Medicina[JOURNAL]
Sun
200 papers
Antibiotic Consumption and Healthcare-Associated Infection Surveillance in a Multi-Unit Emergency Hospital in Romania: A Retrospective Observational Study.
Matei MC, Chirica VA, Ifrim M … +4 more , Morariu C, Spaiuc D, Manole A, Moscalu M
Medicina (Kaunas) · 2026 Jun · PMID 42356183 · Full text
: Healthcare-associated infections (HAIs) remain a major challenge in emergency hospital settings, where high patient turnover and empirical antibiotic use may contribute to the emergence and spread of multidrug-resistan...
: Healthcare-associated infections (HAIs) remain a major challenge in emergency hospital settings, where high patient turnover and empirical antibiotic use may contribute to the emergence and spread of multidrug-resistant organisms. Monitoring antibiotic consumption is essential for antimicrobial stewardship and infection prevention. This study evaluated antibiotic consumption patterns across multiple hospital units and explored their ecological relationship with HAI rates. : A retrospective observational study was conducted in a tertiary-level emergency hospital in Romania between 1 January 2021 and 31 October 2025. Antibiotic consumption was quantified using Defined Daily Dose per 100 bed-days (DDD/100 bed-days) according to World Health Organization (WHO) methodology and categorized using the WHO Access, Watch, and Reserve (AWaRe) classification. HAI data were collected using standardized surveillance definitions. Statistical analyses were primarily descriptive and exploratory and included graphical trend assessment, simple linear regression for temporal trend description, and Spearman correlation analysis for exploratory ecological co-variation assessment. : Antibiotic consumption showed substantial variability across hospital units, without a consistent temporal trend over the study period. The Watch group predominated over the Access group from 2023 onward, while Access antibiotics remained below the WHO-recommended 60% threshold. The highest antibiotic consumption was observed in the Medical Wards, followed by Surgical Wards and the Intensive Care Unit. A total of 27 HAIs were identified (0.27 per 1000 patient-days), with the highest incidence observed in the ICU. The most frequent infections were infections (33.3%) and catheter-associated urinary tract infections (29.6%). Exploratory ecological analyses did not identify robust associations between total antibiotic consumption and HAI rates across hospital units. A numerically elevated co-variation was observed between fluoroquinolone consumption and infection incidence; however, this finding should be interpreted strictly as exploratory and hypothesis-generating. : Antibiotic use varied across hospital units, with predominance of broad-spectrum agents and suboptimal adherence to WHO AWaRe targets. Reported HAI incidence remained low and should be interpreted within the limitations of routine surveillance systems and potential under-ascertainment. These findings support the value of continuous institutional surveillance of antibiotic use and HAIs while highlighting the limitations of aggregated ecological analyses.
Intermittent Levosimendan Administration for Advanced Heart Failure Treatment in Adults with Congenital Heart Disease (Levo-ACHD Study).
Fusco F, Altobelli I, Casale V … +11 more , Borrelli N, Ciriello GD, Barracano R, Merola A, Grimaldi N, Palma M, Papaccioli G, Correra A, Colonna D, Scognamiglio G, Sarubbi B
Medicina (Kaunas) · 2026 Jun · PMID 42356182 · Full text
Heart failure (HF) is a major cause of morbidity in adults with congenital heart disease (ACHD), who may also have limited access to transplant. Intermittent levosimendan administration has shown benefit in advanced HF d...
Heart failure (HF) is a major cause of morbidity in adults with congenital heart disease (ACHD), who may also have limited access to transplant. Intermittent levosimendan administration has shown benefit in advanced HF due to acquired heart disease, but currently, there are no data on ACHD. We aimed to evaluate the effects of this treatment in ACHD patients with advanced heart failure, focusing on both clinical status and objective outcome measures. We conducted a single-center retrospective analysis of ACHD patients aged >18 years with advanced HF who received ≥ three intermittent levosimendan infusions (either 12.5 mg once monthly or 6.25 mg every two weeks over a 6 h infusion) between March 2020 and January 2025 at a tertiary ACHD center. Clinical outcomes during follow-up were compared with those in the year preceding treatment. Primary endpoints included safety and HF-related adverse events, particularly HF hospitalizations. Secondary endpoints included changes in New York Heart Association (NYHA) class, nt-pro-B-natriuretic peptide (nt-proBNP) values, and ventricular systolic function assessed by echocardiography. Twelve patients (median age 44.6 years, 25% female) were included, with heterogeneous congenital diagnoses and advanced HF. Five patients had a systemic right ventricle (sRV) and one had a single ventricle with previous Fontan palliation. During a median follow-up of 1.3 years, intermittent levosimendan was well-tolerated, with no treatment-limiting adverse events. Two patients (16%) required hospitalization for HF during follow-up compared with 8 (66%) in the year preceding treatment. The incidence of HF hospitalizations decreased from 0.83 to 0.20 events per person-year during follow-up ( = 0.03), although findings should be interpreted cautiously given the small sample size and retrospective design. NYHA functional class improved significantly ( = 0.005). While no significant changes were observed in NT-proBNP or left ventricular ejection fraction, patients with a systemic right ventricle (sRV) showed an increase in right ventricular fractional area change (27 ± 7.4% to 30.6 ± 7%, = 0.02); however, this observation should be regarded as exploratory given the limited sample size. Two deaths occurred, consistent with the severity of the underlying disease and not directly attributable to levosimendan and the Fontan patient received a successful heart and liver transplant. In a small, real-world cohort of ACHD and advanced HF, intermittent levosimendan administration was safe and associated with improved symptoms, reduced HF hospitalizations, and signals of enhanced systemic right ventricular function. These hypothesis-generating findings may help inform future multicenter studies in ACHD patients with advanced HF, suggesting a potential role for intermittent levosimendan in selected patients, while highlighting the need for prospective, adequately powered studies to confirm its efficacy and better define optimal patient selection.
Survival Outcomes and Machine Learning-Based Prediction of 12-Month Mortality in Glioblastoma Before and During the COVID-19 Pandemic: A SEER Population-Based Study.
Adalı Y, Çınar ÖE, Dere ÜA
Medicina (Kaunas) · 2026 Jun · PMID 42356181 · Full text
: The COVID-19 pandemic disrupted cancer diagnosis and treatment pathways worldwide. Glioblastoma is an aggressive primary brain malignancy requiring timely multimodal care. This study evaluated survival outcomes among g...
: The COVID-19 pandemic disrupted cancer diagnosis and treatment pathways worldwide. Glioblastoma is an aggressive primary brain malignancy requiring timely multimodal care. This study evaluated survival outcomes among glioblastoma patients diagnosed before and during the COVID-19 pandemic and prepared a dataset for machine learning-based prediction of 12-month mortality. : Patients aged ≥20 years diagnosed with glioblastoma between 2018 and 2021 were identified from the SEER database using ICD-O-3 histology codes 9440/3, 9441/3, and 9442/3. Patients were categorized as pre-COVID period (2018-2019) or COVID period (2020-2021). OS and CSS were evaluated using Kaplan-Meier curves, log-rank tests, and Cox regression models. Machine learning models predicted 12-month all-cause mortality using registry variables. : The final cohort included 9914 patients; 4819 were diagnosed pre-COVID and 5095 during COVID. Median OS was 11 months pre-COVID and 10 months during COVID; 12-month OS was 44.3% and 41.2%, respectively. Median CSS was 11 months in both periods; 12-month CSS was 46.9% and 44.1%, respectively. COVID-period diagnosis was modestly associated with poorer OS (adjusted HR 1.050, 95% CI 1.006-1.095, = 0.025) and CSS (adjusted HR 1.048, 95% CI 1.003-1.095, = 0.035). Machine learning models showed moderate discrimination for 12-month mortality prediction. : Glioblastoma patients diagnosed during the COVID period had modestly poorer OS and CSS in conventional survival analyses; however, competing-risk analysis did not show a significant association with cancer-specific death. Registry-based machine learning models provided moderate 12-month mortality prediction, supporting their potential utility for population-level prognostic assessment.
Clinical Determinants of 90-Day Mortality After Tracheostomy in Critically Ill Patients: A Multicenter Retrospective Cohort Study.
Özgüngör Y, Yeniay H, Gilik BE … +3 more , Karagöz E, Çakırgöz M, Seven S
Medicina (Kaunas) · 2026 Jun · PMID 42356180 · Full text
: Tracheostomy is frequently performed in critically ill patients requiring prolonged invasive mechanical ventilation; however, factors associated with intermediate-term mortality after tracheostomy remain poorly charact...
: Tracheostomy is frequently performed in critically ill patients requiring prolonged invasive mechanical ventilation; however, factors associated with intermediate-term mortality after tracheostomy remain poorly characterized. This study aimed to identify clinical and procedural factors associated with 90-day all-cause mortality after tracheostomy in ICU patients. : This retrospective multicenter cohort study included 292 adult patients who underwent tracheostomy in two tertiary ICUs between 1 October 2023 and 1 June 2025. Demographic characteristics, admission diagnoses, comorbidities, clinical severity scores, procedural variables, microbiological culture results, and survival data were collected. Univariate analyses, multivariable binary logistic regression, Cox proportional hazards regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis were performed. : The overall 90-day all-cause mortality rate was 74.7%. Age, Charlson Comorbidity Index, and APACHE II score were significantly associated with 90-day mortality in univariate analyses, whereas tracheostomy timing and technique were not. In multivariable logistic regression analysis, the Charlson Comorbidity Index and APACHE II score were independently associated with mortality. Cox proportional hazards regression confirmed that both APACHE II score and Charlson Comorbidity Index were independently associated with mortality over time. ROC analysis demonstrated moderate discriminative performance for age, Charlson Comorbidity Index, and APACHE II score. : In critically ill patients undergoing tracheostomy, 90-day mortality was high and was driven primarily by acute illness severity and comorbidity burden rather than procedural characteristics. These findings support incorporating biological vulnerability, expected recovery potential, and goals-of-care discussions into tracheostomy decision-making.
Intraoperative Driving Pressure and Postoperative Pulmonary Complications Following Cardiac Surgery: A Prospective Observational Study.
Yılmaz C, Ata F, Yırtımcı S … +7 more , Çevikkalp E, Ulusoy E, Karaca Ü, Balkaya AN, Onur T, İskender A, Gamlı M
Medicina (Kaunas) · 2026 Jun · PMID 42356179 · Full text
: Postoperative pulmonary complications (PPCs) remain an important cause of morbidity after cardiac surgery. Driving pressure (DP), defined as the difference between plateau pressure and positive end-expiratory pressure,...
: Postoperative pulmonary complications (PPCs) remain an important cause of morbidity after cardiac surgery. Driving pressure (DP), defined as the difference between plateau pressure and positive end-expiratory pressure, has been proposed as a bedside marker of respiratory system mechanics during lung-protective ventilation. However, its relationship with PPCs in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) remains uncertain. This study aimed to evaluate the association between intraoperative DP and PPCs following CPB-supported cardiac surgery. : This single-center prospective observational study included 99 adult patients undergoing elective cardiac surgery with CPB. All patients were ventilated using a standardized lung-protective strategy with a tidal volume of 6 mL/kg predicted body weight and a fixed PEEP of 5 cmHO. Patients were categorized according to intraoperative DP as Group I (DP < 13 cmHO, = 66) and Group II (DP ≥ 13 cmHO, = 33). The primary outcome was a composite PPC endpoint, defined as the occurrence of at least one EPCO-defined pulmonary complication during the postoperative hospital stay. Multivariable logistic regression was performed to assess whether pre-CPB DP was independently associated with PPCs after adjustment for body mass index, CPB time, and age. : Patients with DP ≥13 cmHO had higher post-CPB and ICU-admission lactate concentrations. Pneumothorax, pleural effusion, atelectasis, CPAP requirement, and prolonged mechanical ventilation were more frequent in the elevated-DP group. Mechanical ventilation duration, ICU stay, and hospital stay were also longer in this group. Composite PPCs occurred in 41 patients (41.4%). Although higher pre-CPB DP showed a non-significant trend toward increased PPC risk in univariable analysis (OR 1.121, 95% CI 0.988-1.273; = 0.077), it was not independently associated with the composite PPC endpoint after adjustment (adjusted OR 1.091, 95% CI 0.952-1.251; = 0.212). In contrast, higher pre-CPB DP was significantly associated with prolonged postoperative ventilation and longer mechanical ventilation, ICU, and hospital stay durations. : Elevated intraoperative DP was associated with a higher unadjusted burden of PPCs and delayed postoperative recovery after CPB-supported cardiac surgery. However, pre-CPB DP was not an independent predictor of the composite PPC endpoint after adjustment for relevant confounders. These findings suggest that DP may serve as a clinically useful marker of impaired respiratory mechanics and postoperative vulnerability rather than as an independent causal determinant of PPCs.
Qualitative Experience with an Adherence Promotion Intervention Among Individuals with Bipolar Disorder: What Is Helpful and Unhelpful?
Kelley EL, Sajatovic M, Mallu A … +4 more , Rufai FS, Weise C, Black J, Levin JB
Medicina (Kaunas) · 2026 Jun · PMID 42356178 · Full text
: Pharmacotherapy is a first-line treatment for bipolar disorder (BD), although half of individuals report suboptimal medication adherence. Medication adherence enhancement programs that are brief, person-specific, and r...
: Pharmacotherapy is a first-line treatment for bipolar disorder (BD), although half of individuals report suboptimal medication adherence. Medication adherence enhancement programs that are brief, person-specific, and remotely delivered may be an effective adjunct to treatment. The aim of this study was to qualitatively assess what individuals with BD who participated in a Customized Adherence Enhancement (CAE) program found most helpful and unhelpful about this program, focusing on elements most generalizable to medication adherence promotion. : = 14 participants with BD from the intervention arm of a randomized effectiveness trial of CAE vs. enhanced treatment-as-usual participated in one-on-one virtual, semi-structured interviews. Interviews were recorded, transcribed, and summarized using thematic content analysis to identify themes reflecting what was helpful and unhelpful about the program. : Participants identified six main themes reflecting impactful aspects of the medication adherence promotion program: practical tools (e.g., worksheets), self-awareness (e.g., identification of triggers), psychoeducation/content (e.g., specific CAE modules), emotional distress (e.g., difficult emotions arose during sessions), format (e.g., pros/cons of virtual format), and interventionist factors (e.g., rapport). : Results provide participant-identified useful aspects of a remotely delivered, adjunctive medication adherence promotion program for individuals in treatment for BD in public-sector settings. Strategies for improvement and scale-up of the program include ensuring sufficient technologic and emotional support throughout the program. Future studies may investigate the longer-term impact of such interventions with multiple stakeholder input and consideration of diverse populations, settings, and cultural contexts.
The Clinical Role of Electrocardiographic Morphology of Premature Ventricular Contractions for Prognostic Outcomes in Children.
Kunigeliene R, Marinskis G, Usonis V … +1 more , Kinciniene O
Medicina (Kaunas) · 2026 Jun · PMID 42356177 · Full text
Premature ventricular contractions are among the most common arrhythmias encountered in clinical practice. However, this disorder can be associated with arrhythmia-induced cardiomyopathy or be the first sign of primary m...
Premature ventricular contractions are among the most common arrhythmias encountered in clinical practice. However, this disorder can be associated with arrhythmia-induced cardiomyopathy or be the first sign of primary myocardial diseases. Certain morphologies of premature ventricular contractions are associated with a higher risk for sudden arrhythmia and cardiac dysfunction in the adult population. There is data on the clinical value and significance of the contraction morphology in adults, but there is a lack of such data for children. This observational prospective study of pediatric outpatients with premature ventricular contractions was conducted at Vilnius University Hospital Santaros Clinics. Inclusion criteria comprised children aged 3-17 years with more than 5% premature ventricular contractions over 24 h. Exclusion criteria included previously diagnosed congenital heart defects and cardiomyopathies, channelopathies, or the presence of any acute condition. The electrocardiographic morphology and measurements were assessed, analyzed, and described in this study. The electrocardiograms of 80 patients were analyzed according to the ECG-estimated morphology of the arrhythmia complex, arrhythmic QRS complex duration, ratio with the normal QRS complex, and maximum deflection index in V5-V6 derivations. Cardiac MRI abnormalities (8 of 30 MRI studies) was reliably associated with a PVC duration of >150 ms and the maximal amount of extrasystoles per 24 h, with a median amount of 29.6%. A long postcoupling interval (>0.9 s) was associated with PVC progression. In this exploratory pediatric cohort, wider PVC QRS duration and higher maximal PVC burden were associated with ventricular MRI abnormalities, while longer postcoupling interval was associated with PVC progression.
Trauma-Associated Tinnitus and Hearing Loss: A Comprehensive Narrative Review of Prevalence, Risk Factors, and Clinical Outcomes.
Boicu DG, Bitere-Popa OR, Cozma RS … +6 more , Diac MM, Scripcaru A, Mârțu CM, Olariu R, Iațentiuc IM, Bulgaru Iliescu D
Medicina (Kaunas) · 2026 Jun · PMID 42356176 · Full text
: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awa...
: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. : A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., "acoustic trauma," "blast injury," "traumatic brain injury," "head trauma") with terms related to auditory dysfunction (e.g., "tinnitus," "hearing loss," "auditory dysfunction"). Eligible studies included observational studies (cohort, cross-sectional, case-control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. : The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. : Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens.
Effect of Reprocessed Micronized Acellular Dermal Matrix on Postoperative Dysphagia After Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Study.
Kim DH, Hur JW, Hong JT
Medicina (Kaunas) · 2026 Jun · PMID 42356175 · Full text
: Postoperative dysphagia following anterior cervical discectomy and fusion (ACDF) remains a common complication affecting patient quality of life. This study evaluated the safety and clinical efficacy of reprocessed mic...
: Postoperative dysphagia following anterior cervical discectomy and fusion (ACDF) remains a common complication affecting patient quality of life. This study evaluated the safety and clinical efficacy of reprocessed micronized acellular dermal matrix (ADM) compared to conventional gel-type anti-adhesive agents in patients undergoing single-level ACDF. : This retrospective propensity score-matched study included 108 patients (54 matched pairs) who underwent single-level ACDF between January 2021 and December 2025. The ADM group received CGDerm Matrix™ and the control group received Mediclore™. The primary outcome was postoperative swallowing function assessed by the Swallowing Impairment Score (SIS-6) at 3 months (pre-specified primary time point). Secondary outcomes included VAS, NDI, modified MacNab criteria, adhesion scores, prevertebral soft tissue swelling, and perioperative inflammatory markers. Bonferroni correction was applied for multiple comparisons (adjusted α = 0.0125). : The ADM group demonstrated significantly lower SIS-6 scores at 3 months (0.26 ± 0.16 vs. 0.68 ± 0.27, = 0.01), which remained significant after Bonferroni correction. All other clinical and radiological outcomes were comparable between groups. No device-related complications occurred. : ADM application in ACDF surgery appears safe and is associated with improved postoperative swallowing function at 3 months. However, the clinical significance of observed differences requires further investigation.
Comparing Digital Cognitive Interventions to Active Controls and Usual Care for Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis.
Lee H, Lim Y, Lee SH
Medicina (Kaunas) · 2026 Jun · PMID 42356174 · Full text
: Mild cognitive impairment (MCI) and dementia are prevalent public health challenges with limited pharmacological options for cognitive enhancement. Digital cognitive rehabilitative interventions (DCIs) have emerged as...
: Mild cognitive impairment (MCI) and dementia are prevalent public health challenges with limited pharmacological options for cognitive enhancement. Digital cognitive rehabilitative interventions (DCIs) have emerged as a promising non-pharmacological approach, offering accessibility and personalized strategies. However, their efficacy across diverse populations and contexts remains unclear. This study evaluated the effectiveness of DCIs in improving global cognitive function in individuals with MCI and dementia by comparing them to active controls and usual care. : Ten databases, including Ovid-Medline, Ovid-Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, KoreaMed, KMbase, RISS, and KISS, were searched for studies published up to May 2025. Global cognitive and executive functions, along with quality of life, were assessed. Meta-analyses using Review Manager version 5.4 were conducted to evaluate global cognitive function improvements, first stratified by comparator group (active control vs. usual care) and further stratified by patient (MCI vs. dementia) and intervention (computer-based vs. virtual reality cognitive training) types. : This systematic review and meta-analysis analyzed 37 studies. Overall, DCIs improved global cognitive function compared to the control group (SMD = 0.44, 95% CI: 0.18, 0.69). However, subgroup analysis showed no significant effect when DCIs were compared with active controls (SMD = 0.24, 95% CI: -0.35, 0.82). Subgroup analysis showed benefits for individuals with MCI (SMD = 0.43, 95% CI: 0.16, 0.70) but yielded inconclusive results for those with dementia (SMD = 0.95, 95% CI: -0.69, 2.59). Computer-based DCIs were effective (SMD = 0.57, 95% CI: 0.20, 0.93), whereas VR-based interventions had inconsistent outcomes (SMD = 0.32, 95% CI: -0.34, 0.98). : DCIs may improve cognitive function compared with usual care, particularly in patients with MCI. However, their added benefits overactive cognitive interventions remain uncertain. Further well-designed studies are needed to clarify the relative advantages of DCIs across patient populations and intervention formats.
Adding Preoperative Oral Antibiotics to Mechanical Bowel Preparation Reduces Surgical Site Infections in Elective Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials.
Guadalajara H, Putan A, García Arranz M … +4 more , León-Arellano M, Sanz-Baro R, Ramirez JM, García-Olmo D
Medicina (Kaunas) · 2026 Jun · PMID 42356173 · Full text
: Surgical site infections (SSIs) remain common after elective colorectal surgery. This systematic review and meta-analysis evaluated whether adding oral antibiotic bowel preparation (OAB) to mechanical bowel preparation...
: Surgical site infections (SSIs) remain common after elective colorectal surgery. This systematic review and meta-analysis evaluated whether adding oral antibiotic bowel preparation (OAB) to mechanical bowel preparation (MBP) reduces SSIs compared with MBP alone. : PubMed, the Cochrane Library, Scopus, and ClinicalTrials.gov were searched for English-language randomized controlled trials published from January 2005 to January 2025. Eligible trials enrolled adults undergoing elective colorectal surgery and compared MBP+OAB versus MBP alone, with standard intravenous prophylaxis in both groups. The primary outcome was overall SSI; secondary outcomes were incisional SSI and organ-space SSI. Risk of bias was assessed with RoB 2, certainty with GRADE, and odds ratios (ORs) were pooled using DerSimonian-Laird random-effects models. The protocol was prespecified but not prospectively registered. : Twelve trials including 4073 patients were included (MBP+OAB, n = 2069; MBP, n = 2004). MBP+OAB reduced overall SSI (OR 0.53, 95% CI 0.37-0.75; < 0.001; I = 62.5%; 95% prediction interval 0.17-1.66), incisional SSI (OR 0.52, 95% CI 0.34-0.80; = 0.003; I = 57.5%), and organ-space SSI (OR 0.63, 95% CI 0.45-0.88; = 0.007; I = 8.3%). The effect was preserved in metronidazole-containing regimens (OR 0.46, 95% CI 0.33-0.65), but this subgroup was exploratory. Excluding high-risk-of-bias studies supported the primary result. Publication-bias assessment was underpowered. Overall and organ-space SSI were moderate-certainty outcomes; incisional SSI was low-certainty, and anastomotic leak was very low-certainty. : In contemporary elective colorectal surgery when MBP is used, adding preoperative OAB probably reduces SSIs. Findings do not establish whether OAB alone is sufficient or whether MBP is necessary; stewardship-relevant outcomes remain insufficiently reported. Funding was provided by ISCIII grant PI25/01285.
Fecal Zonulin-Related Proteins in Inflammatory Bowel Disease: Associations with Clinical Disease Activity and Inflammatory Markers.
Frandeș SI, Frandeș O, Macarie M … +2 more , Ionele CM, Bățagă SM
Medicina (Kaunas) · 2026 Jun · PMID 42356172 · Full text
: Intestinal barrier dysfunction is increasingly recognized as a contributor to inflammatory bowel disease (IBD) pathophysiology. Zonulin, a regulator of epithelial tight-junction permeability, has emerged as a potential...
: Intestinal barrier dysfunction is increasingly recognized as a contributor to inflammatory bowel disease (IBD) pathophysiology. Zonulin, a regulator of epithelial tight-junction permeability, has emerged as a potential non-invasive biomarker; however, its clinical relevance remains uncertain. This study evaluated whether fecal zonulin levels reflect clinical disease activity in inflammatory bowel disease and explored their association with ileal involvement in Crohn's disease (CD). : Forty-six consecutive IBD patients (26 CD, 20 UC) were prospectively included. Fecal zonulin was measured using a commercially available ELISA. In this study, the term "fecal zonulin" refers to ELISA-detected zonulin-related proteins. Clinical disease activity was assessed using CDAI for CD and the Mayo score for UC. Standard blood and fecal inflammatory markers were obtained, and subgroup analyses were performed according to disease type and location. : Fecal zonulin levels were significantly higher in active IBD compared with remission (106.37 vs. 53.80 ng/mL, = 0.002). Patients with CD had higher zonulin concentrations than those with UC (91.4 vs. 51.0 ng/mL, = 0.001). Zonulin showed a moderate positive correlation with fecal calprotectin (r = 0.338; = 0.021). In multivariable analysis, clinical disease activity remained independently associated with zonulin levels, whereas ileal involvement was no longer statistically significant. : Fecal zonulin is associated with disease activity in IBD, suggesting that fecal zonulin-related proteins may represent a potential adjunctive marker of epithelial barrier dysfunction and clinical disease activity in IBD. However, these findings should be considered exploratory and require validation in larger, longitudinal multicenter studies using standardized assays and endoscopic correlation.
Temperature Variations on the External Root Surface During Warm Injectable Gutta-Percha Obturation at Different Thermo-Plasticization Settings: An In Vitro Study.
Paven M, Marinescu AG, Abuabboud O … +6 more , Cîrligeriu LE, Nica LM, Cărăbiș BG, Kovacs IM, Velea-Barta OA, Oancea R
Medicina (Kaunas) · 2026 Jun · PMID 42356171 · Full text
: Warm injectable gutta-percha techniques may improve three-dimensional filling of complex canal anatomy, but heat transfer to the external root surface may threaten periodontal tissues when the 47 °C threshold is exceed...
: Warm injectable gutta-percha techniques may improve three-dimensional filling of complex canal anatomy, but heat transfer to the external root surface may threaten periodontal tissues when the 47 °C threshold is exceeded. This in vitro study quantified external root-surface temperature changes during obturation with the Woodpecker FI-G/FI-P system and compared manufacturer preset temperatures with actual device output. : Twenty extracted single-rooted human teeth standardized to 18 mm were prepared and assigned to obturation at 180 °C (Group A, = 10) or 230 °C (Group B, = 10). Infrared thermography recorded coronal, middle, and apical root-surface temperatures. A second device-based experiment measured FI-G and FI-P output at preset temperatures of 150 °C, 180 °C, 200 °C, and 230 °C. : The 230 °C setting produced significantly higher middle-third temperatures than the 180 °C setting (41.84 ± 5.52 °C vs. 36.99 ± 3.21 °C; = 0.027; Cohen's d = 1.07), whereas coronal and apical differences were not significant. The highest external root-surface value was 49.6 °C, and 3/10 specimens obturated at 230 °C exceeded 47 °C in the middle third. A significant coronal-to-middle gradient reversal was observed at 230 °C ( = 0.045). Device measurements showed strong attenuation between preset and output temperatures: at 230 °C, the FI-G tip base reached 150.0 °C but the tip apex reached 51.3 °C, while FI-P plugger tips reached 120.0 °C. : The 180 °C setting produced a more predictable thermal profile, whereas 230 °C increased localized middle-third overheating risk. These in vitro findings support cautious temperature selection, especially in teeth with reduced dentin thickness or compromised root anatomy.
Cup-to-Disc Ratio Is Associated with Disability in Multiple Sclerosis: A Combined OCT and Subjective Visual Vertical Study.
Vienažindytė I, Klėgėris T, Ulozienė I … +3 more , Kaski D, Glebauskienė B, Balnytė R
Medicina (Kaunas) · 2026 Jun · PMID 42356170 · Full text
: Non-invasive biomarkers reflecting neurodegeneration are increasingly important in multiple sclerosis (MS). Optical coherence tomography (OCT) provides quantitative measures of retinal structure, most commonly peripapi...
: Non-invasive biomarkers reflecting neurodegeneration are increasingly important in multiple sclerosis (MS). Optical coherence tomography (OCT) provides quantitative measures of retinal structure, most commonly peripapillary retinal nerve fiber layer (pRNFL) thickness. However, the potential clinical relevance of optic nerve head morphology, including cup-to-disc ratio (CDR), remains insufficiently explored. We investigated associations between OCT-derived parameters, subjective visual vertical (SVV), and disability in MS. : In this retrospective study, 100 patients with MS were included. OCT parameters (pRNFL thickness and area-based CDR) were analyzed at baseline and follow-up. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Detailed optic neuritis history was not consistently available in the retrospective clinical records and therefore could not be systematically accounted for in the analyses. SVV was evaluated in 37 patients using a virtual reality-based protocol. Associations were assessed using Spearman correlation and linear regression analyses. Multivariable regression models were adjusted for age, sex, and follow-up duration. : pRNFL thickness was not associated with baseline EDSS (rho = -0.06, = 0.55) or annualized EDSS change. Baseline CDR correlated with both baseline EDSS (rho = 0.30, = 0.0065) and follow-up EDSS (rho = 0.46, < 0.0001). In univariable regression analysis, baseline CDR was associated with follow-up EDSS (B = 3.33, R = 0.23, < 0.0001), remaining significant after adjustment for age, sex, and follow-up duration (B = 2.59, 95% CI 1.26-3.92, = 0.0002). No significant associations were observed between OCT parameters and SVV measures. : Higher CDR values, but not pRNFL thickness, were associated with disability measures in this exploratory MS cohort. However, these findings should be interpreted cautiously because optic neuritis history could not be systematically accounted for and physiological optic disc variability may substantially influence CDR measurements.
Artificial Intelligence-Driven Fractional Flow Reserve Assessment: Technical Foundations, Clinical Insights, and Future Directions.
Hafez A, Awad K, Farina JM … +13 more , Nour M, Mohamed MR, Scalia IG, Ahmed S, Abdelfattah F, Razaghi M, Chollet L, Etchegoyen CV, Ibrahim R, Tamarappoo B, Stib M, Ayoub C, Arsanjani R
Medicina (Kaunas) · 2026 Jun · PMID 42356169 · Full text
Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality. Accurate diagnosis of ischemia-causing coronary stenoses is essential for guiding revascularization and improving outcomes. Althoug...
Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality. Accurate diagnosis of ischemia-causing coronary stenoses is essential for guiding revascularization and improving outcomes. Although invasive fractional flow reserve (FFR) remains the gold standard for functional lesion assessment, its use is limited by procedural invasiveness, cost, and complexity. CT-derived FFR (FFRct), based on computational fluid dynamics (CFD), was the first major advance in noninvasive physiological assessment, but its adoption has been hindered by intensive off-site computation and dependence on high-quality imaging. This review summarizes the evolution from invasive FFR to AI-driven functional assessment of coronary lesions. We examine the principles and validation of CFD-based FFRct and then focus on the shift toward artificial intelligence, including both machine learning (ML) and deep learning (DL) approaches. These methods range from models using engineered geometric and plaque features trained on large synthetic datasets to end-to-end systems that learn directly from imaging data. We discuss key validation studies evaluating diagnostic accuracy, prognostic value, and clinical utility, with attention to performance in challenging settings such as intermediate stenoses, heavy calcification, and patients with comorbidities. We also highlight major barriers to widespread adoption, including dependence on input data quality, limited explainability, regulatory hurdles, and integration into clinical workflows. Finally, we outline future directions, including AI-enabled virtual PCI planning, multimodal risk stratification, and broader access to functional cardiac assessment. AI has the potential to transform noninvasive coronary imaging by enabling a single CCTA scan to provide rapid, integrated evaluation of anatomy, plaque characteristics, and physiological significance, supporting more personalized care and better clinical outcomes.
Effect of Perioperative Ketamine and Esketamine on Postoperative Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Al Subhi M, Al Yousufi M, Alnajdi H … +4 more , Al-Balushi A, Al Alawi IK, Al Abri S, Al-Mufargi Y
Medicina (Kaunas) · 2026 Jun · PMID 42356168 · Full text
: Postoperative fatigue (POF) is a frequent complication that negatively affects recovery and quality of life following surgery. Ketamine and esketamine, as N-methyl-D-aspartate (NMDA) receptor antagonists, may reduce po...
: Postoperative fatigue (POF) is a frequent complication that negatively affects recovery and quality of life following surgery. Ketamine and esketamine, as N-methyl-D-aspartate (NMDA) receptor antagonists, may reduce postoperative fatigue; however, current evidence remains inconclusive. This systematic review and meta-analysis aimed to evaluate the effects of perioperative ketamine and esketamine on postoperative fatigue in adult surgical patients. : A systematic search of major electronic databases was conducted to identify randomized controlled trials comparing perioperative ketamine or esketamine with placebo or standard care in adult surgical patients. Fatigue outcomes during the first postoperative week were analyzed using random-effects meta-analyses and reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroup analyses were performed according to NMDA antagonist type, surgical procedure, and administration regimen. Sensitivity analyses included exclusion of studies using patient-controlled intravenous analgesia (PCIA) and leave-one-out analyses. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE approach. : Eight randomized controlled trials (n = 906 participants) were included in the qualitative and quantitative synthesis. No significant overall reduction in postoperative fatigue was observed at POD1 (SMD -0.37, 95% CI -0.87 to 0.13), although esketamine demonstrated a significant benefit in subgroup analysis. Ketamine/esketamine significantly reduced postoperative fatigue at POD3 (SMD -0.58, 95% CI -0.86 to -0.30) and POD7 (SMD -0.38, 95% CI -0.65 to -0.12). Subgroup analyses demonstrated greater reductions in fatigue among patients undergoing colorectal surgery. Sensitivity analyses excluding PCIA studies and leave-one-out analyses confirmed the robustness of the findings at POD3 and POD7. The certainty of evidence was rated as low for POD1 and moderate for POD3 and POD7. : Perioperative ketamine and esketamine were associated with reduced postoperative fatigue from POD3 onward in adult surgical patients, with more consistent benefits observed in colorectal surgery populations. Further high-quality studies are needed to determine the clinical significance of these findings and their impact on postoperative recovery outcomes.
Preoperative Psoas Muscle Index and Psoas Attenuation in Patients Undergoing Nephrectomy for Renal Cell Carcinoma: A Retrospective Cohort Study.
Ipek OM, Dincer E, Aydiner O … +3 more , Sevinc AH, Hanci Sevinc B, Aras E
Medicina (Kaunas) · 2026 Jun · PMID 42356167 · Full text
Evidence linking sarcopenia and myosteatosis to oncological outcomes in renal cell carcinoma (RCC) remains inconsistent. We aimed to evaluate whether preoperative psoas muscle measurements are associated with tumor stage...
Evidence linking sarcopenia and myosteatosis to oncological outcomes in renal cell carcinoma (RCC) remains inconsistent. We aimed to evaluate whether preoperative psoas muscle measurements are associated with tumor stage, recurrence, and survival in RCC patients undergoing nephrectomy. A total of 199 patients who underwent nephrectomy with a diagnosis of RCC between 2018 and 2024 were retrospectively evaluated. Preoperative computed tomography images were used to measure the bilateral psoas muscle area at the L3 vertebral level and Hounsfield unit (HU) values. The psoas muscle index (PMI) was calculated. PMI and psoas HU values were analyzed as continuous variables, as this approach preserves statistical information and avoids misclassification bias inherent to arbitrary dichotomization, particularly given the absence of population-specific validated thresholds for Turkish RCC patients. Tumor stage, metastasis, recurrence, and survival data were analyzed. The mean age of the patients was 60.29 ± 11.62 years, and 67.84% were male. The mean PMI was 5.11 ± 1.54 cm/m while the mean psoas HU value was 38.63 ± 8.95 HU. PMI was significantly higher in patients with advanced-stage (T3 and T4) disease than in those with early-stage (T1 and T2) disease (5.57 ± 1.49 vs. 4.30 ± 1.28, < 0.001). A positive correlation was found between T stage and PMI (r = 0.396, < 0.001) and between tumor size and PMI (r = 0.215, = 0.002). Modest but significant correlations were found between age and both PMI (r = -0.274, < 0.001) and psoas HU values (r = -0.347, < 0.001). In this retrospective nephrectomy series, conducted in a cohort inherently enriched for adequate performance status and surgical fitness, PMI showed a positive correlation with pathological T stage and tumor size, intriguingly higher PMI values were observed in patients with advanced T stages. These findings suggest that the role of psoas-based muscle measurements in the prognostication of this subset of RCC patients (advanced disease but candidates for surgical treatment) may be limited.
Condylar Positional Changes Following Manual Proximal Segment Positioning During Bilateral Sagittal Split Ramus Osteotomy: A Cephalometric Study.
Tanrısever NC, Gökalp H
Medicina (Kaunas) · 2026 Jun · PMID 42356166 · Full text
: Maintenance of condylar position during bilateral sagittal split ramus osteotomy (BSSRO) is important for preserving temporomandibular joint biomechanics and skeletal stability. During surgery, loss of muscle tone unde...
: Maintenance of condylar position during bilateral sagittal split ramus osteotomy (BSSRO) is important for preserving temporomandibular joint biomechanics and skeletal stability. During surgery, loss of muscle tone under general anesthesia may alter the condyle-fossa relationship, making accurate repositioning of the proximal segment challenging. Although manual positioning remains the most commonly used intraoperative approach, evidence regarding its ability to preserve the preoperative condyle-fossa relationship remains limited. This study evaluated changes in the condyle-fossa relationship following BSSRO performed with manual proximal segment positioning. : This single-center retrospective study included lateral cephalometric radiographs of 14 patients (8 females, 6 males; aged 19-29 years) with skeletal Class III malocclusion treated with combined orthodontic treatment and BSSRO. Radiographs were obtained preoperatively (T0), immediately postoperatively (T1), and at the final follow-up examination (T2). Condylar position was assessed using a Cartesian coordinate system, joint space measurements, and the Condyle Position Index (CPI). Statistical analyses were performed using the Friedman and Wilcoxon signed-rank tests ( < 0.05). : Significant differences were observed in CPI and anterior joint space measurements across the observation periods. Interval analysis demonstrated increased CPI values and decreased anterior joint space measurements between T1 and T2, whereas no significant immediate postoperative changes were observed. Intra-observer reliability was excellent, with intraclass correlation coefficients exceeding 0.90 for all variables. : Manual positioning of the proximal segment during BSSRO may provide acceptable immediate postoperative condyle-fossa stability but may not completely maintain the preoperative condyle-fossa relationship over time. Although no significant immediate postoperative changes were observed, significant changes in the condyle-fossa relationship were identified at the final follow-up examination. These findings support the need for further prospective studies incorporating clinical temporomandibular joint assessment and three-dimensional imaging.
Foveal Density and Multi-Domain OCTA Biomarkers May Help Identify Preclinical Diabetic Microvasculopathy in Type 2 Diabetes Mellitus.
Zlatanović M, Živković MLJ, Zlatanović N … +2 more , Brzaković M, Jovanović M
Medicina (Kaunas) · 2026 Jun · PMID 42356165 · Full text
: Type 2 diabetes mellitus (T2DM) causes retinal microvascular changes that precede clinically apparent diabetic retinopathy (DR). We aimed to identify which optical coherence tomography angiography (OCTA) biomarkers bes...
: Type 2 diabetes mellitus (T2DM) causes retinal microvascular changes that precede clinically apparent diabetic retinopathy (DR). We aimed to identify which optical coherence tomography angiography (OCTA) biomarkers best distinguish eyes with T2DM without clinical DR from healthy controls and to evaluate machine learning classifiers trained on a comprehensive 68-parameter OCTA panel. In this prospective case-control study, 80 patients with T2DM without clinical DR and 33 controls underwent 3 × 3 mm macular OCTA using an Optovue RTVue Avanti System. After outlier screening, 221 eyes (155 T2DM, 66 controls) were analyzed. Sixty-eight OCTA parameters were extracted, covering FAZ morphometry (including foveal density FD-300), SCP and DCP vessel density and layer thickness, outer-retina and choriocapillaris flow, and a full retinal-thickness map. Between-group comparisons used the Mann-Whitney U test with Benjamini-Hochberg FDR correction. Logistic regression, random forest, and XGBoost classifiers were evaluated with patient-grouped 10-fold cross-validation; feature importance was quantified via SHAP. Forty-two of 68 parameters reached FDR significance (q < 0.05). Deep capillary plexus vessel density was the most discriminative family (whole image rb = -0.66, q = 2.5 × 10; parafovea rb = -0.64). FD-300 was reduced in T2DM (median 47.55% vs. 51.86%; rb = -0.57; q = 1.0 × 10) and emerged as the top SHAP feature (mean |SHAP| = 0.81). FAZ circularity decreased without FAZ-area enlargement, and outer-retina flow was paradoxically elevated (rb = +0.39), consistent with a projection artifact. XGBoost using all 68 features achieved a patient-grouped cross-validated AUC of approximately 0.91, compared with 0.85 for conventional SCP + DCP whole-image density. No parameter correlated with current HbA1c in T2DM (all q > 0.98), and the well-controlled (<7%) and poorly controlled (≥7%) subgroups were indistinguishable across five of six principal biomarkers, consistent with metabolic memory. FD-300 remained independent after adjustment for hypertension, hyperlipidemia, and age (OR = 0.76; 95% CI 0.69-0.84; < 0.001). : A multi-compartment OCTA panel outperforms conventional two-layer vessel-density metrics in detecting preclinical diabetic microvasculopathy, although external validation is required before clinical use. FD-300 is the single most informative biomarker, while choriocapillaris and retinal thickness measures provide complementary, compartment-specific signals. Because the OCTA signature is decoupled from the current HbA1c, screening should not be deferred in well-controlled T2DM.
Fall-Related Extremity Injuries During a Severe Snowfall and Icing Episode in Diyarbakır, Türkiye: Injury Patterns, Treatment Characteristics, and Need for Surgery in the Emergency Department.
Altintaş M, Çetinkaya R, Özel M … +1 more , Balsak H
Medicina (Kaunas) · 2026 Jun · PMID 42356164 · Full text
: Severe snowfall and icing are associated with weather-related trauma presentations, especially in cities unaccustomed to prolonged winter conditions. However, the clinical characteristics of these injuries and their im...
: Severe snowfall and icing are associated with weather-related trauma presentations, especially in cities unaccustomed to prolonged winter conditions. However, the clinical characteristics of these injuries and their implications for surgical management remain incompletely understood. This study aimed to describe injury patterns, treatment approaches, and factors associated with the need for surgery among patients presenting with extremity trauma during an intense snowfall and icing episode in Diyarbakır. : This single-center retrospective observational study included patients presenting to the emergency department with extremity trauma during a severe snowfall and icing period. Demographic characteristics, injury features, imaging modality, ambient temperature, anatomical localization, and treatment approaches were analyzed. Patients were categorized according to nonoperative versus operative management. Factors associated with the need for surgery were evaluated using univariable and multivariable logistic regression analyses. Receiver operating characteristic analysis was used to assess the discriminative ability of age and ambient temperature for predicting the need for surgery. : A total of 943 patients were included. The largest age group was 18-44 years (38.6%), and 55.9% were male. Fractures were identified in 50.7% of cases, whereas 46.7% had no fracture and 2.7% had joint dislocation. Upper-extremity injuries predominated (65.2%), with distal segment involvement observed in 55.0% of cases. Most presentations occurred on days with mean ambient temperatures ≤ 0 °C (81.5%). Overall, 82.1% of patients were managed nonoperatively, while 17.9% required surgical treatment. In multivariable analysis, increasing age and the use of computed tomography were independently associated with the need for surgery, whereas ambient temperature was not. : Fall-related extremity injuries during severe snowfall and icing were predominantly upper-extremity and distal injuries, and most were managed nonoperatively. The need for surgery was more strongly associated with patient age and injury complexity than with ambient temperature alone. These findings describe a distinct trauma profile during short-term winter events in mild-climate cities.
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