Medical Sciences

14 pages, 1662 KB

Open AccessSystematic Review

Transcriptomic and Metagenomic Biomarkers in Peri-Implantitis: A Systematic Review, Diagnostic Meta-Analysis, and Functional Meta-Synthesis

by Carlos M. Ardila, Eliana Pineda-Vélez and Anny M. Vivares-Builes

Med. Sci. 2025, 13(3), 187; https://doi.org/10.3390/medsci13030187 - 12 Sep 2025

Abstract

Background/Objectives: Evidence from transcriptomic and histopathologic studies has revealed that peri-implantitis lesions are characterized by deeper inflammatory infiltration, increased immune cell accumulation, and distinctive molecular signatures. This systematic review aimed to evaluate the diagnostic and pathophysiological potential of transcriptomic, metagenomic, and bioinformatic biomarkers [...] Read more.

Background/Objectives: Evidence from transcriptomic and histopathologic studies has revealed that peri-implantitis lesions are characterized by deeper inflammatory infiltration, increased immune cell accumulation, and distinctive molecular signatures. This systematic review aimed to evaluate the diagnostic and pathophysiological potential of transcriptomic, metagenomic, and bioinformatic biomarkers in peri-implantitis by integrating findings from bioinformatics and machine learning-based studies. The dual objective was to identify biologically relevant markers and assess the accuracy of predictive models, addressing diagnostic gaps in peri-implant disease management. Methods: Eligible designs included cross-sectional, case–control, and cohort studies. Literature searches were conducted across PubMed, EMBASE, Scielo, and Scopus, with independent screening, data extraction, and quality assessment. Functional meta-synthesis was used to thematically organize biomarkers and pathways, while diagnostic meta-analysis pooled ROC-AUC values to assess model performance. Results: Eleven studies met the inclusion criteria. Functional synthesis revealed five recurring biomarker themes: innate and adaptive immune responses, immune cell infiltration, fibroblast activation, and ceRNA regulation. A meta-analysis of six studies reported a pooled AUC of 0.91 (95% CI: 0.88–0.93) with I² = 0%, indicating no heterogeneity, supporting the reliability of ML-based models in distinguishing peri-implantitis from healthy conditions. Sources of variation included differences in validation strategies and data preprocessing. Conclusions: Integrating transcriptomic, metagenomic, and bioinformatic biomarkers with machine learning may enable earlier and more accurate diagnosis of peri-implantitis. The identified biomarkers highlight molecular and microbial pathways linked to inflammation and tissue remodeling, underscoring their potential as diagnostic indicators and therapeutic targets with translational relevance. Full article

(This article belongs to the Section Translational Medicine)

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11 pages, 381 KB

Open AccessArticle

Clinical Evaluation of a Pollen-Extract-Based Phytotherapy Compared to Conventional Therapies in Chronic Prostatitis and Chronic Pelvic Pain Syndrome

by Marius Ivănuță, Dragoș Puia, Alin Adrian Cumpănaș, Ana-Maria Ivănuță, Veaceslav Groza and Cătălin Pricop

Med. Sci. 2025, 13(3), 186; https://doi.org/10.3390/medsci13030186 - 11 Sep 2025

Abstract

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent condition characterized by pelvic pain and urinary symptoms with multifactorial aetiology. Standard treatments, including alpha-blockers, often have limited long-term effectiveness. This study aimed to evaluate the efficacy and safety of a standardized pollen [...] Read more.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent condition characterized by pelvic pain and urinary symptoms with multifactorial aetiology. Standard treatments, including alpha-blockers, often have limited long-term effectiveness. This study aimed to evaluate the efficacy and safety of a standardized pollen extract (Deprox^® 500), alone or in combination with alpha-blockers, in reducing CP/CPPS symptoms and the need for rescue medication. Methods: This prospective, multicentre study included 207 male patients with CP/CPPS treated at two Romanian urology centres between January 2023 and January 2025. Patients were divided into three groups: Group A—alpha-blocker monotherapy; Group B—standardized pollen extract monotherapy; and Group C—combination therapy with standardized pollen extract and alpha-blocker. Symptom severity and treatment response were evaluated using the validated English versions of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IIEF-5), all of which were translated into Romanian for use in this study. Results: Groups B and C both demonstrated significantly greater reductions in pelvic pain and urinary symptoms compared to Group A (p = 0.01), with marked improvements in NIH-CPSI and IPSS. Conclusions: A standardized pollen extract used alone or in combination with an alpha-blocker significantly improved CP/CPPS symptoms and reduced the need for NSAID rescue medication. These findings support its potential as a safe and effective therapeutic option. Full article

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16 pages, 2824 KB

Open AccessReview

Mitral Valve Prolapse and Sudden Cardiac Death—A Puzzle with Missing Pieces: Review of the Literature and Case Report

by Diana Roxana Opris, Marius Mihai Harpa, David-Emanuel Anitei, Paul Calburean and Roxana Rudzik

Med. Sci. 2025, 13(3), 185; https://doi.org/10.3390/medsci13030185 - 10 Sep 2025

Abstract

Background: Mitral valve prolapse is a common valvular heart disorder, usually associated with a benign prognosis in the absence of significant mitral regurgitation. However, a subset of patients is at increased risk for complex ventricular arrhythmias and sudden cardiac death. Identifying these high-risk [...] Read more.

Background: Mitral valve prolapse is a common valvular heart disorder, usually associated with a benign prognosis in the absence of significant mitral regurgitation. However, a subset of patients is at increased risk for complex ventricular arrhythmias and sudden cardiac death. Identifying these high-risk individuals remains a major clinical challenge. Case Summary: We present the case of a 71-year-old female patient with recurrent syncopal episodes, a strong family history of sudden cardiac death, and complex ventricular ectopy. Multimodality imaging revealed bileaflet mitral valve prolapse, severe mitral regurgitation, mitral annular disjunction, and the Pickelhaube sign, with no evidence of myocardial fibrosis on cardiac magnetic resonance imaging. The patient underwent minimally invasive mitral valve repair and received an implantable cardioverter-defibrillator for primary prevention of sudden cardiac death. Follow-up revealed significant reverse cardiac remodeling, marked reduction in arrhythmic burden, and restoration of mitral valve function. Family screening identified mitral annular disjunction in both of her daughters, who were asymptomatic and without arrhythmias. Discussion: Mitral annular disjunction has emerged as a potentially arrhythmogenic substrate, especially in patients with familial clustering, raising the possibility of a genetic predisposition. Risk stratification remains difficult, as no individual clinical, electrocardiographic, or imaging marker has demonstrated consistent predictive value. Surgical correction of mitral valve prolapse with associated mitral annular disjunction may lead to a reduction in arrhythmic risk and promote favorable structural remodeling. Conclusions: This case-based review emphasizes the importance of advanced imaging techniques in the identification and management of high-risk mitral valve prolapse phenotypes. Early surgical intervention and close arrhythmic surveillance may improve outcomes, although further research is necessary to define risk assessment tools and explore the genetic background of arrhythmogenic mitral valve disease. Full article

(This article belongs to the Special Issue Traditional Surgery and Minimally Invasive Approaches to Valvular Heart Disease)

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33 pages, 7696 KB

Open AccessArticle

Proteome Differences in Smooth Muscle Cells from Diabetic and Non-Diabetic Abdominal Aortic Aneurysm Patients Reveal Metformin-Induced Mechanisms

by Tara A. R. van Merrienboer, Karlijn B. Rombouts, Albert C. W. A. van Wijk, Jaco C. Knol, Thang V. Pham, Sander R. Piersma, Connie R. Jimenez, Ron Balm, Kak K. Yeung and Vivian de Waard

Med. Sci. 2025, 13(3), 184; https://doi.org/10.3390/medsci13030184 - 10 Sep 2025

Abstract

Aims: Surgery remains the only definitive treatment option for abdominal aortic aneurysms (AAA), as no conclusive evidence supports drug effectiveness in preventing AAA growth. Although type 2 diabetes (T2D) is an important cardiovascular risk factor, patients with T2D show reduced AAA presence [...] Read more.

Aims: Surgery remains the only definitive treatment option for abdominal aortic aneurysms (AAA), as no conclusive evidence supports drug effectiveness in preventing AAA growth. Although type 2 diabetes (T2D) is an important cardiovascular risk factor, patients with T2D show reduced AAA presence and growth, associated with metformin use. We aimed to investigate the potential benefits of metformin on AAA using proteomics and in vitro experiments. Methods: Proteomics analysis using tandem mass spectrometry was performed on aortic smooth muscle cells (SMCs) from non-pathological controls (C-SMC, n = 8), non-diabetic (ND, n = 19) and diabetic (D, n = 5) AAA patients. Key findings were subsequently validated in aortic tissue using mass spectrometry-based proteomics. SMCs were cultured with/without metformin and analyzed. Results: Comparison of the proteome of SMCs from ND-AAA patients with controls revealed a reduction in proteins associated with metabolic processes and mitochondrial function. Cytoskeletal and extracellular matrix (ECM) proteins were elevated in ND-AAA-SMCs versus C-SMCs, with a similar cluster of mechanosensitive proteins being increased in ND-AAA-SMCs versus D-AAA-SMCs. D-AAA-SMCs showed an improved metabolic and antioxidant profile, enriched in pentose phosphate pathway proteins responsible for NAD(P)H generation (G6PD, PGD) and NAD(P)H-dependent antioxidants (NQO1, CBR1, AKR1C1, AKR1B1, GSTM1), all regulated by NRF2, an antioxidant transcription factor. Over half of the proteins identified in the protein–protein interaction network, constructed from proteins with higher expression in D-AAA SMCs versus ND-AAA SMCs, were verified in D-AAA aortic tissue. In vitro, metformin causes a shift from aerobic to anaerobic metabolism, increased AMPK activation and elevated mitochondrial biogenesis, indicated by increased PGC-1α expression. Metformin increased the gene expression of PGD, CBR1 and the protein expression of NQO1, with enhanced translocation of pNRF2 to the nucleus, due to reduced KEAP1 as negative regulator of NRF2. Consequently, metformin enhanced the gene expression of well-known antioxidant regulators SOD2 and CAT. Conclusions: This study identified significant differences in the proteome of SMCs derived from controls, ND-AAA and D-AAA patients. It highlights distinct pathways in relation to mechanosensing, metabolism and redox balance as therapeutic targets of metformin that may underlie its inhibition of AAA progression. Full article

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14 pages, 478 KB

Open AccessArticle

Renal Failure and Systolic Heart Failure Have Synergistic Effect on In-Hospital All-Cause Mortality in Patients with Normotensive Acute Pulmonary Embolism

by Mirjana Mijuskovic, Brankica Terzic, Sonja Salinger, Jovan Matijasevic, Sandra Pekovic, Tamara Preradovic-Kovacevic, Ljiljana Kos, Bjanka Bozovic, Irena Mitevska, Bojan Mitrovic, Aleksandar Neskovic, Ema Jevtic, Vladimir Miloradovic, Boris Dzudovic and Slobodan Obradovic

Med. Sci. 2025, 13(3), 183; https://doi.org/10.3390/medsci13030183 - 10 Sep 2025

Abstract

Background/Objectives: Renal failure (RF) and systolic heart failure (sHF) are very often associated with each other, and their synergistic influence can affect the prognosis of acute pulmonary embolism (aPE) patients. The aim of this study is to evaluate the associations between RF, [...] Read more.

Background/Objectives: Renal failure (RF) and systolic heart failure (sHF) are very often associated with each other, and their synergistic influence can affect the prognosis of acute pulmonary embolism (aPE) patients. The aim of this study is to evaluate the associations between RF, sHF, and in-hospital mortality in patients with normotensive aPE. Methods: We analyzed data from the Regional PE Registry (REPER), and 1968 patients with CT pulmonary angiography-confirmed aPE who had a systolic blood pressure of 100 mmHg and higher, and for whom creatinine blood levels and left ventricular ejection fraction (LVEF) were measured at admission to hospital were enrolled. The patients were divided into four groups: the first group comprised patients without renal and systolic heart failure, the second those with RF (creatinine clearance less than 60 mL/min), the third those with sHF (LVEF less than 50%), and the fourth those with both RF and sHF. The primary endpoint of this study was in-hospital all-cause mortality. Results: There are significant differences between in-hospital mortality among the groups: 38/1247 (3.0%) vs. 63/514 (12.9%) vs. 10/99 (10.1%) vs. 20/108 (18.5%) (p < 0.001). In the multivariable regression model adjusted for age, right ventricular dysfunction, and troponin levels, the presence of renal failure, sHF, and both were independently associated with in-hospital all-cause mortality with ORs of 3.59 (95%CI 2.04–6.30, p < 0.001) vs. 3.97 (1.71–9.25, p = 0.001) vs. 6.39 (3.15–12.99, p < 0.001), respectively. Conclusions: The association of renal failure and systolic heart failure has a deleterious prognosis in patients with normotensive aPE. Full article

(This article belongs to the Section Cardiovascular Disease)

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20 pages, 747 KB

Open AccessReview

Obesity and Pregnancy: Impact on Childbirth Timing, Delivery Mode, and Maternal Recovery: An Update

by Angeliki Gerede, Maria Danavasi, Sofoklis Stavros, Anastasios Potiris, Athanasios Zikopoulos, Efthalia Moustakli, Charikleia Skentou, Ekaterini Domali, Nikolaos Nikolettos and Makarios Eleftheriades

Med. Sci. 2025, 13(3), 182; https://doi.org/10.3390/medsci13030182 - 10 Sep 2025

Viewed by 359

Abstract

This review explores the impact of maternal obesity on pregnancy outcomes, emphasizing its significant global health challenge and profound implications for both mothers and infants. It influences the timing and mode of childbirth, elevating the risk of conditions like hypertensive disorders, cesarean delivery, [...] Read more.

This review explores the impact of maternal obesity on pregnancy outcomes, emphasizing its significant global health challenge and profound implications for both mothers and infants. It influences the timing and mode of childbirth, elevating the risk of conditions like hypertensive disorders, cesarean delivery, and gestational diabetes mellitus. The review focuses on analyzing how maternal obesity affects postpartum recovery, birth timing, and delivery methods. Relevant studies were identified using PubMed and Scopus. Findings indicate that obese pregnant women are at higher risk for medically indicated preterm birth, scheduled and emergency cesarean sections, and labor induction. Postpartum recovery is often prolonged due to breastfeeding challenges, infection risks, and delayed wound healing. Additionally, maternal obesity increases the likelihood of fetal complications such as macrosomia and long-term metabolic disorders. These results highlight the importance of personalized treatments and early weight control to improve the health of both mother and baby. A comprehensive approach integrating clinical care, public health initiatives, and policy measures is essential to reduce pregnancy complications associated with obesity. Full article

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23 pages, 2127 KB

Open AccessArticle

Decoding Fear: Analysis and Prognosis of Preoperatory Stress Level Through Advanced Statistical Modelling—A Prospective Study Across Multiple Surgical Specialties

by Cristina Gena Dascălu, Andrei Ionut Cucu, Andreea Vovciuc, Sorin Axinte, Serban Turliuc, Amelian Madalin Bobu, Camelia Tamas, Vlad Porumb, Emilia Patrascanu, Catalin Mihai Buzduga, Paula Alexandra Blanaru, Anca Petruta Morosan, Iulian Prutianu, Roxana Covali, Andreea Ioana Pruteanu, Claudia Florida Costea and Alexandru Carauleanu

Med. Sci. 2025, 13(3), 181; https://doi.org/10.3390/medsci13030181 - 5 Sep 2025

Viewed by 222

Abstract

Background: Preoperative stress is a multifactorial phenomenon shaped by physiological, psychological, and social influences, with a substantial impact on postoperative recovery. This study aimed to quantify preoperative stress levels, identify associated factors, and rank their predictive importance. Methods: A prospective study was conducted [...] Read more.

Background: Preoperative stress is a multifactorial phenomenon shaped by physiological, psychological, and social influences, with a substantial impact on postoperative recovery. This study aimed to quantify preoperative stress levels, identify associated factors, and rank their predictive importance. Methods: A prospective study was conducted on 197 patients scheduled for general surgery, orthopedics, neurosurgery, or otorhinolaryngology procedures between December 2024 and June 2025 at Suceava County Emergency Clinical Hospital. Stress levels were assessed using the Brief Measure of Emotional Preoperative Stress (B-MEPS), translated and culturally adapted into Romanian. Statistical analyses included nonparametric tests, generalized linear modeling, and Random Forest regression. Results: The mean B-MEPS score was 21.42 ± 6.04 (range: 11–34), indicating a moderate level of preoperative stress. Higher stress scores were significantly associated with female sex (p < 0.001), lower educational attainment (p = 0.003), divorced marital status (p = 0.007), a history of cancer (p = 0.002), and the type of surgical intervention (p = 0.003). Random Forest analysis identified the type of surgery, educational level, and sex as the strongest predictors. Conclusions: Preoperative stress is chiefly influenced by the type of surgical procedure, educational level, and sex, with potential synergistic effects among these factors. Early identification of high-risk patients enables targeted, personalized interventions to mitigate anxiety and improve perioperative outcomes. Further research should include formal validation of the Romanian version of B-MEPS and the integration of additional psychosocial variables. Full article

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25 pages, 3777 KB

Open AccessReview

Metabolic Reprogramming Through Polyphenol Networks: A Systems Approach to Metabolic Inflammation and Insulin Resistance

by Shakila Jahan Shimu, Jawad Ul Karim Mahir, Fardin Al Fahad Shakib, Arafath Amin Ridoy, Ratin Al Samir, Nadia Jahan, Md Fahim Hasan, Sadman Sazzad, Shamima Akter, Mohammad Sarif Mohiuddin, Md Jalal Ahmed Shawon, Mohammad Hossain Shariare, Mohammad Mohabbulla Mohib and Mohammad Borhan Uddin

Med. Sci. 2025, 13(3), 180; https://doi.org/10.3390/medsci13030180 - 5 Sep 2025

Viewed by 1044

Abstract

Obesity-induced insulin resistance and type 2 diabetes mellitus (T2DM) represent complex systemic disorders marked by chronic inflammation, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress. These pathophysiological processes disrupt insulin signaling and β-cell function, leading to impaired glucose homeostasis across multiple organs. [...] Read more.

Obesity-induced insulin resistance and type 2 diabetes mellitus (T2DM) represent complex systemic disorders marked by chronic inflammation, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress. These pathophysiological processes disrupt insulin signaling and β-cell function, leading to impaired glucose homeostasis across multiple organs. Conventional therapies often target isolated pathways, overlooking the intricate molecular crosstalk and organelle-level disturbances driving disease progression. Citrus-derived polyphenols—including hesperidin, naringenin, nobiletin, and tangeretin—have emerged as promising agents capable of orchestrating a multi-targeted “metabolic reprogramming.” These compounds modulate key signaling pathways, including AMPK, PI3K/Akt, NF-κB, and Nrf2, thereby enhancing insulin sensitivity, reducing pro-inflammatory cytokine expression, and restoring redox balance. Furthermore, they improve mitochondrial biogenesis, stabilize membrane potential, and alleviate ER stress by modulating the unfolded protein response (UPR), thus supporting cellular energy homeostasis and protein folding capacity. Evidence from preclinical studies and select clinical trials suggests that citrus polyphenols can significantly improve glycemic control, reduce oxidative and inflammatory markers, and preserve β-cell function. Their pleiotropic actions across molecular and organ-level targets position them as integrative metabolic modulators. This review presents a systems-level synthesis of how citrus polyphenols rewire metabolic signaling networks and organelle resilience, offering a holistic therapeutic strategy to mitigate the root causes of obesity-induced insulin resistance. Full article

(This article belongs to the Section Endocrinology and Metabolic Diseases)

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16 pages, 1151 KB

Open AccessArticle

Total-Arterial Revascularization Is Superior in Heart Failure Patients with Reduced Ejection Fraction—A Propensity Score Matched Retrospective Multicenter Analysis

by Christian Jörg Rustenbach, Julia Schano, Christoph Salewski, Helene Häberle, Kristian-Christos Ngamsri, Ilija Djordjevic, Stefanie Wendt, Tulio Caldonazo, Ibrahim Saqer, Shekhar Saha, Philipp Schnackenburg, Lina Maria Serna-Higuita, Torsten Doenst, Christian Hagl, Thorsten Wahlers, Christian Schlensak and Stefan Reichert

Med. Sci. 2025, 13(3), 179; https://doi.org/10.3390/medsci13030179 - 5 Sep 2025

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Abstract

Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017–2023). After 1:1 propensity [...] Read more.

Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017–2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. Results: MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (p = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, p < 0.001), shorter hospital stay (10 d vs. 12 d, p = 0.002), reduced ventilation time (8 h vs. 12 h, p < 0.001), lower delirium (5.0% vs. 14.2%, p = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, p = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, p < 0.001). Conclusions: In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits. Full article

(This article belongs to the Section Cardiovascular Disease)

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17 pages, 785 KB

Open AccessArticle

Integrated Genomic Analysis Reveals the Synergistic Role of PNPLA3 and ABCC8 Variants in Diabetic MASLD in Pakistan

by Asma Shabbir, Ambrina Khatoon, Zaigham Abbas, Sucheta Srivastava and Talat Mirza

Med. Sci. 2025, 13(3), 178; https://doi.org/10.3390/medsci13030178 - 5 Sep 2025

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Abstract

Introduction: Metabolic dysfunction associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD), is a growing global health concern, particularly in South Asia. While PNPLA3 is a well-recognized genetic contributor to MASLD, the role of other metabolic genes, such [...] Read more.

Introduction: Metabolic dysfunction associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD), is a growing global health concern, particularly in South Asia. While PNPLA3 is a well-recognized genetic contributor to MASLD, the role of other metabolic genes, such as ABCC8, remains unexplored in South Asian populations. In this study, we aim to investigate the genetic association and potential synergy between PNPLA3 (rs738409) and ABCC8 (rs146378237) variants in MASLD pathogenesis in a Pakistani cohort. Methods: A two-phased case–control study was conducted. Whole Exome Sequencing (WES) was performed on 6 MASLD cases and 6 healthy controls to identify relevant variants, followed by validation via Sanger sequencing in an extended MASLD cohort (n = 52). Variant frequencies were compared with 96 ethnically matched controls from the 1000 Genomes Project. Furthermore, the association of the variants with clinical, biochemical, and fibrotic parameters was assessed. Results: The PNPLA3 rs738409 G allele (MAF = 0.47) and ABCC8 rs146378237 T allele (MAF = 0.36) were significantly enriched in MASLD cases and strongly associated with cirrhosis. The TT genotype of ABCC8 was also linked to T2DM and low HDL levels. Importantly, eight MASLD patients harbored both GG (PNPLA3) and TT (ABCC8) genotype, and all were known cases of diabetes, suggesting a synergistic genetic interaction. Conclusions: This is the first report of ABCC8 rs146378237 in a South Asian MASLD cohort, revealing population-specific risk and a gene–gene interaction that may inform targeted screening and personalized management of MASLD in high-risk diabetic individuals. Full article

(This article belongs to the Section Hepatic and Gastroenterology Diseases)

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Graphical abstract

14 pages, 839 KB

Open AccessArticle

Pediatric Medication Prescribing Across Urgent Care Visits: An Epidemiologic View from a Primary Care Setting in the Kingdom of Saudi Arabia

by Reem S. AlOmar, Nouf A. AlShamlan, Ahmed A. Al Yateem, Abdulrahman A. Al-Abdulazeem, Ahmed M. Al-Turki, Reema J. Alghamdi, Najla A. Alhamed, Sameerah Motabgani, Adam F. Aldhawyan and Malak A. Al Shammari

Med. Sci. 2025, 13(3), 177; https://doi.org/10.3390/medsci13030177 - 5 Sep 2025

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Abstract

Background: Urgent care clinics (UCCs) embedded within primary healthcare settings play a vital role in managing acute, non-life-threatening conditions in children. However, limited data exist on medication prescribing patterns in such settings in the Kingdom of Saudi Arabia (KSA), particularly regarding antibiotic use. [...] Read more.

Background: Urgent care clinics (UCCs) embedded within primary healthcare settings play a vital role in managing acute, non-life-threatening conditions in children. However, limited data exist on medication prescribing patterns in such settings in the Kingdom of Saudi Arabia (KSA), particularly regarding antibiotic use. This study aimed to describe the epidemiology of pediatric urgent care visits and identify factors associated with prescribing within a model primary healthcare (PHC) center. Methods: A retrospective chart review was conducted for all urgent care visits made by pediatric patients (<14 years) at a model PHC center in the KSA for all visits in 2024. Sociodemographic variables, visit timing, diagnosis, and prescription data were extracted from electronic health records. Multivariable logistic regression was used to analyze predictors of medication prescribing. Results: Of the 1016 pediatric urgent care visits, 62.5% resulted in medication prescriptions, and 23.62% of those visits included at least one antibiotic, primarily penicillins (71.33%). Cephalosporins and tetracyclines were not prescribed. Prescriptions were 67% more likely among adolescents and 70% less likely among infants when compared to school-aged children (95% CI = 1.04–2.67 and 95% CI = 0.15–0.61, respectively). Respiratory and ENT-related diagnoses accounted for most prescriptions. No significant sex-based differences in prescribing were observed. Conclusions: The epidemiological patterns observed indicate that respiratory and ENT conditions, as well as seasonal peaks in autumn and winter, are the main drivers of prescribing in pediatric urgent care. These findings have implications for strengthening disease surveillance, anticipating service demand, guiding preventive interventions such as vaccination and health education, and supporting evidence-based planning of primary care resources. Full article

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14 pages, 1167 KB

Open AccessReview

Beyond Obesity

by George A. Bray and Donna H. Ryan

Med. Sci. 2025, 13(3), 176; https://doi.org/10.3390/medsci13030176 - 4 Sep 2025

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Abstract

Diagnosis of clinical obesity has been highlighted by the recent publication from a Commission Report in The Lancet, suggesting the addition of a new diagnostic category, “Preclinical Obesity,” to the already existing ones. Diagnostic criteria for obesity began in the first half [...] Read more.

Diagnosis of clinical obesity has been highlighted by the recent publication from a Commission Report in The Lancet, suggesting the addition of a new diagnostic category, “Preclinical Obesity,” to the already existing ones. Diagnostic criteria for obesity began in the first half of the 20th century, when life insurance companies provided information tables of ideal body weight levels and/or desirable body weight levels based on actuarial associations with mortality. This was replaced by the body mass index or BMI in the third quarter of the 20th century. This tool documented the epidemic of obesity in the US in the last three decades of the 20th century. The recognition of the importance of fat distribution, pioneered by the work of Jean Vague in France, provided a new understanding of obesity. The limitations of BMI and the availability of effective new treatments have heightened the need for new diagnostic guidelines. Obesity represents an increase in body fat and an alteration in its distribution and function. But at the same time, obesity is a stigmatized word and a pejorative term. This communication discusses ways to better diagnose the increase in body fat and its abnormal distribution. We ask whether there is an alternative word to replace obesity and suggest that adiposity or healthy weight could be options. Full article

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26 pages, 4263 KB

Open AccessSystematic Review

Diagnostic Accuracy of Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Effluent and Ascitic Fluid for Early Detection of Peritonitis: A Systematic Review and Meta-Analysis

by Manuel Luis Prieto-Magallanes, José David González-Barajas, Violeta Aidee Camarena-Arteaga, Bladimir Díaz-Villavicencio, Juan Alberto Gómez-Fregoso, Ana María López-Yáñez, Ruth Rodríguez-Montaño, Judith Carolina De Arcos-Jiménez and Jaime Briseno-Ramírez

Med. Sci. 2025, 13(3), 175; https://doi.org/10.3390/medsci13030175 - 4 Sep 2025

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Abstract

Background: Peritonitis in peritoneal dialysis and cirrhosis remains common and leads to morbidity. Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated as a rapid adjunctive biomarker. Methods: Following PRISMA-DTA and PROSPERO registration (CRD420251105563), we searched MEDLINE, Embase, Cochrane Library, LILACS, Scopus, and Web of [...] Read more.

Background: Peritonitis in peritoneal dialysis and cirrhosis remains common and leads to morbidity. Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated as a rapid adjunctive biomarker. Methods: Following PRISMA-DTA and PROSPERO registration (CRD420251105563), we searched MEDLINE, Embase, Cochrane Library, LILACS, Scopus, and Web of Science from inception to 31 December 2024, and ran an update on 30 June 2025 (no additional eligible studies). Diagnostic accuracy studies measuring NGAL in peritoneal/ascitic fluid against guideline reference standards were included. When 2 × 2 data were not reported, we reconstructed cell counts from published metrics using a prespecified, tolerance-bounded algorithm (two studies). Accuracy was synthesized with a bivariate random effects (Reitsma) model; 95% prediction intervals (PIs) were used to express heterogeneity; small-study effects were assessed by Deeks’ test. Results: Thirteen studies were included qualitatively and ten were entered into a meta-analysis (573 cases; 833 controls). The pooled sensitivity was 0.95 (95% CI, 0.90–0.97) and specificity was 0.86 (0.70–0.94); likelihood ratios were LR+ ≈7.0 and LR− 0.06. Between-study variability was concentrated on specificity: the PI for a new setting was 0.75–0.98 for sensitivity and 0.23–0.99 for specificity. Deeks’ test showed evidence of small-study effects in the primary analysis; assay/platform and thresholding contributed materially to heterogeneity. Conclusions: NGAL in peritoneal/ascitic fluid demonstrates high pooled sensitivity but variable specificity across settings. Given the wide prediction intervals and the signal for small-study effects, NGAL should be interpreted as an adjunct to guideline-based criteria—not as a stand-alone rule-out test. Standardization of pre-analytics and assay-specific, locally verified thresholds, together with prospective multicenter validations and impact/economic evaluations, are needed to define its clinical role. Full article

(This article belongs to the Section Hepatic and Gastroenterology Diseases)

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23 pages, 959 KB

Open AccessSystematic Review

Systemic Lupus Erythematosus in Pregnancy

by Angeliki Gerede, Efthymios Oikonomou, Sofoklis Stavros, Anastasios Potiris, Panagiota Papasozomenou, Menelaos Zafrakas, Ekaterini Domali, Nikolaos Nikolettos and Makarios Eleutheriades

Med. Sci. 2025, 13(3), 174; https://doi.org/10.3390/medsci13030174 - 4 Sep 2025

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Abstract

Background/Objectives: The reciprocal relationship between Systemic Lupus Erythematosus (SLE) and pregnancy continues to elude the scientific community’s approaches for a clear understanding. Multiple studies have reached dissimilar results regarding the impact that SLE exerts on pregnancy, whilst the potential risks of lupus pregnancies [...] Read more.

Background/Objectives: The reciprocal relationship between Systemic Lupus Erythematosus (SLE) and pregnancy continues to elude the scientific community’s approaches for a clear understanding. Multiple studies have reached dissimilar results regarding the impact that SLE exerts on pregnancy, whilst the potential risks of lupus pregnancies continue to encumber women of childbearing age. Whether SLE predisposes to a complicated pregnancy and conversely whether pregnancy impacts the progression of the disease is aimed to be assessed by this systematic review. Methods: A thorough search of original research articles was conducted using online databases (PubMed, Google Scholar), initially identifying 877 potential studies. Results: Upon further assessment for relevance and eligibility, 65 articles were selected for detailed analysis. Conclusions: We concluded that, even though advanced approaches have optimized SLE prognosis and treatment, the complexity of the disease requires further extensive study in order to grasp the mechanism behind the susceptibility to adverse complications. SLE pregnancy cannot be considered without risk. Comprehensive, multidisciplinary, and continuous monitoring of the disease course prior to, during, and after pregnancy is necessary to ensure optimal recovery and minimal maternal and fetal complications. Tailored treatments and novel biomarkers would move us towards precise patient-centered care that addresses each patient’s unique disease profile and pregnancy needs, ultimately improving both maternal and fetal outcomes in women with systemic lupus erythematosus. Full article

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17 pages, 634 KB

Open AccessSystematic Review

Minimally Invasive Left Ventricular Assist Device Implantation: A Systematic Review of Current Evidence on Clinical Outcomes and Surgical Approaches

by Baglan Turtabayev, Seitkhan Joshibayev, Umit Kervan, Samat Zharmenov, Yerbol Ustemirov, Almas Begdildayev and Gali Iskakbayev

Med. Sci. 2025, 13(3), 173; https://doi.org/10.3390/medsci13030173 - 4 Sep 2025

Viewed by 298

Abstract

Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, [...] Read more.

Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies. Results: A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis. Conclusions: Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery. Full article

(This article belongs to the Section Cardiovascular Disease)

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22 pages, 984 KB

Open AccessReview

The Association of MicroRNA-21 with Carotid Artery Disease and Ischemic Stroke: From Pathophysiology to Clinical Implications and Potential Therapy

by Aleksandar Sič, Marko Atanasković, Alyan Ahmed, Ivan Petrović, Filip Simović, Boris Burnjaković, Una Tonković, Aarish Manzar, Simra Shadab, Selena Gajić, Danka Bjelić, Vidna Karadžić Ristanović and Marko Baralić

Med. Sci. 2025, 13(3), 172; https://doi.org/10.3390/medsci13030172 - 3 Sep 2025

Viewed by 447

Abstract

Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, with carotid atherosclerosis being its key etiological factor. MicroRNA-21 (miR-21) regulates intracellular signal pathways responsible for vascular changes and ischemic brain injury, and is recognized as a potential diagnostic and [...] Read more.

Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, with carotid atherosclerosis being its key etiological factor. MicroRNA-21 (miR-21) regulates intracellular signal pathways responsible for vascular changes and ischemic brain injury, and is recognized as a potential diagnostic and prognostic biomarker. It modifies the activity of macrophages (MΦ) and vascular smooth muscle cells, causing inflammation and affecting the stability of atherosclerotic plaques. A deficiency of miR-21 in macrophages stimulates the inflammatory response and plaque growth. It promotes both the synthesis of extracellular matrix, stabilizing the plaque, and the degradation of the fibrin cap, which leads to plaque instability. The effect of miR-21 on endothelial cells differs: it stimulates both NO· synthesis and inflammation. During ischemic stroke, miR-21 demonstrates neuroprotective effects by modulating post-ischemic inflammation and protecting the integrity of the blood–brain barrier. Therapy targeting miR-21 shows potential in experimental models, but it requires cell-specific delivery and precise timing. Further research efforts should focus on the effects of miR-21 on different cell types, as well as the development of new technologies for diagnostic and therapeutic applications. Full article

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17 pages, 1015 KB

Open AccessArticle

Sociodemographic, Lifestyle, and Social Isolation Correlates of TyG, METS-IR, and SPISE-IR Scores in a Large Spanish Working Population

by Pere Riutord-Sbert, Pedro Juan Tárraga López, Ángel Arturo López-González, Irene Coll Campayo, Carla Busquets-Cortés and José Ignacio Ramírez Manent

Med. Sci. 2025, 13(3), 171; https://doi.org/10.3390/medsci13030171 - 3 Sep 2025

Viewed by 272

Abstract

Background: Insulin resistance (IR) is a central feature in the pathophysiology of type 2 diabetes and a major determinant of cardiovascular morbidity. While sociodemographic and lifestyle factors are established contributors, the role of social isolation as a potential determinant of IR remains underexplored [...] Read more.

Background: Insulin resistance (IR) is a central feature in the pathophysiology of type 2 diabetes and a major determinant of cardiovascular morbidity. While sociodemographic and lifestyle factors are established contributors, the role of social isolation as a potential determinant of IR remains underexplored in working populations. Objectives: To assess the association between sociodemographic variables, lifestyle habits, and social isolation with three validated insulin resistance indexes—Triglyceride–Glucose (TyG), Metabolic Score for Insulin Resistance (METS-IR), and Single Point Insulin Sensitivity Estimator (SPISE-IR)—in a large cohort of Spanish workers. Methods: A cross-sectional study was conducted involving 117,298 workers from occupational health centers across Spain. Sociodemographic data, lifestyle factors (Mediterranean diet adherence, physical activity, and smoking), and social support levels (ENRICHD Social Support Instrument) were recorded. Biochemical and anthropometric parameters were obtained through standardized protocols. Logistic regression models estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for high IR risk across the three indexes, adjusting for potential confounders. Results: Male sex, older age, lower social class, smoking, low Mediterranean diet adherence, physical inactivity, and low social support were independently associated with higher odds of IR in all three indexes. The strongest associations were observed for physical inactivity (OR range 6.21–9.95) and low social support (OR range 1.98–3.76). Although effect sizes varied by index, patterns of association were consistent. Conclusions: Sociodemographic, lifestyle, and psychosocial factors, including social isolation, are strongly associated with insulin resistance in working populations. Integrating social support assessment into occupational health strategies may enhance early detection and prevention of IR and related cardiometabolic diseases. Full article

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24 pages, 2090 KB

Open AccessArticle

Clinical and Paraclinical Predictors of Survival in Amyotrophic Lateral Sclerosis: Results from a Three-Year Longitudinal Cohort Study

by Anca Motataianu, Laura Barcutean, Ioana Ormenisan, Medeea Roman, Rodica Balasa, Zoltan Bajko and Mihai Dumitreasa

Med. Sci. 2025, 13(3), 170; https://doi.org/10.3390/medsci13030170 - 3 Sep 2025

Viewed by 403

Abstract

Background: Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disorder with highly variable progression and survival. Identifying early prognostic indicators is essential for patient stratification and management. Objectives: To evaluate clinical, respiratory, and functional predictors of survival in a prospective cohort of ALS [...] Read more.

Background: Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disorder with highly variable progression and survival. Identifying early prognostic indicators is essential for patient stratification and management. Objectives: To evaluate clinical, respiratory, and functional predictors of survival in a prospective cohort of ALS patients over a three-year period. Methods: A cohort of 44 ALS patients was followed from 2022 to 2025. Demographic and anthropometric characteristics, clinical data including ALS subtypes and phenotypes, site of onset, revised ALS functional rating scale (ALSFRS-R) and subscores, ALSFRS-R progression rate, time to diffusion and generalization, spirometric parameters, and progression patterns were assessed. Survival analysis was performed using Kaplan–Meier estimates and univariate and multivariate Cox proportional hazard regression analysis. Results: The overall median survival time was 53 months. Univariate Cox regression revealed that older age at onset, shorter diagnostic delay, lower respiratory function, lower vitamin D levels, and rapid vertical progression were associated with reduced survival. Bulbar-onset phenotype and rapid disease progression rate (ΔPR) were significant predictors of mortality. Specific ALSFRS-R subscores also showed prognostic relevance. A longer time to diffusion as well as a longer time to generalization were significantly associated with prolonged survival. Multivariate analysis confirmed the independent prognostic value of ΔPR, time to diagnosis, and ALSFRS-R swallowing and handwriting subscores. Conclusions: This study supports the prognostic value of previously studied clinical and paraclinical markers in ALS and proposes novel predictors, ALSFRS-R handwriting, and time to diffusion, which require further validation in larger prospective cohorts. Full article

(This article belongs to the Section Neurosciences)

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19 pages, 1631 KB

Open AccessArticle

Evaluation of the Clinical Efficacy of a Novel Palmitoylethanolamide–Equisetum arvense Supplement for the Management of Chronic Pain: Findings from a Prospective Clinical Trial

by Marco Invernizzi, Simone Mulè, Lorenzo Lippi, Rebecca Galla, Arianna Folli, Sara Ferrari, Domenico Tiso and Francesca Uberti

Med. Sci. 2025, 13(3), 169; https://doi.org/10.3390/medsci13030169 - 3 Sep 2025

Viewed by 485

Abstract

Background: Chronic pain represents a major therapeutic challenge due to the limited efficacy and tolerability of conventional pharmacological treatments. Equisetum arvense L., a medicinal plant with potent antioxidant properties, and palmitoylethanolamide (PEA), an endogenous fatty acid amide with well-established anti-inflammatory and analgesic [...] Read more.

Background: Chronic pain represents a major therapeutic challenge due to the limited efficacy and tolerability of conventional pharmacological treatments. Equisetum arvense L., a medicinal plant with potent antioxidant properties, and palmitoylethanolamide (PEA), an endogenous fatty acid amide with well-established anti-inflammatory and analgesic effects, are increasingly recognised as promising nutraceutical agents. Methods: This prospective, single-centre clinical trial aimed to evaluate the efficacy and safety of a novel oral supplement (Assonal^®PEA) combining 600 mg of PEA and 300 mg of Equisetum arvense L. in improving the reduction of pain and quality of life in patients with chronic pain, also obtaining information on the patient’s state of satisfaction after the treatment. Fifty patients suffering from chronic pain (low back pain and radiculopathy) for two months were enrolled and received the supplement over eight weeks in a tapered regimen (two tablets daily for two weeks, followed by one tablet daily). Results: Clinical outcomes were evaluated using validated instruments, including the Numeric Pain Rating Scale (NPRS), Verbal Rating Scale (VRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Global Perceived Effect (GPE), and EuroQol-5D-5L. Results showed a significant decrease in pain intensity (NPRS: −3.8 points; VRS: −2.1 points; p < 0.0001), along with meaningful improvements in patient-perceived benefit, pain descriptors, and quality of life (EQ-5D-5L: +35%; p < 0.0001). Conclusions: These findings endorse the use of this novel PEA–Equisetum arvense formulation as a safe, well-tolerated, and potentially effective supplementary intervention for managing chronic pain. No adverse events were reported, and the overall response rate reached 94%. Full article

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16 pages, 2220 KB

Open AccessSystematic Review

Comparison of HyFoSy, HyCoSy and X-Ray Hysterosalpingography in the Assessment of Tubal Patency in Women with Infertility: A Systematic Review and Meta-Analysis

by Emmanouil M. Xydias, Vasileios Emmanouil, Maria Koutini, Anna Ntanika, Elias Tsakos, Matthew Prior, Ippokratis Sarris, Ioannis Thanasas, Alexandros Daponte and Apostolos C. Ziogas

Med. Sci. 2025, 13(3), 168; https://doi.org/10.3390/medsci13030168 - 2 Sep 2025

Viewed by 315

Abstract

Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared [...] Read more.

Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared it to hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy). Methods: Online databases were systematically searched and evaluated according to the PRISMA 2020 guidelines. Statistical heterogeneity was assessed. Diagnostic sensitivity, specificity and inter-method agreement were evaluated, along with mean pain scores. Results: This analysis included data from 9 studies and 1354 patients with conclusive diagnostic data from 2422 tubes and 1294 patients with data on intra-procedural pain. With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69%, respectively (p = 0.074), while pooled specificity was 95% and 85%, respectively, favoring HyFoSy (p < 0.001). HyFoSy was more tolerable with regard to pain, but this was not statistically significant. Regarding the HyFoSy and HSG comparison, pooled Cohen’s k was 0.38, indicating fair-moderate agreement. In subsequent analysis, with HSG as a reference standard, HyFoSy demonstrated low sensitivity (61%) but high specificity (87%). With regard to experienced pain, HyFoSy and HSG had a difference of 2.4 units on a 10-point scale, favoring HyFoSy (p < 0.001). Conclusions: HyFoSy was superior to HyCoSy and may be used as a first-line tubal assessment method, with HSG being utilized in inconclusive cases. However, further research is still required due to the small number of available studies. Full article

(This article belongs to the Section Gynecology)

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13 pages, 260 KB

Open AccessArticle

Is Basic Training in Palliative Care Sufficient to Guarantee the Improvement of Knowledge and Skills in This Area?—A Medical Knowledge Assessment Study

by Rita Monteiro, Hugo Ribeiro, César Vinicius José, Joana Brandão Silva, Ricardo Marinho, João Rocha Neves and Marília Dourado

Med. Sci. 2025, 13(3), 167; https://doi.org/10.3390/medsci13030167 - 2 Sep 2025

Viewed by 422

Abstract

Background: With the growing population requiring palliative care (PC), it is essential to enhance and expand the availability of this care in Portugal. Throughout both pre-graduate and post-graduate training for doctors, there are limited learning opportunities in this area, necessitating further training [...] Read more.

Background: With the growing population requiring palliative care (PC), it is essential to enhance and expand the availability of this care in Portugal. Throughout both pre-graduate and post-graduate training for doctors, there are limited learning opportunities in this area, necessitating further training to improve the knowledge and skills needed to support patients at the end of their lives. Studies conducted on doctors and medical students have demonstrated a clear need for improved training. Additionally, others have noted significant benefits for residents who underwent post-graduate training in this field while caring for patients nearing the end of life. This study aims to evaluate the impact of a basic training program on improving palliative care knowledge among medical doctors. Methods: This was a cross-sectional study, carried out by sharing a questionnaire with the participants enrolled in the “Intensive Palliative Medicine Course” organized by a group of doctors in November 2021. The questionnaire was completed by participants at three moments of training (before, immediately after the course, and 6 months after the course), and it contained questions to assess the theoretical knowledge, skills, and abilities obtained. Results: In total, 93 out of 204 (45.58%) doctors responded before training, 80 (39.21%) immediately after training, and 36 (17.64%) six months after training. After training, an improvement in knowledge was observed (p = 0.014), which did not appear to persist six months after the course (p = 0.574). However, six months after training, an increase in doctors’ confidence in referring patients to Palliative Care Teams or Units (p = 0.009) and medicating patients who may be in the last months of their lives (p = 0.005) was observed. Conclusions: The results regarding theoretical medical knowledge did not seem to stabilize over time, so it may be necessary to create more specific training opportunities for the medical profession. An increase in doctors’ self-confidence in referring and medicating patients with palliative care needs was observed, which may be associated with better medical care provided. It is necessary to carry out more studies to evaluate the impact of combined theoretical and practical training on the knowledge and confidence of doctors in PC. Full article

14 pages, 1865 KB

Open AccessArticle

Lavender–Neroli Aromatherapy for Reducing Dental Anxiety and Pain in Children During Anesthesia: A Two-Arm Randomized Controlled Trial

by Rama Abdalhai, Yasser Alsayed Tolibah, Racha Alkhatib, Chaza Kouchaji and Ziad D. Baghdadi

Med. Sci. 2025, 13(3), 166; https://doi.org/10.3390/medsci13030166 - 1 Sep 2025

Viewed by 721

Abstract

Objective. This randomized controlled trial evaluated the efficacy of lavender–neroli oil aromatherapy in managing dental anxiety and pain in children undergoing inferior alveolar nerve block (IANB) anesthesia. Methods. Fifty-four children aged 6–11 years were randomly assigned to either a control group or an [...] Read more.

Objective. This randomized controlled trial evaluated the efficacy of lavender–neroli oil aromatherapy in managing dental anxiety and pain in children undergoing inferior alveolar nerve block (IANB) anesthesia. Methods. Fifty-four children aged 6–11 years were randomly assigned to either a control group or an aromatherapy group. Children in the control group were asked to wear a regular scented-free nitrous oxide mask. Children in the control group were asked to wear a regular scented-free nitrous oxide mask. Children in the intervention group inhaled lavender–neroli oil via a nitrous oxide nasal mask for 5 min before and during IANB administration. Anxiety and pain levels were assessed pre-and post-treatment using the Facial Image Scale (FIS), Face–Legs–Activity–Cry–Consolability (FLACC) scale, and vital signs (heart rate, blood pressure, oxygen saturation). The collected data were statistically analyzed using SPSS software 20. The Mann–Whitney U test was used for analyzing FIS results, and the independent T test and T Paired test were used for analyzing heart rate, blood pressure, and oxygen saturation results. Results. Results demonstrated significantly lower anxiety, heart rate, blood pressure, and pain scores in the aromatherapy group compared to the control group (p < 0.05), with no significant change in oxygen saturation. Conclusions. Lavender–neroli aromatherapy is a safe, low-cost, and effective adjunct to reduce anxiety and discomfort during pediatric dental anesthesia. Full article

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11 pages, 242 KB

Open AccessArticle

Impact of Nutritional Status on Pulmonary Function in Pediatric Cystic Fibrosis: A Retrospective Multicenter Study from Upper Egypt

by Khaled Saad, Eman F. Gad, Samaher F. Taha, Sherin A. Taha, Hamada K. Fayed, Mahmoud Elsaeed, Thamer A. M. Alruwaili, Mohamed Fahmy M. Ibrahim, Amira Elhoufey, Ahmed M. Esmat Mansour and Amir M. Aboelgheet

Med. Sci. 2025, 13(3), 165; https://doi.org/10.3390/medsci13030165 - 1 Sep 2025

Viewed by 442

Abstract

Aim: This study aimed to evaluate the nutritional status of children with cystic fibrosis (CF) and investigate the correlation between malnutrition and the decline of pulmonary function in this population. Methods: We retrospectively analyzed the clinical data of children with CF admitted to [...] Read more.

Aim: This study aimed to evaluate the nutritional status of children with cystic fibrosis (CF) and investigate the correlation between malnutrition and the decline of pulmonary function in this population. Methods: We retrospectively analyzed the clinical data of children with CF admitted to four large tertiary centers in Upper Egypt. We compared clinical characteristics among children with different nutritional statuses and evaluated the correlation between malnutrition and pulmonary functions. Results: A total of 104 children with CF, including 54 males (52%), aged 3 to 18 years, were analyzed. Respiratory symptoms were present in all cases (100%). Malnutrition was observed in 72% (75/104) of the participants, with affected children exhibiting significantly lower body weight and serum albumin levels. Pulmonary function tests showed that vital capacity (VC) and the predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/FVC, and expiratory flow at 25%, 50%, and 75% of FVC were all lower in the malnourished group compared to children with normal nutrition. Correlation analysis demonstrated that the body mass index (BMI) Z-score was positively correlated with these pulmonary function indicators. Conclusions: Malnutrition is highly prevalent among Egyptian children with CF and is associated with decreased pulmonary function. Improving nutritional status may enhance lung function in this population. Full article

(This article belongs to the Section Pneumology and Respiratory Diseases)

12 pages, 868 KB

Open AccessArticle

Use of Benzodiazepines in Medical Students: A Comparative Analysis Between Medical and Other University Degrees

by Paula Fernández de Frutos, Francisco Javier García-Sánchez, Natalia Mudarra-García, Fernando Roque-Rojas, Syed Ihtisham-Kakakhel and Davide Luordo-Tedesco

Med. Sci. 2025, 13(3), 164; https://doi.org/10.3390/medsci13030164 - 1 Sep 2025

Viewed by 429

Abstract

Background: The use of benzodiazepines among university students has been scarcely investigated. This situation raises particular concerns in medical students, due to their exposure to stressful situations and, especially, their familiarity with psychotropic drugs. Material and methods: A descriptive cross-sectional observational study was [...] Read more.

Background: The use of benzodiazepines among university students has been scarcely investigated. This situation raises particular concerns in medical students, due to their exposure to stressful situations and, especially, their familiarity with psychotropic drugs. Material and methods: A descriptive cross-sectional observational study was conducted using an anonymous online survey disseminated among universities in the Community of Madrid during April 2024. Results: 25.07% of students stated they had used benzodiazepines at least once, especially from the third academic year onwards. The prevalence was higher among medical students (32.34%). Use was mainly occasional, although 20.21% reported daily use. Among the reasons for use, managing academic stress reached 45.74%. Up to 15.96% of respondents reported a feeling of dependence, and 32.26% noticed concentration difficulties as a side effect of benzodiazepine use. Conclusions: Benzodiazepine use is a relevant phenomenon among university students, with particular incidence in medical degrees. Its onset usually coincides with advanced stages of the degree, which underscores the need for preventive interventions tailored to the academic environment and for the rational use of psychotropic drugs in young populations. Full article

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12 pages, 523 KB

Open AccessArticle

Vitamin D Deficiency and Risk of Surgical Site Infections: A Retrospective Chart Review from a Tertiary Care Center in Qatar

by Rana Farsakoury, Ahmad Hamdan, Muhammad Naseem Khan, Habib H. Farooqui, Sara Al Harami and Susu M. Zughaier

Med. Sci. 2025, 13(3), 163; https://doi.org/10.3390/medsci13030163 - 1 Sep 2025

Viewed by 401

Abstract

Background/Objectives: Vitamin D deficiency is common in the Middle East, where it affects about 90% of the population. 25-hydroxyvitamin D [25(OH)D]. plays a key role in immune function and antimicrobial defense. Its deficiency has been implicated in surgical site infections (SSIs) also, [...] Read more.

Background/Objectives: Vitamin D deficiency is common in the Middle East, where it affects about 90% of the population. 25-hydroxyvitamin D [25(OH)D]. plays a key role in immune function and antimicrobial defense. Its deficiency has been implicated in surgical site infections (SSIs) also, which lead to increased healthcare costs and morbidity. Around 60% SSIs are preventable by addressing factors like 25(OH)D levels among others. In Qatar, 55.8% of the population is 25(OH)D deficient, but no direct link has been established between 25(OH)D deficiency and SSI risk. This study aims to investigate the relationship between deficient 25(OH)D levels and SSI development in surgical patients at Hamad Medical Corporation (HMC), Qatar. Methods: A retrospective chart review was conducted on adult patients who underwent surgery at HMC, Qatar, between January 2021 and December 2023, with known 25(OH)D levels measured within three months before surgery. A multivariate logistic regression analysis was conducted to evaluate the relationship between 25(OH)D levels and SSIs. Results: This retrospective chart review included 24,097 patients, with 3818 (15.8%) being 25(OH)D deficient. The mean age of the patients was 45 years, and 55% of them were female. The proportion of SSIs was highest in the 25(OH)D deficient group (2.7%) compared to the insufficient (1.8%) and sufficient (1.9%) groups, with a p-value of <0.01. The mean 25(OH)D level was 23 ng/mL in the SSI group, compared to 25 ng/mL in the no SSI group, with a p-value of <0.01. Multivariate logistic regression analysis identified several independent risk factors for SSIs, including 25(OH)D deficiency, male gender, intermediate and major case levels, longer operative times, lower preoperative serum albumin, and contaminated and dirty wounds, all with p-values of <0.05. Conclusions: Preoperative lower 25(OH)D levels increase the risk of SSIs. This study emphasizes the importance of optimizing 25(OH)D levels before surgery to reduce the occurrence of SSIs. Full article

(This article belongs to the Section Immunology and Infectious Diseases)

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11 pages, 844 KB

Open AccessArticle

Looking for Fabry, Finding More: LVH Screening Yields Unexpected Gaucher Diagnosis

by Sylwia Szczepara, Klaudia Pacia, Katarzyna Trojanowicz, Klaudia Bielecka, Michał Tworek, Zuzanna Sachajko, Katarzyna Holcman, Piotr Podolec and Monika Komar

Med. Sci. 2025, 13(3), 162; https://doi.org/10.3390/medsci13030162 - 1 Sep 2025

Viewed by 376

Abstract

Objective: Fabry disease (FD) is a rare, X-linked lysosomal storage disorder resulting from deficient α-galactosidase A activity, which can manifest as left ventricular hypertrophy (LVH). We aimed to assess the prevalence of FD in an unselected cohort of patients with unexplained LVH. Methods [...] Read more.

Objective: Fabry disease (FD) is a rare, X-linked lysosomal storage disorder resulting from deficient α-galactosidase A activity, which can manifest as left ventricular hypertrophy (LVH). We aimed to assess the prevalence of FD in an unselected cohort of patients with unexplained LVH. Methods and results: We screened 202 unrelated adults with LVH using enzymatic assays for α-galactosidase A in dried blood spots. Patients with low activity underwent GLA gene sequencing. Echocardiographic parameters were evaluated according to ESC guidelines. FD was diagnosed in 4 women (2%), each carrying distinct pathogenic GLA mutations. All affected individuals showed normal or borderline enzyme activity. Cardiac, renal, or neurological symptoms were observed variably among patients. Echocardiographic findings revealed slightly lower wall thickness and preserved systolic function in FD patients compared to those without FD. Cascade genetic screening identified 16 additional family members with the same mutations. One patient (0.5%) was incidentally diagnosed with Gaucher disease based on syndromic features and enzymatic testing. Conclusions: FD was identified in 2% of patients with unexplained LVH, who were females. Enzyme-based screening followed by targeted genetic testing is a cost-effective strategy for FD detection. Early diagnosis is essential for prompt treatment and family counselling, underscoring the importance of routine FD screening in patients with LVH of unclear aetiology. Our findings support the use of targeted screening for Fabry disease in patients with LVH and systemic features, and highlight the potential to identify other lysosomal disorders in selected cases. Full article

(This article belongs to the Section Cardiovascular Disease)

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10 pages, 758 KB

Open AccessSystematic Review

A Systematic Review Exploring the Phytochemical Composition and Anticancer Activities of Acacia catechu

by Navya Rana, Madhu Bala, Vinod Kumar, Rohitash Yadav, Neeraj Jain, Don Mathew, Khushboo Bisht, Rakesh Kumar and Sunil Kumar

Med. Sci. 2025, 13(3), 161; https://doi.org/10.3390/medsci13030161 - 1 Sep 2025

Viewed by 400

Abstract

Background: Acacia catechu is an important traditional medicinal plant that has been used to manage several ailments. Many in vitro and in vivo studies have demonstrated that it exhibits chemopreventive and antineoplastic effects by modulating diverse signaling pathways and molecular targets involved in [...] Read more.

Background: Acacia catechu is an important traditional medicinal plant that has been used to manage several ailments. Many in vitro and in vivo studies have demonstrated that it exhibits chemopreventive and antineoplastic effects by modulating diverse signaling pathways and molecular targets involved in cancer progression. This review attempts to systematically investigate the anticancer mechanisms of A. catechu, encompassing antiapoptotic, antioxidant, and antiproliferative activities. Material and Methods: This review was conducted using scientific databases such as Scopus, Web of Science, and Google Scholar, covering the studies from 2000 to 2024. The PRISMA methodology was applied, using the keywords A. catechu, phytoconstituents, and cancer. Results: A total of 39 studies were compiled from various databases that cited the biological use of A. catechu. The plant has an abundance of phenolic compounds, including catechin, epicatechin, epigallocatechin-3-O-gallate, and epicatechin-3-O-gallate, which show strong anticancer activities. The anticancer potential of A. catechu is explained as it regulates several modulators like reactive oxygen species and cytokines, and downregulates oncogenic molecules like c-myc and various signaling pathways, such as c-Jun and NF-κB. Conclusions: Our findings suggest that A. catechu and its bioactive constituents have the potential for cancer prevention and therapy. However, further mechanistic investigations using pure compounds, along with preclinical and clinical trials, are essential to translate this potential into clinical applications. Full article

(This article belongs to the Special Issue Feature Papers in Section Cancer and Cancer-Related Diseases)

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14 pages, 770 KB

Open AccessArticle

Diagnostic Accuracy of Anthropometric and Metabolic Indicators for Predicting MASLD: Evidence from a Large Cohort of Spanish Workers Using FLI and LAP

by Juan José Guarro Miguel, Pedro Juan Tárraga López, María Dolores Marzoa Jansana, Ángel Arturo López-González, Pere Riutord Sbert, Carla Busquets-Cortés and José Ignacio Ramirez-Manent

Med. Sci. 2025, 13(3), 160; https://doi.org/10.3390/medsci13030160 - 1 Sep 2025

Viewed by 387

Abstract

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a major global health concern associated with insulin resistance, metabolic syndrome, and cardiovascular morbidity. Early identification of at-risk individuals through simple, non-invasive methods is essential, particularly in working populations. Objectives: This study aimed to assess and [...] Read more.

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a major global health concern associated with insulin resistance, metabolic syndrome, and cardiovascular morbidity. Early identification of at-risk individuals through simple, non-invasive methods is essential, particularly in working populations. Objectives: This study aimed to assess and compare the diagnostic accuracy of four widely used anthropometric and metabolic indicators—body mass index (BMI), waist-to-height ratio (WtHR), triglyceride–glucose index (TyG), and waist–triglyceride index (WTI)—in identifying individuals at risk of metabolic-dysfunction-associated steatotic liver disease (MASLD), as determined by the Fatty Liver Index (FLI) and the Lipid Accumulation Product (LAP), within a large sample of Spanish workers. Methods: A cross-sectional analysis was performed on data from 386,924 Spanish employees aged between 18 and 69 years. Standardized anthropometric and laboratory measurements were obtained as part of routine occupational medical examinations conducted from 2021 to 2023. The presence of NAFLD was inferred using two validated surrogate markers: FLI and LAP. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were used to assess the discriminatory ability of each index, stratified by sex. Results: WTI and TyG demonstrated the highest diagnostic accuracy for both FLI- and LAP-defined NAFLD, with AUC values >0.95 in both sexes. WTI showed the best overall performance, followed closely by TyG. WtHR outperformed BMI but was less accurate than the metabolic indices. Sex-stratified analyses confirmed consistent patterns, with slightly higher AUCs for TyG and WTI in women. BMI consistently yielded the lowest discriminatory performance. Conclusions: WTI and TyG are superior to BMI and WtHR for non-invasive screening of MASLD in occupational settings. Their simplicity, low cost, and strong predictive value support their integration into routine workplace health surveillance. Sex-specific thresholds and prospective validation are warranted to enhance clinical application. Full article

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16 pages, 2020 KB

Open AccessSystematic Review

Artificial Intelligence Models for Diagnosis of Periodontitis Using Non-Invasive Biological Markers: A Systematic Review and Meta-Analysis of Patient-Based Studies

by Carlos M. Ardila, Anny M. Vivares-Builes and Pradeep Kumar Yadalam

Med. Sci. 2025, 13(3), 159; https://doi.org/10.3390/medsci13030159 - 1 Sep 2025

Viewed by 468

Abstract

Background/Objectives: Early diagnosis of periodontitis remains challenging using traditional clinical methods. This systematic review and meta-analysis evaluated the diagnostic accuracy of artificial intelligence (AI) models trained on non-invasive or minimally invasive biomarkers—including saliva, gingival crevicular fluid (GCF), and immunologic profiles—for diagnosing and [...] Read more.

Background/Objectives: Early diagnosis of periodontitis remains challenging using traditional clinical methods. This systematic review and meta-analysis evaluated the diagnostic accuracy of artificial intelligence (AI) models trained on non-invasive or minimally invasive biomarkers—including saliva, gingival crevicular fluid (GCF), and immunologic profiles—for diagnosing and classifying periodontitis in human subjects. Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane CENTRAL was conducted from database inception to June 2025. Eligible studies used AI or machine learning models with patient-derived biomarker data and reported diagnostic performance metrics. Results: Seven studies were included, employing various AI models such as random forest, artificial neural networks, and gradient boosting. Biomarkers were derived from saliva (n = 4), saliva-derived biomarkers from oral rinse (n = 1), immunologic profiles (n = 1), and tissue-based gene expression (n = 1). Reported area under the receiver operating characteristic (ROC) curve (AUC) ranged from 0.83 to 0.96. Meta-analysis of studies with comparable outcomes showed a pooled sensitivity of 0.89 (95% CI: 0.84–0.93), a specificity of 0.87 (95% CI: 0.80–0.92), and a summary AUC of 0.92. Subgroup analysis revealed that models using salivary biomarkers achieved a higher pooled AUC (0.94) than those using GCF or immunologic markers (AUC: 0.89). Sensitivity analyses excluding studies with unclear bias did not significantly alter pooled estimates, affirming robustness. The overall certainty of evidence was rated as moderate to high. Conclusions: AI-based diagnostic models utilizing salivary, microbiome, or immunologic biomarkers demonstrated quantitatively high accuracy; however, the overall certainty of evidence was rated as moderate to high due to limitations in study design and validation. Full article

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7 pages, 294 KB

Open AccessBrief Report

Rural–Urban Disparities in Treatment and Disease-Specific Survival for Patients with Intrahepatic Cholangiocarcinoma: A Retrospective Cohort Analysis of the 2000 to 2021 SEER Database

by Odelia H. Moon, Mitchell A. Taylor, Omar Hamadi, Aditya Sharma and Peter Silberstein

Med. Sci. 2025, 13(3), 158; https://doi.org/10.3390/medsci13030158 - 1 Sep 2025

Viewed by 320

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural–urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER [...] Read more.

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural–urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER database. Methods: The SEER database was queried to identify biopsy-confirmed cases of ICC from 2000 to 2021. Differences in clinicopathologic features and treatment between rural and urban patients were assessed using Chi-square and Fischer’s exact tests. Disease-specific survival was compared using Kaplan–Meier and log-rank tests as well as multivariable Cox regressions. Results: A total of 14,940 ICC patients were identified. Rural patients were less likely than urban patients to receive chemotherapy (789 of 1588 [49.7%] vs. 7112 of 13,352 [53.3%], p = 0.006) and surgical treatment (305 of 1588 [19.2%] vs. 2922 of 13,352 [21.9%], p = 0.013). Rural patients experienced reduced 5- and 10-year DSS rates (7.0% and 4.0%) compared to urban patients (9.0% and 6.0%, p < 0.001). In multivariable analysis, rural residence independently demonstrated a 17% increased risk of disease-specific mortality compared to their urban counterparts (aHR 1.17, 95% CI 1.03–1.32). Conclusions: This study demonstrates significant rural–urban disparities in ICC treatment and survival throughout the US, independent of other prognostic factors. Further investigation into factors driving these disparities is warranted to improve outcomes for rural ICC patients. Full article

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Med. Sci., Volume 13, Issue 3 (September 2025) – 107 articles

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