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Updated Friday, 03 December 2021

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1319
Author(s):  
Teruhiko Imamura ◽  
Masakazu Hori ◽  
Shuhei Tanaka ◽  
Koichiro Kinugawa

Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor is a recently introduced oral medication to treat renal anemia, but its clinical implication in patients with heart failure, particularly heart failure with preserved ejection fraction (HFpEF), remains unknown. We had a 91-year-old woman with HFpEF who was admitted to our institute to treat her worsening heart failure. She initiated HIF-PH inhibitor daprodustat to treat her renal anemia (hemoglobin 8.8 g/dL and estimated glomerular filtration ratio 15.6 mL/min/1.73 m2). Following a 6-month treatment with daprodustat, hemoglobin increased up to 10.4 g/dL, left ventricular mass index decreased from 107 g/m2 to 88 g/m2, and plasma B-type natriuretic peptide decreased from 276 pg/mL to 122 pg/mL, despite doses of other medications remaining unchanged. HIF-PH inhibitors might be a promising tool to ameliorate renal anemia and facilitate cardiac reverse remodeling in patients with HFpEF.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1320
Author(s):  
Anca Maria Panaitescu ◽  
Mihaela Roxana Popescu ◽  
Anca Marina Ciobanu ◽  
Nicolae Gica ◽  
Brindusa Ana Cimpoca-Raptis

During gestation, the maternal body should increase its activity to fulfil the demands of the developing fetus as pregnancy progresses. Each maternal organ adapts in a unique manner and at a different time during pregnancy. In an organ or system that was already vulnerable before pregnancy, the burden of pregnancy can trigger overt clinical manifestations. After delivery, symptoms usually reside; however, in time, because of the age-related metabolic and pro-atherogenic changes, they reappear. Therefore, it is believed that pregnancy acts as a medical stress test for mothers. Pregnancy complications such as gestational hypertension, preeclampsia and gestational diabetes mellitus foreshadow cardiovascular disease and/or diabetes later in life. Affected women are encouraged to modify their lifestyle after birth by adjusting their diet and exercise habits. Blood pressure and plasmatic glucose level checking are recommended so that early therapeutic intervention can reduce long-term morbidity. Currently, the knowledge of the long-term consequences in women who have had pregnancy-related syndromes is still incomplete. A past obstetric history may, however, be useful in determining the risk of diseases later in life and allow timely intervention.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1318
Author(s):  
Rūta Butkevičienė ◽  
Jolanta Kuznecovienė ◽  
David Harrison ◽  
Eimantas Peičius ◽  
Gvidas Urbonas ◽  
...  

Background: The literature on professionals’ perceptions of dignity at the end-of-life (EOL) shows that there is a need for studies set in different cultural contexts. Lithuania represents one of these little-studied contexts. The aim of this study is to understand professionals’ attitudes, experiences, and suggestions concerning EOL dignity to provide knowledge upon which efforts to improve EOL care can be grounded. The research questions are “How do Lithuanian health care professionals understand the essence of dignity at the end-of-life of terminally ill patients?” and “How do they believe that dignity at the EOL can be enhanced?”. Materials and Methods: The study was exploratory and descriptive. It employed an interpretive phenomenological method to understand the essence of the phenomenon. Lightly structured interviews were conducted with professionals who had EOL experience, primarily with elderly and late middle-aged patients. from medicine, nursing, social work, and spiritual services. The interviews were primarily conducted by audiovisual means due to pandemic restrictions. Using a constant comparative method, the research team systematically codified text and developed themes by consensus after numerous analytic data iterations. Results: Four primary themes about EOL dignity were identified: Physical Comfort, Place of Care and Death, Effects of Death as a Taboo Topic, and Social Relations and Communication. A fifth, overarching theme, Being Heard, included elements of the primary themes and was identified as a key component or essence of dignity at the EOL. Conclusions: Patient dignity is both a human right and a constitutional right in Lithuania, but in many settings, it remains an aspiration rather than a reality. Being Heard is embedded in internationally recognized patient-centered models of EOL care. Hearing and acknowledging individuals who are dying is a specific skill, especially with elderly patients. Building the question “Is this patient being heard?” into practice protocols and conventions would be a step toward enhancing dignity at the EOL.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1315
Author(s):  
Susumu Fukahori ◽  
Yasushi Obase ◽  
Chizu Fukushima ◽  
Daisuke Takao ◽  
Jun Iriki ◽  
...  

Anti-tumor necrosis factor alpha (TNFα) therapy is widely used to treat various inflammatory conditions. Paradoxically, there are several case reports describing the development of bronchocentric granulomatosis treated with TNFα inhibitors, and it is difficult to determine the effect of treatment using conventional spirometry because the lesions are located in small airways. However, it has been reported that the forced oscillation technique (FOT) is useful in the evaluation of small airway disease in bronchial asthma or chronic obstructive pulmonary disease. We performed the FOT to determine the effect of treatment on bronchocentric granulomatosis and found it to be useful. We report the case of a 55-year-old female with ulcerative colitis who was treated with golimumab and who developed bronchocentric granulomatosis as a sarcoid-like reaction to golimumab. She was successfully treated with prednisone, and the treatment efficacy was confirmed by the FOT. The FOT may be useful in the evaluation of small airway disease in bronchocentric granulomatosis. This case may help inform clinicians of the usefulness of the FOT to assess small airway disease in various diseases.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1311
Author(s):  
Adam Sulewski ◽  
Dominik Sieroń ◽  
Karol Szyluk ◽  
Mikołaj Dąbrowski ◽  
Łukasz Kubaszewski ◽  
...  

Background and objectives: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. Materials and Methods: We present a group of 10 patients with degeneration of large joints and adjacent epiphyses of long bones and the spine, with a background of bone infarctions and avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. Conclusions: During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN; hence, more research is needed.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1314
Author(s):  
Renata Solimini ◽  
Francesco Paolo Busardò ◽  
Filippo Gibelli ◽  
Ascanio Sirignano ◽  
Giovanna Ricci

Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1313
Author(s):  
Alessia Todeschini ◽  
Ilaria Loconte ◽  
Antonella Contaldo ◽  
Enzo Ierardi ◽  
Alfredo Di Leo ◽  
...  

A 80-year-old woman underwent vulvar melanoma resection and segmental lung resection for pulmonary metastasis. Immunotherapy with Nivolumab was performed. One year later, the patient was admitted for gastrointestinal (GI) recurrent bleeding and severe anemia. Esophagoastroduodenoscopy and colonoscopy did not show any abnormality, while videocapsule endoscopy (VCE) revealed an irregular and exophytic whitish area with a “coal-black” central depression. Small bowel resection was performed and histological examination revealed S100 protein strongly positive melanoma metastasis. The patient died six months later from disease progression. A “coal-black” appearance of intestinal metastatic melanoma has been described only twice before this report. In one case the patient had been treated by immunotherapy with interferon A and dendritic cell-based vaccination. In our patient, it is presumable that the picture we observed was a consequence of Nivolumab treatment inducing the disappearance of melanocytes in the area surrounding the metastasis with the onset of the central coal-black lesion encircled by whitish tissue. This picture should be emblematic of intestinal metastatic melanoma in subjects treated with immunotherapy showing occult/obscure bleeding.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1312
Author(s):  
So-Hyun Kim ◽  
Sung-Hyoun Cho

Background and Objectives: This study aimed to assess the effect of neck stabilization exercise on respiratory function in stroke patients through longitudinal observation and determine whether there is a difference in its effect based on the side of paralysis in the patients. It is difficult to observe the amount of change observed in individuals and groups as most intergroup comparison studies only use mean values. To address these shortcomings, this study adopted a hierarchical linear model (HLM) in our trajectory analysis. Materials and Methods: We conducted neck stabilization training three times a week for four weeks in a single group of 21 stroke patients. To evaluate respiratory function, their forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiration ratio (FEV1/FVC), and peak cough flow (PCF) were measured. Data analysis was performed using HLM 8.0. Results: A significant increase was found in the respiratory function after neck stabilization training (p < 0.05). While neck stabilization training overall was longitudinally effective, the growth rate of respiratory function in left-sided paralytic patients was less than the whole group value. Conversely, the growth rate of respiratory function in right-sided paralytic patients was greater than the whole group value. Conclusions: This study demonstrated that neck stabilization training is longitudinally effective in improving respiratory function in stroke patients. Additionally, the growth rate of respiratory function was greater in patients with right side paralysis than in patients with left side paralysis.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1316
Author(s):  
Darius Tomina ◽  
Smaranda Buduru ◽  
Cristian Mihail Dinu ◽  
Andreea Kui ◽  
Cătălina Dee ◽  
...  

Background and Objectives: Dental occlusion and gingival recession have been studied over the past years especially because of the increasing incidence of occlusal interferences in young patients. The purpose of this pilot study is to investigate any association between occlusal dysfunctions and gingival recessions. Data on gingival phenotype and previous orthodontic treatment were also collected to assess any correlation with the presence of gingival recession. Materials and Methods: Forty systemically healthy subjects, without signs of periodontitis and with gingival recessions, were included in the study. The following parameters were determined: location and extent of the gingival recession, gingival phenotype and functional occlusion by means of observing and registering the occlusal contacts in maximum intercuspation position, protrusive and lateral guidance. Results: Premolars were mostly affected in cases of working-side interferences during lateral guidance (71.19% of the affected teeth during left and 75% during right mandibular movements). The chi-squared exact test applied for the analysis of contingency tables revealed statistically significant associations between excursive interferences during lateral guidance and anterior guidance and the presence of gingival recession on the involved group of teeth. Conclusions: The results suggest that most gingival recessions might be associated with working-side interferences, the highest number of gingival recessions being associated with active interferences during lateral guidance.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1317
Author(s):  
Šarūnas Judickas ◽  
Raimundas Stasiūnaitis ◽  
Andrius Žučenka ◽  
Tadas Žvirblis ◽  
Mindaugas Šerpytis ◽  
...  

Background and Objectives: Oncohematological patients have a high risk of mortality when they need treatment in an intensive care unit (ICU). The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the ICU and their risk factors. Materials and Methods: A prospective single-center observational study was performed with 114 patients from July 2017 to December 2019. Inclusion criteria were transfer to an ICU, hematological malignancy, age >18 years, a central line or arterial line inserted or planned to be inserted, and a signed informed consent form. Univariate and multivariable logistic regression models were used to evaluate the potential risk factors for ICU mortality. Results: ICU mortality was 44.74%. Invasive mechanical ventilation in ICU was used for 55.26% of the patients, and vasoactive drugs were used for 77.19% of patients. Factors independently associated with it were qSOFA score ≥2, increase of SOFA score over the first 48 h, mechanical ventilation on the first day in ICU, need for colistin therapy, lower arterial pH on arrival to ICU. Cut-off value of the noradrenaline dose associated with ICU mortality was 0.21 μg/kg/min with a ROC of 0.9686 (95%CI 0.93–1.00, p < 0.0001). Conclusions: Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. Despite our findings, we do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline.


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