Medicina[JOURNAL]
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200 papers
Predictors of Heart Failure in Pediatric Patients with End-Stage Kidney Disease Secondary to Nephrotic Syndrome.
Wei M, Huang H, Shen Y … +3 more , Wei L, Li Y, Guo H
Medicina (Kaunas) · 2026 Jun · PMID 42356143 · Full text
: To investigate prognostic risk factors and determine the incidence, clinical characteristics, and predictors of heart failure (HF) development in pediatric patients with end-stage kidney disease (ESKD) secondary to ste...
: To investigate prognostic risk factors and determine the incidence, clinical characteristics, and predictors of heart failure (HF) development in pediatric patients with end-stage kidney disease (ESKD) secondary to steroid-resistant nephrotic syndrome (SRNS). : We conducted a retrospective cohort study of pediatric patients diagnosed with ESKD secondary to nephrotic syndrome (NS) between 2014 and 2020. Patients were stratified based on clinical outcomes and the occurrence of HF during follow-up. Comparative analyses of clinical characteristics, laboratory parameters, and cardiac assessments were performed across groups. Multivariate logistic regression was used to identify independent risk factors for HF development within the first year and for adverse prognosis at five years. : The cohort comprised 172 children with ESKD secondary to NS. Multivariate logistic regression identified HF as an independent risk factor for adverse long-term outcomes in pediatric patients with ESKD. During follow-up, HF developed in 27 patients (15.7%) within the first year after ESKD diagnosis, and in 45 patients (26.2%) by the end of five years. Early HF onset (within the first year) was associated with a significantly reduced five-year survival rate. Independent risk factors for HF development included elevated cardiac troponin I levels (OR = 6.786, 95% CI: 2.326-19.799), a history of cardiac arrhythmias (OR = 2.951, 95% CI: 1.260-6.912), and the presence of left heart enlargement (OR = 23.669, 95% CI: 2.876-194.827), and valvular regurgitation at the initial post-ESKD diagnosis evaluation. : HF is associated with markedly reduced survival. Crucially, our findings demonstrate that pre-existing cardiovascular structural abnormalities-specifically left heart enlargement-and elevated cTnI are robust, early predictors of HF. These findings necessitate a paradigm shift in pediatric ESKD management, we advocate for the implementation of systematic baseline echocardiographic and biomarker screening at the immediate onset of ESKD. Identifying these subclinical, yet modifiable, structural changes provide a critical therapeutic window for targeted anti-remodeling interventions to significantly improve long-term prognosis.
Association Between Epicardial Adipose Tissue Thickness and Early Arrhythmia Recurrence After Electrical Cardioversion for Atrial Fibrillation and Atrial Flutter in Patients With and Without Heart Failure-An Observational Study.
Kadum F, Benko K, Batičić L … +1 more , Petretić A
Medicina (Kaunas) · 2026 Jun · PMID 42356142 · Full text
: Atrial fibrillation (AF) and atrial flutter are associated with significant morbidity. While electrical cardioversion (ECV) is a standard treatment for sinus rhythm restoration, early arrhythmia recurrence is common. E...
: Atrial fibrillation (AF) and atrial flutter are associated with significant morbidity. While electrical cardioversion (ECV) is a standard treatment for sinus rhythm restoration, early arrhythmia recurrence is common. Epicardial adipose tissue (EAT) is a metabolically active depot linked to atrial remodeling, yet its role in predicting post-ECV outcomes remains unclear. This study aimed to evaluate the association between EAT thickness measured by echocardiography and early arrhythmia recurrence following elective ECV in patients with and without heart failure (HF). : A single-center observational study was conducted including 76 patients (38 with previously diagnosed HF) who underwent successful elective ECV (eECV) for AF or atrial flutter. Preprocedural transesophageal echocardiography was performed to exclude thrombi, while EAT thickness was assessed via transthoracic echocardiography (TTE). The primary outcome was early arrhythmia recurrence (within 30 days), and a secondary outcome was arrythmia recurrence in the HF subgroup. Data were analyzed using univariable and multivariable logistic regression, receiver operating characteristic (ROC) analysis, and subgroup analysis in patients with HF. : Arrhythmia recurrence occurred in 19 patients (25.0%) within the follow-up period. Mean EAT thickness did not differ significantly between patients with and without recurrence (3.74 ± 1.41 mm vs. 3.58 ± 1.78 mm; = 0.42). EAT thickness did not emerge as a significant predictor of recurrence in univariable or multivariable models, demonstrating poor discriminative ability (AUC = 0.56). Similar findings were observed in the HF subgroup (OR = 0.94, = 0.75; AUC = 0.49). Conversely, left atrial (LA) size was significantly associated with recurrence (OR = 2.76, = 0.043). While EAT thickness correlated with body mass index and HF, it did not predict immediate rhythm outcomes. : In our study, measurement of EAT thickness via TTE was not associated with early arrhythmia recurrence after eECV, including in patients with concomitant HF. These findings suggest that early post-cardioversion stability may depend more on established structural atrial remodeling, especially by LA enlargement, than on linear EAT thickness. Further research utilizing advanced volumetric imaging is warranted to clarify the role of epicardial adiposity in atrial arrhythmogenesis.
Impact of the SARS-CoV-2 Pandemic on Oral and Maxillofacial Surgery Activity: A Seven-Year Retrospective Study from a Romanian Emergency Hospital.
Alexandru GC, Gligor LN, Chioran D … +8 more , Pricop MO, Cosoroabă RM, Riviș M, Mânea HC, Urîtu A, Roi A, Roi CI, Olariu TR
Medicina (Kaunas) · 2026 Jun · PMID 42356141 · Full text
: The SARS-CoV-2 pandemic disrupted oral and maxillofacial surgery (OMS) services worldwide because of the high aerosol-generating nature of head-and-neck procedures, restricted access to elective dental care, and system...
: The SARS-CoV-2 pandemic disrupted oral and maxillofacial surgery (OMS) services worldwide because of the high aerosol-generating nature of head-and-neck procedures, restricted access to elective dental care, and systemic reallocation of hospital resources. Continuous longitudinal multi-year data covering both the pandemic and the post-pandemic phases from regional Romanian (and more broadly central and southeastern European) emergency centers remain scarce. We aimed to quantify the impact of the pandemic on OMS activity in a large Romanian regional referral center and to evaluate post-pandemic resilience. : We conducted a retrospective single-center study of all inpatient admissions to the OMS Clinic of a tertiary emergency hospital in western Romania between 1 January 2018 and 31 December 2024. Three periods were pre-specified: pre-pandemic (2018-2019), pandemic (2020-2022) and post-pandemic (2023-2024). A Newey-West segmented interrupted-time-series (ITS) regression and a negative-binomial monthly count model with Fourier seasonality were fitted; length of hospital stay was further analyzed with a multivariable gamma-log generalized linear model adjusted for age, sex, county, primary ICD-10 chapter and total ICD-10 codes. Variables analyzed included case volume, demographics, primary and secondary ICD-10 diagnoses, length of hospital stay (LOS), case complexity (total ICD-10 codes per admission) and in-hospital mortality. : A total of 11,628 inpatient admissions corresponding to 8084 unique patients (56.5% male; mean age 52.2 ± 19.2 years) were analyzed. Compared with the pre-pandemic baseline (mean 2037 admissions/year), annual volume dropped by 45.1% in 2020, 44.0% in 2021 and 32.3% in 2022, with a nadir of -76% during the first state of emergency (April 2020; = 34 admissions). Recovery was rapid; 2024 exceeded the pre-pandemic baseline by +10.1% on raw counts and by +16.2% on admissions per 100,000 catchment population using year-specific INS denominators. The segmented ITS regression confirmed an immediate level drop of -114.2 admissions/month in March 2020 (95% CI -133.1 to -95.3; < 0.001) and a positive post-intervention slope of +2.06 admissions/month (95% CI 1.23-2.88; < 0.001), with observed monthly volume returning to the counterfactual projection by October 2023. The case mix shifted significantly (χ = 406.9, < 0.0001); elective benign neoplasm admissions were reduced from 7.2% to 2.0%, while neoplasms of uncertain behavior nearly doubled from 15.7% to 27.5%. Case complexity increased during the pandemic (mean ICD codes 4.08 ± 2.42 vs. 3.44 ± 2.30; < 0.001); after exclusion of administrative codes (whole Z chapter and U07.x), the difference attenuated to 3.34 vs. 3.17 codes (still < 0.001 by Kruskal-Wallis), indicating that the largest portion of the unadjusted increase was driven by the new mandatory pre-admission SARS-CoV-2 screening code Z11.5 rather than true clinical complexity. Notably, the clinically interpretable proxy R63.3 (feeding difficulty) independently rose from 41.5% to 53.1%. The crude median LOS did not differ between the pre-pandemic and pandemic periods (3.07 vs. 3.06 d; = 0.19) and dropped significantly post-pandemic (2.22 d; < 0.001); however, after multivariable adjustment for case mix, age, sex, county and code count, the LOS was 15.7% shorter during the pandemic (adjusted ratio 0.84, 95% CI 0.82-0.87; < 0.001) and 22.8% shorter post-pandemic (adjusted ratio 0.77, 95% CI 0.75-0.80; < 0.001) relative to baseline. : The pandemic caused a severe but transient contraction of OMS activity accompanied by increased case complexity and a marked shift away from elective surgery. Inpatient volume returned to and exceeded the pre-pandemic baseline by 2024. These results support the value of standing pandemic-preparedness protocols, sustained access to preventive dental care, and integrated tele-triage pathways for future public-health crises.
Editorial for the Special Issue "Diabetes, Hypertension, and Cardiovascular Diseases: New Insights, Risk Factors, and Drug Therapies".
Theofilis P, Mantzouranis E, Chrysohoou C … +1 more , Tsioufis K
Medicina (Kaunas) · 2026 Jun · PMID 42356140 · Full text
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide [...].
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide [...].
Dose Adjustment of JAK Inhibitors for the Management of Moderate-to-Severe Atopic Dermatitis: A Single-Centre Retrospective Study.
Falcidia C, D'Oria F, Foggi G … +6 more , Facheris P, Bianco M, Ibba L, Narcisi A, Costanzo A, Gargiulo L
Medicina (Kaunas) · 2026 Jun · PMID 42356139 · Full text
: Janus kinase (JAK) inhibitors have expanded the therapeutic options for moderate-to-severe atopic dermatitis (AD). The possibility of dose modulation with abrocitinib (100 and 200 mg) and upadacitinib (15 and 30 mg), b...
: Janus kinase (JAK) inhibitors have expanded the therapeutic options for moderate-to-severe atopic dermatitis (AD). The possibility of dose modulation with abrocitinib (100 and 200 mg) and upadacitinib (15 and 30 mg), both selective JAK1 inhibitors, represents a potential clinical advantage, allowing dose escalation in cases of insufficient response and dose de-escalation in the setting of poor tolerability or during maintenance treatment. However, real-world data remain limited, and the rationale for dose adjustment is not always standardized. This study aimed to describe, using a real-world database, the frequency, timing, and reasons for dose modifications of these agents. : We retrospectively analyzed the clinical data of 212 patients with moderate-to-severe AD treated with abrocitinib (n = 47) or upadacitinib (n = 165). Dose adjustments, including dose escalation and dose de-escalation, were recorded together with their timing and clinical reasons. : In the abrocitinib group, 34/47 patients (72.3%) initiated treatment at 100 mg, whereas 13/47 patients (27.7%) started at 200 mg. Six patients (12.8%) underwent a dose adjustment. One patient (2.1%) switched from 200 to 100 mg because of complete AD remission and concomitant menstrual cycle alterations, whereas five patients (10.6%) underwent dose escalation from 100 to 200 mg because of incomplete disease control. Among the six abrocitinib-treated patients who underwent dose adjustment, achievement of IGA 0/1 after dose modification was documented in all cases. In the upadacitinib group, 93/165 patients (56.4%) started at 15 mg, whereas 72/165 patients (43.6%) started at 30 mg. Overall, 44/165 patients (26.7%) underwent at least one dose adjustment, accounting for a total of 50 dose modifications: 27 escalations from 15 to 30 mg and 23 de-escalations from 30 to 15 mg. Among patients initiating treatment at 15 mg, 23/93 patients (24.7%) increased the dose to 30 mg after a median of 33.1 weeks because of suboptimal disease control. Among those starting at 30 mg, 21/72 patients (29.2%) reduced the dose to 15 mg after a median of 44.3 weeks. Of these, 12/21 patients (57.1%) reduced the dose because of adverse events, including herpetic infections and acne, whereas the remaining patients de-escalated because of optimal disease control. Some patients underwent multiple dose modifications: four followed a 30→15→30 mg sequence, with re-escalation after 13.2 weeks because of suboptimal disease control, and two followed a 15→30→15 mg sequence, with dose reduction after approximately 26.7 weeks because of herpes zoster. Overall, 29/44 patients achieved IGA 0/1 within 16 weeks and 38/44 within 32 weeks after dose modification. : In this real-world cohort, dose adjustments of selective JAK1 inhibitors were frequently performed in patients with moderate-to-severe AD, particularly among those treated with upadacitinib. Dose escalation was mainly used to address suboptimal disease control, whereas dose de-escalation was performed in the setting of adverse events or optimal disease control. The availability of two dosing regimens may allow treatment intensity to be adapted to individual disease severity, response, and tolerability, supporting a personalized approach to AD management.
Circulating microRNAs in Atrial Fibrillation: Clinical Significance and Future Perspectives.
Ozmen C
Medicina (Kaunas) · 2026 Jun · PMID 42356138 · Full text
Atrial fibrillation (AF) remains one of the most clinically demanding arrhythmias in contemporary cardiology-not because its mechanisms are unknown, but because what we know does not yet translate into precise, individua...
Atrial fibrillation (AF) remains one of the most clinically demanding arrhythmias in contemporary cardiology-not because its mechanisms are unknown, but because what we know does not yet translate into precise, individualized management. Existing risk scores predict adverse outcomes reasonably well at the population level but perform inadequately for individual patients, and the molecular substrate driving disease progression remains largely invisible at the bedside. MicroRNAs (miRNAs), small non-coding RNA molecules of 20-25 nucleotides found stably in peripheral blood, have attracted considerable attention as potential biomarkers capable of bridging this gap. Their involvement in atrial fibrosis, electrical remodeling, and inflammatory signaling is mechanistically well-grounded. Whether this mechanistic plausibility can be translated into clinical utility is the central question this review addresses. We summarize the biological rationale for circulating miRNAs as AF biomarkers, review the most consistently replicated miRNA expression findings across clinical studies and meta-analyses, and appraise what the evidence supports-and what it does not-regarding diagnostic accuracy, prognostic value, and clinical decision-making applications. We also outline what the field needs to accomplish to move from promising findings to routine clinical use.
The Cribriform Plate: A Multifaceted Neuroimmune Hub in CNS Health and Disease.
Cetınkaya K, Algın O
Medicina (Kaunas) · 2026 Jun · PMID 42356137 · Full text
The cribriform plate (CP) functions as a dynamic neuroimmune interface through which olfactory nerve bundles exit the brain within a specialized perineural microenvironment (cpPME). While traditionally viewed as a passiv...
The cribriform plate (CP) functions as a dynamic neuroimmune interface through which olfactory nerve bundles exit the brain within a specialized perineural microenvironment (cpPME). While traditionally viewed as a passive structural barrier, emerging evidence positions the CP as a central hub for cerebrospinal fluid (CSF) drainage, glymphatic-lymphatic clearance, and antigen presentation. This review provides a comprehensive understanding of recent advances in cpPME research, highlighting the adaptive remodeling of the immune landscape in response to neuroinflammation and aging. We critically evaluate the translational gap between rodent models and human physiology, discussing the implications for neurodegenerative diagnostics, neuroinflammatory conditions, infectious diseases and "nose-to-brain" therapeutic delivery. By integrating anatomical, physiological, and immunological perspectives, we offer a comprehensive framework for understanding the CP's role in CNS homeostasis and its potential as a transformative diagnostic and therapeutic target.
The CALLY Index Is Associated with Overall Survival in Patients with De Novo Metastatic Gastric Adenocarcinoma.
Akgül F, Can S, Gökmen İ … +6 more , Bakır Kahveci G, Bayrakçı İ, Yurdatap Koç D, Demirdelen E, Çakıcı V, Erdoğan B
Medicina (Kaunas) · 2026 Jun · PMID 42356136 · Full text
: Systemic inflammation, nutritional impairment, and immune dysregulation are important determinants of outcomes in advanced malignancies. The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker...
: Systemic inflammation, nutritional impairment, and immune dysregulation are important determinants of outcomes in advanced malignancies. The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker that reflects these biological domains, but its prognostic relevance in de novo metastatic gastric adenocarcinoma has not been well defined. : This multicenter retrospective cohort study included 234 patients with de novo metastatic gastric adenocarcinoma treated between January 2015 and December 2025. Baseline CALLY was calculated before systemic treatment. A cohort-specific CALLY threshold of 1.21 was obtained using conventional ROC analysis, with all-cause mortality status at last follow-up as the binary outcome. Survival was evaluated using Kaplan-Meier analysis and Cox proportional hazards regression. To avoid guarantee-time bias, treatment exposure variables that became known only after treatment initiation, including the number of chemotherapy cycles delivered, were excluded from the baseline Cox models. Diagnosis period was included in the multivariable model to account for treatment-era heterogeneity. : Overall, 133 patients (56.8%) were classified as low-CALLY and 101 (43.2%) as high-CALLY. Median OS was significantly longer in the high-CALLY group than in the low-CALLY group (13.9 vs. 8.6 months; log-rank < 0.001). Low CALLY was associated with inferior OS in univariable analysis (HR: 1.77, 95% CI: 1.31-2.38; < 0.001) and remained associated with worse OS after adjustment for baseline clinicopathological factors, first-line treatment category, and diagnosis period (adjusted HR: 1.77, 95% CI: 1.24-2.53; = 0.002). The PFS difference between the CALLY groups was not statistically significant (HR: 1.15, 95% CI: 0.87-1.51; = 0.326). : Low baseline CALLY was independently associated with shorter OS in this retrospective cohort. These findings support CALLY as a practical candidate prognostic biomarker, while external validation and time-to-event-based cut-off assessment are needed before clinical implementation.
A New Radiological Parameter in Pediatric Lateral Condyle Fractures: How Effective Is Fragment Size?
Aman T, Gencer B, Sağlam N … +1 more , Türkmen İ
Medicina (Kaunas) · 2026 Jun · PMID 42356135 · Full text
: This study was conducted to investigate the effects of fragment size on clinical and radiological outcomes and the development of complications during the surgical treatment of pediatric lateral condyle fractures. : Th...
: This study was conducted to investigate the effects of fragment size on clinical and radiological outcomes and the development of complications during the surgical treatment of pediatric lateral condyle fractures. : This retrospective cohort study evaluated data from 47 pediatric patients with lateral condyle fractures, including demographic information, fracture type, range of motion, complications, radiographic assessments, capitellum size, and presence of a lateral bump. Clinical evaluations were performed using the Hardacre functional classification. To objectively investigate the effect of fragment size on prognosis, the total anterior-posterior (AP) and lateral fragment areas, as well as the corresponding AP and lateral capitellum areas (to provide an individualized constant for ratio calculation), were measured. The fractured fragment/capitellum area ratio was then calculated by dividing the fragment area by the respective capitellum area. All statistical analyses were conducted using a two-tailed significance threshold of < 0.05, and corresponding 95% confidence intervals were calculated where applicable. : After a mean follow-up of 66 months (range: 12-142 months), no significant association was identified between the fractured fragment/capitellum area ratio and either the range of motion ( > 0.05) or the presence of a palpable lateral bump ( > 0.05). In contrast, a higher fractured fragment/capitellum area ratio was found to be significantly associated with the presence of radiographic complications ( = 0.01) and a larger final capitellar area ( = 0.02). : The fractured fragment/capitellum area ratio, a newly defined parameter for quantifying initial fracture size in pediatric lateral condylar fractures, demonstrated no measurable effects on clinical outcomes, the presence of a lateral bump, or range of motion; however, it was significantly associated with the development of radiological complications and may represent an important predictor of subsequent capitellar hypertrophy. : This study corresponds to Level III-retrospective cohort study.
ONX-0914 Alleviates Impaired Diabetic Wound Healing by Restoring Redox Homeostasis and Modulating Pro-Inflammatory Response.
Çıkı B, Kayalı D, Uzun H … +3 more , Altıner N, Şenyiğit A, Yılmaz B
Medicina (Kaunas) · 2026 Jun · PMID 42356134 · Full text
: Diabetes mellitus (DM) is frequently associated with impaired wound healing due to persistent oxidative stress, chronic inflammation, and dysregulated proteasome activity, leading to delayed tissue repair and increased...
: Diabetes mellitus (DM) is frequently associated with impaired wound healing due to persistent oxidative stress, chronic inflammation, and dysregulated proteasome activity, leading to delayed tissue repair and increased risk of chronic ulcers. The present study aimed to investigate the role of the immunoproteasome system in diabetic wound healing, with a particular focus on its involvement in oxidative stress and inflammatory pathways, and to evaluate whether pharmacological inhibition with ONX-0914 improves tissue repair. : Experimental diabetes was induced in rats using streptozotocin (STZ), and the animals were allocated to three groups: healthy control, STZ-induced diabetic, and STZ + ONX-0914 treatment. Wound healing was evaluated by macroscopic analysis of wound closure and histopathological examination at days 3, 7, and 14. Oxidative stress and antioxidant status were assessed by measuring malondialdehyde (MDA) levels and antioxidant enzyme activities (SOD, CAT, and GSH-Px) in serum and wound tissues. Proteasome activity was analyzed fluorometrically, while systemic and local inflammatory responses were determined by ELISA and Western blot analysis of IL-1β, TNF-α, and IL-6. : STZ-induced diabetes significantly delayed wound closure, increased lipid peroxidation, reduced antioxidant enzyme activities, and elevated systemic and tissue inflammatory cytokine levels. Treatment with ONX-0914 markedly accelerated wound closure and improved histological healing parameters, including re-epithelialization, granulation tissue formation, and angiogenesis. Moreover, ONX-0914 significantly reduced MDA levels while restoring SOD, CAT, and GSH-Px activities in both serum and wound tissues. The treatment also inhibited proteasome activity and significantly suppressed the expression of IL-1β, TNF-α, and IL-6. : ONX-0914 significantly improves diabetic wound healing by restoring antioxidant defenses, reducing oxidative damage, and attenuating inflammatory signaling pathways. These findings suggest that immunoproteasome inhibition represents a promising therapeutic strategy for enhancing tissue repair in diabetic conditions.
The Frequency of Exacerbations in Patients with COPD and Their Nutritional Status: A Multicenter Study.
Degirmenci C, Inam MG, Oral Tapan O … +10 more , Idikut A, Yesilyurt S, Tekin F, Ozturk SN, Gencer Tuluy M, Fidan U, Tunc S, Cetin N, Kose Kabil N, Yilmaz Kaya Z
Medicina (Kaunas) · 2026 Jun · PMID 42356133 · Full text
: Nutritional impairment and systemic inflammation contribute to disease progression and poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). The geriatric-nutritional-risk-index (GNRI) and prognostic-nutrition...
: Nutritional impairment and systemic inflammation contribute to disease progression and poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). The geriatric-nutritional-risk-index (GNRI) and prognostic-nutritional-index (PNI) are practical markers reflecting both nutritional and immune status. In elderly COPD patients, malnutrition-related exacerbations often worsen quality of life and increase hospitalization. Identifying reliable predictors of exacerbation risk is therefore important for improving disease management. This study evaluated the association between GNRI, PNI and exacerbation frequency across different age groups in COPD. : This multicenter retrospective study included 302 patients with COPD from 10 medical centers. All patients were classified as GOLD Group-E according to exacerbation history. Demographic characteristics, pulmonary function tests, Charlson-Comorbidity-Index (CCI), pharmacological treatments, dyspnea scores, and annual exacerbation frequency were obtained from hospital databases. Laboratory parameters including complete blood count, C-reactive protein, albumin, and total protein were recorded. GNRI, PNI, and neutrophil-to-lymphocyte ratio (NLR) were calculated to evaluate nutritional and inflammatory status. : The mean age of participants was 67.9 ± 9.6 years and 26.5% were female. Elderly patients had significantly higher CCI scores, longer disease duration, greater cumulative smoking exposure, and more frequent exacerbations than younger patients ( < 0.001). Pulmonary function parameters were significantly lower in the elderly group, while long-term oxygen therapy and nebulizer use were more common ( < 0.001). Baseline and exacerbation NLR levels were higher in elderly patients, whereas GNRI and PNI values were lower during both stable disease and exacerbation periods. Patients with more than four exacerbations per year had significantly higher NLR and lower GNRI values. : Elderly COPD patients in GOLD Group-E demonstrate marked inflammatory and nutritional burden. Lower PNI values were independently associated with increased annual exacerbation frequency, while lower GNRI values were observed in patients with greater inflammatory and nutritional burden. Routine immune-nutritional assessment may improve risk stratification and help identify patients who could benefit from early multidisciplinary management.
Documented Borderline Personality Disorder and EMR Indicators of Potential Under-Recognition in Depressive Outpatients.
Dang L, Oo SL, Wongpakaran N … +4 more , Oon-Arom A, Jenraumjit R, DeMaranville J, Wongpakaran T
Medicina (Kaunas) · 2026 Jun · PMID 42356132 · Full text
: This study aimed to estimate the prevalence of documented borderline personality disorder (BPD) diagnosis and study-defined BPD indicators among adults with depressive disorders in outpatient psychiatric care, and to q...
: This study aimed to estimate the prevalence of documented borderline personality disorder (BPD) diagnosis and study-defined BPD indicators among adults with depressive disorders in outpatient psychiatric care, and to quantify a subgroup who were indicator-positive but had no documented diagnosis (potential under-recognition). : This retrospective, cross-sectional study included adult outpatients with depressive disorders receiving pharmacological treatment at Maharaj Nakorn Chiang Mai Hospital. BPD status was classified using (1) a documented BPD diagnosis in the electronic medical record (EMR) and (2) study-defined indicators, comprising a symptom-based indicator (documentation of ≥5 DSM-5 BPD criteria) and a prescribing-based indicator (antidepressant treatment with concurrent use of antipsychotics and/or mood stabilizers). Prevalence and overlap across diagnoses and indicators were summarized using a Venn distribution. : Among 1175 patients, 63 (5.4%) had a documented BPD diagnosis. Using EMR indicators, 84 (7.1%) met the symptom-based indicator and 325 (27.7%) met the prescribing-based indicator. In total, 374 (31.8%) had either a documented BPD diagnosis or at least one indicator, while 801 (68.2%) had neither. Overall, 370 (31.5%) met at least one indicator (symptom-based and/or prescribing-based). Among indicator-positive patients, 311 (84.1%) had no documented BPD diagnosis, representing 26.5% (311/1175) of the total cohort. : Study-defined EMR indicators flagged a substantial subgroup with potential under-recognition of BPD features in depressive-disorder clinics. These indicators may help prioritize targeted assessment and structured diagnostic evaluation to support access to BPD-informed care and support referral to BPD-informed psychotherapy.
The Use of Physical Energy-Based Therapies in the Management of Osteoarthritis.
Musorrofiti MG, Bonifacio M, Cipolloni V … +3 more , Mattia E, Bellomo R, Saggini R
Medicina (Kaunas) · 2026 Jun · PMID 42356131 · Full text
Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving toler...
Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive-resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care.
Pericoronary, but Not Epicardial, Cardiac Fat Thickness Is Associated with Sarcopenia in Hospitalized Older Adults.
Erdoğan K, Erten R, Tuna Doğrul R … +7 more , Çayhan V, Boz S, Ceren İ, Demirel E, Selvi Öztorun H, Eken G, Sılay K
Medicina (Kaunas) · 2026 Jun · PMID 42356130 · Full text
: Sarcopenia is a major geriatric condition associated with functional decline and adverse outcomes. Cardiac fat depots exhibit metabolic activity and are linked to cardiometabolic risk; however, the extent to which epic...
: Sarcopenia is a major geriatric condition associated with functional decline and adverse outcomes. Cardiac fat depots exhibit metabolic activity and are linked to cardiometabolic risk; however, the extent to which epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) quantified on standard thoracic computed tomography (CT) scans are associated with sarcopenia in older inpatients remains inadequately explored. This study investigated the associations of EAT and PCAT thickness with sarcopenia. : This is a retrospective observational study using CT data obtained for clinical purposes and routine geriatric assessment data. In this single-center retrospective study, 101 inpatients aged ≥65 years who underwent unenhanced thoracic CT and bioelectrical impedance analysis within 3 months were included. EAT and PCAT thicknesses were measured using standardized methods. Sarcopenia status was based on a previously established clinical diagnosis according to EWGSOP2 criteria. Multivariable logistic regression, body mass index (BMI)-stratified analyses, and ROC curve evaluations were performed. : The participants had a mean age of 78.5 ± 7.6 years; 54.5% were female. Fifty-five patients (54.5%) met the diagnostic criteria for sarcopenia. PCAT was significantly thicker in sarcopenic participants relative to non-sarcopenic ones (12.25 ± 2.50 vs. 11.17 ± 2.32 mm, = 0.028), while no corresponding difference was observed for EAT ( = 0.959). After controlling for age, sex, and BMI, each 1 mm increase in PCAT thickness was independently associated with an increased odds of sarcopenia (OR 1.399, 95% CI 1.133-1.727, = 0.002). With the addition of the PCAT, the discriminatory power was modest (AUC 0.637 overall and 0.715 for BMI ≥25 kg/m). In exploratory stratified analyses, the association was numerically larger in the BMI ≥25 kg/m subgroup (OR 1.48, = 0.008); however, the formal BMI-by-PCAT interaction was not statistically significant ( = 0.290), so this subgroup finding is considered hypothesis-generating. : PCAT thickness measured on routine non-contrast thoracic CT was associated with prevalent sarcopenia, whereas EAT thickness was not. ROC analyses showed modest discrimination; therefore, any proposed cut-offs should be considered exploratory and require prospective validation and external confirmation before clinical use.
"Brain-First" vs. "Body-First" PD: Definitions and Implications in Everyday Clinical Practice: A Systematic Review.
Pilateris I, Bostanjopoulou S
Medicina (Kaunas) · 2026 Jun · PMID 42356129 · Full text
Parkinson's disease's (PD) underlying pathophysiology still remains incompletely understood, with Braak's hypothesis of ASyn pathology propagation being the most widely accepted. Recently, a novel model has been introduc...
Parkinson's disease's (PD) underlying pathophysiology still remains incompletely understood, with Braak's hypothesis of ASyn pathology propagation being the most widely accepted. Recently, a novel model has been introduced, proposing two distinct ASyn propagation pathways: a bottom-up trajectory termed Body-first PD, and a central nervous system (CNS)-initiated pathway termed Brain-first PD. This distinction introduces new perspectives in the PD literature landscape regarding diagnosis, prognostic factors and patient management. This study set out to systematically synthesize the current literature comparing Brain-first and Body-first PD, with a focus on clinical characteristics and disease progression, diagnostic biomarkers, and management approaches. A systematic literature search was conducted in March 2025 using PubMed, Cochrane Library, DOAJ and Google Scholar. Human observational, diagnostic, and interventional studies published between 2019 and March 2025, including patients with de novo or early PD, were eligible. Pre-motor REM sleep behavioral disorder (RBD) was used as the primary differentiation criterion. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklists. Results were synthesized using a narrative approach. Sixteen studies comprising 2107 PD patients met the inclusion criteria. Body-first PD was associated with a higher non-motor symptom (NMS) burden, faster disease progression, and a higher prevalence of cognitive impairment. Additionally, Body-first PD patients exhibited more widespread and symmetrical neurodegeneration, along with electrophysiological and metabolic differences. Distinct biomarker and microbiome profiles were also observed between subtypes. No eligible studies addressing management approaches were identified. In conclusion, the available evidence suggests that Brain-first and Body-first PD may represent two distinct pathophysiological entities, a proposal with great significance for the diagnosis, prognosis and management of PD patients. However, the predominantly cross-sectional nature of the current literature limits causal inference. Future longitudinal and interventional studies are required to clarify the potential clinical implications of this subtype classification theory.
Safety and Metabolic Outcomes of Three-Port Laparoscopic Sleeve Gastrectomy Without Liver Retractor: A 2000-Patient Retrospective Study.
Öner MÖ, Aslan F, Binici S … +2 more , Beger B, Beger O
Medicina (Kaunas) · 2026 Jun · PMID 42356128 · Full text
: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed metabolic bariatric surgery procedures worldwide. However, conventional LSG generally requires liver retraction for adequate visualization of...
: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed metabolic bariatric surgery procedures worldwide. However, conventional LSG generally requires liver retraction for adequate visualization of the operative field. This study aimed to evaluate the feasibility, perioperative safety, and metabolic outcomes of a modified three-port LSG technique performed without the use of a liver retractor. : This retrospective single-center cohort study included 2000 consecutive individuals with obesity who underwent three-port laparoscopic sleeve gastrectomy between January 2020 and December 2023. All procedures were performed without mechanical liver retraction by two experienced bariatric surgeons. Operative outcomes, postoperative complications, weight loss parameters, metabolic variables, and histopathological findings were evaluated during a 12-month follow-up period. All included patients completed the predefined follow-up schedule. Postoperative complications were classified according to the Clavien-Dindo classification system. The mean operative time, defined as skin-to-skin duration, was 30 ± 15 min, and the median hospital stay was 2.3 days. No conversion to open surgery, additional trocar placement, or rescue liver retractor use was required. The overall complication rate was 9.4%, with most complications classified as Clavien-Dindo grade I-II. Reoperation was required in three patients (0.15%), and no mortality was observed. Significant metabolic improvements were detected following surgery. Mean HbA1c levels decreased from 7.23% preoperatively to 5.67% at 12 months ( < 0.001), while BMI decreased from 42.6 kg/m to 28.7 kg/m ( < 0.001). Excess weight loss and total weight loss at 12 months reached 82.4% and 34.2%, respectively. Diabetes remission was achieved in 65.4% of patients with baseline type 2 diabetes mellitus. Continuous glucose monitoring findings demonstrated reduced postoperative glycemic variability. Three-port laparoscopic sleeve gastrectomy performed without a liver retractor appears to be a feasible and effective surgical approach when performed by experienced bariatric surgeons. The technique was associated with acceptable perioperative safety and favorable metabolic outcomes. However, because of the retrospective single-center design and absence of a conventional comparison group, definitive conclusions regarding superiority or equivalence to standard techniques cannot be established. Prospective multicenter comparative studies are required to validate these findings.
Dose-Adjusted EPOCH-R in Aggressive B-Cell Lymphomas: Efficacy, Molecular Prognostic Factors, and Real-World Outcomes from a Multicenter Turkish Cohort-A Turkish Oncology Group (TOG) Study.
Kidi MM, Asoglu H, Soysal M … +14 more , Koseci T, Kara IO, Sahin B, Paydas S, Aykan MB, Karadurmus N, Barista I, Akin S, Kus F, Akay MO, Kalyon H, Boga C, Ozdogu H, Bayram E
Medicina (Kaunas) · 2026 Jun · PMID 42356127 · Full text
: Comprehensive real-world data on dose-adjusted EPOCH-R (DA-EPOCH-R) incorporating molecular prognostic stratification remain limited. We evaluated the long-term efficacy, safety, and prognostic determinants of DA-EPOCH...
: Comprehensive real-world data on dose-adjusted EPOCH-R (DA-EPOCH-R) incorporating molecular prognostic stratification remain limited. We evaluated the long-term efficacy, safety, and prognostic determinants of DA-EPOCH-R in a multicenter Turkish cohort. : This retrospective study included 140 patients with aggressive B-cell lymphoma (diffuse large B-cell lymphoma [DLBCL], = 81; primary mediastinal B-cell lymphoma [PMBL], = 39; other, = 20) treated with DA-EPOCH-R at five academic centers (2015-2020). Molecular profiling included immunohistochemistry (MYC, BCL-2, BCL-6) and fluorescence in situ hybridization (FISH). Survival was estimated by Kaplan-Meier analysis with Cox regression for prognostic factors. : At a median follow-up of 50.1 months, 5-year overall survival (OS) and event-free survival (EFS) rates were 71.3% and 66.3%, respectively (complete response rate: 68.6%). Molecular subtypes included double-expressor (DEL; = 39), triple-expressor (TEL; = 21), double-hit (DHL; = 17), and triple-hit lymphoma (THL; = 11). Five-year OS by IPI risk group ranged from 88.6% (low) to 49.4% (high) ( = 0.005). DEL status did not confer inferior OS ( = 0.738), whereas DHL and THL had markedly poor outcomes ( < 0.001). In multivariate analysis, IPI ≥ 3 (HR 2.54; = 0.007) and FISH rearrangement (HR 3.62; < 0.001) independently predicted inferior OS. Grade 3-4 neutropenia occurred in 57.1%, with no grade 3-4 cardiotoxicity. : DA-EPOCH-R provides favorable long-term outcomes in aggressive B-cell lymphomas. DEL status did not confer a survival disadvantage, an association that is hypothesis-generating and requires confirmation, as the present design cannot establish a causal mechanism. FISH-defined DHL/THL remain associated with dismal outcomes, warranting novel therapeutic strategies.
Long-Term Follow-Up of Women with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A 16-Year Longitudinal Study.
Tomić S, Pastornački A, Drljača M … +3 more , Glogovac J, Bošković V, Brkić S
Medicina (Kaunas) · 2026 Jun · PMID 42356126 · Full text
: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disorder characterized by persistent or relapsing fatigue lasting at least six months, not alleviated by rest and not previously present. It is a...
: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disorder characterized by persistent or relapsing fatigue lasting at least six months, not alleviated by rest and not previously present. It is accompanied by post-exertional symptom exacerbation and non-restorative sleep. Fatigue is often disabling and reduces daily activity by more than 50%. This study aimed to evaluate the long-term frequency of somatic and psychiatric disorders in women previously diagnosed with ME/CFS and to describe the long-term clinical course, laboratory findings, and fatigue-related changes during a 16-year follow-up period. : Sixteen years ago, 40 women diagnosed with ME/CFS according to then-current CDC criteria were enrolled at the Clinic for Infectious Diseases and the Center for Laboratory Medicine, University Clinical Center of Vojvodina. All participants provided informed consent. After 16 years, 20 women agreed to follow-up evaluation. At both time points, participants underwent structured questionnaires, clinical examination, psychological assessment, and comprehensive laboratory testing, including hematological, biochemical, endocrinological, and virological analyses. Fatigue severity was assessed using the FibroFatigue Scale (FFS) and the Multidimensional Assessment of Fatigue (MAF) scale. : During follow-up, 15% of participants were diagnosed with rheumatoid arthritis, 10% with cervical or breast cancer, 5% experienced premature myocardial infarction, 5% developed bronchial asthma, and 20% were diagnosed with clinical depression. Progression of ME/CFS was observed in 15%, while 5% reported infertility. Additionally, 15% developed arterial hypertension. Only 15% of participants did not report symptom worsening or new diagnoses. : Over the 16-year follow-up, 85% of women with ME/CFS developed significant somatic or psychiatric conditions. These findings suggest that women diagnosed with ME/CFS may experience substantial long-term somatic and psychiatric disease burden, supporting the need for continued clinical monitoring and individualized follow-up.
Vitamin D Levels and Uropathogen Distribution in Urinary Tract Infections: A Six-Year Retrospective Study from Cyprus.
Arık H, Tınazlı M, Süer K
Medicina (Kaunas) · 2026 Jun · PMID 42356125 · Full text
: Urinary tract infections (UTIs) represent one of the most frequently encountered bacterial infections in clinical practice. Although vitamin D (vit D) is recognised for its immunomodulatory properties, its relationship...
: Urinary tract infections (UTIs) represent one of the most frequently encountered bacterial infections in clinical practice. Although vitamin D (vit D) is recognised for its immunomodulatory properties, its relationship with the spectrum of uropathogens remains unclear. This study investigated the distribution of UTI-causing pathogens in relation to serum vit D status and demographic variables including age, sex, season, and year of presentation at a tertiary hospital in the Eastern Mediterranean. : A retrospective cross-sectional analysis was conducted on 942 adult patients with culture-confirmed UTIs at a university hospital in Cyprus between January 2019 and December 2024. Serum 25-hydroxyvitamin D [25(OH)D] levels were classified as deficient (≤20 ng/mL), insufficient (20-29.9 ng/mL), or sufficient (≥30 ng/mL) according to Turkish Endocrinology Society (TEMD) guidelines. Pathogen distribution was correlated with vit D category, sex, age group, season, and year using chi-square analysis and multivariable logistic regression. Timing of urine culture collection (at admission vs. more than 48 h after admission), catheter use, upper vs. lower urinary tract classification, and comorbidity data were recorded for each patient. : Escherichia coli was the most frequently isolated uropathogen (48.83%), followed by Klebsiella pneumoniae (18.79%) and Enterococcus faecalis (11.89%). No statistically significant association was found between vit D level and uropathogen type ( = 0.504). Infections were more prevalent in females (70.49%) and in patients aged over 70 years (56.26%). Vit D deficiency was present in 47.98% of the cohort. Catheter-derived specimens accounted for 35.1% of cultures. Upper tract infection was diagnosed in 233 patients (24.7%) and lower tract infection in 709 patients (75.3%). The most frequent comorbidities were hypertension (48.4%), diabetes mellitus (33.1%), and chronic kidney disease (21.0%); on multivariable analysis, diabetes mellitus (adjusted OR = 1.4) and chronic kidney disease (adjusted OR = 1.6) were independently associated with K. pneumoniae infection. In vit D-deficient patients, K. pneumoniae infection risk was significantly higher during winter in unadjusted analysis (OR = 1.8; 95% CI: 1.3-2.5) and remained elevated after multivariable adjustment (aOR = 1.6; 95% CI: 1.1-2.3). Vit D levels showed significant seasonal variation ( < 0.001), with lower values in winter (18.6 ng/mL) and higher values in summer (28.4 ng/mL). : On multivariable analysis, no statistically significant association was found between vit D level and uropathogen species overall (χ = 13.291; = 0.504); a seasonal interaction was observed between vit D deficiency and Klebsiella infections in winter. UTI risk was highest in elderly and female patients. These findings point to the need for considering seasonal and dietary factors in UTI management and call for prospective investigation.
Visual Outcomes After Mix-and-Match Implantation of Trifocal and Extended Depth-of-Focus Intraocular Lenses: A Systematic Review and Meta-Analysis.
Rakhimova M, Aldasheva N, Auyezova A … +4 more , Orazbekov L, Utelbayeva Z, Svetlanova S, Karibayeva I
Medicina (Kaunas) · 2026 Jun · PMID 42356124 · Full text
: The use of presbyopia-correcting intraocular lenses (IOLs) has become an integral part of modern cataract surgery. Trifocal IOLs are designed to provide functional vision at multiple distances but may be associated wit...
: The use of presbyopia-correcting intraocular lenses (IOLs) has become an integral part of modern cataract surgery. Trifocal IOLs are designed to provide functional vision at multiple distances but may be associated with dysphotopsia and reduced contrast sensitivity. In contrast, extended depth-of-focus (EDOF) IOLs offer a smoother defocus profile and fewer photic phenomena; however, they often provide insufficient uncorrected near visual acuity. To overcome the limitations of each design, a mix-and-match implantation strategy, involving implantation of a trifocal IOL in one eye and an EDOF IOL in the fellow eye, has been proposed. The objective of this systematic review was to evaluate whether mix-and-match implantation can maintain high visual acuity at near, intermediate, and distance ranges in the early postoperative period. : A systematic literature search was conducted in five electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, and ScienceDirect, following PRISMA guidelines. Studies reporting outcomes of mix-and-match implantation with a trifocal IOL in one eye and an EDOF IOL in the fellow eye were included. Only studies presenting binocular uncorrected visual acuity (UCVA) at a distance, intermediate, and near ranges, expressed in logMAR units, were considered. Visual outcomes assessed at approximately 3 months postoperatively were extracted. : Five studies involving 225 patients were included. The pooled mean logMAR UDVA at 3 months was 0.05 (95% CI: 0.03-0.07), with substantial heterogeneity (I = 80.1%). The pooled mean logMAR UNVA was 0.09 (95% CI: 0.05-0.14), with high heterogeneity (I = 87.9%). For intermediate vision, the pooled mean logMAR UIVA was 0.03 (95% CI: -0.00 to 0.06), with moderate heterogeneity (I = 72.5%). Meta-regression analyses did not show statistically significant associations between publication year and visual outcomes for UDVA ( = 0.695), UNVA ( = 0.469), or UIVA ( = 0.099). Sensitivity analyses confirmed the robustness of the pooled estimates. : Mix-and-match implantation of a trifocal IOL in one eye and an EDOF IOL in the fellow eye provides favorable early binocular visual acuity across distance, intermediate, and near ranges. However, substantial heterogeneity across studies and very low certainty of evidence warrant cautious interpretation of these findings.
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