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Pharmacological Management of Metabolic Syndrome in Crisis Settings: A Narrative Review and Three-Axis Model
No full textMetabolic syndrome (MetS) is a multifactorial condition with rising global prevalence and significant long-term health risks. In emergency contexts such as wartime, MetS management becomes increasingly complex due to disrupted healthcare access, limited drug availability, and heightened psycho-emotional stress. This narrative review synthesizes current evidence on pharmacological strategies for MetS, focusing on three widely used agents, metformin, alpha-lipoic acid (ALA), and glucagon-like peptide-1 (GLP-1) receptor agonists, and introduces a three-axis model to address treatment barriers.
Seventy-eight peer-reviewed publications from 2015 to 2025 were thematically analyzed to assess the therapeutic efficacy, safety, and feasibility of metformin, ALA, and GLP-1 receptor agonists. These agents demonstrate complementary mechanisms targeting insulin resistance, oxidative stress, and cardiometabolic risk factors with favorable safety profiles and relatively high availability. In constrained settings, pharmacological management must prioritize feasibility, simplicity, and continuity of care. Strategies such as avoiding overlapping mechanisms, integrating lifestyle interventions, and leveraging telemedicine are essential.
The proposed three-axis model provides a practical tool for clinicians to identify and address barriers related to physicians, drugs, and patients, thereby improving personalized therapy planning. It emphasizes the importance of tailored care, therapeutic sequencing, drug bioavailability, and patient adherence, especially in situations of social instability. This review stresses the need for multidisciplinary approaches to MetS treatment, going beyond pharmacology to include systemic resilience and patient-centered care
Polymyxin B-Associated Acute Kidney Injury: Risk Factors and Short-Term Outcomes in a Single-Center Retrospective Cohort
No full textIntroduction. Polymyxin B (PMB) and other antibiotics in the polymyxin group are known to be nephrotoxic. In recent years, due to the increasing prevalence of antibiotic resistance, they have become a frequent treatment option for infections caused by multidrug-resistant Gram-negative bacteria.
Our study aims to comprehensively examine the nephrotoxic effects and clinical characteristics of PMB in patients receiving treatment without dose reduction.
Methods. This study included 176 patients, who were divided into two groups based on the presence or absence of acute kidney injury (AKI). The groups were analyzed for nephrotoxicity, associated risk factors, mortality, and other clinical characteristics.
Results. Gender, pathogen, site of infection, comorbidities, additional nephrotoxic agents, duration of antibiotic use, and mechanical ventilation status were not identified as risk factors for AKI development. However, advanced age was found to be associated with nephrotoxicity (OR = 1.024, 95% CI 1.001–1.047; p = 0.037). Additionally, the mortality rate was higher in the AKI group (p = 0.001), although no significant difference was observed in the survival analysis (p = 0.189).
Conclusions. PMB is commonly used in critically ill patients, and PMB-associated AKI tends to develop early during treatment. While most clinical characteristics were not independently associated with AKI, advanced age was identified as a significant risk factor. Therefore, close monitoring of renal function is recommended throughout PMB therapy
Diagnostic Significance of Peri-Implant Crevicular Fluid Biomarkers: A Narrative Review
Full text linkEvaluation of peri-implant tissue health is typically based on conventional clinical parameters, including subjective and visual signs of inflammation or tissue destruction, assessment of pocket probing depth, bleeding, suppuration, and X-ray analysis of progressive bone level changes. Subsequently, the assessment of biomarkers in peri-implant crevicular fluid (PICF) has been proposed to improve the standard diagnostic protocol. PICF is a site-specific fluid that contains cells, microbes, cytokines, and other mediators. Studies have been conducted to evaluate the diagnostic significance of PICF biomarkers in the early identification of peri-implant diseases. However, this non-invasive method can be used to monitor healing processes after implant installation or soft tissue augmentation as well. Despite numerous studies, the reliability of specific biomarkers remains controversial, and their diagnostic value should be evaluated comprehensively. This narrative review aimed to compare published research on the diagnostic potential of biomarkers in PICF.
After screening the scientific data, all biomarkers were grouped based on their associated biological processes. The most extensively studied categories were pro- and anti-inflammatory cytokines, tissue degradation markers, and bone remodeling factors. Despite extensive research confirming the high reliability of several cytokines, such as IL-1β, TNF-α, MMP-8, etc., many other biomarkers still require additional research to establish their specificity and sensitivity in assessing peri-implant tissues
The Role of Telehealth Applications in Chronic Kidney Disease Management: A Systematic Review of Randomized Controlled Trials
Full text linkIntroduction. Chronic kidney disease (CKD) is a long-term condition affecting over 800 million individuals worldwide, accounting for more than 10% of the global population. Effective management of CKD is essential to prevent disease progression. With technological advancements, various mobile health applications are now utilized to treat and manage kidney diseases.
This study aims to examine the use of telehealth interventions in CKD care management and systematically evaluate the effectiveness of studies conducted in this context.
Methods. This study retrieved data from studies indexed in the Web of Science, PubMed, and Scopus databases, published between 2014 and 2024. The search keywords included “chronic kidney disease” OR “CKD,” “telehealth,” “mobile,” “mhealth,” AND “dialysis,” “experimental.” This systematic review incorporated all full-text randomized controlled trials (RCTs) published in English that met the inclusion criteria. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials.
Results. This systematic review included all full-text English-language RCTs, identifying 9,477 records in the initial search. Six studies met the inclusion criteria and were included in the review following evaluation. Since only RCTs were considered, the study design remained homogeneous. However, heterogeneity was observed in the measured outcomes. The most frequently reported outcome measures included patient laboratory findings and quality-of-life scores. Sample sizes varied across studies, with intervention group sizes ranging from 24 to 169 participants.
Conclusion. Telehealth interventions, including mobile health applications, video visits, and remote monitoring, have demonstrated positive effects on self-management, disease control, and quality of life in patients with CKD. The findings suggest that telehealth applications can be an effective tool in managing CKD, particularly monitoring key health indicators such as blood pressure and laboratory values
Comparative Diagnostic Performance of Endoscopic Classifications for Predicting Histopathology in Large Laterally Spreading Colorectal Tumors
Full text linkIntroduction. Colorectal cancer is a major cause of cancer-related mortality worldwide, and early, accurate diagnosis is essential for effective management. Optical diagnosis using image-enhanced endoscopy and standardized classifications has improved real-time assessment of lesion morphology, yet the optimal approach for large laterally spreading tumors (LSTs), especially granular mixed type, remains under debate. This study aimed to compare the diagnostic performance of the JNET, Kudo, Modified Sano, Hiroshima classifications, and forceps biopsy in predicting histopathology for large LSTs, with a focus on differentiating between granular (LST-G) and non-granular (LST-NG) subtypes.
Methods. Ninety-five patients with LSTs > 20 mm were enrolled, with the largest lesion per patient selected for analysis. Patients were stratified into LST-G and LST-NG groups using the Paris classification. Lesions were evaluated using optical diagnosis based on four endoscopic classifications: Kudo, JNET, Modified Sano, and Hiroshima. Targeted forceps biopsies were obtained from areas of the most pronounced changes, and subsequent endoscopic resection specimens served as the histopathological reference standard. The diagnostic performance metrics were calculated, including sensitivity, specificity, predictive values, and diagnostic accuracy.
Results. In the LST-G group, the Modified Sano classification achieved the highest sensitivity (92.31%) but had low specificity (52.38%). In contrast, the Hiroshima classification exhibited low sensitivity (65.22%) but achieved superior specificity (100%), along with the highest positive predictive value (100%), negative predictive value (82.22%), and overall diagnostic accuracy (86.67%). Forceps biopsy demonstrated a balanced diagnostic performance, slightly surpassing JNET in sensitivity (79.49% vs. 71.79%), specificity (95.24% vs. 90.48%), negative predictive value (96.88% vs. 93.33%), positive predictive value (71.43% vs. 63.33%), and diagnostic accuracy (85% vs. 78.3%). In contrast, for LST-NG lesions, the JNET classification outperformed other modalities across most diagnostic metrics, with the highest sensitivity (71.43%), specificity (100%), and positive predictive value (100%); however, it had a slightly lower negative predictive value and diagnostic accuracy compared to the Hiroshima classification (84% vs. 93.75% and 88.57% vs. 94.29%, respectively).
Conclusions. Among the evaluated endoscopic classifications, JNET proved to be the most effective for large LST-NG, while for LST-G, the Modified Sano classification demonstrated the highest sensitivity, and the Hiroshima classification excelled in other diagnostic metrics. Although further improvements in optical diagnosis are warranted, targeted forceps biopsy provides no additional diagnostic benefits before resection
A Hybrid Approach to Modelling ECC Risk: Effectiveness of Nonparametric Regression and MLFNN Techniques
Full text linkIntroduction. Early childhood caries (ECC) is a prevalent dental condition that significantly impacts children’s quality of life and is influenced by both environmental and metabolic factors. Anthropometric variables such as weight, height, and body mass index serve as indicators of overall growth and nutritional status, which are closely linked to oral health. Additionally, family size may play a role in ECC risk by influencing dietary habits and oral hygiene practices. Despite these associations, the complex and nonlinear relationships between these factors and ECC risk remain insufficiently explored.
This study aims to investigate the potential relationships between ECC risk and a combination of social (family size) and anthropometric parameters (weight, height, and body mass index) by employing nonparametric regression and validating these relationships with a multilayer feed-forward neural network (MLFNN).
Methods. This cross-sectional observational study utilized secondary data from Universiti Sains Malaysia Hospital, Kota Bharu, Kelantan, Malaysia. The dataset was divided into training (60%), testing (30%), and validation (10%) subsets. A generalized additive model (GAM) was used to capture nonlinear relationships, followed by MLFNN validation. Model performance was assessed using root mean squared error (RMSE), mean absolute error (MAE), median absolute error (MedAE), and mean squared error (MSE).
Results. The dataset exhibited non-normality, justifying the use of nonparametric regression. In the GAM, only weight showed a nonlinear relationship, with no other predictors significantly influencing ECC risk, except for the intercept. The MLFNN achieved an error value of 0.089 and an accuracy of 91.09%, with height contributing the most to ECC risk estimation.
Conclusions. Integrating nonparametric regression and MLFNN validation provides a robust framework for modelling ECC risk, capturing complex nonlinear relationships between family size and anthropometric factors. Height emerged as the most influential predictor, highlighting its association with growth and systemic health, followed by weight, body mass index, and family size. These findings underscore the need for a multifactorial approach in ECC prevention, emphasizing nutritional and family-related factors in pediatric dental care
Diagnostic Value of Hematological Parameters in Patients with Brucellosis
Full text linkIntroduction. Brucellosis, a widespread zoonotic disease caused by the genus Brucella, presents with nonspecific clinical manifestations, making early diagnosis challenging. This study aimed to evaluate the usefulness of hematological parameters as potential biomarkers for the preliminary diagnosis of brucellosis.
Methods. A retrospective case-control study was conducted on 100 patients diagnosed with brucellosis and 100 healthy controls. The complete blood count parameters (neutrophils, lymphocytes, monocytes, and platelets), derived indices, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and pan-immune inflammation value (PIV), and C-reactive protein (CRP) levels were compared among the participants. CRP levels were measured by the nephelometric method. Receiver operating characteristic (ROC) analysis was applied for parameters showing significant differences. In addition, the patient group was divided into subgroups based on antibody titers, and differences in these parameters between the subgroups were analyzed.
Results. Median CRP levels were higher in the patient group compared to the control group, whereas median neutrophil and lymphocyte counts were significantly lower. No significant differences were found in other hematological parameters and indices. In ROC analysis, CRP showed a sensitivity of 77.8% and a specificity of 95.0% at a cut-off value of 3.33 mg/L. Although neutrophil and lymphocyte counts showed statistical significance, their sensitivity and specificity were comparatively low. CRP levels in the 1/160 antibody titer group were lower than those in the 1/640, 1/1280, and > 1/1280 antibody titer groups (p = 0.006, p = 0.015, p = 0.014, respectively).
Conclusions. CRP remains a valuable marker for the diagnosis of brucellosis. In contrast, no significant differences were found in NLR, PLR, MLR, SII, and PIV between brucellosis and healthy controls. Further research is warranted to identify new biomarkers that are easily accessible, cost-effective, and provide valuable information for the diagnosis and follow-up of brucellosis
Immune subtype as a moderator of the prognostic significance of mutations in lung adenocarcinoma: a TCGA data analysis
No full textIntroduction. Lung adenocarcinoma is a genetically and immunologically heterogeneous disease, with key mutations affecting prognosis and response to therapy. This study aimed to evaluate the impact of individual and combined mutations in six key genes (TP53, KRAS, STK11, KEAP1, EGFR, BRAF) on overall survival in patients with lung adenocarcinoma, considering the tumor’s immune subtype.
Methods. A cohort of 390 patients from the TCGA-LUAD dataset was analyzed using survival models stratified by immune subtype: high, medium, and low. Kaplan–Meier analysis and multivariable Cox regression were used for statistical analysis. A p-value <0.05 was considered statistically significant.
Results. Significantly better median overall survival was observed in the high immune subtype group (59.7 months) compared to medium (45.2 months) and low (29.9 months) subtypes (p = 0.0017). The STK11 mutation and KRAS+TP53 co-mutation were the strong predictors of poor prognosis in the high immune subtype. In the medium immune subtype, KRAS+STK11, KRAS+KEAP1, and especially STK11+KEAP1 co-mutations were associated with markedly increased mortality risk. No statistically significant predictors were identified in the low immune subtype, although KRAS mutation showed a trend toward worse outcomes.
Conclusions. The prognostic impact of genetic mutations in lung adenocarcinoma is significantly modulated by the tumor’s immune context
Appendiceal mucinous adenocarcinoma invading the ovaries with subsequent pseudomyxoma peritonei: a histopathological case report
No full textIntroduction. Appendiceal mucinous adenocarcinoma (AMA) is a rare gastrointestinal malignancy that may spread beyond the appendix, invading adjacent organs and leading to pseudomyxoma peritonei (PMP). Its diagnosis remains challenging due to an asymptomatic course or nonspecific clinical and radiological findings.
Case presentation. We report the case of a 42-year-old woman with class II obesity and no significant symptoms, who underwent a routine annual check-up. Initial ultrasound revealed adenomyosis, and subsequent pelvic MRI demonstrated multilocular cystic ovarian masses. The patient underwent bilateral salpingo-oophorectomy, omentectomy, and removal of tumor deposits from the bladder peritoneum and pouch of Douglas. Intraoperatively, extensive omental infiltration with an «omental cake» sign was observed. Histopathological assessment revealed bilateral mucinous ovarian tumors and mucin lakes in the omentum, confirming metastatic mucinous adenocarcinoma of the appendix with subsequent development of PMP.
Conclusion. This case illustrates that bilateral ovarian mucinous tumors should raise suspicion for metastatic disease, particularly of appendiceal origin. Macroscopically observed peritoneal «omental cake» and histopathologically verified omental mucin lakes are important diagnostic clues. Histopathological and immunohistochemical evaluation are critical in diagnosis and distinguishing metastatic appendiceal mucinous adenocarcinoma from primary ovarian mucinous tumors
Community-Acquired Meningoencephalitis Caused by Acinetobacter lwoffii: A Rare Clinical Case
Full text linkIntroduction. Acinetobacter lwoffii is a rare cause of bacterial meningitis, particularly in immunocompetent individuals without prior healthcare exposure. To date, only a very limited number of cases have been documented in the literature.
Case Report. A 17-year-old male patient presented with fever, severe headache, meningeal irritation, and neurological symptoms. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and elevated inflammatory markers. Phenotypic analysis with the Vitek 2C system identified the cerebrospinal fluid isolate as A. lwoffii. Empirical antibiotic therapy was initiated and subsequently adjusted based on sensitivity testing, improving clinical and laboratory parameters.
Conclusions. This case highlights the pathogenic potential of A. lwoffii to cause severe central nervous system infections in healthy individuals. It emphasizes the importance of early microbiological diagnosis and targeted antibiotic therapy. The clinical picture, diagnostic approach, treatment strategy, and outcome are discussed in relation to the existing evidence