Medicine and Pharmacy Reports最新文献

Background: Microsurgical head and neck reconstruction requires specialized expertise that can be challenging to develop in regional healthcare settings. This study documents the collaborative learning curve experience of establishing microsurgical capabilities through multidisciplinary team integration.

Methods: A retrospective case series analyzed 8 consecutive head and neck microsurgical reconstructions performed between October 2018 and October 2021 in Constanta, Romania. All procedures were performed by the same primary surgeon with systematic collaborative multidisciplinary support. Data included patient demographics, risk factors, collaborative team composition, operative metrics, outcomes, and learning curve progression assessment.

Results: Eight patients (5 male, 3 female) underwent reconstruction for squamous cell carcinoma (SCC, 50%), basal cell carcinoma (BCC, 25%), radiodermitis (12.5%), and iatrogenic facial palsy (12.5%). Procedures included mandibular reconstruction (37.5%), tongue/floor of mouth reconstruction (25%), facial reanimation (12.5%), nasal reconstruction (12.5%), and orbital coverage (12.5%). All cases utilized multidisciplinary teams averaging 3.4 members, with maxillofacial surgeons participating in 75% and general surgeons in 100% of cases. During the early learning phase, operative time decreased from 15 to 10 hours and surgeon confidence advancement from "Low" to "Medium-High" levels. Overall success rate was 62.5% with one partial success (12.5%) and two failures (25%). Risk factors were present in 75% of cases, with failures associated with cumulative risk factors and immunocompromised status.

Conclusions: Microsurgical head and neck reconstruction can be successfully integrated into regional healthcare systems through systematic collaborative learning approaches. The multidisciplinary model enabled safe skill acquisition while maintaining acceptable outcomes during the early learning phase. Key insights include avoiding cumulative risk factors during initial learning and ensuring comprehensive preoperative optimization. This collaborative framework describes an early institutional experience that may be informative for other centers initiating microsurgical programs.

Background and aims: Type 1 diabetes mellitus is a chronic metabolic disease of autoimmune origin with early manifestations, which appear predominantly in childhood. Its incidence has increased in most European countries mainly due to refined diets and increased consumption of sweets. Diabetes is known as a predisposing factor for the development of oral diseases; therefore, prevention at an early age is essential. Genetic factors and environmental factors contribute to the risk of disease, indicating a multifactorial etiology. Along with chronic periodontitis and other oral manifestations, such as increased incidence of tooth decay, aphthous ulcers, salivary qualitative and quantitative changes represent an important segment of diabetes complications. It has been observed that people with diabetes are more prone to oral changes compared to healthy people.In recent years, many studies have been published in the literature that have examined the relationship between type 1 diabetes and oral health. The purpose of this review is to investigate oral health indices in children with type 1 diabetes and how diabetes influences these indices.

Methods: An electronic search of the following databases was conducted to identify the literature assessing the effect of type 1 diabetes on oral health in children and adolescents aged 6-17 years: MEDLINE, Europe PMC, Google Scholar and PubMed. In total, 121 studies were identified. After removing duplicates, a total of 90 articles were included in this systematic review.

Results: This study describes the relationship between oral health in children with type 1 diabetes mellitus and presents the relationship between diabetes mellitus and the incidence of dental caries, periodontal diseases, microbial infections, as well as the influence of diabetes on orthodontic treatment and the measures that are required during the management of treatment in these patients.

Conclusions: The analysis of scientific evidence supports the fact that diabetes has a negative effect on oral health, and changes in the oral cavity will influence glycemic control, with the onset of multiple systemic complications. The association between diabetes and oral health is sometimes ignored and for this reason, instead of the early diagnosis and treatment of certain oral conditions, it leads to late diagnosis, resulting in tooth loss and sometimes even severe complications. Monitoring diabetic and dental patients can reduce diabetes-related complications.

Objectives: The low efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of lower pole stones is well known; the parameters which influence this effect are still under debate: patient age, stone size, presence of double J stent, body mass index (BMI), and radiological parameters of the lower calyx, such as infundibulopelvic angle (IPA), infundibulum length (IL), and width (IW) of patients and the skin-stone size.

Methods: We studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of lower calyx stones. All patients were investigated by uro-CT or intravenous urography (IVU), or kidney, ureter, bladder (KUB) radiography to confirm the diagnosis. J stents were inserted before therapy in 64 (18.6%) renal units. Factors affecting success, stone-free rate and complications were analyzed. We measured the skin-stone distance (SSD) of the lower calyx on 39 uro-CT image data, and infundibulum length, width and infundibulopelvic angle on 31 intravenous urography (IVU).

Results: Our retrospective study (between 2021 and 2024) included a total of 344 patients who underwent ESWL for lower calyceal stone (172 men, 172 women) with an average stone size 9.093±2.829 mm. 68.605% of patients became stone-free after the first ESWL session. The average skin stone distances measured in 0°, 45°, 90° angles were 96.5 ± 24.92 mm. Using the Chi-square test, we concluded that previously stented patients had a statistically lower stone-free rate (SFR) than those without a stent. (p=0.0078). The body mass index (BMI) of patients also influenced the SFR, as calculated with an Unpaired t-test and Welch correction (p = 0.002). We did not find any statistically significant differences between skin-stone sizes of patients with or without successful stone fragmentation (p=0.1147), and infundibulum length (p=0.07), infundibulum width (p=0.7681), and infundibulopelvic angle (p=0.996).

Conclusions: Single ESWL sessions often fail to achieve stone fragmentation and elimination, as this study shows. The success of ESWL sessions can be affected by the anatomical position of the stone, a lower pole kidney stone, the presence of pre-procedural double J stenting, and obesity.

Background: This study aims to assess the impact of COVID-19 infection on both mental well-being and biological parameters of patients with type 2 diabetes, highlighting the potential long-term effects.

Methods: A longitudinal observational study was conducted on a total of 62 patients diagnosed with type 2 diabetes. We used two validated questionnaires: the WHO-5 Well-Being Index (WHO-5) and the Diabetes Distress Scale (DDS). Biological data were extracted from medical records. We had two-point evaluations, in 2023 and 2024. Patients were divided into three groups based on the year of COVID-19 diagnosis: 2020, 2021, 2022. Descriptive and inferential statistics were performed, with results presented as percentages and associations. The Wilcoxon signed-rank test, the Kruskal-Wali's test, and Spearman's rank correlation coefficient (ρ) were applied for non-normally distributed variables. Analyses were performed using Jamovi 3.2.28. A p value < 0.05 was considered statistically significant.

Results: There were 24 (38.7%) females, and 38 (61.3%) males. The mean age was 66.5 years. From the medical history, regarding COVID-19 severity, 7 (11.3%) of cases were classified as mild 29 (46.8%) as moderate, and 26 (41.9%) as severe. WHO-5 scores increased from a mean of 42.5 from 2023 to 51.2 in 2024, indicating improved psychological well-being over time. A significant reduction in diabetes-related emotional distress was observed (p < 0.001). Regimen-related distress scores showed a small but significant decrease from 2023 to 2024 (p = 0.004). A statistically significant correlation was observed between WHO-5 score (2023) and LDL cholesterol (2024) (ρ = 0.629, p = 0.02). Descriptive statistics showed that mean HDL cholesterol values vary with COVID-19 severity levels.

Conclusion: Psychological well-being showed an improvement over time. Emotional distress related to diabetes, including emotional burden and regimen-related distress decreased with time. Serum LDL- and HDL cholesterol levels may play a potential role in supporting psychological well-being. This study reinforces the importance of holistic approaches in managing post-COVID-19 effects, especially in patients with pre-existing metabolic disorders.

Background and aims: Male prolactinoma remains a singular entity. Our study represents the first reported experience of male prolactinoma in Northern Africa. Our work aimed to characterize prolactinomas in the male population, an entity known for its aggressive features, and also to highlight the specific challenges encountered in a North African clinical context.

Methods: This is a retrospective descriptive study of male patients presenting with prolactinoma at the endocrinology, diabetology and nutrition department of a university hospital center over a 10-year period.

Results: The mean age at diagnosis was 37 ± 11 years. Mass effect related symptoms were present in 83% of cases. Decreased visual acuity was found in 60% of cases. Galactorrhea was found in 13% of cases, decreased libido in 60% of cases, and gynecomastia in 20% of cases. At the time of diagnosis, the mean prolactin level was 4,685 ng/ml (79-33,000). All patients had hypogonadotropic hypogonadism. Among our patients, 66% had undergone dopaminergic agonists as monotherapy, and pituitary surgery was performed in 33% of cases in conjunction with dopaminergic agonists. After a 30-month average follow-up, medical treatment achieved prolactin control in 83% of cases and tumor shrinkage in 70%, while surgery achieved prolactin control in 85% and tumor shrinkage in 70% of cases.

Conclusion: Prolactinoma in men is usually invasive and of considerable volume, putting patients at risk of mass effect related symptoms, especially ophthalmologic complications. Hence the importance of early, multidisciplinary and personalized management.

Introduction: Puerperal sepsis is still a life-threatening obstetric complication worldwide, even in settings with advanced medical resources. Clinical manifestations may be subtle and atypical during pregnancy and the puerperium, leading to delays in recognition and treatment. Multidrug-resistant organisms such as Stenotrophomonas maltophilia further complicate management, often requiring aggressive multidisciplinary approaches.

Case presentation: We present a case of vaginal hematoma and peripartum infection with Stenotrophomonas maltophilia accompanied by multiple organ dysfunction syndrome.

Conclusions: The presence of pelvic contusion leads to sepsis caused by multiple infections in the peripartum period and can significantly increase the incidence of diseases associated with bleeding, infection, surgery, and blood product transfusions. The clinical condition of the patient may be worsened in the presence of pre-existing conditions prior to pregnancy.

Background and aims: Sociodemographic factors and diabetes knowledge play a crucial role in the management and long-term outcomes of type 2 diabetes, influencing both disease progression and the risk of complications. We aimed to assess the relationship between socio-economic status and diabetes knowledge using a demographically appropriate questionnaire for evaluating socioeconomic status and a culturally tailored bilingual diabetes knowledge assessment test for patients with type 2 diabetes in a multi-ethnic setting.

Methods: Our study was conducted in Mureş County, Romania, among adults with a minimum one-year history of type 2 diabetes. We collected data on the participants' sociodemographic and socioeconomic status. Our assessment test for diabetes knowledge consisted of 30 true-or-false statements, addressing etiology and risk factors, diabetes-related complications, and treatment, including lifestyle interventions and medication. Statistical analysis was carried out in the SPSS software.

Results: We screened 202 diabetic patients, 109 patients met the inclusion criteria and were enrolled in the study. Data were collected on their sociodemographic and socioeconomic characteristics, and they also completed the diabetes assessment test. Between the sociodemographic features and diabetes knowledge, only the diabetes duration showed a statistically significant positive correlation with the total (r(107) = 0.254, r² = 0.064, p = 0.008) and second domain's scores (r(107) = 0.336, r² = 0.112, p = 0.000). In addition, education level, household income and the type of antidiabetic treatment showed a statistically significant association with assessment test scores (p < 0.05).

Conclusion: In the study population, there was a statistically significant association between the performance on the assessment test and education level, type of antidiabetic treatment, household income and diabetes duration.

Background: Craniofacial anomalies, particularly cleft lip and palate affecting 1 in 500 to 1 in 2,500 live births globally, exert profound influences on physical function, psychological well-being, and social integration throughout the entire life. While surgical advances have improved outcomes, the long-term impact on the quality of life remains incompletely understood, necessitating comprehensive evaluation of psychosocial outcomes following primary surgical repair.

Methods: We conducted a cross-sectional comparative study evaluating 85 pediatric patients aged 4-7 years with surgically repaired non-syndromic cleft lip and/or palate and their caregivers, compared to 90 age-matched healthy controls. All patients underwent standardized surgical repair with minimum 24-month postoperative follow-up. Quality of life was assessed using the validated KINDL questionnaire administered to both children and parents, measuring physical well-being, emotional well-being, self-esteem, family relationships, friendships, and school functioning. Statistical analysis employed independent-samples t-tests and chi-square tests with significance set at p < 0.05.

Results: Children with cleft conditions demonstrated overall quality of life scores comparable to healthy controls (82.15 ± 14.72 vs 83.78 ± 16.72, respectively; 1.9% difference, not statistically significant). However, self-esteem scores were significantly lower in the cleft group (78.17 ± 24.79 vs 83.49 ± 22.17, p = 0.036). Parental assessments yielded high overall scores (80.38 ± 12.41) but identified significant concerns in self-esteem (72.41 ± 16.82) and infirmity perception (72.15 ± 17.67) (both p < 0.01). Age-stratified analysis revealed that children requiring reinterventions and older children (6-7 years) demonstrated greater family-related quality of life concerns.

Conclusions: While children with surgically repaired cleft lip and/or palate achieve overall quality of life outcomes comparable to healthy peers, persistent self-esteem deficits indicate ongoing psychosocial challenges requiring comprehensive multidisciplinary intervention. These findings emphasize the need for holistic care approaches that integrate psychological support, targeted therapies, and family counseling to optimize both functional and psychosocial outcomes beyond primary surgical repair.

Background: Insulin resistance (IR) drives early cardiometabolic risk in populations with high adiposity. Simple fasting markers, such as the triglyceride-glucose (TyG) index and the triglyceride-to-HDL cholesterol ratio (TG/HDL-C), may be helpful. Still, their performance against the updated, non-linear Homeostatic Model Assessment 2 (HOMA2) model in Middle Eastern adults remains unclear.

Objectives: Compare TyG versus TG/HDL-C for HOMA2-defined IR; test modification by Body Mass Index (BMI) (overweight vs. obesity); and evaluate discrimination, calibration, and clinical utility.

Methods: Cross-sectional study of 140 adults without diabetes with overweight/obesity. Fasting triglycerides, HDL-C, glucose, and insulin were assayed under quality control; HOMA2-IR, %S, and %B were derived. Multivariable linear models (per-SD predictors) adjusted for age, sex, and BMI; multiplicative interactions probed effect modification. Higher IR was defined as the sex-specific top quartile of HOMA2-IR. Discrimination (Area Under the Curve AUC; DeLong test), calibration (intercept, slope, Brier), decision-curve analysis (DCA), multiple imputation (20 datasets), and prespecified sensitivity checks were performed.

Results: TyG independently tracked higher HOMA2-IR (β=0.127 per SD; 95% CI 0.033-0.220; p=0.0078), whereas TG/HDL-C was null. TyG×BMI interaction was significant (p=0.0011): negligible in overweight (β≈0.01; p=0.85) but strong in obesity (β=0.29; p<0.001). Discrimination was similar (AUC TyG 0.714 vs TG/HDL-C 0.707; ΔAUC=0.007; p=0.801). DCA showed a higher net benefit for TyG, especially TyG+BMI, across thresholds of 0.20-0.60. Calibration was acceptable; bootstrap-validated metrics and extensive sensitivity analyses were consistent.

Conclusions: In adults without diabetes with excess adiposity, TyG captures HOMA2-defined IR more consistently than TG/HDL-C, with the greatest incremental value in obesity. As a low-cost fasting metric, TyG, particularly when combined with BMI, may refine triage for further evaluation; external validation in regional cohorts is warranted.

Background and aim: Basal cell carcinoma (BCC) is the most common skin cancer, yet reliable non-invasive markers for distinguishing low-risk (LR) from high-risk (HR) lesions are still lacking. Serum metabolomics provides a promising approach for capturing systemic biochemical changes associated with tumor behavior. In this study, we conducted untargeted serum metabolomic profiling using high-performance liquid chromatography coupled with mass spectrometry in 48 patients with histologically confirmed BCC.

Methods: The cohort included 38 HR and 10 LR lesions. After quality filtering, 99 polar and 54 lipophilic metabolites were retained for analysis. Using a significance threshold of P < 0.01 and absolute fold change > 1.2, 10 metabolites differed between HR and LR BCC.

Results: Principal component analysis showed partial separation between the two groups driven by metabolites including dihydroxybutyric acid, glucosylsphingosine, androsterone, and several lysophosphatidylcholines. A linear discriminant model based on the first 4 principal components achieved an AUC of 0.88, corresponding to a sensitivity of 89% and a specificity of 40% for identifying HR lesions. Enrichment analysis revealed representation of multiple chemical classes, including carboxylic acids, steroids, glycerophospholipids, indoles, diazines, and organooxygen compounds. Several metabolites varied significantly by anatomical location and tumor size, while histologic subtype showed no meaningful influence.

Conclusions: These findings provide initial evidence that serum metabolomics can detect metabolic differences between LR and HR BCC and may serve as a basis for developing non-invasive biomarkers to improve BCC risk stratification.