Medica (United States)

Introducción: La dextrocardia es una entidad poco frecuente (1:10,000 nacidos vivos) y su asociación con trastornos del sistema de conducción es aún más rara. La presencia de arritmias como la fibrilación auricular puede estar relacionada con dilatación auricular secundaria a valvulopatía. Objetivo: Se pretende describir las implicaciones técnicas referentes a la implantación de un marcapasos en una paciente con dextrocardia y un trastorno de conducción cardiaca. Métodos: Se realiza el reporte de un caso clínico con revisión de la literatura. Resultados: Se reportó el caso de un paciente femenino de 84 años quién presentó síncope, fibrilación auricular con respuesta ventricular lenta y dextrocardia con situs inversus total. Se indicó la implantación de un marcapasos unicameral en modo VVIR. El procedimiento representó un desafío médico y técnico debido a la anatomía en espejo y la insuficiencia tricuspídea asociada. Se implantó electrodo bipolar en ventriculo derecho en proyecciones fluoroscópicas oblicuas para su correcta colocación en el septum interventricular. Conclusión: En este caso se revisa la necesidad de adaptar la técnica de implante de dispositivos en presencia de variantes anatómicas complejas, así como el valor de herramientas de imagen multimodal para optimizar los resultados en pacientes con cardiopatías congénitas no diagnosticadas previamente. Recibido: 06/11/2025 Abrobado: 04/02/2026

Background: The optimal management of patients with acute ischemic stroke presenting with low National Institutes of Health Stroke Scale (NIHSS) scores and confirmed vessel occlusion remains uncertain. While intravenous thrombolysis (IVT) is standard in many cases, its benefit in this specific subgroup compared to antithrombotic therapy alone is debated. Objective: To evaluate the efficacy and safety of IV thrombolysis versus antithrombotic agents in patients with acute ischemic stroke, low NIHSS scores, and confirmed vessel occlusion. Methods: Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 July 2025 was conducted. Five studies which reported clinical outcome, mortality, and symptomatic ICH were included in qualitative synthesis and meta-analysis. Results: Across the included studies, IV thrombolysis did not significantly improve the likelihood of achieving a good functional outcome compared to antithrombotics (OR 0.98; 95% CI 0.73–1.32; P = 0.89). Mortality rates were also similar between groups (OR 1.2; 95% CI 0.18–7.87; P = 0.85). There was a nonsignificant trend toward increased risk of SICH in the IVT group (OR 2.47; 95% CI 0.79–7.74; P = 0.12). Conclusion: In patients with acute ischemic stroke, low NIHSS, and confirmed vessel occlusion, treatment with IV thrombolysis was not associated with improved functional outcomes or reduced mortality compared to antithrombotic therapy, and carried a nonsignificant increase in the risk of SICH. These findings highlight the need for randomized controlled trials to guide optimal treatment strategies in this patient subgroup.

The article presents the results of a clinical and pharmacological study of the efficacy, tolerability, and safety of complex therapy of depressive disorders in patients with alcohol dependence. The aim of the study was to increase the effectiveness of treatment of comorbid depressive states by combining pharmacotherapy with the antidepressant escitalopram (Cipralex) with the use of intravascular laser hemotherapy and laser reflexology. The study included 50 men of working age, distributed into two groups: the main one (30 people) who received combination therapy, and the control group (20 people) who underwent monotherapy with Cipralex. Effectiveness was assessed using standardized psychometric scales (Hamilton, Montgomery-Asberg scale, Spielberger-Hanin, asthenic scale, quality of life scale). The results showed that patients in the main group experienced a more rapid reduction in depressive symptoms, a decrease in anxiety and asthenia, as well as a significant improvement in quality of life compared to the control group. The therapeutic effects of laser methods contributed to increasing the psycho-emotional stability, performance, and social adaptation of patients, which confirms the expediency of including laser therapy in the treatment programs for alcoholic depression. No side effects or cases of intolerance have been reported. The proposed integrated approach of combining pharmacotherapy with antidepressants with laser methods can be recommended for interdisciplinary treatment and rehabilitation programs to restore mental health and return to productive activities of able-bodied citizens.

Aims: Acute myocarditis is a clinical condition that poses a challenge in clinical management, with its heterogeneous character ranging from clinically silent, mildly self-limiting conditions to serious, life threatening conditions including cardiogenic shock and fatal outcomes. Sacubitril/valsartan affects both the renin-angiotensin-aldosterone system (blockage by valsartan) and the natriuretic peptide system (neprilysin inhibition by sacubitril) pathways. It is one of the main therapies in the management of heart failure with reduced ejection fraction. We evaluated patients who received sacubitril/valsartan therapy with subacute clinically suspected myocarditis and mild reduced ejection fraction. Methods: We evaluated 7 patients who diagnosed subacute clinically suspected myocarditis with mild reduced ejection fraction. On admission, all patients took sacubitril/valsartan. We analyzed those patients in terms of the echocardiographic findings at presentation and following time (at 6 months). Results: The study group included 5 male (71%) and 2 female (29%). During admission, all patients took sacubitril/valsartan. NYHA function and BNP levels at present (class-3, 704.75±143) decrease after 6-monthfollow-up. (class-2, 65.17±14.58). Left ventricle diastolic diameter, left atrium diameter, and E/ E’ at present (56.04±3.07, 41.77±1.23 and 14.83±0.25) decrease after 6-month follow-up. (48.04±2.07, 37.57±1.23 and 7.7±0.14). Ejection fraction increased after 6-month follow-up (from 42.13±2.63) to 51.13±2.63). Conclusion: In subacute clinically suspected myocarditis, sacubitril/valsartan therapy could be an effective alternative.

In kidney transplant recipients, non-adherence to immunosuppressive medications leads to rejection, which negatively affects the function of the transplanted organ and increases mortality rates and healthcare costs. The purpose of this paper is to report a case from the parent study which is designed to test the efficacy of the SystemCHANGETM intervention compared to an attention-control intervention on medication adherence at 6 and 12 months in non-adherent Turkish adult kidney transplant recipients. This is a case report from the Turkish parent study which mirrored the methods of the Medication Adherence Given Individual Change (MAGIC) studies conducted with adult kidney transplant recipients that have been previously published. This study reports a case study of an adult kidney transplant recipient with poor medication adherence enrolled in an innovative six-month SystemCHANGETM intervention. Medication adherence increased immediately and was sustained throughout the intervention and maintenance phases. The SystemCHANGETM intervention resulted in immediate and sustained improvements in medication adherence. The patient experienced a clinically meaningful increase in MA (23%) by improving the timing of doses by linking them to a regularly occurring behavior. This is the first case study conducted in different culture, and the second case study on this topic in the international literature. The SystemCHANGETM intervention was effective in increasing medication adherence and quality of life in this individual.

The optimal surgical technique for the treatment of Bartholin duct cysts and gland abscesses has not been finally chosen. Currently, the following methods are used: needle aspiration, with or without alcohol sclerotherapy; silver nitrate cyst ablation; use of laser technique; fistulization using Word catheters, Foley catheters, or Jacobi rings; incision and drainage followed by primary suture closure; cyst marsupialization; and cyst excision. This article describes a clinical case of Jacobi ring catheter outpatient treatment of a Bartholin gland abscess. A 8 Fr/Ch silicone coated latex Foley catheter was used to make the Jacobi ring catheter. The catheter was inserted into the abscess cavity through two separate incisions, forming a closed rubber ring after tying a USP 4/0 polypropylene thread passed through the catheter channel. The operation was performed in the office. We used local infiltration anesthesia with 2 ml of 2% lidocaine solution. The patient was prescribed oral antibacterial therapy with amoxicillin (875 mg) and clavulanic acid (125 mg) twice a day for five days and the use of ointment with dioxomethyltetrahydropyrimidine (40 mg) and chloramphenicol (75 mg) topically. The pain was relieved immediately. The abscess cavity was drained perfectly by the Jacobi ring catheter, which did not cause discomfort to the patient. Clinical signs of inflammation disappeared within a week. The patient’s activity, including sexual one, was not limited. The Jacobi ring catheter was removed after four weeks. However, four months later, the patient returned due to formation of a Bartholin duct cyst. Since there were no signs of inflammation, authors performed marsupialization. This clinical case demonstrated the convenience of using the Jacobi ring catheter for the treatment of the Bartholin gland abscess in the office: the technique is easy to perform, with specific instruments and devices not required, and allows for rapid relief of disease symptoms and reliable and long-term drainage of the abscess cavity. The technique is recommended to leave the Jacobi ring catheter for at least six to eight weeks. That may be the possible key to preventing recurrences, the possibility of which the patient must be warned about. However, this applies to any method of treating Bartholin duct cysts and gland abscesses.

Intracranial hemorrhage (ICH) is a devastating stroke subtype with a high rate of mortality and disability. Therapeutic options available are primarily limited to supportive care and blood pressure control, whereas the surgical approach remains controversial. In this study, we explored the effects of noninvasive vagus nerve stimulation (nVNS) on hematoma volume and outcome in a rat model of collagenase-induced ICH. Adult male Wistar rats were randomized into two study groups: (1) ICH-treated (rats treated with five 2-min nVNS) and (2) ICH-control (ICH with sham nVNS). Each group received either a 0.1-U or a 0.2-U collagenase dose. After assessing neurological function, rats were euthanized at 24 h for spectrophotometric hemoglobin assay, hematoma volume measurements, and histological studies. The ICH-treated group that received the 0.1-U collagenase dose demonstrated significantly smaller hematoma volume and improved motor function compared with the ICH-control with the same dose. Furthermore, the pooled data for the ICH-treated groups (both 0.1 U and 0.2 U of collagenase) revealed a reduction in neuronal loss in the perihematomal region in the histopathological studies. This effect was not significant for the group that received a 0.2-Ucollagenase dose. nVNS therapy in acute settings may provide a neuroprotective effect and limit hematoma expansion in smaller volumes, improving neurological function post-ICH.

Deep brain stimulation (DBS), a proven treatment for movement disorders, also holds promise for the treatment of psychiatric and cognitive conditions. However, for DBS to be clinically effective, it may require DBS technology that can alter or trigger stimulation in response to changes in biomarkers sensed from the patient's brain. A growing body of evidence suggests that such adaptive DBS is feasible, it might achieve clinical effects that are not possible with standard continuous DBS and that some of the best biomarkers are signals from the cerebral cortex. Yet capturing those markers requires the placement of cortex-optimized electrodes in addition to standard electrodes for DBS. In this Perspective we argue that the need for cortical biomarkers in adaptive DBS and the unfortunate convergence of regulatory and financial factors underpinning the unavailability of cortical electrodes for chronic uses threatens to slow down or stall research on adaptive DBS and propose public-private partnerships as a potential solution to such a critical technological gap.

The SMAD-specific E3 ubiquitin protein ligase 2 (SMURF2) has emerged as a critical regulator in cancer biology, modulating the stability of Hypoxia-Inducible Factor 1-alpha (HIF1α) and influencing a network of hypoxia-driven pathways within the tumor microenvironment (TME). SMURF2 targets HIF1α for ubiquitination and subsequent proteasomal degradation, disrupting hypoxic responses that promote cancer cell survival, metabolic reprogramming, angiogenesis, and resistance to therapy. Beyond its role in HIF1α regulation, SMURF2 exerts extensive control over cellular processes central to tumor progression, including chromatin remodeling, DNA damage repair, ferroptosis, and cellular stress responses. Notably, SMURF2's ability to promote ferroptotic cell death through GSTP1 degradation offers an alternative pathway to overcome apoptosis resistance, expanding therapeutic options for refractory cancers. This review delves into the multifaceted interactions between SMURF2 and HIF1α, emphasizing how their interplay impacts metabolic adaptations like the Warburg effect, immune evasion, and therapeutic resistance. We discuss SMURF2's dual functionality as both a tumor suppressor and, in certain contexts, an oncogenic factor, underscoring its potential as a highly versatile therapeutic target. Furthermore, modulating the SMURF2-HIF1α axis presents an innovative approach to destabilize hypoxia-dependent pathways, sensitizing tumors to chemotherapy, radiotherapy, and immune-based treatments. However, the complexity of SMURF2's interactions necessitate a thorough assessment of potential off-target effects and challenges in specificity, which must be addressed to optimize its clinical application. This review concludes by proposing future directions for research into the SMURF2-HIF1α pathway, aiming to refine targeted strategies that exploit this axis and address the adaptive mechanisms of aggressive tumors, ultimately advancing the landscape of precision oncology.

Introduction: Atrioesophageal fistulas (AEF) are severe life-threatening complications that can occur after left atrial ablation for the treatment of atrial fibrillation (AF). Although new ablation modalities promote a non-thermal mechanism of action, uncertainty remains surrounding their ability to reduce AEFs when implemented at scale. The international POTTER-AF survey found that AEFs continue to occur despite traditional preventative efforts, but trends in the U.S. are less clear. However, data from the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database can provide insight. Research Question: What are the recent trends in AEF reporting following left atrial ablation? Aim: To determine the number of AEFs and patient outcomes reported using the FDA’s MAUDE database over the last 5 years. Methods: Reports were reviewed from the FDA’s MAUDE database for entries filed from January 1st, 2019 through January 1st, 2024. Product codes LPB, OAE, and OAD, representing cardiac ablation catheters and radiofrequency generators, were reviewed for reports of AEFs. Each report was reviewed to remove duplicate reports and to verify patient outcomes. Results: A total of 202 reports of AEF were identified, with 128 non-fatal fistulas, and 74 reported deaths. Of the 202 reports, 110 were reported under the code LPB, 66 under OAE, and 26 under OAD. Reports generally increased over the analysis time frame, with 30 reports in 2019, 28 in 2020, 45 in 2021, 45 in 2022, and 54 in 2023 (Figure 1). Esophageal protective methods were reported to be luminal esophageal temperature (LET) monitoring in 61 cases, esophageal deviation in 3 cases, no protective method in 10 cases, and not mentioned in the remaining 128 cases. Conclusion: Despite widespread AEF awareness and adoption of traditional preventive efforts the annual rate of reported AEFs in the United States continues to grow, and fatality rates remain high, suggesting the need for improved preventative efforts.