Maedica最新文献

{"title":"Exploring the Knowledge and Attitudes of Physicians on Polypharmacy and Deprescribing in Clinical Practice: a Cross-Sectional Study.","authors":"Madhavi Eerike, Gerard Marshall Raj, Priyadharsini Rajendran, Veena Nayak, Paul Mathai, Vijaya Kumar Karra, Sakthivadivel Varatharajan, Rekha Priyadarshini, Gomathi Ramaswamy, Venugopalan Gunasekaran, Jayachandran Selvaraj, Sandhiya Selvarajan, Anu Chandran, Shivanand Kattimani, Rijesh Potangadi, Surendran Padinchara Kunhipilakkandiy, Narayanan Puthiya Veettil, Raghavendr Rao, Mukhyaprana Prabhu, Jerin Jose Cherian, Tanu Anand","doi":"10.26574/maedica.2025.20.2.264","DOIUrl":"10.26574/maedica.2025.20.2.264","url":null,"abstract":"<p><p>Objective: Polypharmacy, defined as the use of five or more medications, is increasingly prevalent among geriatric patients due to the complexity of managing multiple chronic conditions. This study aimed to evaluate physicians' knowledge of deprescribing, their familiarity with deprescribing tools and the factors influencing the deprescribing process.</p><p><strong>Materials and methods: </strong>This cross-sectional survey was conducted among 290 physicians from four prominent tertiary care centers in South India between October 2023 and March 2024. A self-administered semi-structured questionnaire was employed to evaluate physicians' knowledge of polypharmacy, attitudes toward fall-risk-increasing drugs (FRIDs) and practices related to deprescribing interventions. Data collection was managed using Microsoft Excel, while descriptive and bivariate analyses were performed using SPSS to analyze the findings.</p><p><strong>Results: </strong>The study revealed that a majority of physicians (148; 51.0%) were unfamiliar with the term \"deprescribing\" and reported no formal training in the practice. Analysis based on physicians' knowledge scores showed that participants with higher scores (≥28) demonstrated significantly greater awareness of the Tool to Improve Medications in the Elderly via Review (TIMER) and Fit fOR The Aged (FORTA) list compared to those with lower scores. Among these more knowledgeable physicians, 48.1% (n=13; p=0.054) were aware of TIMER but had not utilized it in practice, while 33.3% (n=9; p=0.016) reported familiarity with the FORTA list without its practical application.</p><p><strong>Conclusion: </strong>Deprescribing plays a vital role in managing polypharmacy and minimizing its associated risks in the aging population. However, its adoption is constrained by significant barriers, including a lack of awareness, insufficient formal training and limited integration of evidence-based deprescribing tools into clinical practice.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"264-274"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981156","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":"Innate Immunity Receptor TLR9 Drives Erythrocyte Cholesterol and Ferroprotin Accumulation in a Glutaminase-Independent Manner. Implications for Metabolic Associated Fatty Liver Disease.","authors":"Konstantinos Mimidis, Zoi Kyriakou, Nikolaos Politis, Panagiotis Veniamis, Dimitris Vlachos, Tentes Ioannis, Konstantinos Anagnostopoulos, Charalampos Papadopoulos","doi":"10.26574/maedica.2025.20.2.220","DOIUrl":"10.26574/maedica.2025.20.2.220","url":null,"abstract":"<p><strong>Background: </strong>During metabolic associated fatty liver disease (MAFLD), lipotoxicity induces toll-like receptor 9 (TLR9) upregulation and mitochondrial DNA-induced TLR9 activation in the liver, driving metabolic hepatic inflammation. We wondered whether there is augmented erythrocyte TLR9 in MAFLD and we explored the effect of erythrocyte TLR9 activation on cholesterol and sphingomyelin content, glutaminase activity and TLR9, ferroportin and monocyte chemoattractant protein 1 (MCP-1) levels.</p><p><strong>Methods: </strong>Twenty-four patients (15 men and nine women) with MAFLD and nine healthy controls (four men and five women) were enrolled. Erythrocytes were isolated from EDTA-containing blood. Protein levels were measured in erythrocyte lysates (Triton X-100 0.1% v/v), erythrocyte membranes (isolated by hypotonic lysis) with enzyme-linked immunosorbent assays, whereas lipids and enzyme activities were measured in erythrocyte hemoglobin-free membranes by a semi-quantitative thin layer chromatography and assay kits, respectively.</p><p><strong>Results: </strong>The total but not surface levels of TLR9 were increased (p=0.002) in erythrocytes of MAFLD patients. Erythrocyte TLR9 activation drove cholesterol and ferroportin-1 accumulation, but not glutaminase-1 upregulation. Toll-like receptor 9 activation did not induce a significant change on the levels of TLR9 and MCP-1.</p><p><strong>Conclusions: </strong>Erythrocyte TLR9 is upregulated in MAFLD patients and drives cholesterol and ferroportin-1 accumulation in a glutaminase-independent manner. Augmented erythrocyte TLR9 could participate in metabolic inflammation during MAFLD.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"220-227"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981348","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":"Factors Leading to Conversion from Laparoscopy to Open Surgery in Partial Nephrectomy: a Case Series and Literature Review.","authors":"Alexandru Iordache, Nicoleta Alina Mares, Niculae Iordache, Claudiu-Octavian Ungureanu, Razvan-Ionut Popescu, Octav Ginghina","doi":"10.26574/maedica.2025.20.2.228","DOIUrl":"10.26574/maedica.2025.20.2.228","url":null,"abstract":"<p><p>Minimally invasive surgery offers significant benefits for partial nephrectomy. Intraoperative incidents and postoperative complications lead to conversion to open surgery and increase perioperative morbidity and mortality. Understanding the factors that contribute to the occurrence of complications is important for reducing the perioperative risk. Between 2022 and 2024, we prospectively observed intraoperative complications in cases of partial nephrectomy performed laparoscopically in the Urology Department of 'Professor Dr. Theodor Burghele' Clinical Hospital, Bucharest, Romania. We report seven cases in which laparoscopic partial nephrectomy was converted to an open approach, requiring prompt management. The most common complication leading to conversion was the presence of adhesions, which made dissection of the planes difficult, followed by intraoperative bleeding, which hindered optimal visualization. Laparoscopic partial nephrectomy is challenging and its management must be individualized. Conversion during laparoscopic renal procedures is usually rare; however, a significant event is influenced by the complexity of the procedure and patient characteristics.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"228-234"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981240","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":"Early Experience with Robotic Pancreatic Resections: a Retrospective Cohort Study of 20 Consecutive Cases.","authors":"Danilo Coco, Silvana Leanza, Massimo Giuseppe Viola","doi":"10.26574/maedica.2025.20.2.151","DOIUrl":"10.26574/maedica.2025.20.2.151","url":null,"abstract":"<p><strong>Background: </strong>Robotic pancreatic surgery has emerged as a minimally invasive alternative to open procedures, offering potential benefits in precision and recovery. This study evaluates the feasibility, safety and learning curve of robotic duodenopancreatectomy (RDP) and robotic distal splenopancreatectomy (RDSP) during the initial phase of implementation at a single institution.</p><p><strong>Methods: </strong>A retrospective analysis of 20 consecutive patients, who underwent RDP (n=12) or RDSP (n=8) between January 2020 and December 2022, was performed. Data on operative time, intraoperative blood loss, conversion rates, postoperative complications (classified by Clavien-Dindo and ISGPS criteria) and length of hospital stay (LOS) were collected. Early (first six RDPs and four RDSPs) and late cases were compared to assess progression along the learning curve. Statistical analysis included Mann-Whitney U and Fisher's exact tests.</p><p><strong>Results: </strong>The median operative time for RDP decreased from 480 minutes [interquartile range (IQR) 420-540] in early cases to 390 minutes (IQR 360-420) in later cases (p=0.03). The operative time for RDSP remained stable at 300 minutes (IQR 240-360; p=0.12). Intraoperative blood loss was 200 mL (IQR 100-400) for RDP and 150 mL (IQR 50-300) for RDSP. Two RDP cases (16.7%) required conversion to open surgery due to vascular adhesions. Postoperative complications included pancreatic fistula in 20% of cases, delayed gastric emptying in 15% of cases and major complications (Clavien-Dindo ≥III) in 25% of cases. The median LOS was 10 days (IQR 8-18) for RDP and seven days (IQR 5-10) for RDSP. No 90-day mortality was observed.</p><p><strong>Conclusions: </strong>Robotic pancreatic resections are feasible and safe during the early learning curve, with morbidity comparable to open surgery. Operative efficiency improved significantly for RDP, highlighting the importance of structured training and case volume. These findings support the adoption of robotic techniques in pancreatic surgery, though further studies are needed to validate long-term outcomes.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"151-159"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981473","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":"Exocrine Pancreatic Insufficiency: Postoperative Complication Emerging Decades after Surgery?","authors":"João Pedro Santos DE Lança Pereira, Elisa Veigas, Eurico Oliveira, Edite Nascimento","doi":"10.26574/maedica.2025.20.2.428","DOIUrl":"10.26574/maedica.2025.20.2.428","url":null,"abstract":"<p><p>Exocrine pancreatic insufficiency (EPI) arises from a deficiency in pancreatic enzymes, leading to malabsorption and varied symptoms such as gastrointestinal discomfort, weight loss and steatorrhea. Though EPI commonly follows chronic pancreatitis or pancreatic surgery, its delayed onset is rarely discussed. We report a unique case of EPI manifesting 29 years after pancreaticoduodenectomy. A 71-year-old female, who underwent pancreaticoduodenectomy for carcinoma in 1992, presented with fatigue, weight loss, edema, diarrhea and paresthesias. Physical examination revealed mucocutaneous pallor, ascites, lower limb edema and brittle hair. Laboratory results indicated anemia, hypoproteinemia, vitamin deficiencies and severe fecal elastase reduction. After excluding other possible etiologies such as malignancy, autoimmune and infectious, the diagnosis of EPI was established. Treatment included enzyme replacement, vitamin supplementation and diuretics, leading to symptom resolution and normalization of laboratory parameters over a 12-month period. This case underscores the prolonged latency of post-surgical EPI, presenting diagnostic challenges. Exocrine pancreatic insufficiency can severely impair nutrient absorption, causing significant morbidity. In our patient, timely enzyme supplementation and nutritional management reversed the symptoms and deficiencies. The 29-year delay in symptom onset is among the longest documented, emphasizing the need for long-term vigilance in post-pancreatic surgery patients.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"428-431"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981447","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 Dark Side of the Moon - Significant Disagreements between Two-Dimensional and Three-Dimensional Echocardiographic Parameters of the Right Ventricular Function in Patients with Acute Myocardial Infarction.","authors":"Vladimir Bratu, Ruxandra Copciag, Tudor Lixandru, Dragos Vinereanu","doi":"10.26574/maedica.2025.20.2.192","DOIUrl":"10.26574/maedica.2025.20.2.192","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aims to assess correlations and agreements between parameters and classification of the right ventricular (RV) function obtained by 2D echocardiography (2DE) - tricuspid annular plane systolic excursion (TAPSE), RV systolic wave velocity (S'T), fractional area change (FAC) and RV ejection fraction (3D RVEF) obtained by advanced 3D echocardiography (3DE).</p><p><strong>Materials and methods: </strong>Patients admitted with acute myocardial infarction (AMI) were enrolled in the study after emergency coronary angiography. Standard 2DE and 3DE acquisitions were carried out in the first 48 hours since admission and later analysed offline by an advanced echocardiographer with five years of training in 2DE and three years of training in 3DE. Correlations between continuous echocardiographic variables were assessed using the Pearson correlation test. Patients were classified as having normal RV function or dysfunction based on current practice guidelines cut-off values and association between 2DE and 3DE parameters was assessed using the Pearson Chi-square test. Further, agreement between these categories was analysed using Cohen's k test.</p><p><strong>Results: </strong>Sixty-three patients (52 males, mean age 56.8 ± 10.3 years) enrolled between December 2019 and June 2022 were analysed. The correlation between 3D RVEF and TAPSE, S'T and FAC was no statistically significant (r = 0.217, p = 0.088), weak (r = 0.385, p 0.001) and modest (r = 0.482, p = 0.002), respectively. Classification of RV function by FAC was the only 2DE parameter that exhibited statistically significant agreement [(χ2 (1, n=63) = 7.725, p=0.005)] and association (k = 0.3345, CI [-0.0747,0.5943]) when compared with 3D RVEF based classification.</p><p><strong>Conclusions: </strong>Our study shows that, in a population of patients with acute myocardial infarction, measurements of RV function obtained by standard 2DE have varying degrees of correlation with 3D RVEF, and the subsequent classification of RV function using current cut-off values for these parameters leads to the misclassification of a significant number of patients.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"192-199"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12346997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981372","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":"Anthropometric Cadaveric Analysis of the Quadrangular Space and Deltoid Region: Anatomical Perspectives for Clinical Applications in the Indian Population.","authors":"Sundip Hemant Charmode, Abhishek Kumar Mishra, Simmi Mehra","doi":"10.26574/maedica.2025.20.2.316","DOIUrl":"10.26574/maedica.2025.20.2.316","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular structures beneath the deltoid, particularly the axillary nerve and posterior circumflex humeral artery, are vulnerable to injury from intramuscular injections or compression in the quadrangular space, especially in overhead athletes. Studies by Kakati et al (2013) and Desai et al (2019) report intramuscular injection-related nerve injury rates of 1.5% to 15% and 82.5%, respectively. However, there is a lack of cadaveric studies in the Indian population, prompting this anthropometric study.</p><p><strong>Aim: </strong>Aims and objectives: This study aims to assess the dimensions of the quadrangular space and examine the branching pattern of the axillary nerve and its relationship with the posterior circumflex humeral artery.</p><p><strong>Methods: </strong>This two-year cross-sectional study, approved by the Institutional Ethical Committee (Protocol ID: F-IM/15/2023), was conducted at AIIMS Rajkot in collaboration with Orthopaedics. Anthropometric measurements of the quadrangular space (height, width, and depth), deltoid muscle, distances of the axillary nerve and posterior circumflex humeral artery from the origin point and AXN-PCHA relationship patterns were obtained from 12 (seven male and five female) cadavers using vernier callipers.</p><p><strong>Results: </strong>Among the 24 specimens, type 1 branching pattern was the most common, observed in 12 specim ens (50 %), followed by type 2 in six specimens (25%), type type-3 in five specimens (21%), and type 4 in one specimen (0.041%). The dimensions of quadrangular space varied, with height ranging from 4.28 mm to 5.57mm, width from 10.57 mm to 13.75 mm, and depth from 9.97 mm to 12.84 mm.</p><p><strong>Conclusion: </strong>The mean dimensions (in mm) of the quadrangular space in males and females were 4.77 for height, 11.79 for width, and 11.01 for depth. The type-1 branching pattern was the most frequently observed.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"316-324"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981374","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":"Turicella otitidis Extra-otic Infections in Humans - a Narrative Review.","authors":"Sofia Maraki, Viktoria Eirini Mavromanolaki, Anna Kasimati","doi":"10.26574/maedica.2025.20.2.383","DOIUrl":"10.26574/maedica.2025.20.2.383","url":null,"abstract":"<p><p>Turicella otitidis is a Gram-positive bacillus, commensal inhabitant of the external auditory canal. It is the causative agent of external otitis and otitis media. Extra-otic infections are rarely been identified especially in patients with comorbidities. A narrative review was performed based on a search of PubMed/Medline and Scopus databases to collect information on the epidemiologic, clinical and microbiologic data of extra-otic infections by T. otitidis . Studies published until December 2024 were screened and analyzed to extract data on pathogen characteristics, antibiotic resistance profiles, treatment and outcomes. A total of 13 studies reporting infections by T. otitidis other than otitis including an equal number of patients were eligible. The mean age of patients was 34.08 years (range, 3-75 years). A male predominance was observed (1.6:1). Four patients were immunocompromised and four underwent recent surgical procedures. The most common infection type was bacteremia (38.4%), followed by abscesses, mastoiditis, ocular infections and skin and soft tissues infections. In the majority of cases (63.6%) a single method of identification was applied, such as matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), polymerase chain reaction (PCR), Vitek 2 automated system and analytical profile index (API) Coryne. Antimicrobial resistance to erythromycin was 80%, while all isolates were susceptible to vancomycin. Vancomycin (45.5%) and cephalosporins (45.5%) were the most commonly used antimicrobials. In all cases with available data, the outcome was favorable. T. otitidis is an emerging pathogen causing extra-otic infections in humans, especially in the presence of predisposing conditions. Future studies are warranted to elucidate the microorganism's pathogenicity and the factors and mechanisms underlying its virulence.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"383-387"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12346990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981482","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":"Mechanical Versus Injection Endoscopic Therapy for Dieulafoy's Lesion: a Systematic Review and Meta-Analysis.","authors":"Tarek Nahle, Hadi Farhat, Rasha Harb, Lynne Hoteit, Issam Fasih, Cesar Yaghi, Rita Slim","doi":"10.26574/maedica.2025.20.2.366","DOIUrl":"10.26574/maedica.2025.20.2.366","url":null,"abstract":"<p><strong>Background: </strong>Dieulafoy's lesion is a rare but potentially life-threatening gastrointestinal condition that often requires endoscopic management. However, there is a lack of consensus on the optimal endoscopic intervention for this condition. This meta-analysis aimed to compare the efficacy and safety of endoscopic mechanical interventions versus endoscopic injection interventions in the treatment of Dieulafoy's lesion.</p><p><strong>Methods: </strong>A systematic literature search was conducted using PubMed, Google Scholar pages 0-20 and Cochrane Library databases to identify relevant studies published up to March 2023. Studies comparing the outcomes of endoscopic mechanical and injection interventions for Dieulafoy's lesion were included. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random or fixed effects model depending on the heterogeneity I 2 value. A total of seven comparative studies were included in the meta-analysis consisting of three clinical trials and four retrospective studies. The clinical outcomes consisted of the initial hemostasis, as well as adverse events: recurrent bleeding, death and the need for an operation.</p><p><strong>Results: </strong>It was shown that endoscopic injection therapy was associated with a lower risk of recurrent bleeding in the treatment of Dieulafoy's lesion compared to mechanical therapy (95% CI, OR=0.33 [0.16, 0.69] , p-value=0.003). However, there were no significant differences between mechanical and injection techniques in terms of initial hemostasis, death, or need for an operation.</p><p><strong>Conclusion: </strong>Our findings suggest that injection methods may be preferred over mechanical techniques in the management of Dieulafoy's lesion due to its potential to reduce recurrent bleeding. Although it is a simple and a non-expensive technique, further studies are needed to confirm these findings and evaluate the long-term outcomes of both interventions.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"366-373"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12347001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981376","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":"Short- and Long-Term Impact of Metabolic Surgery on Obesity Outcomes in Iranian Non-Diabetic Obese Patients.","authors":"Leila Moradi, Zahra Farhangiyan, Makieh Tangestani, Amir Ashrafi","doi":"10.26574/maedica.2025.20.2.209","DOIUrl":"10.26574/maedica.2025.20.2.209","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic surgery (MS) has been demonstrated to achieve sustained weight loss with significant improvement of metabolic parameters, including reduced cardiovascular diseases and diabetes. This study aimed to evaluate the effect of MS on obesity outcomes and cardiovascular risk factors in Iranian non-diabetic obese patients.</p><p><strong>Methods: </strong>This retrospective follow-up study included non-diabetic obese patients with a body mass index (BMI) of 30 kg/m 2 or higher who underwent MS (LSG or GB) in a single institution in Ahvaz, Iran, from April 2019 to March 2023. Of the 162 reviewed patients, 139 subjects (85.80%) who completed one-year follow-up visits were included in this study. Medical history, anthropometric, biochemical parameters, comorbidities and Framingham risk score (FRS) were evaluated at baseline and annual visits after MS.</p><p><strong>Results: </strong>The mean weight and BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), FRS, lipid profile, liver enzymes and fasting blood glucose (FBS) were significantly improved 12 months postoperatively. The percentage of total weight loss (%TWL) and BMI loss (%BMI) was 30.32±8.14 and 30.32±8.14, respectively, at the one-year follow-up after surgery. At one-year follow-up, a significant resolution of hypertension and dyslipidemia was observed in 44.4% and 73.9% of patients, respectively, and this improvement was stable throughout the follow-up period, with no significant difference between procedures. The type of MS had no effect on changes in weight and BMI at one-year and long-term follow-up after surgery (P>0.05), except the mean weight loss was greater with RYGB than LSG at one-year follow-up.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":"20 2","pages":"209-219"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12346991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981428","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}