Maedica[JOURNAL]
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200 papers
Pathological Predictors of Residual Cancer Burden Following Neoadjuvant Chemotherapy in Breast Cancer.
Carabas BA, Tapoi D, Costache M
Maedica (Bucur) · 2026 Mar · PMID 41978854 · Full text
BACKGROUND: Neoadjuvant chemotherapy (NAC) has become standard treatment for locally advanced breast cancer. The residual cancer burden (RCB) system provides standardized quantification of residual disease with establish...
BACKGROUND: Neoadjuvant chemotherapy (NAC) has become standard treatment for locally advanced breast cancer. The residual cancer burden (RCB) system provides standardized quantification of residual disease with established prognostic value. However, relationships between pre-treatment characteristics and post-treatment RCB outcomes remain incompletely characterized. OBJECTIVE: To comprehensively evaluate associations between pre-treatment pathological characteristics (pre-treatment stage, Nottingham grade) and post-treatment outcomes (RCB class and score, post-therapy grade) and to assess prognostic significance of additional pathological features including tumor necrosis, lymphovascular invasion (LVI), perineural invasion (PNI), and in situ carcinoma and neoplasm focality. METHODS: This retrospective cohort study included 180 breast cancer patients who received NAC followed by definitive surgery. Pre-treatment assessment included pathological T (pT) stage and Nottingham histological grade from core biopsies. Post-treatment evaluation included RCB classification (RCB-0 through RCB-III), RCB continuous score, post-therapy grade and assessment of necrosis, LVI, PNI, tumoral necrosis and uni/multifocal disease. RESULTS: Pre-treatment tumor characteristics and post-treatment pathological features provide complementary prognostic information. RCB classification effectively stratifies patients, with additional refinement through LVI, PNI, necrosis and focality assessment. CONCLUSIONS: Integration of multiple pathological parameters enhances risk stratification and may guide personalized adjuvant treatment decisions.
Medication Adherence and Its Determinants in Patients with Type 2 Diabetes Mellitus Attending an Internal Medicine Outpatient Department.
Olatunji OO, Patnaik PK, Sathiya V … +2 more , Otu-Ansah JB, Mede BN
Maedica (Bucur) · 2026 Mar · PMID 41978853 · Full text
BACKGROUND: Medication adherence remains a central element in achieving optimal glycemic control in type 2 diabetes mellitus. Many patients struggle to follow prescribed therapy, leading to early metabolic deterioration...
BACKGROUND: Medication adherence remains a central element in achieving optimal glycemic control in type 2 diabetes mellitus. Many patients struggle to follow prescribed therapy, leading to early metabolic deterioration and a higher burden of complications. Understanding the factors that shape adherence in routine clinical settings can help guide targeted interventions. MATERIALS AND METHODS: A hospital-based observational study was conducted in the Internal Medicine Outpatient Department of the Dominica China Friendship Hospital, Dominica, between August 2024 and January 2025. Adults diagnosed with type 2 diabetes mellitus and on treatment for at least six months were eligible. A total of 420 patients were enrolled. Medication adherence was measured using the eight-item Morisky medication adherence scale (MMAS-8). Sociodemographic, clinical and behavioral characteristics were documented through structured interviews and medical records. Data were analyzed using chi-square tests to assess associations and multivariate logistic regression was applied to identify independent predictors of adherence. RESULTS: Participants had a mean age of 54.6 ± 10.8 years, with males comprising 58.3% of the cohort. According to MMAS-8 scoring, 29.3% demonstrated high adherence, 41.9% moderate adherence and 28.8% low adherence (mean score 6.21 ± 1.54). Forgetfulness, discontinuation of therapy after symptomatic improvement and financial constraints were the most commonly reported barriers. On multivariable analysis, higher education, simplified drug regimen, regular follow-up and good glycemic control emerged as independent predictors of good adherence. Participants with high adherence exhibited significantly lower mean HbA1c levels compared with poorly adherent individuals (6.8 ± 0.9% vs 8.3 ± 1.1%, p < 0.001). CONCLUSION: Medication adherence was suboptimal in a substantial proportion of adults with type 2 diabetes mellitus. Interventions that strengthen diabetes education, reduce regimen complexity and promote structured follow-up may improve adherence and support better glycemic control.
When Portal Venous Gas Is Not Catastrophic: Accidental Hydrogen Peroxide Ingestion Managed Conservatively.
Andronikou A, Papadopoulos C, Kouskos E … +2 more , Pegios A, Dinaki K
Maedica (Bucur) · 2026 Mar · PMID 41978852 · Full text
Accidental ingestion of hydrogen peroxide is uncommon but may lead to alarming clinical and radiological findings. Portal venous gas is traditionally associated with severe intra-abdominal pathology; however, benign etio...
Accidental ingestion of hydrogen peroxide is uncommon but may lead to alarming clinical and radiological findings. Portal venous gas is traditionally associated with severe intra-abdominal pathology; however, benign etiologies should also be considered. We report the case of a 63-year-old woman who presented with abdominal pain following accidental ingestion of hydrogen peroxide. The estimated concentration was low (likely household preparation ~3%), although the exact volume ingested was uncertain. Computed tomography revealed extensive portal venous gas and duodenal pneumatosis. Arterial blood gas analysis and serum lactate levels were within normal limits, supporting the absence of bowel ischemia. The patient was managed conservatively with supportive care and supplemental oxygen, with complete radiological and clinical resolution. This case highlights the importance of correlating imaging findings with clinical presentation to guide appropriate management and avoid unnecessary invasive interventions.
Validity of a Questionnaire Assessing Preparedness and Self-Reported Confidence of Lebanese Emergency Department Personnel in Managing Ophthalmic Emergencies and Mass Ocular Trauma.
Daher A, Jabbour N, Abdul Fattah M … +3 more , Tlaiss Y, Itaoui R, Abiad B
Maedica (Bucur) · 2026 Mar · PMID 41978851 · Full text
BACKGROUND: Ophthalmic emergencies constitute a significant portion of emergency department (ED) visits; yet, many non-ophthalmologists report feeling underprepared for their management. In Lebanon, mass-casualty events...
BACKGROUND: Ophthalmic emergencies constitute a significant portion of emergency department (ED) visits; yet, many non-ophthalmologists report feeling underprepared for their management. In Lebanon, mass-casualty events like the 2020 Beirut Port Blast have further highlighted the critical need for structured assessment of personnel preparedness in managing ocular trauma. This study aimed to evaluate the validity and reliability of a novel questionnaire designed to measure the self-reported preparedness and confidence of ED personnel and first responders in managing acute ocular emergencies. METHODS: A cross-sectional validation study was conducted among 431 Lebanese ED healthcare providers and first-line responders, primarily paramedics (69.6%). The 10-item Likert scale instrument underwent expert review for content validity. Psychometric evaluation included internal consistency reliability (Cronbach's α and McDonald's ω) and construct validity via exploratory factor analysis (EFA). RESULTS: The instrument demonstrated high internal consistency (Cronbach's α = 0.922; McDonald's = 0.924) and strong sampling adequacy (KMO = 0.910). EFA supported a clinically interpretable two-factor structure: "Trauma-Specific Stabilization and Escalation Confidence" and "General Emergency Preparedness in Ophthalmology". Participants reported the lowest confidence in medication indications (mean = 2.53) and training adequacy (mean = 2.62). CONCLUSION: The questionnaire is a valid and reliable tool for assessing self-reported preparedness in ophthalmic emergency management. It can serve as a standardized benchmarking instrument to identify educational gaps and guide training interventions in high-throughput, resource-constrained acute care settings.
Clinical Implications of Low Anion Gap in Critically Ill Patients: Insights from the BOLD Multi-Centre Blood Gas Dataset.
Rathinam J, Job Sb M, More AR … +1 more , Cherian D
Maedica (Bucur) · 2026 Mar · PMID 41978850 · Full text
OBJECTIVES: Low and subnormal anion gap (AG) values are frequently overlooked in clinical practice despite potential diagnostic and prognostic implications. We aimed to characterise the distribution of AG and albumin-cor...
OBJECTIVES: Low and subnormal anion gap (AG) values are frequently overlooked in clinical practice despite potential diagnostic and prognostic implications. We aimed to characterise the distribution of AG and albumin-corrected anion gap (CAG) in a large multicentre cohort of critically ill patients, quantify the prevalence of low and subnormal values and examine AG behaviour in the presence of clinically significant lactic acidosis. MATERIALS AND METHODS: We performed a retrospective secondary analysis of the publicly available Blood Gas and Oximetry Linked Dataset (BOLD), comprising de-identified records from MIMIC-III, MIMIC-IV and eICU-CRD databases. Anion gap and CAG were calculated, with CAG being adjusted for albumin. Low AG was defined as <6 mmol/L, subnormal as 6-10 mmol/L and elevated as >16 mmol/L. Clinically significant lactic acidosis was defined as lactate >5 mmol/L. Mortality differences were assessed using Pearson's chi-square test. RESULTS: Among 37,763 admissions with available AG data, AG was less than 6 mmol/L in 1.6% of patients and <10 mmol/L in 15.3% of subjects. After albumin correction, CAG was less than 6 mmol/L in 0.5% of patients and <10 mmol/L in 5.8% of subjects. In the subgroup with lactate >5 mmol/L, 19.2% of patients did not have an elevated AG and 8.2% did not exhibit an increased CAG. Among patients with normal or low CAG values, in multivariable logistic regression adjusting for age, pH, albumin, SOFA score and comorbidity index, clinically significant lactic acidosis remained independently associated with mortality [adjusted odds ratio (OR) 3.05, 95% confidence interval (CI) 2.04-4.56]. CONCLUSIONS: Low and subnormal AG values are relatively common in critically ill patients even after albumin correction and the causes remain unclear. A substantial proportion of patients with clinically significant lactic acidosis do not exhibit an elevated AG. Clinicians should exercise caution when using AG to categorise metabolic disorders, as high-anion-gap physiology may be masked by an underlying low or subnormal anion gap.
Transcendental Meditation as a Modulator of Cognitive and Psychological Well-Being.
Daulatabad V, K P, H E … +8 more , R N, A A, B A, V N, John N, Bhargav H, N R, V P
Maedica (Bucur) · 2026 Mar · PMID 41978849 · Full text
Meditation is the practice of focusing the mind on a particular object, thought, or activity to reach a calm, stable state. Meditation is been practised since ancient past in various forms. Transcendental meditation (TM)...
Meditation is the practice of focusing the mind on a particular object, thought, or activity to reach a calm, stable state. Meditation is been practised since ancient past in various forms. Transcendental meditation (TM) is widely practiced for its potential benefits on mental and physical well-being using the mantra "OM" as an object of awareness. Despite its popularity in the Global North, evidence of its impact on cognitive and psychological health remains limited in the Indian context. To evaluate the effects of TM practice on cognitive performance by audiovisual reaction time and psychological parameters. This single-group quasi-experimental study was conducted after Institutional Ethics Committee approval. Thirty-four volunteers (13 males and 21 females aged 25-50 years) underwent a 12-week TM intervention from a certified instructor. Audiovisual reaction time was measured using a Psychotronics digital reaction time apparatus and ADI Power Lab 8. The Profile of Mood States (POMS), Pittsburgh Sleep Quality Index (PSQI) and Standardized Assessment of Personality Abbreviated Scale (SAPAS) were used for psychological assessment. Resilience was measured using the Nicholson McBride Resilience Questionnaire (NMRQ). Data were analyzed using SPSS version 29. Audiovisual reaction time was significantly reduced as a result of TM for cognitive tasks suggesting enhanced cognitive processing speed. Highly significant improvements were also observed in mood scores, sleep quality, resilience levels after the TM intervention (p<0.0001). Personality traits showed an increase in positive scores toward emotional stability. Transcendental meditation improves cognitive performance and psychological well-being, supporting its potential as a complementary approach for mental health promotion and stress reduction. It can also be utilized for enhancing focus and attention, in activities demanding rapid and accurate responses, such as sports.
Atrial Cardiomyopathy.
Cinteza M
Maedica (Bucur) · 2026 Mar · PMID 41978848 · Full text
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Prevalence and Predictors of Pulmonary Hypertension in End-Stage Renal Disease: a Single-Center Cross-Sectional Study.
Neagu A, Capusa C, Zugravu A … +2 more , Croitoru EL, Bogdan MA
Maedica (Bucur) · 2026 Mar · PMID 41978847 · Full text
BACKGROUND: Pulmonary hypertension (PH) is highly prevalent in patients with chronic kidney disease (CKD) and is a strong predictor of mortality. The relative contributions of vascular access for hemodialysis (HD) in the...
BACKGROUND: Pulmonary hypertension (PH) is highly prevalent in patients with chronic kidney disease (CKD) and is a strong predictor of mortality. The relative contributions of vascular access for hemodialysis (HD) in the pathogenesis of PH remain under debate. This study analyses the prevalence and potential predictors of PH in End-stage renal disease (ESRD). MATERIAL AND METHODS: A retrospective cross-sectional study of 51 CKD patients on maintenance dialysis (86% HD, 14% peritoneal dialysis (PD)) was conducted. Patients underwent comprehensive echocardiography to estimate systolic pulmonary artery pressure (SPAP). Pulmonary hypertension was defined as SPAP > 35 mm Hg. The associations between SPAP and vascular access type, arteriovenous fistula (AVF) location and echocardiographic parameters were analyzed using univariate and multivariable linear regression models. RESULTS: The prevalence of PH was 31% and the median SPAP was 30 mm Hg. There was no significant difference in SPAP between patients with central venous catheters, proximal AVFs or distal AVFs. Left atrial volume was the strongest independent predictor of SPAP (beta = 0.41, p < 0.001). Elevated E/e' ratio (p = 0.002) and reduced left ventricular ejection fraction (p = 0.016) were significantly associated with SPAP in univariate analysis. PD patients exhibited significantly smaller left atrial volumes compared to HD patients (p = 0.023). CONCLUSIONS: Pulmonary hypertension is frequent in ESRD. The main drivers of PH in ESRD are volume overload and left heart disease. These findings support volume management as the primary therapeutic target for PH in the dialysis population.
Death in Epilepsy: Ictogenic Vs. Cardiogenic Mechanisms and Immunoassays in Postmortem Interval Estimation - Case Report.
Turlea IR, Curca GC, Matei L … +1 more , Stoica A
Maedica (Bucur) · 2026 Mar · PMID 41978846 · Full text
BACKGROUND: Epilepsy may cause sudden death. More scenarios are possible: sudden unexpected death in epilepsy (SUDEP), cardiac and non-cardiac mechanisms of death. This study presents the case history of a 57-year-old pe...
BACKGROUND: Epilepsy may cause sudden death. More scenarios are possible: sudden unexpected death in epilepsy (SUDEP), cardiac and non-cardiac mechanisms of death. This study presents the case history of a 57-year-old person known for epilepsy who experienced a final tonic-clonic seizures with ictal cardiorespiratory arrest shortly after hospital admission. The present study aimed to determine 1) the cause of death and possible mechanisms; and 2) reference values for immunoassays at 36.8-hour postmortem interval. MATERIALS AND METHODS: A full medico-legal autopsy was performed. Postmortem findings and a large panel of investigations are provided: anatomic pathology, pericardial chemistry investigations, forensic serology and toxicology. Immunoassays including sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with Western blotting for vinculin and enzyme-linked immunosorbent for cardiac TnT, vinculin and desmin were used to assess the postmortem interval. RESULTS: Cause of death, mechanisms and medico-legal causality are debated. Autopsy findings and relevant investigations did not reveal a single identifiable cause of death incompatible with life. Even more, SUDEP appears improbable and status epilepticus not documented. An ictogenic cause of death with autogenous and cardiac mechanisms involvement, enhanced by concomitant conditioning factors, a severe metabolic acidosis, respiratory failure with impaired ventilation and extensive myocardial fibrosis appears more probable. SDS-PAGE with Western Blot was able to detect the native molecular band 117 kD of vinculin and three molecular products of degradation at 90 kD, 87 kD, 84 kD at 36,8-hour postmortem interval and therefore confirmed the postmortem interval, while ELISA detected cardiac TnT (178.85 pg/mL), vinculin (570.96 pg/mL) and desmin (565.77 pg/mL) in the skeletal muscle. CONCLUSIONS: This case highlights the important role played by medico-legal autopsy in death investigation in epilepsy. If for legal purpose causality is required, causes of death and conditioning factors are to be extensively investigated and connected. ELISA delivered benchmarks references at 36.8-hour postmortem interval and provided to be a valuable immunoassay method in estimation of postmortem interval.
Current Approach in Acute Biliary Pancreatitis - a Narrative Review.
Dima AL, Manda AL, Davitoiu DV … +2 more , Lutic CV, Voiculescu DI
Maedica (Bucur) · 2026 Mar · PMID 41978845 · Full text
INTRODUCTION: Acute biliary pancreatitis (ABP), caused by gallstone migration, is the most common form of acute pancreatitis. Although overall mortality has decreased due to therapeutic advances, severe forms still carry...
INTRODUCTION: Acute biliary pancreatitis (ABP), caused by gallstone migration, is the most common form of acute pancreatitis. Although overall mortality has decreased due to therapeutic advances, severe forms still carry a mortality rate of 10-30%. METHODOLOGY: This narrative review analyses guidelines, randomized trials and meta-analyses published between 2021-2025 that were selected according to PRISMA 2020 criteria. RESULTS: Severity assessment relies on clinical scores (BISAP, CTSI) and 48-hour CRP levels, while artificial intelligence models such as EASY-APP may improve early risk stratification. Abdominal ultrasound remains the first-line diagnostic tool, with MRCP and elevated ALT supporting biliary aetiology. Current management favours moderate fluid resuscitation with Ringer lactate and early enteral nutrition, while avoiding total parenteral nutrition. Pain control may include NSAIDs or opioids, with epidural analgesia considered in severe cases. Antibiotic therapy is reserved for infected necrosis or cholangitis. Endoscopic retrograde cholecysto-pancreatography (ERCP) is selectively indicated mainly for therapeutic purposes. Early cholecystectomy during the same admission is the standard for mild ABP, whereas moderate and severe forms require a step-up approach. CONCLUSIONS: Modern management of ABP is oriented to more physiological approaches, emphasizes individualized care, minimally invasive strategies and physiological support, as well as a tailored approach to the support and interventional components, contributing to improved outcomes and reduced mortality in specialized centres.
Therapeutic Implication of Hyaluronic Acid Gel Following Impacted Mandibular Third Molar Surgery: an Observational Study.
Achuthan V, Abidha R, Aslam A S … +3 more , Rani Tv J, P S S, Vidhyadahran V
Maedica (Bucur) · 2026 Mar · PMID 41978844 · Full text
INTRODUCTION: This study sought to assess the effectiveness of intraoral hyaluronic acid (HA) gel in alleviating postoperative pain, oedema and trismus after mandibular third molar surgery, and its capacity to reduce the...
INTRODUCTION: This study sought to assess the effectiveness of intraoral hyaluronic acid (HA) gel in alleviating postoperative pain, oedema and trismus after mandibular third molar surgery, and its capacity to reduce the need for non-steroidal anti-inflammatory drugs (NSAIDs). MATERIALS AND METHODS: This split-mouth study included 33 healthy patients aged 18 to 45 years with bilaterally impacted mandibular third molars who came to the Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna, India, between November 2023 and March 2025. In the experimental procedure, 0.2% HA gel was applied to the extraction socket, while the control side did not receive any HA gel after surgical extraction. Postoperative evaluations of pain, oedema and trismus were documented on days 3 and 7 for both groups. RESULTS: The use of HA markedly decreased pain perception during the initial postoperative period. However, trismus and the degree of oedema did not differ statistically significantly between the experimental and control groups. CONCLUSION: The intraoral application of HA gel after mandibular third molar surgery demonstrated analgesic effects and reduced the need for NSAID use.
Diagnostic Approach for Cricoid Cartilage Tumors.
Lianou AD, Magdalini B, Psychogios G
Maedica (Bucur) · 2026 Mar · PMID 41978843 · Full text
BACKGROUND: Tumors of the cricoid cartilage are rare, with chondroma and chondrosarcoma being the most common histologic types. Clinical presentation is often insidious and symptoms usually appear when the lesion enlarge...
BACKGROUND: Tumors of the cricoid cartilage are rare, with chondroma and chondrosarcoma being the most common histologic types. Clinical presentation is often insidious and symptoms usually appear when the lesion enlarges significantly or invades surrounding structures. Differentiating benign chondroma from low-grade chondrosarcoma remains challenging due to overlapping imaging findings and nonspecific clinical presentation. Histopathological examination following biopsy remains the gold standard for definitive diagnosis. CASE PRESENTATION: We present the case of a middle-aged male patient with a posterior cricoid cartilage lesion in whom a transcervical biopsy was performed to obtain a definitive diagnosis while avoiding tracheostomy. This approach provided safe access to the tumor while preserving cricoid stability and laryngeal function and minimizing unnecessary morbidity. Imaging modalities, including ultrasound, computed tomography and magnetic resonance imaging, were used in combination with flexible endoscopy and intraoperative neuromonitoring to guide diagnostic and management decisions. CONCLUSIONS: This case highlights the diagnostic challenges associated with cricoid cartilage tumors and demonstrates that transcervical biopsy may represent a safe and effective diagnostic approach in selected cases. Careful preoperative planning and individualized diagnostic and therapeutic strategies are essential for optimal management and functional preservation.
The Dual Burden: Long-Term Impact of COVID-19 on Tuberculosis Incidence - Presentation and Outcomes.
Ganji V, Kamble B, Mustafa F … +6 more , Ravi N, Madhusudhan U, Archana G, Kalpana M, Taranikanti M, John NA
Maedica (Bucur) · 2026 Mar · PMID 41978842 · Full text
INTRODUCTION: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major public health concern globally ranking as the second leading infectious disease and the 13th leading cause of death worldwide. The gl...
INTRODUCTION: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major public health concern globally ranking as the second leading infectious disease and the 13th leading cause of death worldwide. The global healthcare systems have experienced unprecedented challenges in recent years due to COVID-19 pandemic causing widespread disruptions. Delaying TB diagnosis and treatment led to lower reported incidence but could increase mortality, hindering efforts to eradicate TB. Although a few studies have focused on COVID-19 and TB cases to date, most of them are case reports. Since it is unclear whether patients with COVID-TB co-infection have a worse prognosis or more likely to develop severe disease, we believed that doing this study was a necessity. The present systematic review investigates the long-term effects of COVID-19 on TB incidence, reporting follow-up and treatment outcomes. OBJECTIVES: The present study aimed to explore the long-term impact of COVID-19 on TB incidence, presentation and outcome. METHODS: We conducted our systematic review following PRISMA (Preferred reporting in systematic reviews and meta-analysis) guidelines. We performed a comprehensive literature search of EMBASE, PubMed, Scopus, The Lancet, Web of Science and Cochrane Central Register of Controlled Trials. The search items included "Corona virus disease 19", "impact of COVID-19", "SARS-CoV-2", "Tuberculosis", "TB and COVID-19 co-infection", "comorbidities", "prognosis", "incidence", "outcomes" and "risk factors" for articles published between the 1st of January 2020 and the 31st of June 2024. Searches were limited to English language only. We included articles with primary outcomes including studies which reported TB incidence or notification rates, clinical presentation, treatment interruption or outcomes of TB due to COVID-19 and TB-COVID-19 co-infection. Cohort studies, case-control studies, cross-sectional studies and surveillance or registry-based studies were included. RESULTS: Information regarding COVID-19 and TB was collected from the databases, and out of 1973 articles, 41 articles were included. COVID-19 has had a negative impact on TB control programs leading to decrease in reporting of TB cases. As per the global tuberculosis report by WHO 2025, there has been approximately one-third reduction in incidence rates with TB case notifications declining by 21% of TB cases notification in 2020 compared to 2019. The reports indicated that the number of people diagnosed with TB was 7.5 million in 2022 above the baseline of 7.1 million in 2019 and 5.8 million in 2020. CONCLUSION: COVID-19 has affected TB diagnosis and control, with a significant decline in TB case notifications leaving many undiagnosed cases, thereby reversing years of progress in TB control. The high-TB burden countries like India should tackle the havoc caused by the COVID-19 pandemic by addressing the needs of the poor and having a concrete agenda and perpetual TB strategy to reach the target by 2030.
AI Prediction of Bone Graft Integration Success Using CBCT Datasets in Simulated Peri-Implant Defect.
Panda S, Sehdev B, Manohar M … +3 more , Samanta A, Basha SS, Raghavendra PDS
Maedica (Bucur) · 2026 Mar · PMID 41978841 · Full text
BACKGROUND: The integration of bone grafts is a determinant factor for achieving the success of implants and the outcome of healing is hard to predict. Artificial intelligence (AI) holds potential in the cone-beam comput...
BACKGROUND: The integration of bone grafts is a determinant factor for achieving the success of implants and the outcome of healing is hard to predict. Artificial intelligence (AI) holds potential in the cone-beam computed tomography (CBCT) image analysis to predict regenerative outcomes. The purpose of the present study was to create and test a deep learning model to engage the success of bone graft integration in the case of simulated peri-implant defects in CBCT datasets. METHODS: We conducted a retrospective study based on data of 847 CBCT scans of patients who experienced loss of soft tissues around the implant due to bone grafting operations. The 12-month radiographic and clinical outcomes have been used to classify defects into successful (n=512) and unsuccessful integration (n=335). ResNet-50 built on transfer learning was proposed as a convolutional neural network (CNN). The data were separated into training (70%), validation (15%) and testing (15%) sets. The performance of the models was compared in terms of accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC) and F1-score. RESULTS: The AI model had an overall accuracy of 87.3 ± 2.1, a sensitivity of 89.6 ± 1.8, a specificity of 84.2 ± 2.4 and an AUC-ROC of 0.912 ± 0.023. It was found that defect morphology classification had a high predictive ability and circumferential defects exhibited a better prediction ability (91.2) than dehiscence-type defects (82.7) (p <0.01). The model showed better results than clinical assessment (87.3% vs. 71.4% p<0.001). CONCLUSION: The created AI model exhibits strong predictive power of bone graft integration success based on CBCT scans, which could provide a means to plan the treatment individually and make more effective clinical decisions in the field of implant dentistry.
Robotic Adrenalectomy for Large Virilizing Adrenal Mass: a Case Report and Literature Review.
Coco D, Leanza S, Sessa L … +3 more , Genova R, Barranco G, Viola MG
Maedica (Bucur) · 2026 Mar · PMID 41978840 · Full text
BACKGROUND: Androgen-secreting adrenal tumors are rare causes of virilization in adult women and often raise concerns regarding malignancy, particularly when tumor size exceeds 6 cm. Current guidelines recommend surgical...
BACKGROUND: Androgen-secreting adrenal tumors are rare causes of virilization in adult women and often raise concerns regarding malignancy, particularly when tumor size exceeds 6 cm. Current guidelines recommend surgical resection in hormonally active adrenal masses, with minimally invasive surgery increasingly adopted in selected cases. CASE REPORT: We report the case of a 50-year-old woman presenting with progressive virilization due to a right adrenal mass measuring 10 cm. Hormonal evaluation revealed marked androgen excess, with elevated serum testosterone, androstenedione and dehydroepiandrosterone sulfate levels. Imaging studies showed a well-defined adrenal lesion without radiological signs of local invasion. The patient underwent robot-assisted laparoscopic adrenalectomy (RALA). The postoperative course was uneventful, with complete resolution of virilizing symptoms and normalization of androgen levels. Histopathological examination confirmed a benign androgen-secreting adrenal adenoma. CONCLUSION: This case demonstrates that robot-assisted laparoscopic adrenalectomy is a safe and effective treatment option for large, hormonally active adrenal tumors in carefully selected patients. Robotic surgery offers the benefits of minimally invasive approaches while maintaining oncological safety, supporting its role in guideline-concordant management of complex adrenal lesions.
Diagnostic and Clinical Significance of the Special AT-Rich Sequence-Binding Protein 2 Deregulation in Gastrointestinal Malignancies.
Davris D, Falidas E, Adamopoulou M … +5 more , Tsiambas E, Metaxas IE, Poultsidi A, Tzovaras G, Zacharoulis D
Maedica (Bucur) · 2026 Mar · PMID 41978839 · Full text
INTRODUCTION: Gastrointestinal malignancies (GIs) - especially the colon adenocarcinoma (CAD) - represent the third leading cause of cancer-related morbidity and mortality, respectively. The development and progression o...
INTRODUCTION: Gastrointestinal malignancies (GIs) - especially the colon adenocarcinoma (CAD) - represent the third leading cause of cancer-related morbidity and mortality, respectively. The development and progression of CAD is a multistep procedure in which a variety of deregulated molecules are implicated. Among them, the special AT-rich sequence-binding protein 2 (SATB2, gene locus: 2q33.1) seems to be a reliable marker for differential diagnosis and prognosis in patients suffering from GIs. OBJECTIVE: The purpose of the current clinic-molecular review was to describe the role of the SATB2 protein in normal cell homeostasis and activity of epithelial cells and also to investigate the impact of its deregulation on GI and especially CAD patients. MATERIAL AND METHOD: A systematic review of the literature was implemented based on the international PubMed database. Publications were evaluated at the basis of scientific importance and historical value regarding the SATB2 identification, nature, function and deregulation. The following keywords were used: SATB2, colon, carcinoma, transcription, DNA-binding. Fifty (n=50) important papers were selected for providing well-documented knowledge for the marker's behavior in non- and neoplastic disorders, also focused on GIs and CAD malignancies (CADs). RESULTS: The majority of the examined original research studies reported a bi-phasic (overexpression/loss of expression) SATB2 protein pattern in GIs and specifically CADs. Additionally, they suggest that SATB2 should be a part of an immunohistochemical (IHC) panel - which also includes markers such as cytokeratins and transcriptional factors (caudal type homeobox 2-CDX2) - for implementing an accurate IHC-based diagnosis in primary and metastatic malignant tumors with GI origin. CONCLUSIONS: SATB2 is a reliable and sensitive protein marker for differential diagnosis regarding GIs, including CADs. SATB2 gene silencing that leads to low or complete loss of its expression seems to be associated with an aggressive phenotype in CADs (advanced stage, increased metastatic potential, short survival rates).
Long-term Life-Quality Outcomes after Corrective Adolescent Idiopathic Scoliosis Surgery: 10-Year Postoperative Assessment Comparing Lenke Classification and Fused Levels.
Zygogiannis K, Komaitis S, Christakakis PC … +5 more , Gerasimidis P, Karounias A, Kalampokis A, Moschos S, Chatzikomninos I
Maedica (Bucur) · 2025 Dec · PMID 41537087 · Full text
Adolescent idiopathic scoliosis (AIS) is a complex spinal deformity often requiring surgical correction in progressive cases. While posterior spinal fusion (PSF) is the standard treatment, long-term outcomes beyond 10 ye...
Adolescent idiopathic scoliosis (AIS) is a complex spinal deformity often requiring surgical correction in progressive cases. While posterior spinal fusion (PSF) is the standard treatment, long-term outcomes beyond 10 years and the impact of Lenke classification and fusion length on patients' quality of life remain underexplored. This study aims to evaluate the 10-year postoperative outcomes of AIS patients treated with PSF, comparing results across different Lenke curve types and fusion lengths. This retrospective study with a minimum follow-up of 10 years analyzed a cohort of 98 AIS patients who underwent PSF. Those with neuromuscular, congenital, or syndromic scoliosis were excluded. Outcomes included radiographic parameters and patient-reported metrics: SRS-22, SF-36 and Oswestry disability index (ODI). Subgroup analyses were performed based on Lenke classification and number of vertebrae fused. Patients showed excellent long-term outcomes, with a mean SRS-22 total score of 4.5, SF-36 physical and mental scores above population norms and a mean ODI of 5.6%, indicating minimal disability. Lenke 1 patients (single thoracic curves) had superior outcomes in pain, satisfaction and total SRS-22 scores compared to those with more complex curves. Shorter fusions (≤nine levels) were associated with better function, self-image and lower disability, without compromising satisfaction or pain relief. Posterior spinal fusion in AIS yields durable improvements in function, pain and quality of life after 10 years. Shorter fusion constructs and simpler curve patterns are linked to slightly better outcomes, supporting selective fusion strategies when appropriate. These findings underscore the value of individualized surgical planning based on curve characteristics and motion preservation, while integrating modern technologies and AI models to further improve inter-reliability, decision making and patients' quality of life.
Pancreatic Function in Chronic Proton Pump Inhibitor Use: Findings from a Cross-Sectional Study.
Chalissery LF, Eerike M, Chalissery LF … +3 more , Sakthivadivel V, Sampath S, Sindhura G
Maedica (Bucur) · 2025 Dec · PMID 41537086 · Full text
BACKGROUND: Proton pump inhibitors (PPIs) are widely used for acid-related disorders. Recent evidence suggests potential associations between long-term PPI use and pancreatic dysfunction, though findings remain inconsist...
BACKGROUND: Proton pump inhibitors (PPIs) are widely used for acid-related disorders. Recent evidence suggests potential associations between long-term PPI use and pancreatic dysfunction, though findings remain inconsistent. This study aimed to evaluate pancreatic function in patients on long-term PPI therapy. METHODS: A cross-sectional study was conducted in a tertiary care hospital from March 2023 to June 2024. Ninety-seven adults aged 18-65 years who were using PPIs (≥three doses/week for ≥eight weeks) were recruited from outpatient services. Patients with diabetes or those on medications affecting glucose metabolism were excluded. Blood samples were analyzed for C-peptide, amylase, glycated hemoglobin (HbA1c) and random blood sugar (RBS). C-peptide levels were categorized as normal (≤4.20 ng/mL) or abnormal (>4.20 ng/mL). Other biochemical parameters were also similarly classified using standard laboratory cut-offs. Prevalence of dysfunction was expressed as percentages. Associations between C-peptide levels and age, sex, amylase, HbA1c, RBS, PPI type and duration were assessed using odds ratios and Chi-square/Fisher's exact tests. RESULTS: Participants had a mean age of 51.2 years and 62.9% of them were females. The most common PPI was pantoprazole (76.3%). Abnormal C-peptide levels were observed in 10.3% of participants. Raised HbA1c levels were noted in 48.5% of subjects. There were no significant associations with pancreatic function and age, sex, type and duration of PPI treatment. CONCLUSION: No definitive association between chronic PPI usage and pancreatic dysfunction could be established. A possible association may be suspected due to the high prevalence of raised HbA1c levels in long-term PPI users. Further studies are required to elaborate on these findings.
Clinical Outcomes of Percutaneous Plantar Fasciotomy in Patients with Refractory Plantar Fasciitis: a Retrospective Cohort Study.
Balalis KM, Dimitriou R, Balalis M … +4 more , Christoforidis C, Chaniotakis C, Siligardou MR, Kastanis G
Maedica (Bucur) · 2025 Dec · PMID 41537085 · Full text
BACKGROUND: Plantar fasciitis is the most common cause of chronic heel pain. Accurate diagnosis is essential, as similar symptoms may arise from other conditions. Surgery is considered after six months of failed conserva...
BACKGROUND: Plantar fasciitis is the most common cause of chronic heel pain. Accurate diagnosis is essential, as similar symptoms may arise from other conditions. Surgery is considered after six months of failed conservative treatment, with various techniques available. This retrospective study aimed to evaluate the outcomes of percutaneous plantar fascia release under local anesthesia in patients with plantar fasciitis. METHODS: This retrospective study included adult patients diagnosed with plantar fasciitis - based on clinical and radiological evaluation - who underwent percutaneous plantar fascia release under local anesthesia between 2017 and 2020 in our Outpatient Orthopedic Clinic. Patients with previous foot surgeries, infections, tumours, systemic conditions (rheumatoid arthritis), or bilateral involvement were excluded. All had persistent symptoms for over six months despite conservative treatment. Data collected included demographics, symptom duration, body mass index (BMI), pain characteristics and functional limitations. Outcomes were assessed using the visual analog scale (VAS) and subjective patient satisfaction. Statistical analysis was performed using comparisons of means and the Chi-square test. RESULTS: Twenty-three patients (15 women and eight men with a mean age of 50 years, range 39-78) underwent percutaneous plantar fascia release. The mean preoperative VAS score was 8.9 (range: 8-10) for pain, and 8.5 (range: 8-10) for daily activity limitation,. At six months postoperatively, the average VAS score decreased to 1.9 (range: 1-7) for pain and 1.6 (range: 1-6) for activity limitation, based on a telephone survey using the Benton-Weil questionnaire. Two patients (8.7%) reported persistent pain and dissatisfaction. The remaining 21 patients (91.3%) reported satisfactory outcomes. No correlation between spur size and outcomes was found. Statistical analysis showed a significant improvement in both pain and function (p < 0.05). CONCLUSIONS: Percutaneous plantar fasciotomy is a safe and effective treatment for plantar fasciitis. Further studies are needed to determine the optimal extent of fascial release and to refine patient selection criteria.
Radiographic Predictors of Extraction and Impaction Patterns of Third Molars among Adults in Saudi Arabia: a Retrospective Radiographic Study.
Almaghlouth BA, Al Jarboua RT, Al Khaldi HO … +4 more , Al Marar FH, Alwusaybie LH, Alqahtani RF, Alshammery DA
Maedica (Bucur) · 2025 Dec · PMID 41537084 · Full text
BACKGROUND: Third molar impaction is a prevalent dental condition with varying clinical presentations across populations. This retrospective study evaluated radiographic predictors and treatment outcomes of third molar i...
BACKGROUND: Third molar impaction is a prevalent dental condition with varying clinical presentations across populations. This retrospective study evaluated radiographic predictors and treatment outcomes of third molar impactions among adults in Saudi Arabia. MATERIALS AND METHODS: A total of 791 panoramic radiographs obtained from patients referred to the Oral and Maxillofacial Surgery units at Dammam Medical Complex and Riyadh Elm University Hospital between 2018 and 2022 were analyzed. The angulation and level of impaction were assessed using the Pell and Gregory classification system. Statistical analyses, including logistic regression and chi-square tests, were performed to identify significant predictors of extraction. RESULTS: The study cohort had a mean age of 35.3 ± 11.8 years, with females representing 53.1% of cases. Vertical impaction was the most common type (49.3%), followed by mesioangular (27.7%) and horizontal (14.8%). Tooth #48 (mandibular right third molar) was the most frequently extracted (43.7%), followed by tooth #18 (33.3%) and tooth #28 (31.6%). Logistic regression revealed that age 31-45 years, referral for extraction based on radiographic evaluation, impaction of tooth #48, Pell and Gregory Class II and Position B were significant predictors of extraction (p < 0.05). CONCLUSION: Overall, 36.7% of cases required surgical extraction, whereas 63.3% were managed conservatively with periodic follow-up. These findings underscore the clinical value of early radiographic evaluation and individualized treatment planning to minimize complications associated with third molar impactions.
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