","authors":"İsmail Engin, Mazhar Müslüm Tuna","doi":"10.1159/000552080","DOIUrl":"10.1159/000552080","url":null,"abstract":"<p><p><p>Objective: Mild autonomous cortisol secretion (MACS) is characterized by cortisol excess without overt Cushing's syndrome. While metabolic complications are well documented, the psychological burden remains incompletely understood. This study aimed to assess self-reported depressive and anxiety symptoms and health-related quality of life in MACS patients using validated Turkish instruments and compare findings with Turkish population norms.</p><p><strong>Methods: </strong>This cross-sectional study included 40 MACS patients (34 women, 6 men; mean age 56.3 ± 9.3 years) from 45 newly diagnosed patients (3 excluded as per exclusion criteria, 2 declined). MACS was diagnosed according to European Society of Endocrinology guidelines. As part of institutional protocol, psychological assessments were routinely performed at diagnosis for all newly diagnosed patients. Assessments included Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Short Form-36 (SF-36) using validated Turkish versions.</p><p><strong>Results: </strong>Mean BDI category score was 1.93 ± 0.80 (minimal-to-mild depressive symptoms) and mean BAI category score was 2.30 ± 0.82 (mild anxiety symptoms). SF-36 scores were significantly lower than Turkish population norms across all domains except emotional well-being (p < 0.001 for all significant domains except bodily pain, p = 0.012). Subgroup analysis by post-dexamethasone cortisol levels showed no significant differences in psychological parameters.</p><p><strong>Conclusions: </strong>MACS patients exhibit impaired quality of life across most SF-36 domains compared to Turkish population norms, despite only mild self-reported depressive and anxiety symptoms. Although limited by the absence of a matched control group and potential confounding by metabolic comorbidities, these findings suggest that psychological screening and quality of life assessment may be valuable in MACS evaluation. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"460-466"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenge of Hypophosphatasia Diagnosis in Patients with Fibromyalgia.","authors":"Tamara L Rodríguez-Araya, Anastasia Mocritcaia, Eva González-Roca, María B Busso, Xavier Torres, Chafik A Chacur, Anna Arias, Luciano Polino, Collin D Adao, Helena Flórez, Pilar Peris","doi":"10.1159/000548638","DOIUrl":"10.1159/000548638","url":null,"abstract":"<p><strong>Objective: </strong>Recent reports suggest that mild forms of hypophosphatasia (HPP) may be misdiagnosed as fibromyalgia (FM), thus exposing patients to potential complications (e.g., fractures). It seems reasonable to determine alkaline phosphatase (ALP) levels in all patients diagnosed with FM. We aimed to study this clinical recommendation by assessing the prevalence of HPP in a cohort of patients diagnosed with FM in a specialized unit.</p><p><strong>Subjects and methods: </strong>This retrospective study (2014-2021) included 713 patients with FM and previous determinations of ALP levels from a Multidisciplinary Fibromyalgia Unit of a Rheumatology Department. Medical records (ALP levels, history of fractures, radiologic studies, pharmacological treatment, and comorbidities) were reviewed. Patients with at least two ALP determinations under normal values were further evaluated with a study of bone metabolic parameters, ALP substrate [PLP: pyridoxal-5'-phosphate] and genetic testing for alkaline phosphatase, liver/bone/kidney (ALPL) pathogenic variants.</p><p><strong>Results: </strong>16 (3.2%) FM patients (all women with a median age of 50 years) showed low ALP levels. Notably, 5 patients (31.3%) also showed elevated PLP levels, suggesting HPP. However, none presented pathogenic ALPL variants in the genetic study. Other associated conditions, such as subclinical hypothyroidism and the use of dietary supplements/multivitamins, were observed in some of these patients.</p><p><strong>Conclusion: </strong>In the present cohort, 3.2% presented persistently decreased ALP levels. The increased ALPL substrate, PLP, observed in one third of these subjects, together with the negative genetic study in all these subjects, indicate the need to better identify the subjects with FM that may have mild forms of HPP.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"144-153"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Anxiety Levels with Salivary Cortisol Levels in Patients Undergoing Endodontic and Restorative Treatment.","authors":"Alev Ercan, Tufan Ozasir, Birgul Ozasir, Izel Yesil, Zeynep Serra Arslan, Kamran Gulsahi","doi":"10.1159/000547716","DOIUrl":"10.1159/000547716","url":null,"abstract":"<p><p><p>Objectives: This clinical within-subjects study aimed to compare patients' stress levels at the beginning and end of endodontic treatment (ET) and restorative treatment (RT) and to examine whether a correlation exists between dental anxiety levels, as measured by anxiety assessment tests, and cortisol levels obtained from saliva.</p><p><strong>Subjects and methods: </strong>Forty-four patients who required ET and RT on a maxillary premolar were selected. They were asked to complete the Corah's Dental Anxiety Scale (CDAS) before and after each treatment phase. Saliva samples were collected and analysed to determine their salivary cortisol levels using validated liquid chromatography-tandem mass spectrometry. Intragroup comparisons of the CDAS scores and salivary cortisol levels were conducted using the Wilcoxon signed-rank test, while intergroup comparisons were performed using the Mann-Whitney U test. Correlations were assessed using Spearman's method.</p><p><strong>Results: </strong>Statistically significant reductions were observed in the CDAS scores and cortisol levels during treatment. Specifically, the CDAS scores significantly decreased from the pre-ET phase to the post-ET phase (p = 0.004), and from the pre-RT phase to the post-RT phase (p < 0.001). Additionally, the salivary cortisol levels after the post-RT phase were significantly lower than in both the pre-RT and pre-ET phases (p < 0.001).</p><p><strong>Conclusion: </strong>Although the patients reported higher anxiety levels before ET than RT, the absence of a control condition and the time gap between the sessions limited the interpretation of these findings and prevented definitive causal conclusions. No statistically significant correlation was found between the CDAS scores and the cortisol levels. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"71-80"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of Subclinical Visual Pathway Dysfunction in Polio Survivors: A Visual Evoked Potential Study.","authors":"Şencan Buturak, Halit Fidanci","doi":"10.1159/000548020","DOIUrl":"10.1159/000548020","url":null,"abstract":"<p><p><p>Objective: The aim of this study was to assess visual evoked potential (VEP) abnormalities as indicators of subclinical visual pathway dysfunction in polio survivors (PSs) and to examine the relationship between visual cortical excitability and fatigue severity.</p><p><strong>Subjects and methods: </strong>Thirty PSs with a history of childhood poliomyelitis and 30 healthy age- and sex-matched controls underwent pattern-reversal VEP (PRVEP) and flash VEP testing between July 2022 and November 2024 in this prospective case-control study. Participants with ophthalmologic, neurological, or systemic diseases affecting visual pathways were excluded. Fatigue Severity Scale (FSS) scores were assessed in all PSs.</p><p><strong>Results: </strong>Compared to controls, PSs demonstrated significantly reduced amplitudes of the positive wave appearing approximately 100 ms after the stimulus (P100) in PRVEP recordings (p < 0.05), while latencies and flash VEP amplitudes were comparable. VEP responses were unobtainable in two PSs. Seven of the PSs had post-polio syndrome. No significant differences in VEP findings were observed between PSs with and without post-polio syndrome. Fatigue was present in 87% of PSs (FSS >4), but no significant correlation was found between FSS scores and VEP parameters.</p><p><strong>Conclusion: </strong>The reduction in PRVEP amplitudes in PSs, in the absence of ophthalmologic pathology, may reflect subclinical involvement of central visual structures such as the lateral geniculate nucleus or reticular formation. These findings appear to be independent of subjective fatigue severity. </p>.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"162-168"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: \"Recurrent Takotsubo: Interpreting the 5.9-Fold 30-Day Cardiovascular Mortality Signal\".","authors":"Moritz Mirna, Albert Topf","doi":"10.1159/000549581","DOIUrl":"10.1159/000549581","url":null,"abstract":"","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"295-296"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}