Medical Principles And Practice[JOURNAL]
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200 papers
Differentiating Cardiac Sarcoidosis from Arrhythmogenic Right Ventricular Cardiomyopathy: A Systematic Review.
Güvenc TS, Hasdemir H, Abshir A … +1 more , Güvenç TS
Med Princ Pract · 2025 · PMID 40273901 · Full text
UNLABELLED: <p>Objective: Cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are distinct disorders with different pathophysiologic pathways, but they share similar clinical presentations...
UNLABELLED: <p>Objective: Cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are distinct disorders with different pathophysiologic pathways, but they share similar clinical presentations that could lead to misdiagnosis and inappropriate therapeutic decisions. METHODS: We searched PubMed and Google Scholar databases and other relevant literature to retrieve comparative studies including CS and ARVC that were published before 2024. The National Heart, Lung and Blood Institute checklist was used for quality assessment and the review was conducted according to the PRISMA guidelines. Three reviewers determined study eligibility and made quality assessments. RESULTS: A total of seven studies were included in the review. Patients with CS were older (five of seven studies) and had more comorbidities (two of two studies). PR interval (four of five studies) and QRS duration (four of four studies) were longer in CS. Most studies reported lower left ventricular ejection fraction in CS (five of six studies), and septal involvement on cardiac MRI was more common in CS (two of three studies). 18-Fluorodeoxyglucose uptake on positron emission tomography (PET) scan was seen in up to 90% of CS patients. 62.5%-100% of patients with CS fulfilled 1994 or 2010 International Task Force criteria for ARVC. CONCLUSIONS: Available evidence suggests that atrioventricular and intraventricular conduction defects in an older (>40 years) patient with low left ventricular ejection fraction should raise suspicion for CS, especially when other supportive findings, such as 18-fluorodeoxyglucose avidity on PET, were present. Neither 1994 nor 2010 ARVC Task Force criteria should be used to discriminate CS from ARVC. </p>.
Adult Patients with HbS-Only Phenotype of Sickle Cell Disease Have a Decreased Arginine/Asymmetric Dimethylarginine Ratio.
Ugwu A, Onwasigwe CR, Ugwu AO … +3 more , Madu AJ, Anigbogu IO, Egolum CM
Med Princ Pract · 2025 · PMID 40267902 · Full text
UNLABELLED: <p>Introduction: Leg ulcer is the most common cutaneous manifestation of sickle cell disease (SCD). Asymmetric dimethylarginine (ADMA) inhibits nitric oxide synthase, reducing nitric oxide availability, and c...
UNLABELLED: <p>Introduction: Leg ulcer is the most common cutaneous manifestation of sickle cell disease (SCD). Asymmetric dimethylarginine (ADMA) inhibits nitric oxide synthase, reducing nitric oxide availability, and causing endothelial dysfunction. This study examined the relationship between arginine/ADMA ratio and leg ulcers in SCD. METHODS: This was a cross-sectional analytical study of 90 adult subjects including 30 "HbS only" with leg ulcer, 30 "HbS only" without leg ulcer and 30 HbAA subjects. Plasma arginine and ADMA levels were measured by ELISA method. RESULTS: Median arginine level, ADMA level, and arginine/ADMA ratio were 21.05 µmol/L, 3.0 µmol/L, and 7.41, respectively, for HbS-only with leg ulcer; 25.9 µmol/L, 2.8 µmol/L, and 9.6, respectively, for HbS-only without leg ulcer; and 47.8 µmol/L, 1.0 µmol/L (CI: 1.0-1.2), and 48.5, respectively, for HbAA subjects. Median plasma <sc>l</sc>-arginine level was significantly lower in HbS with leg ulcer compared to HbS without leg ulcer (p < 0.001) and HbAA subjects (p < 0.001). Conversely, median plasma ADMA level was significantly higher in HbS-only with leg ulcer compared to HbS without leg ulcer (p = 0.002), and HbAA subjects (p < 0.001). Median arginine/ADMA ratio was significantly lower in HbS-only patients with leg ulcer. CONCLUSION: The HbS-only patients with leg ulcers have lower arginine, higher ADMA, and lower arginine/ADMA ratio when compared to those without leg ulcers and HbAA controls. The prospective arginine/ADMA ratio should be studied to screen patients with higher risks of leg ulcers that could be prevented with specifically targeted care. </p>.
Hypertension in Czech Adults Aged 25-64: Prevalence, Awareness, Control, and Risk Factors in 2019 - A Cross-Sectional Study.
Taniwall A, Lustigová M, Brož J … +11 more , Krollová P, Michalec J, Žejglicová K, Malinovská J, Bučková L, González-Rivas JP, Neto GAM, Pavlovska I, Tuháčková M, Rozsíval L, Urbanová J
Med Princ Pract · 2025 · PMID 40262560 · Full text
UNLABELLED: <p>Objective: This study analysed the prevalence of hypertension and its associated risk factors in Czech adults aged 25-64 using data from the 2019 European Health Examination Survey (EHES). Given the limite...
UNLABELLED: <p>Objective: This study analysed the prevalence of hypertension and its associated risk factors in Czech adults aged 25-64 using data from the 2019 European Health Examination Survey (EHES). Given the limited number of large-scale studies in Central Europe, this study provides crucial evidence to inform public health strategies. Examining gender differences and applying updated control thresholds, it provides valuable insights into hypertension management in Czechia. SUBJECT AND METHODS: We conducted a cross-sectional analysis using EHES 2019 data. Participants underwent a medical examination assessing cardiovascular health, including blood pressure and blood tests. A total of 1,056 participants were included, aged 25-64 years (mean age of 44.4 ± 0.73) years and with a mean BMI of 27.6 ± 0.35 kg/m2. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure (mean of the second and the third measurements, 1 min apart) ≥140/90 mm Hg and/or current antihypertensive treatment. Awareness was determined by self-reporting prior diagnosis. Control was assessed as blood pressure <130/80 mm Hg (control 1) or <140/90 mm Hg (control 2). RESULTS: Hypertension prevalence was 36.3%, with higher rates in males (46.0%) than in females (26.3%, p < 0.001). Awareness was 64.8% greater in females (72.0% vs. 60.9%, p = 0.027). Treatment was received by 47.6% of hypertensives, more by women (57.7% vs. 42.0%, p < 0.001). Control rates were 10.4% (control 1) and 49.4% (control 2). CONCLUSION: Hypertension is common in Czech adults, with gender differences in prevalence, awareness, and treatment. Despite high awareness, treatment and control remain suboptimal, indicating the need for targeted interventions. </p>.
Xenotransplantation of Solid Organs: Revolutionizing Transplantation through Innovation, Ethics, and Global Solutions.
Alobaidi S, Alobaidi S
Med Princ Pract · 2025 · PMID 40262551 · Full text
<p>Xenotransplantation represents a transformative solution to the global organ shortage, leveraging advances in genetic engineering, immunosuppression, and biosecurity. This review explores groundbreaking innovations su...
<p>Xenotransplantation represents a transformative solution to the global organ shortage, leveraging advances in genetic engineering, immunosuppression, and biosecurity. This review explores groundbreaking innovations such as CRISPR-Cas9 and multigene editing, which have redefined immunogenicity reduction and significantly enhanced the graft survival. Key breakthroughs, including the incorporation of human complement-regulatory proteins and α-Gal knockout strategies, have propelled xenotransplantation closer to clinical application. Ethical considerations, such as zoonotic risks and patient selection criteria, are discussed alongside international regulatory efforts to standardize safety protocols. This manuscript uniquely highlights recent preclinical and clinical achievements, such as successful pig-to-human kidney and heart transplants, which underscore the field's potential for clinical translation. By addressing current challenges, such as long-term graft viability and societal acceptance, xenotransplantation is poised to bridge critical gaps in transplantation medicine. Future directions emphasize the integration of innovative technologies and collaborative frameworks to advance clinical applications responsibly. </p>.
Clinical Features, Diagnostic Implications, and Outcomes of Amyotrophic Lateral Sclerosis and Myasthenia Gravis Overlap Syndrome: A Systematic Review.
Nashwan AJ, Hawas Y, Hamad AA … +7 more , Meshref M, Elbehary M, Mohamed RG, Elshahat A, Mabrouk MA, Nashwan AJ, Fouda BH
Med Princ Pract · 2025 · PMID 40209696 · Full text
UNLABELLED: <p>Objective: This review aimed to summarize the current evidence of reported myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS) overlap syndrome regarding clinical and laboratory features, diagno...
UNLABELLED: <p>Objective: This review aimed to summarize the current evidence of reported myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS) overlap syndrome regarding clinical and laboratory features, diagnostic implications, management, outcomes, and comorbid conditions to raise awareness among healthcare providers and aid in proper care provision. METHODS: Recently, a few cases of an unusual association between both diseases have been reported. PubMed, Scopus, and Web of Science were searched from inception until May 2024 to identify eligible studies. After the screening and data extraction, 20 studies with 42 cases suffering from ALS and MG were included. RESULTS: Forty-two cases were categorized into four groups as follows: the first group had 26 cases with MG onset (age range 26-82 years) preceding ALS (age range 46-83 years). The second group had 9 cases with ALS onset (age range 34-89 years) preceding MG (age range 40-89 years). The third group comprised 5 cases of ALS with positive acetylcholine receptor antibodies but without clinical manifestations of MG. The fourth group involved 2 cases of ALS with initial ocular symptoms that were unresponsive to MG treatments. CONCLUSION: The onset of new ptosis or diplopia in ALS patients should prompt clinicians to consider the possibility of a coexisting condition or alternative diagnosis. Additionally, positive acetylcholine receptor antibodies alone are insufficient to diagnose MG if ALS coexists. In patients with ALS, repetitive nerve stimulation tests may be less sensitive for detecting MG. Thus, diagnosing MG in ALS patients should rely on clinical presentation and response to empirical treatment. </p>.
Takotsubo Syndrome Recurrence: A Trigger for Increased 30-Day Cardiovascular Mortality.
Topf A, Mirna M, Hoppe UC … +5 more , Lichtenauer M, Motloch L, Vazirani R, Horn S, Núñez-Gil IJ
Med Princ Pract · 2025 · PMID 40168959 · Full text
OBJECTIVES: Recurrence of Takotsubo syndrome (TTS) has been reported with a rate up to 4%. The effect of TTS recurrence on clinical outcomes has not been in the focus of studies so far. METHODS: In our study, we enrolled...
OBJECTIVES: Recurrence of Takotsubo syndrome (TTS) has been reported with a rate up to 4%. The effect of TTS recurrence on clinical outcomes has not been in the focus of studies so far. METHODS: In our study, we enrolled 435 patients with TTS, of whom 14 patients had a recurrence. The inclusion interval for the index event was from 2015 to 2022, and patients were followed to categorize them in the group of TTS with or without the recurrence. TTS recurrences were registered until June 2024. Blood samples, data on clinical presentation, precipitating factors, cardiovascular risk factors, medications, demographics, echocardiographic and electrocardiographic parameters were obtained. The 30-day cardiovascular mortality (CV), the 30-day mortality, and arrhythmia during hospitalization were evaluated. RESULTS: Comorbidities, ECG changes, premedication, and symptoms were not significantly different between TTS patients with and without recurrence. Only the index left ventricular ejection fraction (LVEF) of TTS patients with recurrence was significantly decreased (p = 0.046). In the case of outcome parameters, TTS patients with recurrence had a significantly, higher 30-day CV mortality compared to those without recurrence (21.4% vs. 3.8%, p = 0.001) with a 5.9-fold higher 30-day CV mortality (B(SE) = 1.94 (0.70), p = 0.001). CONCLUSION: In our study, the TTS recurrence was associated with 5.9-fold higher 30-day CV mortality. Therefore, a more precise monitoring is necessary in this high-risk group. Whether only the reduced LVEF is responsible for the increased 30-day CV mortality is an open issue and more factors can be assumed to play a role.
Not Indolamine 2,3-Dioxygenase Polymorphisms, but Low Levels of Indoleamine 2,3-Dioxygenase and IDO2 Are Associated with Behçet's Syndrome.
Oral HB, Uçar Ü, Atalay YA … +2 more , Özkaya G, Oral HB
Med Princ Pract · 2025 · PMID 40159217 · Full text
UNLABELLED: <p>Objective: Behçet's syndrome (BS) is a multisystemic disorder with a complex genetic background. Indoleamine 2,3-dioxygenase (IDO) and IDO2, key enzymes in tryptophan metabolism, have immunomodulatory effe...
UNLABELLED: <p>Objective: Behçet's syndrome (BS) is a multisystemic disorder with a complex genetic background. Indoleamine 2,3-dioxygenase (IDO) and IDO2, key enzymes in tryptophan metabolism, have immunomodulatory effects. Specific IDO and IDO2 polymorphisms may influence enzymatic activity. This study aimed to explore the association between IDO/IDO2 gene polymorphisms and BS susceptibility, and assess serum levels of IDO and IDO2 in relation to BS. SUBJECTS AND METHODS: Ninety patients with BS and 52 healthy controls were enrolled in this study. Predetermined single-nucleotide polymorphisms (SNPs) were studied at specific gene loci for IDO and IDO2. Serum IDO and IDO2 levels were determined using ELISA. RESULTS: No statistically significant differences were observed in the genotype and allele frequencies of IDO (rs7820268 and rs10108662) and IDO2 (rs4503083) between patients with BS and controls. Furthermore, no significant association was found between clinical findings and SNPs, except that the IDO rs7820268 CT genotype was significantly lower in patients with neurological involvement (0% vs. 42%, p = 0.026, OR = 0.147, 95% CI = 0.18-1.231). Serum levels of IDO and IDO2 were significantly lower in BS patients compared to controls (p < 0.0000 and p < 0.0001, respectively). CONCLUSION: Our research revealed that the serum IDO/IDO2 levels of BS were substantially lower than those in the control group. This finding has the potential to impact IDO activity and reduce immune tolerance. No correlation was observed between IDO/IDO2 polymorphisms and most clinical findings of BS. However, the IDO rs7820268 CT genotype was significantly reduced in neuro-BS, suggesting a protective effect. Larger prospective trials are needed to further explore these findings. </p>.
Risks of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting.
Guvenc O, Güvenç G, Engin M
Med Princ Pract · 2025 · PMID 40132570 · Full text
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Biopsychosocial Factors and Pain Hypervigilance Should Be Considered in the Interpretation of Disease Activity in Systemic Sclerosis.
Kılıç Ö, Kaya MN, Canbaş M … +2 more , Çınar M, Yılmaz S
Med Princ Pract · 2025 · PMID 40122041 · Full text
OBJECTIVE: This study aimed to identify a pain phenotype associated with hypervigilance in systemic sclerosis (SSc) and evaluate possible variables that influence pain hypervigilance symptoms. METHODS: This cross-section...
OBJECTIVE: This study aimed to identify a pain phenotype associated with hypervigilance in systemic sclerosis (SSc) and evaluate possible variables that influence pain hypervigilance symptoms. METHODS: This cross-sectional, observational study included healthy controls (HCs) and SSc patients diagnosed with a score of 9 or higher according to the 2013 American College of Rheumatology-European League against Rheumatism classification criteria. The pain hypervigilance symptoms were evaluated using the central sensitization inventory (CSI), while disease activity was assessed using the European Scleroderma Research Group Activity Index (EScSG-AI). Patients were classified by CSI scores. Comparatives were done. RESULTS: A total of 51 SSc patients (92.2% female, mean age [50.54 years]) and 45 HCs (88.9% female, mean age [52.62]) were included. Education and monthly income were lower for SSc than HCs (p < 0.05). The CSI score ≥40 proportion was 56.9% in SSc and 15.6% in HCs (p < 0.001). Depression-Anxiety-Stress Scale (DASS-21), Epworth Sleepiness Scale (ESS), Global Pittsburgh Sleep Quality Index (PSQI), and EuroQol Five-Dimensional Three-Level Questionnaire (EQ-5D-3L) scores were higher in SSc than HCs (p < 0.05). By using multiple linear regression analysis to determine predictors of CSI score ≥40, the effective variable was EScSG-AI. In multivariate logistic regression analysis, educational level and global PSQI scores were factors associated with CSI score ≥40 in SSc. CONCLUSIONS: CSI score was positively associated with depression, disease activity, stress, anxiety, and poor sleep quality, while it was negatively associated with education and economic status. Pain hypervigilance may affect organ involvement and functioning in SSc. Clinicians should examine its biopsychosocial components.
Clinical and Medical Economic Value of Screening Colonoscopy before Laparoscopic Cholecystectomy.
Igami T, Nakamura M, Ishikawa T … +15 more , Yamamura T, Yamao K, Maeda K, Mizutani Y, Sawada T, Yokoyama Y, Mizuno T, Yamaguchi J, Onoe S, Sunagawa M, Watanabe N, Baba T, Kawakatsu S, Kawashima H, Ebata T
Med Princ Pract · 2025 · PMID 40101693 · Full text
OBJECTIVE: Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was t...
OBJECTIVE: Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the clinical value of medical care costs for SC before LC. SUBJECT AND METHODS: Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed. RESULTS: In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, was 13.1%. The detected rate of CRN requiring resection in the age-groups of <45, 44-55, 55-65, 65-75, ≥75 years was 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, 4 patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the 4 patients with resectable colorectal carcinoma were United States dollar (USD) 84,700 and USD 32,000 USD, respectively. Regarding the technical fee per person, the former group (USD 250) had much economic advantage compared to the latter group (USD 8,000). CONCLUSION: Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.
Effectiveness of Hormonal Therapy for Post-Menopausal Women with Hormone Receptor-Positive Advanced Breast Cancer: A Systematic Review and Meta-Analysis of Clinical Trials.
Okwor VC, Okwor JC, Ukwuoma MK … +2 more , Mitha SB, Nweke MC
Med Princ Pract · 2025 · PMID 40096837 · Full text
OBJECTIVE: Breast cancer (BC) cells exhibit mutations over time, conferring resistance to therapeutic approaches. We attempted to ascertain the efficacy of selected hormonal therapy for advanced BC. METHODS: This is a sy...
OBJECTIVE: Breast cancer (BC) cells exhibit mutations over time, conferring resistance to therapeutic approaches. We attempted to ascertain the efficacy of selected hormonal therapy for advanced BC. METHODS: This is a systematic review and meta-analysis of clinical trials. We searched Medline, PubMed, Cochrane Library, Web of Science, and others. Studies that investigated the effectiveness of hormonal therapy for HR positive (HR+) advanced BC were included. The outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). A random-effect meta-analysis model was employed. The study protocol was registered with the International Prospective Register of Systematic Reviews: CRD42023431939. RESULTS: Twenty-one studies were included in the meta-analysis with an overall sample size of 8,482. ORR and PFS between aromatase inhibitors (AIs) and other hormonal therapies: selective oestrogen receptor degrader, selective oestrogen modulator (SERM) and androgen inhibitors showed no significant difference (OR = 1.122 [0.917-1.374], p = 0.263; OR = 0.010 [0.000-1.292], p = 0.063), respectively. Subgroup analysis showed a statistically significant difference in ORR in favour of patients who received SERM compared to AI (OR = 1.362 [1.033-1.795], p = 0.028). For OS, no significant difference was observed among anastrozole, letrozole, and exemestane recepients (OR = 1.718 [0.021-139.128], p = 0.809). CONCLUSION: Given the above findings, clinical decisions could be based on factors such as the line of cancer treatment, adverse events, drug dosing, and individual drug benefits. Although newer combination therapies are being adopted, the agents explored in this review are still widely used in clinical practice for HR+ BC.
Response to the Letter on "Risks of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting".
Alagha S, Mola S, Çeber M … +1 more , Yıldırım A
Med Princ Pract · 2025 · PMID 40073852 · Full text
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Surveillance of Corrected QT Interval-Prolonging Medications upon Admission throughout Hospitalization in a Tertiary Care Geriatric Ward.
Baralić Knežević I, Kovačević M, Stefanović K … +4 more , Erceg P, Mihajlović G, Aćimović J, Vučićević KM
Med Princ Pract · 2025 · PMID 39978317 · Full text
OBJECTIVE: Long QT syndrome (LQTS) poses a significant risk of torsade de pointes, particularly in older patients due to age-related changes in cardiac repolarization and increased susceptibility to medication-induced QT...
OBJECTIVE: Long QT syndrome (LQTS) poses a significant risk of torsade de pointes, particularly in older patients due to age-related changes in cardiac repolarization and increased susceptibility to medication-induced QTc interval prolongation. Despite the increased risk, data on medication-related LQTS remain limited, leading to this study on its prevalence, characteristics, and risk factors, along with QT-prolonging drug use in older patients. The study aimed to identify clinical and medication-related predictors of LQTS and evaluate the burden of co-prescribed QT-prolonging medications in this population. SUBJECTS AND METHODS: This prospective study at a tertiary care hospital included initial and follow-up ECGs, with medication details were collected. Statistical analyses compared variables, including QTc intervals and medication use, between patients with and without LQTS. RESULTS: The study included 128 adults aged 65 or older, with 27.3% presenting LQTS on admission, increasing to 42.2% after 7 days of hospitalization. Patients with LQTS had a higher prevalence of QTc interval-prolonging medications, list 1 medications, and atrial fibrillation. Laboratory changes and medication use were observed, with significant increases in QTc interval and list 1 medication administration. Male sex and amiodarone use were identified as predictors of LQTS during hospitalization. CONCLUSION: The study reports a high prevalence of prolonged QTc interval and LQTS in older inpatients. Proton pump inhibitors were frequently prescribed despite their QTc-prolonging potential. This underscores the need of close monitoring and awareness of QTc prolongation risks in older patients, advocating for routine ECG assessments and vigilant management of modifiable risk factors, especially the electrolytes.
Histamine Promotes Pseudomonas aeruginosa Biofilm Formation and Renders P. aeruginosa Biofilms More Resistant to Gentamicin and Azithromycin.
Dib K
Med Princ Pract · 2025 · PMID 39938505 · Full text
INTRODUCTION: Pseudomonas aeruginosa biofilms contribute to the persistent presence of this bacterium in the cystic fibrosis airways. P. aeruginosa produces histamine in vitro and expresses histamine receptors. We invest...
INTRODUCTION: Pseudomonas aeruginosa biofilms contribute to the persistent presence of this bacterium in the cystic fibrosis airways. P. aeruginosa produces histamine in vitro and expresses histamine receptors. We investigated whether histamine regulated P. aeruginosa biofilm formation in vitro and contributed to bacterial virulence in Galleria mellonella. METHODS: P. aeruginosa biofilms were measured by staining bacteria adhered on polystyrene with crystal violet. Histamine concentrations were measured by ELISA. G. mellonella survival upon inoculation with P. aeruginosa was measured in the absence or presence of histamine. RESULTS: The concentration of histamine in the BHI broth was 140 ng/mL (1.3 μ<sc>m</sc>). Addition to the broth of diamine oxidase (DAO), an enzyme that catabolizes histamine, reduced by ∼3-fold the concentration of histamine and by 2-fold PAO1 strain biofilms. Addition of histamine (10-9<sc>m</sc>-10-4<sc>m</sc>) to the LB medium augmented P. aeruginosa biofilms. Maximum effects were observed with concentrations of 10-5<sc>m</sc> and 10-8<sc>m</sc> for the mucoid NH57388A strain and the PAO1 strain, respectively. DAO reduced mucoid NH57388A biofilms induced by histamine (10-4<sc>m</sc>) added to the LB medium. Addition of histamine to 48 h formed biofilms reduced anti-biofilm activities of gentamicin and azithromycin. Inoculation of G. mellonella with the PAO1 strain led to augmented histamine concentration in the haemolymph. Inoculation of histamine (10-8<sc>m</sc>) reduced the survival rate of G. mellonella infected with the PAO1 strain. CONCLUSION: Histamine produced during periods of infection may augment P. aeruginosa virulence by promoting the biofilm mode of life of this bacterium.
Vitamin D Supplementation Mediates a Shift toward Anti-Inflammatory Cytokine Response in Multiple Sclerosis.
Al-Shammri S, Chattopadhyay A, Raghupathy R
Med Princ Pract · 2025 · PMID 39938500 · Full text
OBJECTIVE: In this study, we assessed the impact of vitamin D (Vit-D) supplementation on cytokine profile in newly diagnosed drug-naïve multiple sclerosis (MS) patients. METHODS: We recruited 16 patients with incident MS...
OBJECTIVE: In this study, we assessed the impact of vitamin D (Vit-D) supplementation on cytokine profile in newly diagnosed drug-naïve multiple sclerosis (MS) patients. METHODS: We recruited 16 patients with incident MS; those were followed up for 12 months. Serum levels of 25-hydroxy-Vit-D were measured at recruitment and follow-up. Peripheral blood mononuclear cells were isolated from blood samples and stimulated with a mitogen in tissue culture to elicit cytokine production. Culture supernatants were tested after 4 days post-culture for levels of pro-inflammatory (TNF-α, interferon [IFN]-gamma, interleukin [IL]-6, IL-12) and anti-inflammatory cytokines (IL-4, IL-5, IL-10). RESULTS: Baseline blood sample analysis revealed that patients had low Vit-D levels (16.8 [12.41-31.4] nmol/L). Thirteen patients expressed a normal intact parathyroid hormone (iPTH) (5.5 [4.2-6.9]) and were given Caltrate D twice a day; 3 patients having elevated iPTH (mean ± SD: 12.8 ± 1.5) were prescribed 50,000 IU Vit-D once weekly and Caltrate D twice daily. IFN-β1α was prescribed after a confirmed diagnosis of relapsing-remitting MS in 13 patients; 3 patients declined immunotherapy. Irrespective of immunotherapy, we observed a gradual and significant decrease in pro-inflammatory cytokine levels and a steady significant decline in ratios of several pro-inflammatory to anti-inflammatory cytokines. The patients with higher pro-inflammatory to anti-inflammatory cytokine ratios were more prone to having relapses. CONCLUSIONS: Low Vit-D levels and elevated pro-inflammatory cytokines in drug-naïve MS patients suggest a potential immune-pathogenic role for hypovitaminosis D in MS development. Vit-D supplementation may exert protective effects by modulating the immune-inflammatory response, emphasizing its therapeutic importance in MS management.
Exploring Trends and Challenges in Global Health Dental Education: Scoping Review.
Wolpe BH, Rodacoski I, Danelle VA … +2 more , Prado MRM, Bellani WAGO
Med Princ Pract · 2025 · PMID 39938493 · Full text
Oral health is vital to overall well-being but faces significant global challenges, necessitating reform in dental education. Global oral health education empowers professionals to address these issues, promoting global...
Oral health is vital to overall well-being but faces significant global challenges, necessitating reform in dental education. Global oral health education empowers professionals to address these issues, promoting global competencies,s and preventive approaches. The objective was to map scientific articles that approach global oral health education, its practical reality, and curricular inclusion in undergraduate dental programs. This study is a scoping review following the Joanna Briggs Institute's approach, with searches in databases such as PubMed and SciELO using the keywords "global health" and "education, dental," along with the Boolean operator AND. After excluding studies outside of the scope of the research and duplicate articles, 26 articles were selected for analysis. Among the analyzed articles, the need to further discuss the following topics was observed: trends and challenges in global dental education, oral health inequalities and the need for global approaches, and the integrating global health into the dental curriculum. The reviewed studies highlight the importance of adapting curricula to global needs, emphasizing the integration of oral health into global health policies and the promotion of interprofessional competencies. The review underscores the need to internationalize dental education and prepare future dentists to address oral health inequalities, with global partnerships and interprofessional collaboration being essential for the success of these initiatives. The conclusion shows that global oral health education should include preventive and interdisciplinary approaches, preparing professionals for global challenges. This requires integrating global health competencies into curricula and promoting international collaborations in dental education.
Evaluation of the Relationship between CD44 Expression and Gleason Grade among Prostate Adenocarcinoma and Benign Prostatic Hyperplasia: A Cross-Sectional Study.
Kianparsa J, Soltanipur M, Jalali Nadoushan M
Med Princ Pract · 2025 · PMID 39933501 · Full text
INTRODUCTION: This study aimed to investigate the expression of cluster of differentiation 44 (CD44) in prostate adenocarcinoma (PAC) compared to benign prostatic hyperplasia (BPH) to address the need for biomarkers that...
INTRODUCTION: This study aimed to investigate the expression of cluster of differentiation 44 (CD44) in prostate adenocarcinoma (PAC) compared to benign prostatic hyperplasia (BPH) to address the need for biomarkers that can aid in grading classification and prognosis. METHODS: In this cross-sectional study, the CD44 expression in the tissue samples of the PAC and BPH was examined with hematoxylin and eosin and immunohistochemistry methods. The Gleason scores and grades and percentage of CD44 expression for specimens were determined. Data were analyzed using IBM SPSS version 23.0 software. RESULTS: This study included 80 PAC and 83 BPH samples. The mean expression of CD44 in PAC samples was significantly lower than in BPH samples (28.59 ± 14.84 vs. 47.82 ± 14.65, p < 0.001). A moderate to strong significant negative correlation was found between CD44 expression and total Gleason scores and Gleason grade groups (r: -0.743, p < 0.001; r: -0.732, p < 0.001, respectively). Ordinal logistic regression showed that lower CD44 expression was associated with higher odds of advanced disease (OR = 0.884, p < 0.001). CONCLUSION: This study highlights CD44 expression not only as a potential biomarker for PAC diagnosis but also potential guide to therapeutic decision-making. Patients exhibiting lower CD44 levels may require closer monitoring and more aggressive treatment strategies, while those with higher expression may be candidates for less intensive management. Overall, our findings advocate for further investigation into CD44 as a biomarker for prostate cancer aggressiveness, which could ultimately enhance personalized treatment approaches and improve the patient outcomes.
Outcomes of Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in Hemodynamically Stable Patients with Acute Kidney Injury: A Prospective, Observational, Multicenter Study.
AlSahow A, Alkandari O, Bahbahani Y … +16 more , AlYousef A, AlHelal B, AlRajab H, AlQallaf A, AlSharekh M, AlKandari A, Nessim G, Mashal B, Mazroue A, Abdelmoteleb A, ElAbbadi M, Abdelzaher A, Abdallah E, Abdellatif M, ElHusseini Z, Abdelrady A
Med Princ Pract · 2025 · PMID 39904326 · Full text
INTRODUCTION: Continuous dialysis in hemodynamically stable patients with acute kidney injury (AKI) may impact outcomes differently than intermittent dialysis. We evaluated differences in patient and kidney outcomes betw...
INTRODUCTION: Continuous dialysis in hemodynamically stable patients with acute kidney injury (AKI) may impact outcomes differently than intermittent dialysis. We evaluated differences in patient and kidney outcomes between the two modalities. METHODS: Clinical and 30-day outcome data for inpatients with AKI who were hemodynamically stable and not on ventilation and who received intermittent hemodialysis (IHD) or continuous kidney replacement therapy (CKRT) in public hospitals in Kuwait from January 1 to December 31, 2021, were prospectively collected. RESULTS: We recruited 229 patients (age: 59.9 years; males, 60.3%; baseline estimated baseline glomerular filtration [eGFR], 56 mL/min). CKRT accounted for 72.9% of cases due to lack of access to water treatment. No statistically significant differences were observed between groups in terms of age, baseline eGFR, sex, comorbidities, cause of AKI, or fluid administration. The intensive care unit contributed 21% of cases, with no significant difference between groups. More IHD patients received diuretics (62.9% vs. 43.1% for CKRT, p = 0.008). At 30 days, 21.8% of patients had died. There was no statistically significant difference in mortality between groups (16.1% for IHD vs. 24% for CKRT, p = 0.2). Final eGFR was 53.2 mL/min, with no difference between groups. Complete kidney recovery was greater with CKRT (33.1% vs. 13.5%, p = 0.009). Baseline eGFR < 60 mL/min did not influence mortality or kidney recovery. CONCLUSION: Compared with IHD, CKRT did not lower mortality at 30 days, which is similar to that of randomized trials; however, it was associated with better complete kidney recovery, which was reported in observational studies.
Efficacy and Safety of Distal Radial Artery Access versus Proximal Radial Artery Access for Cardiac Procedures: A Systematic Review and Meta-Analysis.
Rehman MEU, Raja HAA, Osama M … +13 more , Kakakhail A, Waseem MH, Mukhlis M, Abdullah Ali M, Abideen ZU, Shoaib M, Din ZU, Tahir A, Hassan MZU, Mazhar U, Haider ST, Saeed S, Nashwan AJ
Med Princ Pract · 2025 · PMID 39904322 · Full text
OBJECTIVE: Cardiac catheterization using the distal radial artery (DRA) access, at the level of the anatomical snuff box post-radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemo...
OBJECTIVE: Cardiac catheterization using the distal radial artery (DRA) access, at the level of the anatomical snuff box post-radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery (PRA) access in cardiac catheterization or angiography. METHODS: A detailed literature search was performed on PubMed, Cochrane, Embase, and Clinicaltrials.gov from inception till June 2024. Risk ratios (RRs) and mean differences (MDs) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on RevMan. RESULTS: Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-h radial artery occlusion rates (RR 0.30, 95% CI: 0.23 to 0.40, p ≤ 0.00001) and time to hemostasis (minutes) (MD -44.46, 95% CI: -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI: 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI: 2.02 to 4.15, p < 0.00001), and puncture attempts (MD 0.69, 95% CI: 0.37 to 1.00, p = 0.00001). CONCLUSION: DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.
Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.
Rehman MEU, Tahir A, Hussain A … +14 more , Ali A, Bin Gulzar AH, Khan AQ, Sajjad M, Shahid F, Zahid S, Aslam U, Yasin TB, Bilal A, Fatima T, Hameed MS, Haider T, Saeed S, Nashwan AJ
Med Princ Pract · 2025 · PMID 39900017 · Full text
BACKGROUND: Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction o...
BACKGROUND: Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction or interval shortening may be a suitable option to recapture response. We undertook a systematic review and meta-analysis to assess the efficacy of dose escalation in IBD patients receiving ustekinumab. METHODS: A systematic literature search was conducted on PubMed, Embase, Clinicaltrails.gov, and Cochrane from inception to June 1, 2024. We conducted a proportional meta-analysis on MetaXL. Our primary outcomes were clinical response and clinical remission. RESULTS: Twenty-eight articles were included (n = 2,129 patients). Eighteen studies (692 patients out of 1,218) reported clinical response, with pooled prevalence of 55% (95% CI: 46-65%). Out of 1,041 patients, 524 showed clinical remission with pooled prevalence of 51% (95% CI: 42-59%). CONCLUSION: This systematic review and meta-analysis showcased promising results, in terms of clinical response and remission, in IBD patients receiving dose escalation of ustekinumab.
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