Diseases

17 pages, 1232 KiB

Open AccessArticle

Effects of Sex and Race on Epidemiology and Comorbidities of Patients with Irritable Bowel Syndrome: A Rome III Era Retrospective Study

by Jacqueline Liu, Kathleen Cheng, Yu Lu, Howard Cabral and Horst Christian Weber

Diseases 2025, 13(5), 161; https://doi.org/10.3390/diseases13050161 - 21 May 2025

Abstract

Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital. [...] Read more.

Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital. Methods: An electronic query was performed using the International Classification of Diseases, 9th Revision (ICD-9) coding to identify 740 outpatients with IBS between 1 January 2005 and 30 September 2007. Demographic data and ICD-9 coded comorbidities were extracted from electronic records. Data analysis used descriptive statistics and multiple logistic regression analyses. Results: Comorbid anxiety and depression were significantly more prevalent in female patients (A:24%, p = 0.03; D:29%, p = 0.008) compared with male patients. White female IBS patients had a higher risk for anxiety but not depression compared with non-White patients (p = 0.02). Female sex (p = 0.02), obesity (p = 0.007), and age above fifty (p = 0.02) but not race/ethnicity were significant risk factors for depression. IBS with constipation was more prevalent in female patients (p = 0.005) and in Hispanic compared with non-Hispanic patients (p = 0.03). Conclusions: Significant sex-based and racial/ethnic differences were identified related to body mass index (BMI), age, and IBS subtypes in this study. Comorbid mood disorders occurred significantly more frequently in female patients, and risk factors for comorbid depression included female sex, older age, and obesity but not race/ethnicity. Full article

(This article belongs to the Section Gastroenterology)

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30 pages, 980 KiB

Open AccessReview

Benefits of Traditional Medicinal Plants to African Women’s Health: An Overview of the Literature

by Fatiha Brahmi, Florence Kampemba Mujinga, Naima Guendouze, Khodir Madani, Lila Boulekbache and Pierre Duez

Diseases 2025, 13(5), 160; https://doi.org/10.3390/diseases13050160 - 20 May 2025

Abstract

Background: In many African areas, herbal products still represent a significant source of healthcare. However, a major gender bias is evident in the literature, as most of the work is carried out by male researchers, collecting data from male traditional practitioners, and thus [...] Read more.

Background: In many African areas, herbal products still represent a significant source of healthcare. However, a major gender bias is evident in the literature, as most of the work is carried out by male researchers, collecting data from male traditional practitioners, and thus often neglecting women’s specific health issues. This warrants a detailed review of the current knowledge about the major medicinal plants historically and still used for women’s health. Objective: This study aims to compile and critically analyze published data on the use of traditional herbal remedies by African women in addressing specific health conditions, in order to evaluate the potential of traditional medicine as a viable alternative or complementary approach to modern healthcare for women globally. Methods: Data were retrieved from databases by combining the following relevant keywords: “abortion, adverse, Africa, attendant, birth, botanical, delivery, developing, drug, ethnomedicine, ethnopharmacology, folk, gynecological, healing, infertility, herb, indigenous, lactation, medicine, native, obstetric, phytomedicine, plant, pregnancy, remedy, side, sub-Saharan, traditional, treatment, women”. Results: More than 125 studies, carried out across 12 African nations, revealed that up to 80% of African women resort to herbal medicines. An estimated 200 medicinally important plant species are reported to be utilized by women in different African countries, including Benin, Cameroon, Côte d’Ivoire, Egypt, Ethiopia, Ghana, Kenya, Mali, Nigeria, South Africa, Tanzania, and Zimbabwe. These herbs have many applications, mostly focused on infertility, pregnancy, painful menstruation, breast feeding, breast cancer, and contraception. Interestingly, according to their occurrence of usage, the plants most commonly reported for these conditions that are important to women are ambivalent plants (i.e., used both as foods and medicines) that include Zingiber officinale Roscoe, Allium sativum L., Cucurbita pepo L., and Ricinus communis L. Conclusions: Even though most women, in most African countries, do use traditional medicine, the amount of work published remains quite limited and no data are available in many countries. Therefore, it is desirable to expand African studies in this direction. Full article

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10 pages, 1310 KiB

Open AccessArticle

Diffusion Tensor Imaging Magnetic Resonance Imaging Assessment in a Clinical Trial of Autologous Dendritic Cell Transfer for Diabetic Kidney Disease: A Molecular Approach

by Ernaldi Kapusin, Aditya Pratama Lokeswara, Yudo Rantung, Bhimo Aji Hernowo, Jonny Jonny, Chrismis Novalinda Ginting and Terawan Agus Putranto

Diseases 2025, 13(5), 159; https://doi.org/10.3390/diseases13050159 - 19 May 2025

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Abstract

Background: Continuous rise of type 2 diabetes mellitus (T2DM) global prevalence, has led to a subsequent increase in the prevalence of diabetic kidney disease (DKD). DKD is associated with higher levels of inflammation and impaired kidney function. Many patients do not receive adequate [...] Read more.

Background: Continuous rise of type 2 diabetes mellitus (T2DM) global prevalence, has led to a subsequent increase in the prevalence of diabetic kidney disease (DKD). DKD is associated with higher levels of inflammation and impaired kidney function. Many patients do not receive adequate treatment for this condition. This research aims to evaluate the therapeutic impact of autologous dendritic cell transfer by examining its effects on renal microstructural changes as assessed through Diffusion Tensor Imaging (DTI) MRI, alongside the analysis of key inflammatory biomarkers, namely Matrix Metalloproteinase-9 (MMP-9) and Intercellular Adhesion Molecule-1 (ICAM-1). Methods: A clinical trial with an open-label design was performed with 25 DKD patients receiving outpatient care at Gatot Soebroto Army Hospital. Each participant was administered a single injection of autologous dendritic cells. Evaluations were conducted both prior to and one month following the treatment. The primary measurements included Diffusion Tensor Imaging (DTI) MRI-derived Fractional Anisotropy (FA) scans and the inflammatory biomarker MMP-9. Results: A notable increase in FA was observed, rising from 242.57 ± 63.97 at baseline to 305.61 ± 152.32 one month after the dendritic cell injection. However, there were no significant changes in MMP-9 and ICAM-1 levels. Additionally, a negative correlation was found between FA and MMP-9 (r = −0.324, p = 0.025). Conclusion: The transfer of autologous dendritic cells significantly enhanced FA, which correlates with a reduction in the inflammatory biomarker MMP-9, suggesting a potential impact on renal repair in DKD. Full article

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10 pages, 1087 KiB

Open AccessCase Report

A Vitiligo-like Cutaneous Reaction Induced by Ribociclib in Advanced Breast Cancer: An Unusual Case Report from Colombia

by John Fernando Montenegro, Giovanna Patricia Rivas-Tafurt, Sinthia Vidal-Cañas, Miguel Ángel Diaz-Diaz, Cesar Eduardo Bermudez, Daniel Florez, Andres Felipe Bravo-Gustin and Yamil Liscano

Diseases 2025, 13(5), 158; https://doi.org/10.3390/diseases13050158 - 19 May 2025

Viewed by 58

Abstract

Background: Cutaneous toxicities associated with CDK4/6 inhibitors are uncommon but may affect treatment adherence. We present the case of a patient with advanced breast cancer who developed vitiligo-like lesions after initiating ribociclib, contributing to the growing evidence of this under-recognized adverse effect. Methods: [...] Read more.

Background: Cutaneous toxicities associated with CDK4/6 inhibitors are uncommon but may affect treatment adherence. We present the case of a patient with advanced breast cancer who developed vitiligo-like lesions after initiating ribociclib, contributing to the growing evidence of this under-recognized adverse effect. Methods: We present the case of a 72-year-old woman diagnosed in 2007 with early-stage, luminal A, HER2-negative breast cancer, initially treated with surgery and tamoxifen. In 2022, she experienced locoregional recurrence with bone metastases. In January 2023, she began treatment with ribociclib plus letrozole. Two months later, she developed intense pruritus, xerosis, and paresthesia, followed by hypopigmented lesions on her face and upper extremities. Clinical evaluation, supported by photographs and a skin biopsy (led to a diagnosis of ribociclib-induced vitiligo. Management included dose adjustments to the ribociclib and dermatologic treatments, including topical corticosteroids, antihistamines, and short courses of oral prednisone. Results: By September 2024, her skin lesions had stabilized and her pruritus improved with a reduced dose of ribociclib (one tablet per day). However, the hypopigmented patches persisted, mainly on her face and extremities. Despite these cutaneous effects, she maintained an acceptable quality of life and continued effective oncologic treatment. Conclusions: This case highlights the importance of early recognition and management of ribociclib-related cutaneous toxicities. A multidisciplinary approach is essential to minimize adverse effects without compromising therapeutic efficacy. Further research into the dermatologic manifestations of targeted therapies is needed to optimize patient care. Full article

(This article belongs to the Section Oncology)

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14 pages, 6476 KiB

Open AccessArticle

Evaluating Second-Generation Deep Learning Technique for Noise Reduction in Myocardial T1-Mapping Magnetic Resonance Imaging

by Shungo Sawamura, Shingo Kato, Naofumi Yasuda, Takumi Iwahashi, Takamasa Hirano, Taiga Kato and Daisuke Utsunomiya

Diseases 2025, 13(5), 157; https://doi.org/10.3390/diseases13050157 - 18 May 2025

Viewed by 173

Abstract

Background: T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI [...] Read more.

Background: T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI applications, yet its effectiveness in myocardial T1 mapping has not been thoroughly investigated. This study aimed to evaluate the impact of SR-DLR on noise reduction and measurement consistency in myocardial T1 mapping. Methods: This single-center retrospective observational study included 36 patients who underwent CMR between July and December 2023. T1 mapping was performed using a modified Look-Locker inversion recovery (MOLLI) sequence before and after contrast administration. Images were reconstructed with and without SR-DLR using identical scan data. Phantom studies using seven homemade phantoms with different Gd-DOTA dilution ratios were also conducted. Quantitative evaluation included mean T1 values, standard deviation (SD), and coefficient of variation (CV). Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement. Results: SR-DLR had no significant effect on mean native or post-contrast T1 values but significantly reduced SD and CV in both patient and phantom studies. SD decreased from 44.0 to 31.8 ms (native) and 20.0 to 14.1 ms (post-contrast), and CV also improved. ICCs indicated excellent inter-observer reproducibility (native: 0.822; post-contrast: 0.955). Conclusions: SR-DLR effectively reduces measurement variability while preserving T1 accuracy, enhancing the reliability of myocardial T1 mapping in both clinical and research settings. Full article

(This article belongs to the Section Cardiology)

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10 pages, 206 KiB

Open AccessReview

Developing a Personalized Approach to Follow-Up Blood Cultures in Gram-Negative Bloodstream Infections: A Narrative Review

by Renatos-Nikolaos Tziolos and Diamantis P. Kofteridis

Diseases 2025, 13(5), 156; https://doi.org/10.3390/diseases13050156 - 17 May 2025

Viewed by 131

Abstract

The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this [...] Read more.

The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this review, we aim to evaluate the strengths and limitations of the most significant studies on FUBCs in GN-BSIs, proposing a more personalized approach for using FUBCs in GN-BSIs. FUBCs seem to have a low yield of persistent positive BC in uncomplicated GN-BSIs and no effect on mortality, but some selected patients may benefit. Available studies show different results regarding the mortality and benefit of FUBCs, mainly due to differences in methodology and patient characteristics. However, selected patients with endovascular infections, central venous catheters, unfavorable responses, and no source control seem to benefit the most. Randomized controlled trials are warranted in order to confirm these indications. Full article

(This article belongs to the Section Infectious Disease)

11 pages, 781 KiB

Open AccessArticle

Increased Degenerative Biomarkers in Females with Patellofemoral Pain: A Cross-Sectional Analysis with 6-Month Progression

by Lori A. Bolgla, Tiana V. Curry-McCoy, Maya Giddens, Madelyn Overton, Bryaunna Barrera, Jasmine Crockett and Monte Hunter

Diseases 2025, 13(5), 155; https://doi.org/10.3390/diseases13050155 - 17 May 2025

Viewed by 111

Abstract

Background/Objectives: Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over [...] Read more.

Background/Objectives: Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over 6 months. Methods: All subjects received a knee x-ray to ensure that none had degenerative changes. Urine and serum were collected and analyzed for C-telopeptide fragments of type II collagen (CTX-II) and C-propeptide II (CP-II); these were then expressed as a cartilage degradation: cartilage synthesis ratio (CTX-II:CP-II). Subjects with PFP rated pain using a 10 cm visual analog scale, and function using the Knee injury and Osteoarthritis Outcome Scores-Patellofemoral (KOOS-PF) questionnaire. Subjects with PFP were tested at baseline and at 6 months. Results: Females with PFP had higher levels of CTX-II:CP-II than controls (p < 0.001) and these remained elevated at 6 months (p = 0.82). Females with PFP reported similar levels of pain (p = 0.30) but higher function at 6 months (p = 0.002). However, the 9.0-point increase in KOOS-PF values did not exceed the minimum important change. Conclusions: Females with PFP but no evident structural changes had more elevated biomarkers than controls. This finding suggests that this cohort may have excessive cartilage turnover which may contribute to knee OA. Full article

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15 pages, 1501 KiB

Open AccessArticle

Curcumin Reverses Antibiotic Resistance and Downregulates Shiga Toxin Expression in Enterohemorrhagic E. coli

by Martin Zermeño-Ruiz, Mirian Cobos-Vargas, Mauro Donaldo Saucedo-Plascencia, Rafael Cortés-Zárate, Leonardo Hernandez-Hernandez, Teresa Arcelia Garcia-Cobian, Teresa Estrada-Garcia and Araceli Castillo-Romero

Diseases 2025, 13(5), 154; https://doi.org/10.3390/diseases13050154 - 17 May 2025

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Abstract

Background: Enterohemorrhagic Escherichia coli (EHEC) is a considerable public health concern associated with several foodborne outbreaks of bloody diarrhea (BD) and the potentially lethal hemolytic uremic syndrome (HUS), the pathophysiology of which is attributable to the Shiga toxin (Stx) produced by this bacterium. [...] Read more.

Background: Enterohemorrhagic Escherichia coli (EHEC) is a considerable public health concern associated with several foodborne outbreaks of bloody diarrhea (BD) and the potentially lethal hemolytic uremic syndrome (HUS), the pathophysiology of which is attributable to the Shiga toxin (Stx) produced by this bacterium. In most patients, supportive treatment will be sufficient; however, in some cases, antibiotic treatment may be necessary. Most antibiotics are not recommended for EHEC infection treatment, particularly those that kill the bacteria, since this triggers the release of Stx in the body, inducing or worsening HUS. Azithromycin, which prevents the release of Stx and is a weaker inducer of the SOS system, has been successfully used to reduce EHEC shedding. It is necessary to identify compounds that eliminate EHEC without inducing Stx release. The use of natural compounds such as curcumin (CUR), a polyphenol derived from turmeric, has been highlighted as an alternative bactericidal treatment approach. Objective: The objective of this study was to establish the effect of CUR and its interactions with selected antibiotics on resistant EHEC O157/H7/EDL933. Methods: Bacterial cultures were exposed to CUR at three different concentrations (110, 220, and 330 µg/mL) and 1.2% DMSO, and the antimicrobial activity of CUR was assessed by measuring the optical density at 600 nm (OD600). The synergy of CUR and the antibiotics was determined with the FIC method. RT-PCR was performed to determine the expression levels of the bla_CTX-M-15, catA1, acrAB-tolC stx2A, and stx2B genes. Results: Our data indicate that CUR did not affect the growth of EHEC, but when combined with the antibiotics, it acted as a bacterial resistance breaker. Synergistic combinations of CUR and cefotaxime or chloramphenicol significantly reduced colony counts. Conclusions: Our findings support the potential of CUR as a sensitizer or in combination therapy against EHEC. Full article

(This article belongs to the Section Infectious Disease)

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11 pages, 1037 KiB

Open AccessCase Report

Hypertensive Emergency and Atypical Hemolytic Uremic Syndrome Associated with Cocaine Use: A Diagnostic and Therapeutic Challenge

by Elena Jiménez Mayor, José C. De La Flor, André Rocha Rodrigues, Celia Rodríguez Tudero, Rocío Zamora González-Mariño, Jacqueline Apaza, Esperanza Moral Berrio and Javier Deira Lorenzo

Diseases 2025, 13(5), 153; https://doi.org/10.3390/diseases13050153 - 15 May 2025

Viewed by 134

Abstract

Background: Atypical hemolytic uremic syndrome (HUS) is a rare form of thrombotic microangiopathy (TMA) characterized by complement dysregulation. Cocaine use has been reported to be a potential trigger of TMA; however, the underlying mechanisms remain poorly elucidated. Proposed hypotheses include direct endothelial injury, [...] Read more.

Background: Atypical hemolytic uremic syndrome (HUS) is a rare form of thrombotic microangiopathy (TMA) characterized by complement dysregulation. Cocaine use has been reported to be a potential trigger of TMA; however, the underlying mechanisms remain poorly elucidated. Proposed hypotheses include direct endothelial injury, activation of the complement cascade, and the unmasking of whether HUS is genetic or acquired. Case Report: We report the case of a 47-year-old man who presented with hypertensive emergency and acute kidney injury following intranasal cocaine use. The laboratory findings were consistent with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and markedly elevated lactate dehydrogenase (LDH) levels. Renal biopsy (RB) revealed classic features of TMA, including glomerular capillary thrombosis, fibrinoid necrosis, and acute tubular injury. Complement studies demonstrated reduced levels of Factor I, indicative of complement dysregulation. The patient was treated with therapeutic plasma exchange and four weekly doses of eculizumab, resulting in hematologic remission and significant improvement in renal function, without the need for dialysis. Genetic testing for known atypical HUS-associated mutations was negative; therefore, maintenance therapy with eculizumab was discontinued without clinical relapses. Discussion: This case underscores cocaine as a rare but important precipitating factor for atypical HUS in predisposed individuals. Early diagnosis, RB, and complement evaluation were essential in determining the etiology and guiding targeted therapy. Complement inhibition with eculizumab was effective in halting disease progression and preventing long-term renal damage. Conclusions: This case highlights the relevance of considering cocaine use as a potential trigger of complement-mediated TMA. Early identification of aHUS features and prompt initiation of complement inhibition therapy may be critical to preventing irreversible kidney injury. Full article

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18 pages, 918 KiB

Open AccessSystematic Review

Uterine Transplantation: Advances, Challenges, and Future Perspectives

by Ana Pereira, Flávia Ribeiro, Sandra Soares and Hélder Ferreira

Diseases 2025, 13(5), 152; https://doi.org/10.3390/diseases13050152 - 15 May 2025

Viewed by 164

Abstract

Background: Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3–5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo [...] Read more.

Background: Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3–5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo implantation or pregnancy viability. Uterus transplantation (UTx) has emerged as a promising treatment for AUFI and has been successfully performed in over 10 countries. Objectives: This study aims to conduct a systematic review of uterus transplantation, evaluating its efficacy and safety, as well as maternal, neonatal, and long-term outcomes. It also explores current challenges and future directions. Methods: The methodology was registered on the PROSPERO platform. A literature search was performed in January 2025 across PubMed, Web of Science, and Scopus for articles published from January 2002 to December 2024 in English or Portuguese. The query was: “uterus/transplantation AND (pregnancy OR complications OR newborn OR premature OR diseases)”. Study quality was assessed by journal impact factor (IF). Data were analyzed using Microsoft Excel. Results: A total of 10 studies were included: four from Sweden, three from the DUETS group, two from the Czech Republic, and one multi-institutional American study. The UTx success rate was 74.0%; clinical pregnancy rate (CPR) and live birth rates (LBR) per embryo transfer (ET) were 36.3% and 22.0%, respectively. No significant increase in congenital or neurological complications was observed. Adverse psychological outcomes were associated with transplant failure or pregnancy loss. Conclusions: UTx is a promising treatment for AUFI, showing favorable pregnancy and birth outcomes without major fetal or neonatal risks. Full article

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11 pages, 254 KiB

Open AccessArticle

The Inverse Association of Mediterranean Diet with Emotional Eating: A Cross-Sectional Study in Greek Adults

by Maria Mentzelou, Sousana K. Papadopoulou, Aikaterini Louka, Georgia-Eirini Deligiannidou, Evmorfia Psara and Constantinos Giaginis

Diseases 2025, 13(5), 151; https://doi.org/10.3390/diseases13050151 - 14 May 2025

Viewed by 214

Abstract

Background/Objectives: Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association [...] Read more.

Background/Objectives: Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association between Mediterranean diet (MD), a dietary pattern promoting mental health, and emotional eating via the Three-Factor Eating Questionnaire (TEFQ). Methods: This is a cross-sectional survey including 328 adults aged 18–75 years. Appropriate questionnaires were applied for evaluating adherence to the Mediterranean diet (MedDiet score) and types of feeding and the expression of emotional food consumption (TFEQ). Results: A mean MedDiet score equal to 30.97 ± 4.93 and a total TFEQ score equal to 45.40 ± 6.31 were noted. MedDiet score was significantly inversely associated with TFEQ total score (r = 0.23, p = 0.026) as well as with TFEQ emotional score (r = 0.37, p < 0.0001). Fruits and vegetables consumption was positively associated with TFEQ emotional score (r = 0.25, p = 0.014, and r = 0.20, p = 0.049, respectively). Conclusions: In order to produce data showing improvements in eating behavior, our findings have highlighted the significance of conducting large, prospective, well-designed, randomized, interventional clinical studies to confirm the inverse association of MD with EE. The interpretation of the results is complicated due to cross-sectional design, the social desirability bias and the self-report nature of both dietary and emotional assessments. Full article

(This article belongs to the Section Clinical Nutrition)

18 pages, 652 KiB

Open AccessArticle

Risk of Insulin Resistance: Comparison of the Commerce vs. Industry Sector and Associated Variables

by María Pilar Fernández-Figares Vicioso, Pere Riutord Sbert, Ángel Arturo López-González, José Ignacio Ramírez-Manent, José Luis del Barrio Fernández and María Teófila Vicente Herrero

Diseases 2025, 13(5), 150; https://doi.org/10.3390/diseases13050150 - 14 May 2025

Viewed by 190

Abstract

Background: Insulin resistance (IR) is a key metabolic alteration that precedes type 2 diabetes and is closely linked to obesity and lifestyle factors. Occupational context may influence IR risk through variations in physical activity, diet, and socioeconomic determinants. Objective: To compare the risk [...] Read more.

Background: Insulin resistance (IR) is a key metabolic alteration that precedes type 2 diabetes and is closely linked to obesity and lifestyle factors. Occupational context may influence IR risk through variations in physical activity, diet, and socioeconomic determinants. Objective: To compare the risk of insulin resistance between workers in the commerce and industry sectors and identify associated sociodemographic and lifestyle factors, in order to improve their occupational health. Methods: This cross-sectional study analyzed data from 56,856 Spanish workers, assessing four IR-related indices: Triglyceride-Glucose Index (TyG), TyG-BMI (Triglyceride-Glucose Body Mass Index), Metabolic Score for Insulin Resistance (METS-IR), and the Single-Point Insulin Sensitivity Estimator (SPISE-IR). The analysis was stratified by sex and sector (commerce vs. industry) and included assessments of age, education level, physical activity, adherence to the Mediterranean diet, and smoking status. Multinomial logistic regressions were performed to determine the factors associated with high IR scores. Results: Across all IR indicators, industry workers—particularly men—presented higher mean values and greater prevalence of high-risk scores compared to those in commerce. Women showed lower values overall but also reflected sector-based differences. In both sexes, non-physical activity, non-adherence to the Mediterranean diet, and smoking were consistently associated with higher IR risk. Males exhibited significantly higher odds of elevated TyG (OR = 2.59, 95% CI: 2.41–2.78), while physical inactivity and poor diet emerged as the most powerful modifiable predictors across all scales (e.g., OR = 10.45 for TyG, OR = 12.33 for TyG-BMI). Industry sector was independently associated with higher odds of insulin resistance compared to commerce. Conclusions: Insulin resistance is more prevalent among industrial workers, especially men and those with unhealthy lifestyles. Occupational health strategies should target sector-specific risk profiles, emphasizing physical activity and dietary interventions. Full article

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13 pages, 2883 KiB

Open AccessArticle

Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database

by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Hadrian Hoang-Vu Tran, Olivia Yessin, Harsh Jha, Ashley Mason, Audrey Thu, Simcha Weissman and Adam Atoot

Diseases 2025, 13(5), 149; https://doi.org/10.3390/diseases13050149 - 13 May 2025

Viewed by 203

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim [...] Read more.

Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim of our study is to analyze the national trends in TAVR procedures, in-hospital outcomes, major readmission causes, and the association of risk factors for readmissions following TAVR. Methods: We analyzed NIS data (2018–2022) to assess TAVR utilization trends, patient demographics, and in-hospital outcomes. The NRD (2021–2022) was used to evaluate 60-day readmission rates for stroke, complete heart block, and heart failure. Multivariate regression models were employed to identify risk factors having significant association with major readmission causes. Results: TAVR utilization increased from 10,788 cases in 2018 to 17,784 in 2022, with a concurrent decrease in in-hospital mortality (1.33% to 0.90%) and length of stay (3.88 to 2.97 days). Of 123,376 TAVR index admissions in 2021, 28,654 patients had 66,100 readmission events (53.57%) in the 60 days following discharge. Heart failure (17,566 cases, 26.57% of readmissions) was the most common readmission cause, followed by complete heart block (1760 cases, 2.66% of readmissions) and stroke (284 cases, 0.42% of readmissions). Predictors of post-TAVR stroke included uncontrolled hypertension (OR 2.29, p < 0.001) and chronic heart failure (OR 2.73, p < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, p < 0.001) and heart failure readmissions (OR 7.65, p < 0.001). Conclusions: TAVR utilization has increased with improving perioperative outcomes, but post-TAVR readmissions remain significant, particularly for heart failure, stroke, and conduction disturbances. Pre-procedural uncontrolled hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation were risk factors with significant association with stroke in the 60 days following TAVR. The presence of documented pre-procedural LBB, RBB, as well as BFB were risk factors with significant association with complete heart block following TAVR placements. Pre-procedural LBB, RBB, BFB, and atrial fibrillation were risk factors having significant association with heart failure readmissions in the 60 days following TAVR. Full article

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11 pages, 239 KiB

Open AccessArticle

Examining Romosozumab Adherence and Side Effects in Osteoporotic Patients After Surgical Fracture Fixation: A Comparative, Descriptive, and Hypothesis-Generating Study with Non-Fractured Controls

by Amarildo Smakaj, Umberto Tarantino, Riccardo Iundusi, Angela Chiavoghilefu, Lorenzo Abbondante, Chiara Salvati, Chiara Greggi and Elena Gasbarra

Diseases 2025, 13(5), 148; https://doi.org/10.3390/diseases13050148 - 11 May 2025

Viewed by 198

Abstract

Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di [...] Read more.

Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di Roma “Tor Vergata”, following the principles of the Declaration of Helsinki. It included postmenopausal women aged over 60, with the case group receiving Romosozumab after fracture fixation, and the control group consisting of women on Romosozumab therapy without fracture fixation. Exclusion criteria included psychiatric conditions, contraindications to Romosozumab, high-energy trauma, or other bone metabolism disorders. Data on fractures, surgeries, FRAX (Fracture Risk Assessment Tool) scores, BMD (Bone Mineral Densit) values, and follow-up details were collected. Side effects, including nasopharyngitis and severe events like hypocalcemia, stroke, and myocardial infarction, were recorded. Adherence was assessed via pharmacy records and patient interviews during routine clinical follow-up visits. Statistical analysis was performed using descriptive statistics, t-tests, and chi-square tests. Results: The study included 25 patients, with 12 in the surgical group and 13 in the conservative treatment group. The surgical group had a mean age of 67.3 years and a follow-up of 374 days, while the conservative group had a mean age of 76.4 years and a follow-up of 287 days. The surgical group underwent various fracture treatments, including femoral, humeral, and distal radius fractures, while the conservative group was treated with immobilization. There were no significant differences in FRAX scores or BMD values between the two groups. Vitamin D levels increased significantly in both groups after supplementation, but parathyroid hormone levels showed no difference. No new fractures occurred, and surgical patients had no delayed union or nonunion, though two had superficial wound infections. Conclusions: Both groups adhered well to Romosozumab therapy, with no severe side effects; minor side effects included myalgia in the surgical group and shoulder arthralgia in the conservative group. Romosozumab is well-tolerated and adherent in osteoporotic patients after osteosynthesis surgery, with adverse events similar to non-fractured individuals. While the study design is appropriate, multicenter trials would improve the sample size and allow for subgroup analysis based on fracture type and demographics. Full article

14 pages, 664 KiB

Open AccessArticle

Long-Term Trends in Respiratory Syncytial Virus A Infections (2007–2024) in Korea

by Jeong Su Han, Sung Hun Jang, Jae-Sik Jeon and Jae Kyung Kim

Diseases 2025, 13(5), 147; https://doi.org/10.3390/diseases13050147 - 10 May 2025

Viewed by 238

Abstract

Background/Objectives: Respiratory syncytial virus A (RSV A) is the leading cause of respiratory infections, particularly in vulnerable populations. This study aimed to investigate the long-term epidemiological trends of RSV A infection in the Republic of Korea over an 18-year period (2007–2024), with emphasis [...] Read more.

Background/Objectives: Respiratory syncytial virus A (RSV A) is the leading cause of respiratory infections, particularly in vulnerable populations. This study aimed to investigate the long-term epidemiological trends of RSV A infection in the Republic of Korea over an 18-year period (2007–2024), with emphasis on age, sex, and seasonal differences. Methods: A total of 23,284 nasopharyngeal swab specimens were analyzed by multiplex real-time PCR. Statistical comparisons were performed using the chi-square test. Results: The RSV A-positivity rate was highest in 2007 (19.7%) and lowest in 2021 (0.1%) (p < 0.001). Infants (0 years) exhibited the highest infection rate (18.5%, 95% CI: 17.3–19.6), whereas adults aged 20–64 years and older adults showed significantly lower rates (0.7% and 0.9%, respectively). Seasonal peaks occurred in winter (15.3%) and autumn (14.7%), indicating earlier onset of RSV A circulation. No significant difference was found between sexes (p = 0.196). Conclusions: This study provides the first long-term retrospective analysis of RSV A trends in the Republic of Korea and reveals a shift toward an earlier seasonal onset. These findings support the need for earlier preventive strategies and optimized vaccination timing, particularly for high-risk groups, such as infants. These findings underscore the importance of seasonal variation and the potential influence of environmental factors, such as ambient temperature, relative humidity, and geographic latitude, on RSV A transmission patterns in Korea, although these variables were not directly analyzed in the present study and warrant further investigation. Full article

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12 pages, 614 KiB

Open AccessArticle

The Prevalence of Emphysema in Patients Undergoing Lung Cancer Screening in a Middle-Income Country

by Marija Vukoja, Dragan Dragisic, Gordana Vujasinovic, Jelena Djekic Malbasa, Ilija Andrijevic, Goran Stojanovic and Ivan Kopitovic

Diseases 2025, 13(5), 146; https://doi.org/10.3390/diseases13050146 - 9 May 2025

Viewed by 207

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and lung cancer are the leading causes of death globally, which share common risk factors such as age and smoking exposure. In high-income countries, low-dose computed tomography (LDCT) lung cancer screening programs have decreased lung cancer mortality [...] Read more.

Background: Chronic obstructive pulmonary disease (COPD) and lung cancer are the leading causes of death globally, which share common risk factors such as age and smoking exposure. In high-income countries, low-dose computed tomography (LDCT) lung cancer screening programs have decreased lung cancer mortality and facilitated the detection of emphysema, a key radiological indicator of COPD. This study aimed to assess the prevalence of emphysema during a pilot LDCT screening program for lung cancer in a middle-income country with a high smoking prevalence. Methods: A secondary analysis of the Lung Cancer Screening Database of the Autonomous Province of Vojvodina, Serbia, from 20 September 2020 to 30 May 2022. Persons aged 50–74 years, with a smoking history of ≥30 pack-years/or ≥20 pack-years with additional risks (chronic lung disease, prior pneumonia, malignancy other than lung cancer, family history of lung cancer, and professional exposure to carcinogens) were offered LDCT. Results: Of 1288 participants, mean age of 62.1 ± 6.7 years and 535 males (41.5%), 386 (30.0%) had emphysema. The majority of patients with emphysema (301/386, 78.0%) had no prior history of chronic lung diseases. Compared to the patients without emphysema, the patients with emphysema reported more shortness of breath (140/386, 36.3% vs. 276/902, 30.6%, p = 0.046), chronic cough (117/386, 30.3% vs. 209/902, 23.17% p = 0.007), purulent sputum expectoration (70/386, 18.1% vs. 95/902, 10.53%, p < 0.001), and weight loss (45/386, 11.7% vs. 63/902, 7.0%, p = 0.005). The patients with emphysema had more exposure to smoking (pack/years, 43.8 ± 18.8 vs. 39.3 ± 18.1, p < 0.001) and higher prevalence of solid or semisolid lung nodules (141/386, 36.5% vs. 278/902 30.8%, p = 0.04). Conclusions: Almost one-third of the patients who underwent the LDCT screening program in a middle-income country had emphysema that was commonly undiagnosed despite being associated with a significant symptom burden. Spirometry screening should be considered in high-risk populations. Full article

(This article belongs to the Section Respiratory Diseases)

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14 pages, 775 KiB

Open AccessArticle

Bacterial Superinfections After SARS-CoV-2 Pneumonia: Antimicrobial Resistance Patterns, Impact on Inflammatory Profiles, Severity Scores, and Clinical Outcomes

by Petrinela Daliu, Iulia Bogdan, Ovidiu Rosca, Alexandra Laura Aelenei, Ioan Sîrbu, Mihai Calin Bica, Monica Licker, Elena Hogea and Delia Muntean

Diseases 2025, 13(5), 145; https://doi.org/10.3390/diseases13050145 - 9 May 2025

Viewed by 251

Abstract

Background and Objectives: Secondary bacterial pneumonia can substantially worsen the clinical trajectory of patients hospitalized for Coronavirus Disease 2019 (COVID-19). This study aimed to characterize bacterial superinfections in COVID-19, including pathogen profiles, resistance patterns, inflammatory responses, severity scores, and ICU admission risk. Methods: [...] Read more.

Background and Objectives: Secondary bacterial pneumonia can substantially worsen the clinical trajectory of patients hospitalized for Coronavirus Disease 2019 (COVID-19). This study aimed to characterize bacterial superinfections in COVID-19, including pathogen profiles, resistance patterns, inflammatory responses, severity scores, and ICU admission risk. Methods: In a retrospective cohort design, we reviewed 141 patients admitted to a single tertiary-care hospital between February 2021 and December 2024. A total of 58 patients had laboratory-confirmed bacterial superinfection by sputum, bronchoalveolar lavage, or blood cultures (superinfection group), whereas 83 had COVID-19 without any documented bacterial pathogens (COVID-only group). We collected detailed microbiological data from sputum, bronchoalveolar lavage (BAL), and blood cultures. Antibiotic sensitivity testing was performed using standard breakpoints for multidrug resistance (MDR). Inflammatory markers (C-reactive protein, procalcitonin, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index) and the severity indices Acute Physiology and Chronic Health Evaluation (APACHE) II, Confusion, Urea, Respiratory rate, Blood pressure (CURB), and National Early Warning Score (NEWS) were measured at admission. Primary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and mortality. Results: Patients in the superinfection group showed significantly elevated inflammatory markers and severity scores compared to the COVID-only group (mean APACHE II of 17.2 vs. 13.8; p < 0.001). Pathogens most frequently isolated from sputum and BAL included Klebsiella pneumoniae (27.6%) and Pseudomonas aeruginosa (20.7%). Multidrug-resistant strains were documented in 32.8% of isolates. The superinfection group had higher ICU admissions (37.9% vs. 19.3%; p = 0.01) and more frequent mechanical ventilation (25.9% vs. 9.6%; p = 0.01). Mortality trended higher among superinfected patients (15.5% vs. 7.2%; p = 0.09). A total of 34% of the cohort had prior antibiotic use, which independently predicted MDR (aOR 2.6, p = 0.01). The presence of MDR pathogens such as Klebsiella pneumoniae (OR 2.8), Pseudomonas aeruginosa (OR 2.5), and Staphylococcus aureus (OR 2.1) significantly increases the risk of ICU admission. Conclusions: Bacterial superinfection exacerbates inflammation and worsens outcomes in COVID-19 patients, such as a higher risk of ICU admission. Full article

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12 pages, 497 KiB

Open AccessArticle

Post-Liver Transplant Kidney Dysfunction: Incidence of Acute Kidney Injury and Chronic Kidney Disease and Risk Factors Related to Chronic Kidney Disease Development

by Ana Flavia Moura, José A. Moura-Neto, Beatriz de Melo Ribeiro, Paula Ribeiro Oliveira, Arthur Guimarães de Freitas, Alessandra Lima Costa, Daniela Moura-Landim, Liana Codes, Paulo Lisboa Bittencourt and Constança Margarida Sampaio Cruz

Diseases 2025, 13(5), 144; https://doi.org/10.3390/diseases13050144 - 6 May 2025

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Abstract

Introduction: Acute kidney injury (AKI) and chronic kidney disease (CKD) are common complications following liver transplantation (LT), significantly impacting graft and patient survival. AKI affects more than 50% of LT recipients, with a subset requiring renal replacement therapy (RRT), while CKD develops in [...] Read more.

Introduction: Acute kidney injury (AKI) and chronic kidney disease (CKD) are common complications following liver transplantation (LT), significantly impacting graft and patient survival. AKI affects more than 50% of LT recipients, with a subset requiring renal replacement therapy (RRT), while CKD develops in up to 60% of cases, increasing long-term morbidity and mortality. This study aimed to determine the incidence of AKI and CKD post-LT and to identify risk factors associated with CKD development. Methods: All adult cirrhotic patients without concurrent CKD submitted to LT between January 2001 and December 2017 at the main transplant center in Salvador, Bahia, Brazil, with more than 6-month survival were included in the study. AKI was defined by KDIGO criteria within the first 7 days post-LT. CKD was diagnosed in the presence of the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and/or proteinuria ≥ 200 mg/g 1 and 5 years after LT. Clinical and biochemical parameters were analyzed using multivariate logistic regression to identify independent predictors of CKD. Results: A total of 177 LT recipients (72.9% male; mean age 53.6 ± 12.6 years) were studied. AKI occurred in 51.4% of them in the first 7 days after LT, and 10 (11%) required RRT. CKD was diagnosed in 30% of LT recipients at 1 year and in 42.9% at 5 years. The majority displayed CKD stage G3 (72.4% at 5 years). Multivariate analysis identified pre-LT serum creatinine (OR 7.74, 95% CI 1.99–30.02) and AKI within 7 days after LT (OR 2.72, 95% CI 1.22–6.06) as independent predictors of CKD development. Conclusions: AKI is highly prevalent in the early post-LT period and is a major determinant of CKD progression. Pre-LT renal function and perioperative AKI were significantly associated with worse long-term nephrological outcomes. Optimized perioperative management and renal monitoring strategies are crucial to minimize progression to end-stage kidney disease in LT recipients. Full article

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23 pages, 3997 KiB

Open AccessReview

Anticancer Mechanisms of Ginsenoside Compound K: A Review

by Yu-Po Lee, Hui-Ting Chan, Tzu-Hsuan Li, Lichieh (Julie) Chu, Sheau-Long Lee, Yu-Quan Chang and Robert YL Wang

Diseases 2025, 13(5), 143; https://doi.org/10.3390/diseases13050143 - 5 May 2025

Viewed by 333

Abstract

Cancer, also known as malignant tumors, is formed due to abnormal mutations and the proliferation of human cells. Cancer cells not only demonstrate accelerated proliferation but also show robust invasive and metastatic potential, disseminating from a primary affected region of the body to [...] Read more.

Cancer, also known as malignant tumors, is formed due to abnormal mutations and the proliferation of human cells. Cancer cells not only demonstrate accelerated proliferation but also show robust invasive and metastatic potential, disseminating from a primary affected region of the body to multiple areas and potentially culminating in organ dysfunction or failure, thereby jeopardizing the individual’s life. The rapid growth of the biopharmaceutical market has given rise to numerous novel medicines, thereby precipitating a paradigm shift in contemporary drug development methodologies. This modification is focused on identifying methodologies that can effectively target cancerous cells while minimizing damage to normal cells. There is an increasing societal movement that supports the utilization of natural ingredients derived from plants. In recent years, traditional herbal medicine has experienced a surge in popularity within the global cancer market. In comparison with the use of more toxic chemotherapy methods, there has been an increasing focus on advanced therapies that exhibit reduced side effects. Ginsenoside compound K (CK) is derived from the natural components in ginseng through biotransformation. The utilization of CK in cancer research is a practice engaged in by numerous scientists. The underlying rationale is that CK exhibits a multitude of effects within the realm of cancer research, including but not limited to the mitigation of inflammation, the suppression of cancerous cell proliferation, and the safeguarding of cardiovascular, hepatic, and renal functions. This review methodically identifies and organizes CK-related journals according to the following key points of cancer treatment: the effects on cancer cells themselves, angiogenesis inhibition, modulation of immune response to identify cancer cells, and inflammation regulation. The intricate interplay between ginsenoside CK and cells is elucidated through a graphical representation. The present review focuses on the results of CK in in vitro tests. It is our hope that the present article will aid future studies on the results of CK in vivo tests, clarify the correlation between cellular mechanisms in vivo and in vitro tests, and assist in the development of drugs. Full article

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13 pages, 1088 KiB

Open AccessArticle

Emergency Presentations of Pediatric Sickle Cell Disease in French Guiana

by Carine Fankep Djomo, Souam Nguele Sile and Narcisse Elenga

Diseases 2025, 13(5), 142; https://doi.org/10.3390/diseases13050142 - 4 May 2025

Viewed by 189

Abstract

Background/Objectives: This study aimed to estimate the proportion of pediatric emergency admissions related to sickle cell disease. Methods: This is a cross-sectional study. The data were collected over a period of 9 years, from 1 January 2014 to 31 December 2022. Results: We [...] Read more.

Background/Objectives: This study aimed to estimate the proportion of pediatric emergency admissions related to sickle cell disease. Methods: This is a cross-sectional study. The data were collected over a period of 9 years, from 1 January 2014 to 31 December 2022. Results: We recorded 858 emergency department visits related to sickle cell disease out of a total of 135,000 pediatric emergency department visits, giving a prevalence of 6.4 per 1000 children aged up to 18 years. The median age was 12 years (8–16) years. The average waiting time in the emergency department for children with sickle cell disease was 2 h (±1) in 2014 and 45 min (±15) in 2022. Children with sickle cell anemia were more likely than others to have been seen by a consultant in an emergency department. The most commonly associated pathology was asthma, with a frequency of 17%. The risk factors for hospitalization were an age between 5 and 10 years and a severe form of sickle cell disease. Conclusions: The treatment of pain and fever were often delayed. This leads us to suggest that systematic prior communication between the pediatric hematologist and the emergency physician is crucial. However, there is a need to define best practices for the management of children with sickle cell disease presenting to the emergency department with a fever. Full article

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16 pages, 4249 KiB

Open AccessArticle

Mortality Risk Analysis of Combination Antiplatelet Therapy in Patients with Ischemic Stroke and Acute Kidney Injury: A Retrospective Cohort Analysis of the MIMIC-IV Database

by Qiangqiang Zhou, Hongyu Xu, Shengrong Long, Wei Wei and Xiang Li

Diseases 2025, 13(5), 141; https://doi.org/10.3390/diseases13050141 - 2 May 2025

Viewed by 203

Abstract

Background: Ischemic stroke (IS), a major cerebrovascular disease, is associated with high disability and mortality rates. Acute kidney injury (AKI) often complicates IS and increases in-hospital mortality. While antiplatelet agents are commonly used for IS treatment, their effectiveness in IS patients with AKI [...] Read more.

Background: Ischemic stroke (IS), a major cerebrovascular disease, is associated with high disability and mortality rates. Acute kidney injury (AKI) often complicates IS and increases in-hospital mortality. While antiplatelet agents are commonly used for IS treatment, their effectiveness in IS patients with AKI is unclear. Methods: This study, using data from the MIMIC-IV database, divided patients into non-combination (clopidogrel or ticagrelor alone) and combination (with aspirin) groups. The primary outcome was 28-day mortality, with secondary outcomes including 90-day, 1-year, and in-hospital mortality. Multivariable Cox and logistic regression models were used to analyze the relationship between antiplatelet regimens and mortality. Subgroup analyses and interaction tests were conducted. Results: Results showed the combination group had lower 28-day, 90-day, 1-year, and in-hospital mortality risks than the non-combination group (all p < 0.001). Subgroup analysis revealed an interaction effect by AKI stage, with combination therapy not significantly reducing mortality in severe AKI (stages 2 and 3, p = 0.743, p = 0.244). Conclusions: This study demonstrates that combination antiplatelet therapy significantly reduces 28-day, 90-day, 1-year, and in-hospital mortality risks of IS patients with AKI, suggesting its potential benefits in improving both short- and long-term clinical outcomes. However, this does not apply to patients with severe AKI, indicating heterogeneous survival benefits of combination therapy across AKI severity. Clinical decision-making should incorporate AKI stage stratification to evaluate the applicability of combination antiplatelet therapy. Further research is needed to explore the impact of AKI staging on antiplatelet therapy in IS patients. Full article

(This article belongs to the Section Neuro-psychiatric Disorders)

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18 pages, 1785 KiB

Open AccessArticle

Labdane Diterpenoids from Leonotis ocymifolia with Selective Cytotoxic Activity Against HCC70 Breast Cancer Cell Line

by Jane Busisiwe Ncongwane, Vuyelwa Jacqueline Tembu, Comfort Mduduzi Nkambule, Douglas Kemboi, Gerda Fouche, Nyeleti Vukea and Jo-Anne de la Mare

Diseases 2025, 13(5), 140; https://doi.org/10.3390/diseases13050140 - 1 May 2025

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Abstract

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited therapeutic options. Leonotis ocymifolia is a shrub widely used in traditional medicine to alleviate cancer-related symptoms. In a search to find safe and efficacious therapeutic agents from medicinal plants, [...] Read more.

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited therapeutic options. Leonotis ocymifolia is a shrub widely used in traditional medicine to alleviate cancer-related symptoms. In a search to find safe and efficacious therapeutic agents from medicinal plants, Leonotis ocymifolia was studied to find compounds with anticancer activity against TNBC. Methods: Compounds from Leonotis ocymifolia were characterized using spectroscopic data such as IR, 1D and 2D NMR, and MS spectrometry and evaluated for cytotoxic activity against triple-negative breast cancer (HCC70), hormone receptor-positive breast cancer (MCF-7), and non-tumorigenic mammary epithelial cell lines (MCF-12A). Results: A previously unreported bis-spirolabdane, 13S-nepetaefolin (1), together with five known labdane diterpenoids, namely nepetaefolin (2), dubiin (3), nepetaefuran (4), leonotin (5), and leonotinin (6), from the genus Leonotis were isolated. Overall, the labdane diterpenoids showed selective activity toward triple-negative breast cancer cells (HCC70). Of the compounds extracted, 13S-nepetaefolin demonstrated the greatest cytotoxic activity with an IC₅₀ of 24.65 µM (SI = 1.08) against HCC70 cells; however, it was equally cytotoxic to non-tumorigenic MCF-12A breast cells (IC₅₀ of 26.55 µM), whereas its isomer (2) showed no activity. This suggests that stereochemistry might have an effect on the cytotoxic activity of the bis-spirolabdane diterpenoids. All the compounds (1–6) demonstrated adsorption, distribution, metabolism, and excretion properties (ADME), while leonotin (5) and leonotinin (6) exhibited lead-like properties and high synthetic accessibility scores. Conclusions: The findings from this study warrant further investigation of L. ocymifolia for potential triple-negative breast cancer (TNBC) therapeutic agents, including potential chemical derivatization of bis-spiro labdane diterpenoid (1) to improve selectivity to TNBC over non-cancer cells. Full article

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16 pages, 2193 KiB

Open AccessReview

Nutrition in Inflammatory Bowel Disease: Strategies to Improve Prognosis and New Therapeutic Approaches

by Nallely Bueno-Hernández, Jesús K. Yamamoto-Furusho and Viridiana Montsserrat Mendoza-Martínez

Diseases 2025, 13(5), 139; https://doi.org/10.3390/diseases13050139 - 1 May 2025

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Abstract

Inflammatory Bowel Disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition of the gastrointestinal tract that significantly impacts nutritional status. Malnutrition is a frequent complication, resulting from reduced nutrient intake, malabsorption, and increased metabolic demands due to [...] Read more.

Inflammatory Bowel Disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition of the gastrointestinal tract that significantly impacts nutritional status. Malnutrition is a frequent complication, resulting from reduced nutrient intake, malabsorption, and increased metabolic demands due to chronic inflammation. A comprehensive nutritional assessment encompassing anthropometric, biochemical, and dietary evaluations is crucial for informing personalized interventions. Several nutritional approaches have been explored to modulate inflammation and the gut microbiota, yielding promising results. The Mediterranean, anti-inflammatory, and low-FODMAP diets have shown potential benefits in symptom control. In contrast, diets high in ultra-processed foods and saturated fats are associated with worsened disease activity. Additionally, stool consistency, assessed using the Bristol Stool Scale, serves as a practical indicator for dietary adjustments, helping to regulate fiber intake and hydration strategies. When dietary modifications alone are insufficient, nutritional support becomes a critical component of IBD management. Enteral nutrition (EN) is preferred whenever possible because it maintains gut integrity and modulates immune responses. It has demonstrated efficacy in reducing postoperative complications and improving disease control. In cases where EN is not feasible, such as in intestinal obstruction, severe malabsorption, or high-output fistulas, parenteral nutrition (PN) is required. The choice between peripheral and central administration depends on treatment duration and osmolarity considerations. Despite growing evidence supporting nutritional interventions, further research is needed to establish standardized guidelines that optimize dietary and nutritional support strategies in managing IBD. Full article

(This article belongs to the Section Gastroenterology)

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13 pages, 1684 KiB

Open AccessSystematic Review

Efficacy and Safety of Adding Ribavirin to Sofosbuvir-Based Direct-Acting Antivirals (DAAs) in Re-Treating Non-Genotype 1 Hepatitis C—A Systematic Review and Meta-Analysis

by Shahd Hamran, Amani A. Al-Rajhi, Kawthar Jasim, Majed A. Al-Theyab, Mohamed Elahtam, Mooza K. Al-Hail, Wadha Al-Fahaidi, Yaman A. Khamis, Yara Dweidri, Abdel-Naser Elzouki and Tawanda Chivese

Diseases 2025, 13(5), 138; https://doi.org/10.3390/diseases13050138 - 29 Apr 2025

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Abstract

Background: There is still debate whether ribavirin should be added to direct-acting antivirals (DAAs) for the management of treatment-experienced individuals with non-genotype-1 hepatitis C. This study compared the efficacy and safety of adding ribavirin to sofosbuvir-based combinations compared to sofosbuvir-based regimens alone in [...] Read more.

Background: There is still debate whether ribavirin should be added to direct-acting antivirals (DAAs) for the management of treatment-experienced individuals with non-genotype-1 hepatitis C. This study compared the efficacy and safety of adding ribavirin to sofosbuvir-based combinations compared to sofosbuvir-based regimens alone in treating non-genotype 1 hepatitis C virus (HCV) in individuals who have been previously treated. Methods: We searched Cochrane CENTRAL, PubMed, SCOPUS, CINAHL and preprint databases from inception to September 2023 for randomized controlled trials (RCTs) that compared sofosbuvir-based regimens with ribavirin to sofosbuvir-based regimens alone in previously treated individuals with non-genotype 1 HCV infection. Data extraction and quality of study assessments were performed by two independent authors, and synthesis was performed using bias-adjusted models, heterogeneity using I2, and publication bias using funnel plots. Results: Eight RCTs compared sofosbuvir-based combinations with and without ribavirin were included. Overall, the addition of ribavirin to sofosbuvir, compared to sofosbuvir alone, did not show a benefit in achieving sustained virological response (SVR) (OR 0.91, 95% CI 0.26–3.17, I2 = 70.0%) with moderate certainty in Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence. In subgroup analysis, there was no benefit of adding ribavirin to sofosbuvir in individuals with non-genotype 1 HCV. The additional ribavirin was associated with increased adverse events (OR 2.03, 95% CI 1.58–2.6, I2 = 8.0%) and treatment discontinuation (OR 1.81, 95% CI 0.78–4.28, I2 = 0.0%). Conclusions: The moderate certainty evidence suggests that adding ribavirin to sofosbuvir-based regimens may not confer benefit in achieving SVR in previously treated individuals with non-genotype 1 HCV but increases the odds of adverse events and treatment discontinuation. More evidence is needed on the effect of additional ribavirin in achieving SVR in individuals with decompensated cirrhosis. Registration: The protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022368868). Full article

(This article belongs to the Special Issue Viral Hepatitis: Diagnosis, Treatment and Management)

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14 pages, 687 KiB

Open AccessArticle

Unmasking the Hidden Morbidity of Ocular Diseases in Primary Care Through a Collaboration with Specialists in Remote Areas: A Cross-Sectional Study from Rural Crete, Greece

by Konstantinos Chliveros, Manolis Linardakis, Ioanna Tsiligianni, Miltiadis Tsilimbaris, Ioannis Pallikaris and Christos Lionis

Diseases 2025, 13(5), 137; https://doi.org/10.3390/diseases13050137 - 29 Apr 2025

Viewed by 164

Abstract

Background: Ocular disorders are not frequently addressed in primary care, which is more visible in remote rural settings. The aim of the study was to assess the prevalence and pattern of eye diseases in a remote rural population of Crete and to [...] Read more.

Background: Ocular disorders are not frequently addressed in primary care, which is more visible in remote rural settings. The aim of the study was to assess the prevalence and pattern of eye diseases in a remote rural population of Crete and to explore whether they represent a hidden morbidity. Materials and Methods: A community-based, cross-sectional study based on data collected through a comprehensive clinical investigation conducted by a mobile ophthalmological unit. Permanent inhabitants, aged over 40 years, living in one remote rural community located on the highest mountain of Crete, were invited to participate. The prevalence of eye diseases was measured during the comprehensive ophthalmological examination. Patients’ medical records were used to assess hidden morbidity. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was applied to measure self-reported vision-targeted health status. Results: A total of 239 individuals agreed to participate; 54.9% were females (n = 151), with a mean ageof 66.13 years (±14.56). The most common diagnoses were refractory errors (59%), cataract (21.7%), glaucoma (11.7%), maculopathy (8.8%), and dry eyes (8.8%). A previously undiagnosed eye disorder was detected in 34.3% (n = 82). Total scores of NEI VFQ-25 measured quality of life were highand significantly lower in Known Cases of eye diseases compared to patients with New or Without diagnosis (76.6 vs. 84.1 and 84.6, respectively, p = 0.009). Conclusions: Our study highlighted the need for increased awareness of primary care in rural areas concerning eye disorders. Local policies should focus on implementing public health interventions and encouraging close cooperation with specialists to overcome accessibility issues. Full article

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25 pages, 5836 KiB

Open AccessSystematic Review

Cardiac Repair and Clinical Outcomes of Stem Cell Therapy in Heart Failure: A Systematic Review and Meta-Analysis

by Salman Muslem, Mariam AlTurani, Muhammad Bilal Maqsood and Maryam Al Qaseer

Diseases 2025, 13(5), 136; https://doi.org/10.3390/diseases13050136 - 29 Apr 2025

Viewed by 521

Abstract

Background: While heart failure with reduced ejection fraction (HFrEF) remains a major global health burden, mesenchymal stem cell (MSC) therapy has emerged as a promising intervention designed to improve cardiac function and reduce morbidity among patients unresponsive to conventional treatments. MSC therapy has [...] Read more.

Background: While heart failure with reduced ejection fraction (HFrEF) remains a major global health burden, mesenchymal stem cell (MSC) therapy has emerged as a promising intervention designed to improve cardiac function and reduce morbidity among patients unresponsive to conventional treatments. MSC therapy has shown promise by targeting left ventricular pressure and improving wall thickness, contributing to reductions in HF-related morbidity and mortality rates. This systematic review and meta-analysis bridges a gap in current research through a focused examination of the most recent clinical trials to cohesively assess MSC therapy in HFrEF patients. Methods: We conducted a systematic review and meta-analysis of clinical trials published from 2018 onwards, which were obtained from multiple databases such as PUBMED, Scopus, EBSCO Medline, EBSCO CINAHL Science Direct, and the Cochrane Library. This review investigates the efficacy and safety outcomes of MSC therapy in patients above 18 years of age with a known diagnosis of heart failure with a reduced ejection fraction (HFrEF). The primary outcome was the change in the left ventricular ejection fraction (LVEF). Secondary outcomes encompassed several efficacy outcomes, such as Global Circumferential strain (GCS), the 6-Minute Walk Test (6MWT), Quality of Life (QoL), and major adverse cardiac events (MACE). A PRISMA flow diagram was constructed to illustrate the identification, screening, eligibility, and inclusion of studies at each stage of the review process. Results: A total of 330 studies were initially identified, but only 12 met the inclusion criteria. MSC therapy resulted in a small, non-significant improvement in LVEF (Hedges’ g = 0.096, p = 0.18) with low heterogeneity (I² = 0.5%). Only QoL showed significant improvement (Hedges’ g = −0.518, p = 0.01). No significant changes in other efficacy outcomes were observed. The therapy was not associated with an increased risk of MACE. Conclusion: While MSC therapy was safe and improved QoL for HFrEF patients, it did not significantly improve LVEF or other efficacy outcomes. Further large-scale, standardized trials are required to better understand the potential role of MSCs in heart failure (HF) therapy. Full article

(This article belongs to the Section Cardiology)

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10 pages, 638 KiB

Open AccessArticle

Minimally Invasive Versus Full Sternotomy Approaches in Mitral Valve Surgery for Infective Endocarditis: A Retrospective Comparative Analysis

by Elisa Mikus, Mariafrancesca Fiorentino, Diego Sangiorgi, Antonino Costantino, Simone Calvi, Elena Tenti, Elena Tremoli, Alberto Tripodi and Carlo Savini

Diseases 2025, 13(5), 135; https://doi.org/10.3390/diseases13050135 - 28 Apr 2025

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Abstract

Background: This study evaluates the outcomes of isolated mitral valve surgery for infective endocarditis performed via conventional full sternotomy or minimally invasive right minithoracotomy. While minimally invasive surgery (MIS) is well-established for elective mitral procedures, its role in infective endocarditis remains less explored [...] Read more.

Background: This study evaluates the outcomes of isolated mitral valve surgery for infective endocarditis performed via conventional full sternotomy or minimally invasive right minithoracotomy. While minimally invasive surgery (MIS) is well-established for elective mitral procedures, its role in infective endocarditis remains less explored due to the complexity of the disease. Methods: A retrospective analysis of 134 patients who underwent isolated mitral valve surgery for infective endocarditis between January 2010 and March 2024 was conducted. Patients were divided into two groups based on the surgical approach: full sternotomy (n = 94) and MIS via right minithoracotomy (n = 40). Variables analyzed included preoperative characteristics, intraoperative details, and postoperative outcomes, such as mortality, complications, and hospital stay duration. Given significant baseline differences, inverse probability weighting was applied for comparability. Results: Mitral valve replacement was performed in 77% of cases. After adjustment, the MIS group demonstrated shorter intensive care unit stays (p = 0.018), with no significant differences in in-hospital mortality (p = 0.145) or total hospitalization length (p = 0.151). Conclusions: Minimally invasive mitral valve surgery is a safe and effective alternative to sternotomy in infective endocarditis, offering comparable outcomes with shorter ICU stays. Further research is needed to refine patient selection and validate these findings. Full article

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30 pages, 2473 KiB

Open AccessReview

Sarcopenia in Rheumatic Diseases: A Hidden Issue of Concern

by Eleni C. Pardali, Markos Klonizakis, Dimitrios G. Goulis, Sousana K. Papadopoulou, Christos Cholevas, Constantinos Giaginis, Christina Tsigalou, Dimitrios P. Bogdanos and Maria G. Grammatikopoulou

Diseases 2025, 13(5), 134; https://doi.org/10.3390/diseases13050134 - 26 Apr 2025

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Abstract

Sarcopenia is characterized by a loss of muscle mass and function, with significant implications for the physical performance of the affected people. Although commonly associated with aging, disease-related sarcopenia is of great clinical importance, particularly as it impacts disease progression and outcomes. Individuals [...] Read more.

Sarcopenia is characterized by a loss of muscle mass and function, with significant implications for the physical performance of the affected people. Although commonly associated with aging, disease-related sarcopenia is of great clinical importance, particularly as it impacts disease progression and outcomes. Individuals with rheumatic diseases (RDs), including rheumatoid arthritis, systemic sclerosis, spondyloarthritides, systemic lupus erythematosus, fibromyalgia, myositis, or vasculitis, exhibit a high prevalence of sarcopenia, which exacerbates their clinical symptoms and contributes to poorer disease outcomes. Chronic inflammation influences muscle tissue degradation, causing a decline in physical performance. Apart from the apparent clinical manifestations, patients with RDs also use pharmacological treatments that negatively impact muscle mass further, increasing the risk of sarcopenia. Nutrition (diet and dietary supplements) and exercise interventions have been recommended as protective measures for sarcopenia as they may mitigate its adverse events. The present narrative review seeks to explore the methods used to assess sarcopenia in patients with RDs, its prevalence among them, and the challenges faced by the affected individuals, while critically assessing the appropriateness and limitations of current sarcopenia assessment tools in the context of RDs. Full article

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15 pages, 1141 KiB

Open AccessCase Report

Clinical Heterogeneity of Early-Onset Autoimmune Gastritis: From the Evidence to a Pediatric Tailored Algorithm

by Ivan Taietti, Martina Votto, Riccardo Castagnoli, Mirko Bertozzi, Maria De Filippo, Antonio Di Sabatino, Ombretta Luinetti, Alessandro Raffaele, Alessandro Vanoli, Marco Vincenzo Lenti, Gian Luigi Marseglia and Amelia Licari

Diseases 2025, 13(5), 133; https://doi.org/10.3390/diseases13050133 - 25 Apr 2025

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Abstract

Autoimmune gastritis (AIG) is an uncommon and often underestimated condition in children, characterized by chronic stomach inflammation leading to the destruction of oxyntic glands with subsequent atrophic and metaplastic changes. This condition is associated with hypo-/achlorhydria, impairing iron and vitamin B12 absorption. The [...] Read more.

Autoimmune gastritis (AIG) is an uncommon and often underestimated condition in children, characterized by chronic stomach inflammation leading to the destruction of oxyntic glands with subsequent atrophic and metaplastic changes. This condition is associated with hypo-/achlorhydria, impairing iron and vitamin B12 absorption. The pathogenesis involves the activation of helper type 1 CD4+/CD25-T-cells against parietal cells. Clinical manifestations in children are not specific and include abdominal pain, bloating, nausea, vomiting, and iron deficiency anemia (IDA). The disease is also linked to an increased risk of pernicious anemia, intestinal-type gastric cancer, and type I neuroendocrine tumors. AIG is often diagnosed through the presence of autoantibodies in the serum, such as parietal cell (APCA) and intrinsic factor (IF) antibodies. However, therapeutic recommendations for pediatric AIG are currently lacking. We aim to present two clinical cases of pediatric-onset AIG, highlighting the heterogeneous clinical manifestations and the challenges in diagnosis with the support of an updated literature review. A 9-year-old girl presented with refractory IDA, initial hypogammaglobulinemia, and a 12-year-old boy was initially diagnosed with eosinophilic esophagitis. Both cases underline the importance of considering AIG in children with chronic gastrointestinal symptoms and gastric atrophy. Diagnostic workup, including endoscopy and serological tests, is crucial for accurate identification. A better understanding of this condition is imperative for timely intervention and regular monitoring, given the potential long-term complications, including the risk of malignancy. These cases contribute to expanding the clinical spectrum of pediatric AIG and highlight the necessity for comprehensive evaluation and management in affected children. Full article

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16 pages, 2859 KiB

Open AccessArticle

Beneficial Effects of White Grape Pomace in Experimental Dexamethasone-Induced Hypertension

by Raluca Maria Pop, Paul-Mihai Boarescu, Corina Ioana Bocsan, Mădălina Luciana Gherman, Veronica Sanda Chedea, Elena-Mihaela Jianu, Ștefan Horia Roșian, Ioana Boarescu, Floricuța Ranga, Maria Doinița Muntean, Maria Comșa, Sebastian Armean, Ana Uifălean, Alina Elena Pârvu and Anca Dana Buzoianu

Diseases 2025, 13(5), 132; https://doi.org/10.3390/diseases13050132 - 24 Apr 2025

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Abstract

Background: Grape pomace (GP), a by-product of winemaking, is a rich source of bioactive polyphenols known for their antioxidant and anti-inflammatory properties. While the cardiovascular benefits of red grape pomace have received significant scientific attention, the therapeutic potential of white grape pomace remains [...] Read more.

Background: Grape pomace (GP), a by-product of winemaking, is a rich source of bioactive polyphenols known for their antioxidant and anti-inflammatory properties. While the cardiovascular benefits of red grape pomace have received significant scientific attention, the therapeutic potential of white grape pomace remains largely unexplored, particularly in glucocorticoid-induced hypertension. Given the rising prevalence of hypertension and the oxidative-inflammatory mechanisms underlying its progression, this study investigates the effects of white GP on blood pressure regulation, oxidative stress, and pro-inflammatory cytokine expression in an experimental model of dexamethasone (DEXA)-induced hypertension (HTN). By focusing on white GP, this research addresses a significant gap in current knowledge and proposes a novel, sustainable approach to managing hypertension through valorising winemaking by-products. Methods: The first concentration used, GP1, was 795 mg polyphenols/kg bw, while the second concentration, GP2, was 397.5 mg polyphenols/kg bw. Results: White GP polyphenols extract in the DEXA_GP1 group had reduced systolic and diastolic blood pressure. The extract with a higher content of polyphenols (GP1) prevented the elevation of serum levels of total oxidative stress (TOS), malondialdehyde (MDA), and oxidative stress index (OSI), while the extract with a lower content of polyphenols (GP2) slightly reduced serum levels of MDA. Both concentrations of GP increased serum levels of NO and Total Thiols, significantly higher (p < 0.05) than in the group treated with lisinopril. The serum levels of tumour necrosis factor-alpha (TNF-α) increased in all groups where HTN was induced. Both doses of GP extract prevented the elevation of TNF-α. Heart tissue levels of the studied cytokines (TNF-α, interleukin (IL)-1β, and IL-6 were not influenced (p > 0.05) by either the HTN induction or the treatment administered. Conclusions: These findings suggest that grape pomace may serve as a promising nutraceutical intervention for hypertension management, particularly in conditions associated with oxidative stress. Full article

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Diseases, Volume 13, Issue 5 (May 2025) – 35 articles

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