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200 papers
The Importance of Surgeon-Performed Point-of-Care Breast Sonography in the Management of Complex Breast Tumors.
Stana M, Sanda NA, Georgescu FT … +4 more , Marinescu A, Dragomir-Serboiu AD, Bordeianu I, Serboiu C
Maedica (Bucur) · 2025 Dec · PMID 41537063 · Full text
Surgeon-performed point-of-care breast sonography (POCBS) offers immediate bedside ultrasound imaging that enhances the management of complex breast tumors by enabling real-time assessment and accelerating diagnosis and...
Surgeon-performed point-of-care breast sonography (POCBS) offers immediate bedside ultrasound imaging that enhances the management of complex breast tumors by enabling real-time assessment and accelerating diagnosis and treatment decisions. This technique complements traditional imaging methods and improves clinical workflows by reducing delays and increasing diagnostic accuracy. Breast imaging reports incorporate BIRADS scores (0 to 6) indicating lesion suspicion levels and recommendations for further action, alongside ACR breast density categories (a to d) that influence imaging modality choice. Ultrasound complements mammography in lesion characterization and biopsy guidance. Five patient cases illustrate how surgeon-performed POCBS altered BIRADS and American College of Radiology (ACR) classifications compared to initial mammography, enabling timely biopsy and oncologic consultation, and highlighting the importance of immediate ultrasound assessment to prevent diagnostic delays. Surgeon-performed breast ultrasound (SPBU) improves diagnostic speed and accuracy by allowing surgeons to integrate clinical and imaging findings instantly, distinguish lesion types and perform biopsies or cyst aspirations during the same visit, reducing patient anxiety and streamlining care.
Effectiveness of Slit Skin Smear Versus Fite-Faraco Staining on Histopathology as a Method of Diagnosis in Leprosy - a Retrospective Hospital-Based Study.
Anandani G, Bhise M, Goswami P … +3 more , Dholariya S, Pathania YS, Agarwal A
Maedica (Bucur) · 2025 Dec · PMID 41537062 · Full text
INTRODUCTION: Although the prevalence of leprosy has significantly decreased in India, it has been still not eradicated, therefore necessitating ongoing efforts to raise awareness for its control. OBJECTIVES: To determin...
INTRODUCTION: Although the prevalence of leprosy has significantly decreased in India, it has been still not eradicated, therefore necessitating ongoing efforts to raise awareness for its control. OBJECTIVES: To determine the diagnostic utility of slit skin smear (SSS) and Fite-Faraco stain (FFS) techniques on histopathology of skin and nerve biopsies for the diagnosis of leprosy in a tertiary care center. MATERIALS AND METHODS: The present cross-sectional study was carried out on patients clinically suspected to have leprosy consulting in a tertiary care center in Gujarat, India, from January 2022 to December 2024. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Continuous variables were presented as mean and categorical variables as numbers and percentages (%). Comparative analysis between various parameters of test effectiveness by using FFS and SSS methods was done. RESULTS: The age of leprosy cases ranged from 18 to 60 years, with a mean age of 35.2 years. Male to female ratio was 5.5 to 1. Histopathologically lepromatous leprosy (61.6%) and multibacillary type based on World Health Organisation (WHO) classification (77%) were the most common forms of leprosy. When comparing the efficacy of SSS and FFS techniques on tissue sections, FFS was found to be more effective than SSS. CONCLUSION: Sufficient knowledge and clinical expertise, along with effective diagnostic techniques, prompt symptom reporting and heightened social awareness to mitigate the stigma associated with the condition from the patient's perspective, can collectively advance the nation towards the goal of leprosy eradication.
Bilateral Keratoconus: a Cataract Preoperative Assessment Incidental Finding. Role of Tomography in Biometry and Multifocality of Cone Effect.
Karmiris E, Christou EE, Spyropoulou M … +2 more , Papaconstantinou E, Stavrakas P
Maedica (Bucur) · 2025 Dec · PMID 41537061 · Full text
Implantation of intraocular lenses (IOLs) for full refractive correction at all distances is the ideal goal for cataract surgery. A comprehensive examination is pivotal to identify corneal pathology such as keratoconus,...
Implantation of intraocular lenses (IOLs) for full refractive correction at all distances is the ideal goal for cataract surgery. A comprehensive examination is pivotal to identify corneal pathology such as keratoconus, in order to achieve optimal outcomes with selection of premium or monofocal IOLs. A 57-year-old male presented for cataract surgery preoperative assessment. Ophthalmological examination indicated an unremarkable condition, while his files did not report any previous ocular pathology. The patient had high expectations for optimal refractive outcomes without spectacles and therefore, implantation of premium IOLs was considered. Preoperative biometric measurements using IOL Master 700 demonstrated a non-significant anterior corneal astigmatism in both eyes. The central corneal topography maps revealed an asymmetric colour appearance indicative of irregular astigmatism in the right eye, while colour gradation towards higher dioptres was present in the left eye. Despite not being pathognomonic for clinical ectasia, these visually relevant asymmetries warranted further investigation. Additional corneal tomography using Pentacam Scheimpflug imaging revealed an inferior symmetrical well-delineated mild keratoconus. Therefore, the selection of monofocal spherical IOL was decided. The patient had uneventful phacoemulsification bilaterally. At one month postoperatively, his unaided visual acuity at distance was 20/20 in both eyes, he could perform a Jaeger 2 scale for near vision, while subjectively had no complaints of unwanted photic phenomena. Our case highlights that a detailed corneal evaluation may add value to appropriate decision making concerning the selection of IOL implant for optimal visual outcomes. In addition, an enhance depth of focus might be provided postoperatively in selected mild keratoconic cases.
Caspase 3/8/9 Apoptotic Pathway Deregulation Analysis in Laryngeal Squamous Cell Carcinoma.
Athanasopoulos M, Tsiambas E, Papanastasiou G … +7 more , Papouliakos S, Vylliotis A, Tsouvelas G, Mastronikolis N, Kyrodimos E, Kavantzas N, Agrogiannis G
Maedica (Bucur) · 2025 Dec · PMID 41537060 · Full text
OBJECTIVES: Among the molecules that are implicated in the regulation of apoptosis (programmed cell death), caspases are most significant acting as strong enhancers. The aim of the current study was to co-analyze the cas...
OBJECTIVES: Among the molecules that are implicated in the regulation of apoptosis (programmed cell death), caspases are most significant acting as strong enhancers. The aim of the current study was to co-analyze the caspases 3, 8 and 9 at their protein expression level in a series of laryngeal squamous cell carcinomas (LSCCs). MATERIALS AND METHODS: Tissue specimens derived from 50 LSCC cases were selected and co-analyzed for determining the caspase 3/8/9 expression. A combination of immunohistochemistry and digital image analysis assays was implemented. RESULTS: According to the analysis of the immunostained slides, females showed higher median expression levels of caspase 3/9 and lower caspase 8 compared to males. However, none of these differences reached statistical significance. Furthermore, median caspase 3 expression levels decreased from Grade 1 to Grade 3, and similar gradual changes were noted for other markers. However, none of these differences reached statistical significance, indicating that the distributions of the biomarkers did not differ significantly by grade. Interestingly, the median caspase 3 levels strongly decreased with stage and this difference was significant (p = 0.033). No significant differences were found across stages for caspase 8/9 and also regarding the anatomical region of the examined tumors. CONCLUSION: Deregulation of caspase 3/8/9 molecules that regulate a crucial cataract of reactions in the apoptotic pathway is a relatively frequent event in LSCCs. Progressive loss of their expression is correlated with an aggressive phenotype in the corresponding malignancies, especially referring to caspase 3. Enhancing caspase 3/8/9 expression - that induces apoptotic rates in malignant tumors including LSCC - is a significant goal and challenge for developing novel targeted therapeutic strategies.
Endoscopic Retrograde Cholangiopancreatography (ERCP) Brush-Based Cytology Vs Biopsy: a Comparative Diagnostic Study.
Niotis A, Kosmas K, Metaxas IE … +9 more , Tsounis D, Syrou A, Baliou E, Riga NG, Kalantzis C, Apostolopoulos P, Vylliotis A, Fotiades P, Tsiambas E
Maedica (Bucur) · 2025 Dec · PMID 41537059 · Full text
OBJECTIVES: Endoscopic retrograde cholangio-pancreatography (ERCP) brush-based cytology is a valuable diagnostic tool regarding the biliary system examination and detection of non- or malignant lesions. Diagnostic accura...
OBJECTIVES: Endoscopic retrograde cholangio-pancreatography (ERCP) brush-based cytology is a valuable diagnostic tool regarding the biliary system examination and detection of non- or malignant lesions. Diagnostic accuracy and sensitivity of this method demonstrate different ranges in a variety of studies. The aim of the current study was to compare the results of ERCP brush-based cytology with the corresponding histopathological diagnoses. MATERIALS AND METHODS: We selected and compared cytological and pathological slides derived from sixty-eight (n=68) patients who underwent ERCP brush-based examination between February 2021 and March 2024. Papanicolaou and eosin-hematoxylin staining assays were performed in the corresponding smears and tissues, respectively. RESULTS: Concerning the initial cytological diagnoses, 38 cases were negative for malignancy, 10 cases atypical, 16 cases suspicious for malignancy and four cases were characterized as positive for malignancy. Histologic correlation confirmed a benign outcome in 39 out of 48 patients, 11 cases were diagnosed as adenoma-dysplasia, whereas 18 cases were considered malignant. The overall concordance between cytology and histology was 66% in sensitivity, 95% in specificity, 84% in accuracy, 90% in positive predictive value and 81% in negative predictive value. CONCLUSION: Endoscopic retrograde cholangio-pancreatography brush-based cytology is a useful and significant preoperative method for initially diagnosing pancreatic-biliary lesions. It provides a high level of specificity, accuracy and predictive value (positive/negative), but a lower level of sensitivity compared to histopathology due to differences that cell and tissue substrates demonstrate during the diagnostic process (morphological features and cell configuration/cyto-architecture).
Locking Compression Plate as a Reduction Tool in Tibial Shaft Nailing for Diaphyseal Segmental Bone Defects: Technical Considerations.
Koutsopoulos A, Argyrou C, Georgiou DF … +2 more , Polyzois DV, Polyzois VD
Maedica (Bucur) · 2025 Sep · PMID 41403816 · Full text
The management of segmental bone defects of the tibial shaft remains a challenging endeavor for orthopedic surgeons. These defects are usually the result of high energy fractures and are frequently associated with high n...
The management of segmental bone defects of the tibial shaft remains a challenging endeavor for orthopedic surgeons. These defects are usually the result of high energy fractures and are frequently associated with high nonunion and infection rates. Achieving appropriate alignment during intramedullary nailing is crucial and often presents technical hurdles. The scope of this paper is to describe and discuss the intraoperative use of a provisional locking plate in achieving satisfactory reduction in the setting of a large tibial shaft bone defect. This technique presents distinct advantages for these challenging cases, including ease of application, satisfactory reduction, intraoperative stability and cost-effectiveness.
Emerging Techniques in Lumbopelvic Fixation: Biomechanical and Clinical Perspectives.
Zygogiannis K, Gerasimidis P, Christakakis PC … +4 more , Manolakos K, Thivaios GC, Tsatsaragkou A, Koulalis D
Maedica (Bucur) · 2025 Sep · PMID 41403815 · Full text
The lumbopelvic junction is a biomechanically complex region that necessitates robust stabilization, especially following spinopelvic dissociation, unstable sacral fractures, or sacrectomy. Lumbopelvic fixation technique...
The lumbopelvic junction is a biomechanically complex region that necessitates robust stabilization, especially following spinopelvic dissociation, unstable sacral fractures, or sacrectomy. Lumbopelvic fixation techniques, such as triangular osteosynthesis and dual S2-alar-iliac (S2AI) screw placement, optimize load transfer, restore spinal-pelvic continuity and reduce mechanical failure risks. Triangular osteosynthesis achieves up to 80% of native spine stiffness under load, while dual S2AI screws restore up to 96% stiffness and show lower screw loosening rates than single screws. Comparative studies reveal that S2AI screws outperform traditional iliac screws in biomechanical stability, pullout strength and reduced hardware-related complications. Multi-rod and quad-rod constructs further enhance construct rigidity, distribute mechanical stress and lower the risk of rod breakage and revision surgeries. Novel anchoring strategies, including sacral hooks and clamps, contribute to improved stability in cases with complex fractures or bone loss. The integration of navigation and robotics ensures higher accuracy in screw placement, minimizes complications and enhances surgical precision. Collectively, these advancements facilitate early mobilization, improved fusion rates, superior pain relief and better functional outcomes, underscoring the evolving landscape of lumbopelvic fixation strategies.
Hippo Signaling Transduction Pathway Deregulation in Eye Diseases.
Gklezakos K, Papanastasiou G, Tsiambas E … +9 more , Ragkos NG, Niotis A, Papouliakos S, Fotiades P, Tsantoulas A, Sioka C, Liontos A, Kalogeropoulos C, Ragos V
Maedica (Bucur) · 2025 Sep · PMID 41403814 · Full text
INTRODUCTION: Among the signaling pathways that regulate critical cell and tissue functions, the Hippo pathway is of great significance and under continuous investigation. The Hippo is a highly conversed pathway initiall...
INTRODUCTION: Among the signaling pathways that regulate critical cell and tissue functions, the Hippo pathway is of great significance and under continuous investigation. The Hippo is a highly conversed pathway initially observed and decoded in . It consists of core molecules such as mammalian STE20-like kinase 1/2 (MST1/2), protein Salvador homologue 1 (SAV1) and MOBKL1A/B (MOB1A/B), and large tumour suppressor kinase 1/2 (LATS1/2), whereas the Yes-associated protein 1 (YAP), and WW-domain-containing transcription regulator 1 (TAZ) proteins act as transcriptional coactivators that bind to the transcriptional enhanced associated domain family 1(TEAD-1). OBJECTIVE: The purpose of the current molecular review was to describe the main molecular and functional aspects of the Hippo pathway and its deregulation in specific eye lesions. MATERIAL AND METHOD: A systematic review of the literature was carried out based on the international medical database PubMed. The year 2005 was set as a prominent time limit for the publication date of the majority of articles, whereas specific references of great importance and historical value in the field of the Hippo discovery and analysis were also included. The following keywords were used: Hippo, TAZ, LATS, YAP1, eye, signaling pathway. A pool of 70 important articles was selected for the present review describing the connections between the implicated in HIPPO pathway molecules, the corresponding normal biochemical and functional features of them, and the deregulation mechanisms that are involved in the pathogenesis of eye lesions. RESULTS: According to the selected publications, Hippo deregulation is observed in a broad spectrum of benign and neoplastic eye diseases. TAZ, LATS, and YAP1 proteins are negatively influenced by the deregulation of the core molecules in them. CONCLUSIONS: Hippo deregulation is critically involved in retina- and lens-related benign lesions as well as in conjunctival fibrosis and ocular surface squamous neoplasia. YAP/TEAD point mutations and abnormal expression of other molecules are the main genetic mechanisms in these lesions.
Redefining Minimally Invasive Head and Neck Surgery without Robotics: the First Romanian TOUSS Experience.
Rujan SA, Bertesteanu SVG, Grigore R … +8 more , Popescu B, Condeescu-Cojocarita M, Nicolaescu A, Bertesteanu GS, Schipor-Diaconu TE, Tudosie MD, Popescu ID, Taher BP
Maedica (Bucur) · 2025 Sep · PMID 41403813 · Full text
BACKGROUND: Transoral ultrasonic surgery (TOUSS) has emerged as a minimally invasive technique for the treatment of head and neck malignancies, offering oncologic outcomes comparable to robotic-assisted approaches, but w...
BACKGROUND: Transoral ultrasonic surgery (TOUSS) has emerged as a minimally invasive technique for the treatment of head and neck malignancies, offering oncologic outcomes comparable to robotic-assisted approaches, but with lower costs and wider accessibility. OBJECTIVE: This study aims to evaluate the clinical and functional outcomes of TOUSS in a single-institution cohort, including the first documented cases of total transoral laryngectomy performed via TOUSS in Romania. METHODS: A retrospective observational analysis was conducted on 39 patients treated at Colțea Clinical Hospital between 2018 and 2024. Eligible patients had T1-T3 squamous cell carcinomas of the oropharynx, oral cavity, supraglottis, or larynx, with appropriate transoral exposure. Data on demographics, tumor characteristics, perioperative outcomes and three-year follow-up were collected. RESULTS: The majority of tumors involved the oropharynx (n=21), followed by the lateral or base of the tongue (n=14), with two cases requiring total laryngectomy. Tracheostomy was avoided in all patients. Nasogastric tube removal occurred by day 10, and the average hospital stay was seven days. At three years, 79.5% of patients remained disease-free, with 10.3% recurrence and 10.3% lost to follow-up. Postoperative complications were minimal and surgically controlled. CONCLUSION: Transoral ultrasonic surgery is a safe and effective alternative to robotic surgery, achieving favorable oncologic and functional outcomes. Its feasibility for total laryngectomy and cost-effectiveness makes it a promising option for wider adoption, particularly in low-resource settings.
Impact of SGLT2 Inhibitors on Device-Detected Arrhythmias: a Preliminary Study.
Catrina BI, Negrea MO, Tanasescu C … +3 more , Batar F, Bitea CI, Manitiu I
Maedica (Bucur) · 2025 Sep · PMID 41403812 · Full text
INTRODUCTION: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant cardiovascular benefits beyond glycemic control, with emerging evidence suggesting antiarrhythmic effects. This prospective s...
INTRODUCTION: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant cardiovascular benefits beyond glycemic control, with emerging evidence suggesting antiarrhythmic effects. This prospective study aimed to establish a study protocol for a future trial assessing the impact of SGLT2i on arrhythmia burden in patients with implantable cardiac devices without heart failure with reduced ejection fraction (HFrEF) and to provide preliminary data on clinical trends. METHODS: Patients with cardiac implantable electrical devices (CIEDs) who underwent routine device interrogation were allocated to either SGLT2i treatment or standard care without SGLT2i based on clinical judgment and patient preference, grounded by existing evidence of potential anti-arrhythmic benefits. Arrhythmic events, including atrial high-rate episodes (AHRE), atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT), were assessed at baseline and after a one-year follow-up. Levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) or brain natriuretic peptide (BNP) were also evaluated. RESULTS: Seventeen patients completed follow-up (eight in the SGLT2i group, nine in the control group). The proportion of patients with arrhythmic events remained unchanged in the control group, whereas a trend toward reduced arrhythmic burden was observed in the SGLT2i group, albeit without achieving statistical significance. Additionally, three patients in the control group progressed to permanent AF, whereas no such progression was observed in the SGLT2i-treated group. BNP values showed a significant reduction in the SGLT2i group after treatment. CONCLUSIONS: This study outlines a feasible protocol for CIED-based arrhythmia monitoring and provides preliminary evidence suggesting a potential antiarrhythmic effect of SGLT2i. Larger randomized controlled trials are needed to confirm these findings.
Morphological Macroscopical Placental Features of Pregnancies Complicated with Fetal Growth Restriction: a Case-Control Study.
Samara AA, Floros T, Zacharouli K … +6 more , Ioannou M, Stamouli D, Janho M, Skentou C, Daponte A, Sotiriou S
Maedica (Bucur) · 2025 Sep · PMID 41403811 · Full text
OBJECTIVES: The purpose of this study is to investigate the morphological differences of the placentas, between normal and complicated with fetal growth restriction (FGR) gestations. METHODS: In the present study, 60 wom...
OBJECTIVES: The purpose of this study is to investigate the morphological differences of the placentas, between normal and complicated with fetal growth restriction (FGR) gestations. METHODS: In the present study, 60 women were prospectively enrolled between 2022-2024 and equally divided into a control group and a FGR one. We measured the weight and dimensions of the collected placentas as well as the diameter and insertion point of the umbilical cord. RESULTS: The mean values of placental weight, surface, volume and maximum diameter showed a statistically significant difference between FGR and controls (p<0.001). Birth weight was positively corelated with umbilical cord diameter (r= 0.666, p<0.001) and placental weight (r= 0.803, p<0.001). Also, umbilical cord's peripheral insertion site and FGR were statistically significantly associated (χ=7.048, p<0.001). However, in linear regression, only placental weight was identified as an independent factor associated with birth weight. Moreover, FGR pregnancies had statistically significant higher mean placental coefficient values compared to pregnancies with normal growth (p=0.035). CONCLUSION: Our results further support the current literature, demonstrating significant placental morphological differences between normal and FGR pregnancies. Considering the severe complications in FGR gestations, translating these findings in ultrasound imaging may introduce novice imaging biomarkers for early detection.
Patient Satisfaction in Primary Care and Emotional Intelligence.
Katsadouri V, Mitropoulos I
Maedica (Bucur) · 2025 Sep · PMID 41403810 · Full text
BACKGROUND: Patient satisfaction, a key outcome in healthcare evaluation, is strongly influenced by the human dimension of care. Emotional intelligence, particularly empathy and emotion regulation, plays a crucial role i...
BACKGROUND: Patient satisfaction, a key outcome in healthcare evaluation, is strongly influenced by the human dimension of care. Emotional intelligence, particularly empathy and emotion regulation, plays a crucial role in shaping patient experiences in primary care settings. This research study focuses on evaluating patients' satisfaction with primary healthcare services and exploring the relationship with the level of their emotional intelligence. METHODS: A cross-sectional study was conducted at the Agioi Anargyroi Health Center in Ilion, Greece. A total of 102 patients completed two validated questionnaires: the Patient Satisfaction Questionnaire (Aletras-Niakas) and the Wong & Law Emotional Intelligence Scale (WLEIS). Data were analyzed with descriptive statistics and correlation tests (Spearman, Pearson, Mann-Whitney, t-test). RESULTS: The results revealed high levels of satisfaction, particularly in areas such as service, appointment procedures, waiting time, provision of medical services and discharge from the center. The mean overall satisfaction score was 4.01 for medical consultation and 4.09 for discharge (scale 1-5). Overall, 68% of respondents were satisfied or very satisfied, while 3% were dissatisfied. The average rating of the National Health System was 69.3/100. Emotional intelligence scores were high, with mean values ranging from 5.22 to 5.77 (scale 1-7). There were statistically significant correlations between emotional intelligence dimensions and patient satisfaction (Spearman's rho = 0.237-0.424, p < 0.05). Patients with public health insurance reported higher satisfaction with access and arrival compared to other groups. CONCLUSION: Patient satisfaction in primary care was high and positively associated with emotional intelligence, especially in emotion management and empathy. These findings highlight the importance of strengthening emotional intelligence skills among both patients and healthcare providers to improve service quality and foster more human-centered care.
Comparison Between Conventional and Enhanced Recovery After Surgery (ERAS) Protocol in Cases of Emergency Laparotomy.
Pawar S, Kumar N, Pankaj D … +5 more , Vishwendu V, Bhushan V, Varma Y, Somvanshi S, Kritika F
Maedica (Bucur) · 2025 Sep · PMID 41403809 · Full text
INTRODUCTION: Enhanced Recovery After Surgery (ERAS) or Early Recovery Programs (ERP) represents a paradigm shift in perioperative care, aiming to mitigate surgical stress and accelerate patient recovery. While well-esta...
INTRODUCTION: Enhanced Recovery After Surgery (ERAS) or Early Recovery Programs (ERP) represents a paradigm shift in perioperative care, aiming to mitigate surgical stress and accelerate patient recovery. While well-established in elective colorectal surgeries, its efficacy in emergency settings, particularly for acute abdomen requiring emergency laparotomy, remains less explored. This study investigates the effect of a tailored ERAS care protocol on patients undergoing emergency laparotomy. MATERIALS AND METHODS: A prospective randomized controlled study was conducted in the Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, India, from April 2023 to April 2025 (CTRI No: CTRI/2023/05/052783).Seventy-eight patients aged 18-65 years, presenting with acute abdomen and scheduled for emergency laparotomy (ASA I-II), were randomized 1:1 into either the ERAS group or conventional (CONV) group (n=39 each) using computer-generated block randomization and serially numbered opaque sealed envelopes (SNOSE). The study was blinded to patients, envelope opening personnel and investigators. The primary endpoint variable was the duration of hospital stay (DHS). Secondary endpoints included postoperative morbidities/ complications (according to Clavien-Dindo classification), time to first flatus, postoperative pain scores/analgesia requirement and reexploration readmission rate. RESULTS: The mean DHS was significantly shorter in the ERAS group (3.17 ± 0.79 days) than the CONV one (7.87 ± 3.22 days) (p<0.001). Early removal of nasogastric tubes (64.10% on Day 0 vs 58.97% on Day ≥3, p<0.001) and urinary catheters (97.44% on Day 1 vs 69.23% on Day ≥3, p<0.001) was significantly higher in the ERAS group. Also, ERAS patients were mobilized earlier (100% on Day 1 vs 48.72% on Day 2, p<0.001) and showed faster recovery of bowel function (early flatus passage 100% vs 74.36% in ≤ three days, p<0.001). Oral diet initiation was significantly earlier in the ERAS group (66.67% on Day 1 vs 87.18% on Day ≥3, p<0.001). Overall postoperative complications were lower in the ERAS group (10.26% vs 33.33%) for immediate complications, and specifically, ERAS showed lower incidences of postoperative ileus (2.56% vs 15.36%), postoperative nausea vomiting (PONV) (5.12% vs 10.24%), lung complications (0% vs 8.18%), superficial surgical site infection (SSI) (5.13% vs 12.82%), deep SSI (0% vs 5.12%) and anastomotic leak (0% vs 2.56%) and readmission-requiring complications (5.13% vs 7.69%). Also, ERAS patients reported lower postoperative pain scores and required less opioid analgesia than subjects in the CONV group. CONCLUSION: Application of a tailored ERAS care protocol approach in patients undergoing emergency laparotomy significantly reduces the DHS, lowers intraoperative blood loss, facilitates earlier removal of tubings, promotes early mobilization and bowel function recovery, accelerates oral diet initiation and significantly decreases postoperative complications including Postoperative ileus, PONV, lung complications and surgical site infections. These findings support the adoption of ERAS principles even in challenging emergency surgical settings.
Structural Changes in Retinal Vein Occlusion: Implications for Functional Outcomes and Visual Field Deficits.
Garnavou-Xirou C, Bontzos G, Xirou T … +6 more , Xirou V, Kanakis M, Tsapardoni F, Kalogeropoulos C, Stavrakas P, Kozobolis V
Maedica (Bucur) · 2025 Sep · PMID 41403808 · Full text
OBJECTIVES: To investigate the relationship between structural retinal changes and functional visual field (VF) deficits in patients with branch retinal vein occlusion (BRVO), aiming to identify potential biomarkers for...
OBJECTIVES: To investigate the relationship between structural retinal changes and functional visual field (VF) deficits in patients with branch retinal vein occlusion (BRVO), aiming to identify potential biomarkers for predicting visual impairment. MATERIALS AND METHODS: This cross-sectional study included 34 patients with unilateral BRVO who were recruited from two tertiary centers in Greece. Comprehensive ophthalmic examinations were performed, including visual acuity, intraocular pressure (IOP) and imaging studies such as optical coherence tomography (OCT), OCT angiography (OCT-A), and fundus photography. Retinal alterations, including atrophy, edema, hemorrhages and neovascularization, were assessed by two masked graders. Visual field testing was performed using Humphrey perimetry. Logistic regression analyses were employed to examine associations between imaging biomarkers and the presence of VF defects. RESULTS: Patients included in the present study had a mean age of 69.1 ± 10.6 years and 58.8% of them were females. Visual field defects were present in 26.5% (9/34) of patients. Structural changes such as retinal atrophy and neovascularization were more prevalent in patients with VF defects. Univariate analysis did not identify OCT-A vessel density or central retinal thickness as significant predictors. Similarly, multivariate logistic regression found no statistically significant associations at the 0.05 level, although trends suggested a relationship between structural damage and functional impairment. CONCLUSIONS: Structural retinal changes, particularly atrophy and neovascularization, appear to be associated with VF defects in BRVO. Despite the lack of statistically significant predictors in multivariate models, these findings highlight the importance of comprehensive functional assessments beyond visual acuity. Future advancements in VF testing technologies may enhance early detection and management of functional deficits in BRVO patients.
Laryngeal Morphology in Voice Disorders: a Review of Imaging and Endoscopic Findings.
Shrikrishna BH, Deepa G
Maedica (Bucur) · 2025 Sep · PMID 41403807 · Full text
OBJECTIVES: This review aimed to synthesize and analyze morphological changes of the larynx in patients with voice disorders, as identified through imaging and endoscopic methods, and to evaluate their diagnostic value....
OBJECTIVES: This review aimed to synthesize and analyze morphological changes of the larynx in patients with voice disorders, as identified through imaging and endoscopic methods, and to evaluate their diagnostic value. MATERIALS AND METHODS: We performed a comprehensive PubMed search using MeSH and Title/Abstract keywords related to laryngeal morphology, voice disorders and imaging modalities. Filters restricted results to human studies in adults which were published as full text, in English, during the last 10 years. Seventeen studies met the inclusion criteria after screening and were included for analysis. Data on imaging modalities, morphological features, diagnostic accuracy and correlations with voice function were extracted. RESULTS: Across the 17 studies, imaging revealed morphological features such as vocal fold edema, nodules, polyps, motion impairment, glottal insufficiency and arytenoid asymmetry. Magnetic resonance imaging demonstrated significant correlations between vocal cord thickening, impaired adduction and dysphonia severity. High-speed videoendoscopy and stroboscopy showed good sensitivity (up to 92%) and specificity (79.2%) for identifying motion impairment and dysphonia classification. Some structural findings, such as arytenoid asymmetry in singers, did not correlate with acoustic deficits. CONCLUSIONS: Imaging and endoscopic evaluations provide valuable diagnostic insights into voice disorders, though variability in protocols and outcome measures limits cross-study comparability. Standardization of imaging methods and reporting is essential for improving diagnostic reproducibility and clinical applicability.
Learning Curve in Robotic D2 Gastrectomy for Gastric Cancer: a Systematic Review and Meta-Analysis of Operative Proficiency and Postoperative Outcomes.
Leanza S, Coco D
Maedica (Bucur) · 2025 Sep · PMID 41403806 · Full text
BACKGROUND: Robotic-assisted D2 gastrectomy combines minimally invasive benefits with enhanced precision, though its technical complexity creates a significant learning curve. This study evaluates the learning process an...
BACKGROUND: Robotic-assisted D2 gastrectomy combines minimally invasive benefits with enhanced precision, though its technical complexity creates a significant learning curve. This study evaluates the learning process and its impact on surgical outcomes. METHODS: We conducted a PRISMA-compliant meta-analysis of studies from major databases (2010-2023) including ≥10 robotic D2 gastrectomies. Outcomes assessed operative metrics, complications and oncological results using random-effects models. RESULTS: Analysis of 30 studies (4,589 patients) revealed that proficiency required 25-50 cases. Significant improvements after achieving proficiency included 35% reduction in operative time (94.6 minutes), 50% less blood loss (89.2 mL), 18% increased lymph node yield (5.3 nodes) and 62% fewer major complications. High-volume centers achieved proficiency 12 cases sooner than low-volume counterparts. CONCLUSION: Robotic D2 gastrectomy demands 25-50 cases for mastery, with outcomes improving substantially post-learning curve. Centralized training and standardized protocols are crucial for optimal implementation.
Dry Eye Syndrome as a Potential Sequel of Laryngopharyngeal Reflux: Shared Mechanisms and Clinical Implications.
Tsilivigkos C, Papantoniou K, Stavrakas M
Maedica (Bucur) · 2025 Sep · PMID 41403805 · Full text
Laryngopharyngeal reflux (LPR) and dry eye syndrome (DES) are two prevalent conditions that significantly impair quality of life and present a growing challenge for otolaryngologists, gastroenterologists, and ophthalmolo...
Laryngopharyngeal reflux (LPR) and dry eye syndrome (DES) are two prevalent conditions that significantly impair quality of life and present a growing challenge for otolaryngologists, gastroenterologists, and ophthalmologists alike. Although they affect different body regions, their common appearance in many patients has led to the reasonable assumption that they share common pathophysiological mechanisms. In this review, we aim to explore the epidemiological, pathophysiological and clinical correlations of LPR and DES. Evidence indicates that tear film synthesis and stability are often impaired in LPR patients. The abnormal presence of pepsin in the tears of LPR patients suggests reflux-mediated ocular surface damage. Moreover, the presence of overlapping comorbidities, autonomic dysfunction and common inflammatory cytokines makes their link even more evident. A combined treatment strategy involving alginates as an adjunct to ocular lubricants has recently shown promising results in the treatment of these patients. A multidisciplinary approach with the cooperation of many different medical specialties can improve symptoms and quality of life in patients who suffer from both conditions.
Acute Appendicitis Over the Time. The Impact of Scientific Discoveries and Technological Advances on the Diagnosis and Treatment of Acute Appendicitis.
Neagu SI, Popa CC
Maedica (Bucur) · 2025 Sep · PMID 41403804 · Full text
Acute appendicitis is the touchstone of any surgeon. The most common surgical pathology, acute appendicitis, has known over time, depending on the level of scientific knowledge, different therapeutic approaches, from abs...
Acute appendicitis is the touchstone of any surgeon. The most common surgical pathology, acute appendicitis, has known over time, depending on the level of scientific knowledge, different therapeutic approaches, from absolute surgical abstinence to absolute surgical indication. No other aspect of surgical pathology has created so many occasions of successes and undeserved failures. Technologization of surgery through the introduction of laparoscopy brought - in addition to indisputable advantages (but whose importance decreases, also indisputably, with patients' age) and additional factors of operative risk - a risk that increases with age and extent of the intervention. At the current time there are clinical studies that optionally support first-line antibiotic treatment for uncomplicated acute appendicitis, surgical treatment being reserved for complicated acute appendicitis. This differentiated therapeutic attitude is possible due to the progresses achieved in abdominal imaging exploration used in the diagnosis of acute appendicitis, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), which have allowed a correct morphopathological diagnosis of acute appendicitis. The clinical examination and continuous monitoring of the evolution are essential for the diagnosis and assessment of the effectiveness of the indicated treatment. Unfortunately, Dieulafoy's assertion from the Listerian period that "one should no longer die of acute appendicitis" is still relevant today, in the era of antibiotic therapy and technologization of surgery, as well as - especially - the completion made by Lejars, "with exceptions" ("sauf exceptions").
Antibiotic Administration and Risk of Multiple Sclerosis: a Systematic Review and Meta-Analysis.
Naser Moghadasi A, Rastkar M, Feili M … +3 more , Ghajarzadeh M, Mohammadi A, Ghajarzadeh M
Maedica (Bucur) · 2025 Sep · PMID 41403803 · Full text
BACKGROUND: Gut-brain axis is a bidirectional interaction between the gut and the nervous system. Antibiotics disrupt this axis. We designed this systematic review and meta-analysis to show if there is an association bet...
BACKGROUND: Gut-brain axis is a bidirectional interaction between the gut and the nervous system. Antibiotics disrupt this axis. We designed this systematic review and meta-analysis to show if there is an association between antibiotic administration and the risk of multiple sclerosis (MS). METHODS: PubMed, Scopus, EMBASE, PsycINFO, Web of Science and Google Scholar were systematically searched by two independent researchers on February 1 2025. The first author of the publication, country of the study, publication year, number of study participants, total female and male population, total use and types of antibiotics were extracted. RESULTS: A literature search revealed 3606 records, 22 full texts were evaluated and finally, six studies remained for systematic review. The pooled odds ratio (OR) for the use of penicillin and MS risk was 1.01 [95% confidence interval (CI): 0.84-1.22] (I=81.6%, P<0.001). The pooled OR for the use of tetracycline and MS risk was 1.20 (95% CI: 1.02-1.4) (I=82.8%, P<0.001). The pooled OR for the use of sulfonamides and MS risk was 1.30 (95%CI: 1.23-1.38) (I=22.1%, P<0.001). The pooled OR for the use of macrolides and MS risk was 1.19 (95% CI: 1.07-1.32) (I=71.3%, P=0.01). The pooled OR for the use of quinolones and MS risk was 1.24 (95% CI: 1.18-1.30) (I=7.8%, P=0.001). CONCLUSIONS: The results of this systematic review and meta-analysis show that, except for penicillin, the use of other antibiotics may increase the risk of MS.
Assessment of Effectiveness of Bupivacaine Trigger-Point Injections in Trapezius Myofascial Pain Syndrome: a Retrospective Study.
Dhole SR, Kamble BD, Bisoi D … +6 more , Satapathy D, Vandana D, Anish S, Prafull K, Karnakar K, Manulata
Maedica (Bucur) · 2025 Sep · PMID 41403802 · Full text
BACKGROUND: Myofascial pain syndrome (MPS) of the trapezius is a common cause of chronic neck and shoulder pain. Among various treatments, trigger point injections (TPIs) using local anesthetics like bupivacaine are freq...
BACKGROUND: Myofascial pain syndrome (MPS) of the trapezius is a common cause of chronic neck and shoulder pain. Among various treatments, trigger point injections (TPIs) using local anesthetics like bupivacaine are frequently administered, though clinical evidence supporting their use remains limited. OBJECTIVE: To evaluate the efficacy of bupivacaine trigger-point injections in patients with trapezius myofascial pain syndrome. METHODS: A retrospective record review of 69 patients diagnosed with trapezius MPS and treated with (0.25%) bupivacaine TPIs in a tertiary care center was conducted. Pain was assessed using the visual analog scale (VAS) and functionality using the neck pain and disability index (NPD) at four time points: pre-injection, immediately after injection, two weeks and one month post-injection. Repeated measures ANOVA and post-hoc analysis were used to evaluate statistical significance. RESULTS: Significant reductions in VAS and NPD scores were observed over time (p < 0.001). The mean VAS decreased from (6.10) to (2.64) and mean NPD from (31.7) to (12.8) over one month. Most patients (n = 65, 94.2%) experienced no adverse effects. Overall, 48 (70.6%) of patients were satisfied with the treatment. CONCLUSION: Bupivacaine trigger point injections are effective and safe for pain relief and functional improvement in trapezius MPS.
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