Journal of clinical medicine research最新文献

{"title":"Effect of Comorbidities on the Incidence of Surgical Site Infection in Patients Undergoing Emergency Surgery: A Systematic Review and Meta-Analysis.","authors":"Asriwati Amirah, Juliandi Harahap, Herick Alvenus Willim, Razia Begum Suroyo, Alhoi Hendry Henderson","doi":"10.14740/jocmr5222","DOIUrl":"10.14740/jocmr5222","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a significant concern in patients undergoing emergency surgery, particularly in those with underlying comorbidities. This meta-analysis aimed to evaluate the effect of comorbidities, including diabetes mellitus, hypertension, obesity, pulmonary disease, cardiac disease, liver disease, and renal disease, on the incidence of SSI in patients undergoing emergency surgery.</p><p><strong>Methods: </strong>We performed a systematic literature search across electronic databases including PubMed, ScienceDirect, Cochrane Library, ProQuest, and Google Scholar to identify studies examining the effect of comorbidities on the incidence of SSI in patients undergoing emergency surgery. To determine the effect size, pooled odds ratios (ORs) were calculated. Statistical analysis was performed using Review Manager 5.3 software.</p><p><strong>Results: </strong>Thirteen studies involving 8,952 patients undergoing emergency surgery were included in this meta-analysis. The pooled analysis showed that the following comorbidities significantly increased the risk of SSI following emergency surgery: diabetes mellitus (OR = 2.22; 95% confidence interval (CI) = 1.52 - 3.25; P < 0.0001), obesity (OR = 1.43; 95% CI = 1.19 - 1.72; P = 0.0001), and liver disease (OR = 1.66; 95% CI = 1.37 - 2.00; P < 0.00001). However, hypertension, pulmonary disease, cardiac disease, and renal disease showed no significant association with SSI.</p><p><strong>Conclusions: </strong>In patients undergoing emergency surgery, the presence of comorbidities including diabetes mellitus, obesity, and liver disease increases the incidence of developing SSI.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 7-8","pages":"345-354"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116774","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":"Renin-Angiotensin System Genes Polymorphisms in Patients With COVID-19 and Its Relation to Severe Cases of SARS-CoV-2 Infection.","authors":"Anna E Bragina, Aida I Tarzimanova, Yulia N Rodionova, Ekaterina S Ogibenina, Aleksandr Yu Suvorov, Natalya A Druzhinina, Lyubov V Vasilyeva, Tatiana I Ishina, Ivan D Medvedev, Marina S Borlakova, Anastasiia R Komelkova, Daria V Gushchina, Artem A Khachaturov, Valery I Podzolkov","doi":"10.14740/jocmr5223","DOIUrl":"10.14740/jocmr5223","url":null,"abstract":"<p><strong>Background: </strong>Different variants of single nucleotide polymorphisms (SNPs) of angiotensinogen (AGT), angiotensin-converting enzyme type 1 (ACE1), and angiotensin II receptors type 1 (AGTR1) and 2 (AGTR2) genes determine different susceptibility to cardiovascular disease (CVD) and hypertension, which can be considered as risk factors for fatal outcomes among coronavirus disease 2019 (COVID-19) patients. The objective of our study was to assess the relation between the frequency of SNPs of the renin-angiotensin system (RAS) components, and the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.</p><p><strong>Methods: </strong>The cross-sectional study included 100 patients with a laboratory-confirmed diagnosis of COVID-19 admitted to the hospital. Criteria for severe COVID-19 included respiratory rate (RR) > 30/min, blood oxygen saturation (SpO₂) ≤ 93%, signs of unstable hemodynamics with systolic blood pressure (SBP) < 90 and/or diastolic blood pressure (DBP) < 60 mm Hg. All patients were identified with alleles and genotypes of the polymorphic markers rs4762 of the AGT gene, rs1799752 of the ACE1 gene, rs5186 of the AGTR1 gene and rs1403543 of the AGTR2 gene using the polymerase chain reaction method in human DNA preparations on real-time CFX96C1000 Touch, Bio-Rad equipment (Syntol, Russia). Statistical analysis was performed in R v.4.2.</p><p><strong>Results: </strong>Patients were divided into groups with severe (n = 44) and moderate COVID-19 (n = 56). For ACE1 rs1799752, a significant deviation from the population distribution was detected in both studied subgroups. A higher frequency of the C allele SNP rs5186 AGTR1 gene was detected in the group with severe disease. More frequent A/A genotype of SNP rs1403543 AGTR2 was detected among females with severe COVID-19. Haplotype analysis revealed more common DCG haplotype among patients with severe COVID-19. The odds ratio for severe COVID-19 in the presence of the DCG haplotype was 3.996 (95% confidential interval: 1.080 -14.791, P < 0.05).</p><p><strong>Conclusions: </strong>Our data suggest that the SNP genes of the RAS components, may allow to identify groups of patients predisposed to a more severe course of COVID-19.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 7-8","pages":"355-362"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116778","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":"Risk Factors and Outcomes of Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Single-Center Study.","authors":"Mostafa Mohrag, Mohammed Abdulrasak, Waseem Borik, Atheer Alshamakhi, Nada Ageeli, Roaa Abu Allah, Maryam Al Hammadah, Somaya Saabi, Reema Moafa, Atheer Darraj, Moath Farasani, Omar Oraibi, Mohammed Somaili, Mohammed Ali Madkhali, Sameer Alqassmi, Ali Someili","doi":"10.14740/jocmr5220","DOIUrl":"10.14740/jocmr5220","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) following cardiac surgery is a well-described phenomenon, usually associated with hemodynamic changes ultimately leading to ischemic injury to the kidneys. In this study, we assessed the occurrence of AKI in a cohort of patients undergoing elective cardiac surgery at a single center.</p><p><strong>Methods: </strong>Patients undergoing elective cardiac surgery (coronary artery bypass grafting (CABG) and/or valve repair) between the years 2016 and 2022 were retrospectively included in the study.</p><p><strong>Results: </strong>During the study, 167 patients underwent CABG, valve replacement, or both procedures. The majority were male (85.0%). Post-operative AKI was observed in 27.5% of patients, with 2.4% requiring continuous renal replacement therapy (CRRT)/dialysis. The majority of AKI cases were staged as Kidney Disease: Improving Global Outcomes (KDIGO) stage 1. Among patients needing CRRT/dialysis, 1.8% recovered renal function within 3 months, with 0.6% experiencing 30-day mortality. In univariate analysis, factors associated with AKI included older age (P = 0.003), severe anemia (P < 0.0001), pre-operative creatinine elevation (P < 0.0001), complex surgeries (P < 0.0001), blood product transfusion (P < 0.0001), longer cross-clamp (XC) and cardiopulmonary bypass (CPB) times (P < 0.0001), and inotropes usage (P < 0.0001). Classical risk factors like diabetes mellitus (DM) and hypertension did not show significant differences. The majority of these factors (severe anemia, age, pre-operative creatinine, post-operative inotrope usage, and cross-clamp times) were consistently significant (P < 0.05) in logistic regression analysis.</p><p><strong>Conclusion: </strong>Post-operative AKI following cardiac surgery is frequent, with significant associations seen especially with pre-operative anemia. Future investigations focusing on the specific causes of anemia linked to AKI development are essential, considering the high prevalence of hemoglobinopathy traits in our population.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 7-8","pages":"375-380"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116779","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":"A Complex Interplay of Tumor Microenvironment Could Enhance Cholangiocarcinoma Progression Even After Surgery: A Prospective Study.","authors":"Asmaa M Zahran, Amal Rayan, Khaled Saad, Khalid Rezk, Ahmed Soliman, Mohamed Ahmed Rizk, Aya Mohammed Mahros, Essam-Eldeen M O Mahran, Mohamed Ahmed Bashir, Heba M Elmasry, Zeinab Albadry M Zahran, Ahmed Khalid Ibrahim, Mohsen M Fageeh, Doaa A Gamal","doi":"10.14740/jocmr5201","DOIUrl":"10.14740/jocmr5201","url":null,"abstract":"<p><strong>Background: </strong>The current study was conducted to explore the impact of macrophages and programmed cell death protein 1 (PD-1) expression on tumor-infiltrating lymphocytes (TILs) on treatment outcomes and to define the interaction between these factors and the clinicopathologic features of advanced cholangiocarcinoma (CCA) patients.</p><p><strong>Methods: </strong>Twenty-five patients with metastatic CCA were recruited for the current study from El-Rajhi Hospital and the Clinical Oncology Department of Assiut University. Additionally, 19 healthy controls were included. Before the flow cytometric detection of immune cells, the diagnosis and staging of CCA were performed based on surgical intervention, imaging, carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) determinations. This was followed by flow cytometric detection of CD4⁺, CD8⁺, CD4⁺PD-1⁺, CD8⁺PD-1⁺, and CD11b⁺CD68⁺ macrophages in the peripheral blood of both patients and controls.</p><p><strong>Results: </strong>The current results revealed higher levels of CD4⁺, CD8⁺, and CD11b⁺CD68⁺ macrophages in controls compared to patients. At the same time, PD-1 expression was significantly higher in patients compared to controls. CD4⁺ was correlated with improved progression-free survival (PFS), while CD8⁺PD-1 was associated with shorter PFS. In general, CD4⁺ and CD8⁺ levels progressively increased with improved response to treatments, differentiation, single organ site metastasis, and surgical interventions. On the contrary, PD-1 expression and macrophages progressively increased with worsening response, dedifferentiation, multiple organ sites, and surgical interventions. The median PFS was 12 months, and the mean ± standard error (SE) was 13.1 ± 1.3.</p><p><strong>Conclusions: </strong>CCA has a desmoplastic microenvironment with complex immunologic topography and tumor-reactive stroma. The immune landscape of the peripheral blood mononuclear cells (PBMCs) in CCA patients before treatment could reflect the state of systemic immune function and response to treatments. Our results revealed that T-lymphocytes correlated with better prognosis while macrophages and PD-1⁺ expression were associated with poor outcomes.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 7-8","pages":"363-374"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116773","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":"Impact of the First Twenty-Four-Hour Area Under the Concentration-Time Curve/Minimum Inhibitory Concentration of Vancomycin on Treatment Outcomes in Patients With Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia.","authors":"Mika Higashi, Takafumi Nakano, Keisuke Sato, Yukiomi Eguchi, Norihiro Moriwaki, Mitsuhiro Kamada, Tadahiro Ikeuchi, Susumu Kaneshige, Masanobu Uchiyama, Toshinobu Hayashi, Atsushi Togawa, Koichi Matsuo, Hidetoshi Kamimura","doi":"10.14740/jocmr5238","DOIUrl":"10.14740/jocmr5238","url":null,"abstract":"<p><strong>Background: </strong>Vancomycin regimens are designed to achieve an area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC) ratio ranging between 400 and 600 µg·h/mL in the steady state. However, in cases of critical infections such as bacteremia requiring an early treatment approach, the clinical course may be affected by the AUC/MIC before reaching the steady state, that is, the AUC/MIC values 24 h after the first dose (first 24-h AUC/MIC). This study evaluated the relationship between the first 24-h AUC/MIC and the clinical course of methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infection.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of patients with MRSA bacteremia in a university hospital between 2015 and 2022. The first 24-h AUC/MIC cutoff was set at 300 µg·h/mL based on the results of early response, and eligible patients were divided into groups with a first 24-h AUC/MIC either < 300 µg·h/mL (< 300 group, n = 32) or ≥ 300 µg·h/mL (≥ 300 group, n = 38). The primary endpoint was the rate of treatment efficacy, and the secondary endpoints were time to clinical and bacteriological improvement and 30-day survival rate.</p><p><strong>Results: </strong>Treatment efficacy and 30-day survival rates were not significantly different between the two groups (78.1% vs. 79.0%, P = 0.933 and 83.9% vs. 87.2%, P = 0.674, respectively). Among patients who showed treatment efficacy, the median time to clinical and bacteriological improvement was 11.5 days and 8.0 days in the < 300 and ≥ 300 groups, respectively; compared to the ≥ 300 group, the < 300 group had a significantly longer time to improvement (P = 0.001).</p><p><strong>Conclusions: </strong>The first 24-h AUC/MIC had no effect on the treatment efficacy and 30-day survival rates. However, the time to clinical and bacteriological improvement was significantly prolonged in the < 300 group, indicating that the first 24-h AUC/MIC does not affect the rate of therapeutic efficacy but may affect the treatment period.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 7-8","pages":"325-334"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116775","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":"Botulinum Toxin Type A and Hyaluronic Acid Dermal Fillers in Dentistry: A Systematic Review of Clinical Application and Indications.","authors":"Marta Maci, Carlotta Fanelli, Mauro Lorusso, Donatella Ferrara, Marino Caroprese, Michele Laurenziello, Michele Tepedino, Domenico Ciavarella","doi":"10.14740/jocmr5202","DOIUrl":"10.14740/jocmr5202","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin type A (BoNT-A) and hyaluronic acid (HA) dermal fillers are increasingly utilized in dentistry for therapeutic and aesthetic purposes. However, a comprehensive synthesis of their clinical applications and indications in dentistry is lacking. This systematic review aimed to analyze the clinical application and indications of BoNT-A and HA dermal fillers in dentistry, providing insights into their efficacy, safety profiles, and limitations.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed/MEDLINE databases to identify relevant studies published between 2018 and 2024. Medical Subject Headings (MeSH) terms and keywords related to BoNT-A, HA dermal fillers, dentistry, clinical applications, and indications were used. Study selection criteria included randomized controlled trials (RCTs) and non-RCTs involving human participants of any age group. Data extraction and synthesis followed established guidelines, focusing on study characteristics, participant demographics, intervention details, outcome measures, and key findings related to BoNT-A and HA dermal fillers' clinical application in dentistry.</p><p><strong>Results: </strong>Systematic searches across electronic databases and grey literature identified 857 records, with an additional 73 from hand searches. After screening titles and abstracts, 542 records were excluded, leaving 374 full-text publications for evaluation. Ultimately, 12 RCTs and 13 non-RCTs were included. The systematic review encompassed diverse geographic locations: Brazil, Italy, Spain, Syria, India, Egypt, Korea, and the Netherlands, involving samples sizes ranging from 14 to 143 participants. The review synthesized findings on HA's efficacy in various areas, including bone repair, gingivitis management, temporomandibular joint disorders, postoperative swelling reduction, periodontal defect treatment, chin and check projection and lips augmentation. BoNT-A exhibited promising efficacy in managing orofacial pain conditions, gummy smile treatment and neuromodulation of the lower third muscles. Safety profiles varied among studies, with some reporting minimal adverse effects while others noted dose-related concerns.</p><p><strong>Conclusion: </strong>BoNT-A and HA dermal fillers offer a wide array of clinical applications in dentistry, ranging from therapeutic interventions to aesthetic enhancements. Despite promising efficacy, careful consideration and monitoring of safety outcomes are essential when integrating these interventions into clinical practice. Further research addressing methodological limitations and safety concerns is warranted to optimize their utilization and improve patient care in dentistry.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 6","pages":"273-283"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725466","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":"Clinically Evident Cardiopulmonary Congestion Does Not Significantly Impact the Prognosis of Patients With Septic Acute Kidney Injury.","authors":"Charlotte Mund, Katharina Asmus, Wajima Safi, Oliver Ritter, Dominique Petrus, Susann Patschan, Daniel Patschan","doi":"10.14740/jocmr5190","DOIUrl":"10.14740/jocmr5190","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common issue among in-hospital patients, with high mortality rates. Sepsis is a primary cause of AKI, particularly in the intensive care unit. Patients with septic AKI often experience cardiovascular congestion, leading to the formal classification of cardiorenal syndrome type 5. The study aimed to evaluate the prognosis of septic AKI patients with and without clinical evidence of cardiovascular congestion.</p><p><strong>Methods: </strong>This was a retrospective observational study. AKI patients were identified using the in-hospital AKI alert system. Sepsis was diagnosed based on laboratory, clinical, and hemodynamic characteristics, with additional consideration of the quickSOFA score. Cardiovascular congestion was diagnosed by assessing clinical (edema), radiographic (pulmonary congestion), echocardiographic (e.g., wall motion abnormalities), and laboratory variables (e.g., N-terminal pro-B-type natriuretic peptide). Endpoints included in-hospital survival, the need for kidney replacement therapy (KRT), and recovery of kidney function (ROKF).</p><p><strong>Results: </strong>In total, 102 patients were included, and cardiopulmonary congestion was diagnosed in 78.4%. Individuals with congestion did not differ from patients without congestion in any of the pre-defined endpoints.</p><p><strong>Conclusions: </strong>It is justified not to consider clinically apparent cardiovascular congestion in septic AKI patients as a risk factor for death <i>per se</i>. Rather, especially in the case of sepsis, clinically apparent positive fluid balance does not seem to be a disadvantage in terms of survival, KRT, and ROKF.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 6","pages":"302-309"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725467","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":"Battle of the Blocks: Which Pain Management Technique Triumphs in Gender-Affirming Bilateral Mastectomies?","authors":"Sengottaian Sivakumar, Aron Kressel, Roni Mendonca, Michael Girshin","doi":"10.14740/jocmr5159","DOIUrl":"10.14740/jocmr5159","url":null,"abstract":"<p><strong>Background: </strong>Gender-affirming mastectomy, performed on transgender men and non-binary individuals, frequently leads to considerable postoperative pain. This pain can significantly affect both patient satisfaction and the overall recovery process. The study examines the efficacy of four analgesic techniques pectoral nerve (PECS) 2 block, erector spinae plane (ESP) block, thoracic wall local anesthesia infiltration (TWI), and systemic multimodal analgesia (SMA) in managing perioperative pain, with special consideration for the effects of chronic testosterone therapy on pain thresholds.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients aged 18 - 45 who underwent gender-affirming bilateral mastectomies at a New York City community hospital. The study compared intraoperative and post-anesthesia care unit (PACU) opioid consumption, postoperative pain scores, the interval to first rescue analgesia, and total PACU duration among the four analgesic techniques.</p><p><strong>Results: </strong>The study found significant differences in intraoperative and PACU opioid consumption across the groups, with the PECS 2 block group showing the least opioid requirement. The PACU morphine milligram equivalent (MME) consumption was highest in the SMA group. Postoperative pain scores were significantly lower in the PECS and ESP groups at earlier time points post-surgery. However, by postoperative day 2, pain scores did not significantly differ among the groups. Chronic testosterone therapy did not significantly impact intraoperative opioid requirements.</p><p><strong>Conclusion: </strong>The PECS 2 block is superior in reducing overall opioid consumption and providing effective postoperative pain control in gender-affirming mastectomies. The study underscores the importance of tailoring pain management strategies to the unique physiological responses of the transgender and non-binary community. Future research should focus on prospective designs, standardized block techniques, and the complex relationship between hormonal therapy and pain perception.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 6","pages":"284-292"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725465","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 Use of Remimazolam During Awake Craniotomy for Seizure Foci Resection in Adolescents: A Case Series.","authors":"Ashley Smith, Sidhant Kalsotra, Joseph D Tobias","doi":"10.14740/jocmr5175","DOIUrl":"10.14740/jocmr5175","url":null,"abstract":"<p><p>Remimazolam is a novel benzodiazepine with sedative, anxiolytic, and amnestic properties similar to midazolam. Metabolism by tissue esterases results in a short clinical half-life of 5 - 10 min and a limited context sensitive half-life. We present initial retrospective clinical experience with the use of remimazolam as an intraoperative adjunct to sedation during awake craniotomy in a cohort of three adolescent patients. A remimazolam infusion was added to a combination of dexmedetomidine and remifentanil to deepen the level of sedation during surgical incision, craniotomy, duraplasty, and surgical dissection for exposure of the seizure foci. The remimazolam infusion was discontinued 30 min prior to the planned awake assessments and electrophysiology testing. The patients emerged calmly and were able to follow commands for intraoperative testing. Our anecdotal experience supports the efficacy of remimazolam for awake craniotomy and tumor resection using a standard asleep-awake-asleep technique. We noted adequate sedation, maintenance of spontaneous respiration, rapid awakening, and no limitations to intraoperative neuromonitoring or awake assessment in our three patients.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 6","pages":"319-323"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725470","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 Between Twenty-Four-Hour Collection and Single Spot Urines for the Detection of Biogenic Amines by High-Performance Liquid Chromatography Tandem Mass Spectrometry.","authors":"Chiara Rosato, Marilena Greco, Giovanni Marciante, Roberta Assunta Lazzari, Floriano Indino, Giambattista Lobreglio","doi":"10.14740/jocmr5070","DOIUrl":"10.14740/jocmr5070","url":null,"abstract":"<p><strong>Background: </strong>Pheochromocytomas and paragangliomas (PPGL) are neuroendocrine tumors that originate from adrenal medulla or extra-adrenal chromaffin cells, respectively. They produce an excess of catecholamines and their metabolites. Abnormal levels of these biomolecules have been also found in pediatric patients with neuroblastoma (NB). Due to the diurnal fluctuation, the laboratory practice recommends the determination of biogenic amines in acidified 24-h urine samples. However, the collection and acidification of specimens cannot be performed easily, especially for children. Spot urines represent an attractive alternative for the detection of catecholamines and corresponding metabolites.</p><p><strong>Methods: </strong>In our study, we enrolled 50 patients with symptoms related to PPGL and we determined the concentration values for both spot and 24-h urine samples using high-performance liquid chromatography tandem mass spectrometry (HPLC/MS-MS). Since day variations of the urinary concentration are due to fluctuations in renal excretion rather than in production, we normalized the concentration of biogenic amines in spot urine and in 24-h urine collection to urinary creatinine concentration. A correlation study between the normalized levels of biogenic amines was performed using a linear regression analysis model and Pearson's correlation coefficients.</p><p><strong>Results: </strong>We obtained a good correlation of values which suggests an interchangeability of the 24-h and random urine samples. Only for epinephrine a weak correlation was determined.</p><p><strong>Conclusions: </strong>Our findings suggest that the sample collection as single spot urine may replace 24-h collection for the detection of urinary biogenic amines by HPLC/MS-MS.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 6","pages":"293-301"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725468","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}