Medicina
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Prognostic Value of Immune Scoring System for Colorectal Cancer Patients with Peritoneal Metastasis.
Background and Objectives: There is no reliable immune scoring system that can help us predict the postoperative outcomes of colorectal cancer patients with peritoneal metastases after cytoreductive surgery. In this cohort, the aims were (1) to evaluate the postoperative morbidity, mortality and surgical oncological outcomes in colorectal cancer patients with peritoneal metastasis; (2) to compare oncological and postoperative outcomes of colon cancer patients with peritoneal metastasis and rectal cancer patients with peritoneal metastasis; and (3) to assess the prognostic value of the modified Glasgow Prognostic Score (mGPS) and the CRP-albumin ratio (CAR). Materials and Methods: A prospectively maintained database of 258 patients who underwent cytoreductive surgery for peritoneal metastases of colorectal origin between 2007 and 2024 was analyzed. ⋯ In both groups, the preoperative mGPS and CAR values were statistically significantly higher in those who developed postoperative high-grade complications (C-D grade III/IV) (p < 0.001) and those who died perioperatively (p = 0.001 and p = 0.002). Conclusions: In multivariate Cox analysis, the CAR was found to be an independent prognostic factor for overall survival in this cohort. CAR and mGPS predicted high-grade complications and postoperative mortality in both groups.
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Background and Objectives: This systematic review evaluates the effectiveness of exercise interventions for managing nonspecific low back pain (NSLBP) and explores their impact on related biopsychosocial factors, physical health variables, and inflammatory biomarkers. Materials and Methods: A comprehensive search of five databases (PubMed, CINAHL, PEDro, SCOPUS, Cochrane Library) was conducted, covering studies from 2019 to 2024. Fifteen randomized controlled trials involving 1338 participants aged 18 to 65 years with NSLBP were included. ⋯ Additionally, it enhanced physical parameters like proprioception, muscle thickness, and physical performance. However, the review found insufficient evidence regarding the effects of exercise on inflammatory biomarkers in NSLBP patients. Conclusions: The findings suggest that physical exercise is an effective intervention for pain reduction and the improvement of overall health in NSLBP, though further research is needed to clarify its impact on inflammation.
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Background and Objectives: Vasopressin increases blood pressure through aquaporin-2-mediated water retention and is useful for managing hemodynamics after surgery. However, even after decades of study, clear clinical guidelines on doses and ideal use cases after cardiovascular surgery remain unclear. Here, the existing literature is synthesized on vasopressin use for cardiac surgeries and coupled with real-world clinical experience to outline a clearer clinical path for vasopressin use. ⋯ Although sole use is not recommended, vasopressin may aid in controlling hemodynamics when given with other volemic or osmolal drugs. Conclusions: Vasopressin may work in a select population of first-line non-responders, but relevant response factors remain unanalyzed and clear guidelines for use remain unestablished. Future, large-scale studies are needed to delineate temporal and demographic characteristics that affect response to vasopressin for the purpose of managing post-surgical capillary leakage and hemodynamics.
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Background and Objectives: Coinfection with SARS-CoV-2 and extrapulmonary tuberculosis (extraPTB) presents unique clinical challenges due to dual inflammatory responses and potential differences in patient profiles compared to those with SARS-CoV-2 infection alone. This study uniquely contributes to the underexplored interaction between extraPTB and SARS-CoV-2, focusing on systemic inflammation as a critical determinant of outcomes. Materials and Methods: This retrospective, cross-sectional study included 123 patients aged 19-91 years, hospitalized at Victor Babeș Hospital in Timișoara from March 2020 to March 2022. ⋯ Low SpO2 and elevated IL-6 were significant predictors of mortality, with severe symptoms tripling fatality odds. Conclusions: Coinfection with extraPTB and SARS-CoV-2 is associated with younger age, heightened systemic inflammation, and longer hospital stays but does not significantly increase mortality risk compared to SARS-CoV-2 alone. These findings underscore the importance of monitoring systemic inflammatory markers and developing tailored management strategies to improve long-term care outcomes for coinfected patients, especially in resource-limited settings.
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Randomized Controlled Trial
Effect of Foot Insole on Planter Pressure Distribution in Patients with Neuropathic Diabetic Foot Ulcer: A Prospective, Randomized, Double-Blinded, Controlled Clinical Trial.
Background and Objectives: Patients with diabetes polyneuropathy are at a heightened risk for developing foot ulcers, often due to dynamic plantar foot pressure patterns that lead to increased pressure and shear forces in specific foot areas. This study aimed to evaluate the effects of foot insoles on peak pressure and the pressure-time integral in patients with polyneuropathy diabetic foot ulcers over a twelve-week period followed by an eight-week follow up. Materials and Methods: This was a prospective, randomized, double-blinded, controlled clinical trial involving 60 patients aged between 50 and 65 years of both genders. ⋯ Results: The results indicated significant differences in peak pressure and pressure-time integral measurements for the rearfoot, midfoot, hallux, and both medial and lateral forefoot areas after twelve weeks of using foot insoles compared to the control group. This suggests that the use of foot insoles effectively reduces peak pressure and the pressure-time integral in these critical areas. Conclusions: The findings of this study support the use of foot insoles as a beneficial intervention for decreasing peak pressure and the pressure-time integral on the hallux, medial, and lateral forefoot in patients with polyneuropathic diabetic foot ulcers, and they could play a crucial role in preventing further complications.