Clinics and Practice

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients’ quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, cannulation pain, and hygiene concerns can affect patient satisfaction. Aim: We aimed to evaluate patient satisfaction with vascular access and to identify the clinical and sociodemographic factors influencing this satisfaction. Methods: We conducted a multicenter cross-sectional study on 235 hemodialysis patients in Italy. Satisfaction was assessed using the Short Form Vascular Access Questionnaire (SF-VAQ). Clinical and sociodemographic data were collected and analyzed with descriptive statistics, correlations, and multivariate regression models. Results: Satisfaction was significantly influenced by local complications, perceived hygiene, and access duration. Lower satisfaction was reported by patients with swelling, bruising, or negative hygiene perceptions. Longer use of the access was also associated with declining satisfaction. Conclusions: Patient satisfaction involves both clinical outcomes and patient perceptions. The integration of patient-reported outcomes (PROs) into vascular access management can help clinicians identify early dissatisfaction and implement interventions that can improve treatment adherence and quality of life. Full article

Aims: The purpose of this study was to evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours (PNETs) at a UK tertiary centre. The secondary aims included identifying prognostic clinicopathological factors that influenced survival. Methods: Patients undergoing curative-intent surgical resection for PNETs between August 2010 and March 2024 were retrospectively reviewed. The data collated included demographics, histopathology, recurrence, and survival outcomes. Results: Eighty-six patients were included, with a median age of 61.5 years (IQR: 50–71) and an equal sex distribution. Most tumours were solitary (88.4%) and located in the pancreatic tail (57%), with distal pancreatectomy performed in 75% of cases. The median tumour size was 25 mm (IQR: 13–40). Lymph node metastases were observed in 23.3% of patients, and R0 resection was achieved in 67%. Most of the PNETs resected were WHO grade 1 tumours (65.1%), followed by grade 2 tumours (26.7%). Postoperative morbidity occurred in 37.2% of cases, while the 30-day postoperative mortality rate was 1.5%. Recurrence was observed in 13.95% of patients, with a median time to recurrence of 36.3 months. The 5-year overall survival (OS) was 83.0%, with a median OS and disease-free survival (DFS) of 143.3 months and 147.0 months, respectively. Multivariable analysis revealed that poorer DFS was associated with larger tumours (p = 0.009), higher tumour grade (p = 0.006), male sex (p = 0.039), vascular invasion (p = 0.003), perineural invasion (p = 0.042) and lymph node metastases (p = 0.015). OS was significantly influenced by the Charlson Comorbidity Index (p < 0.001) and tumour grade (p = 0.025). Conclusions: PNETs are associated with excellent long-term survival following curative-intent resection. However, adverse pathological features are linked to an increased risk of recurrence and a poorer prognosis. Full article

Background/Objectives: Sleep disturbances are among the most prevalent and persistent comorbidities in children and adolescents with autism spectrum disorder (ASD), affecting up to 83% of this population. These disturbances not only impact the quality of life but are increasingly recognized as significant contributors to behavioral dysregulation. Methods: This systematic review synthesizes evidence from 26 studies published between 2010 and 2024, examining the association between sleep problems and behavioral outcomes in individuals with ASD aged 2 to 18 years. Results: The findings reveal consistent associations between sleep-onset insomnia, night walking, bedtime resistance, and various behavioral difficulties, including aggression, hyperactivity, and emotional dysregulation. Internalizing symptoms and exacerbation of core ASD features were also linked to chronic sleep problems. Studies employing objective sleep measures, such as actigraphy and polysomnography, further supported these associations by identifying disruptions in sleep architecture correlated with behavioral severity. While most included studies were of moderate to high methodological quality, the limited number of randomized controlled trials and heterogeneity of sleep and behavior assessment tools highlight the need for standardization. Conclusions: Overall, the review emphasizes the importance of routine sleep evaluation in ASD clinical care and supports targeted sleep interventions as a potential strategy to reduce behavioral problems and improve developmental outcomes. Full article

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient’s medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies. Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel. Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased. Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data. Full article

Background: Burnout among healthcare professionals is increasingly recognized as a syndrome with biological correlations. Beyond psychosocial factors, circadian misalignment, sleep disturbances, and hormonal dysregulation—particularly involving melatonin and cortisol—are emerging as relevant mechanisms. Methods: We systematically reviewed studies published between 2015 and 2025 examining associations between burnout, melatonin, circadian disruption, sleep quality, and related biomarkers in healthcare workers. Results: Across 14 included studies, burnout was associated with suppressed melatonin secretion, cortisol dysregulation, and circadian misalignment, including social jet lag and poor sleep quality. Night-shift nurses consistently displayed greater circadian disruption and higher burnout scores than day-shift colleagues. Evidence also suggests that environmental and interventional approaches—such as optimizing daylight exposure and melatonin supplementation to improve sleep quality and cognitive performance—may mitigate circadian disruption and occupational fatigue. Conclusions: Burnout should be recognized as a biopsychosocial syndrome with measurable chronobiological correlates. Future research should integrate circadian biomarkers into occupational health assessments and evaluate preventive strategies aimed at preserving circadian health in healthcare professionals. Full article

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. Methods: We collected data from 103 patients, with 8 patients lost to follow-up, who were diagnosed with vertebral osteomyelitis, disk infection or discitis between 2009 and 2018. The primary outcome was the 1-year mortality rate in patients treated with either conservative or surgical intervention, with both groups receiving antibiotic treatment. A standardized questionnaire was used to assess health-related quality of life after treatment by evaluating the European Quality of Life 5 Dimension 5 Level version (EQ-5D-5L) and the European Quality of Life Visual Analog Scale (EQ-VAS). In addition, we used the Oswestry Disability Index (ODI) and the Parker Mobility Score to identify backpain-related limitations after treatment. Results: The group receiving surgical treatment had a significantly lower 1-year mortality rate (22%) than did those who were treated conservatively, who had a 4-fold greater risk for death after a year following first diagnosis of SD and treatment. With respect to quality of life, 39 patients answered the standardized questionnaires during follow-up, and the questionnaire results revealed no significant difference in limitations in daily life or in health-related quality of life, with a median Parker Mobility Score of 9 for the conservatively treated patients compared with 7.5 for the surgically treated patients. This difference between the groups was not statistically significant, with a p value of 0.216 > α. A similar result was obtained in the evaluation of the ODI, with a medial index of 30% in the conservatively treated group compared with 24% in the surgical group, which was not statistically significant as indicated by a p value of 0.360 > α. Conclusions: The early surgical approach when treating spondylodiscitis is advantageous for identifying the underlying infection and initiating appropriate antibiotic therapy, therefore reducing mortality and resulting in a greater likelihood of full recovery than the conservative treatment does. Full article

Background and objectives: Numerous studies and meta-analyses have established the efficacy of telemonitoring for blood pressure and other components of metabolic syndrome in improving disease management. Nevertheless, the adoption of telemonitoring technologies is often hindered by personal, technological, and systemic barriers. In Slovakia, where patient–physician contact rates are high, there is limited research on patients’ perspectives regarding telemedicine adoption for cardiovascular risk management. The objective of this study was to examine patients’ perspectives on and perceived obstacles to the use of telemonitoring for arterial hypertension and dyslipidemia in Slovakia. Methods: This cross-sectional, questionnaire-based survey targeted a cohort of 18,053 patients. The survey instrument was designed to gather data on several key areas: patient demographic characteristics, blood pressure measurement habits, the utilization of smart technologies, perceived benefits and barriers to telemonitoring, and patients’ knowledge of their lipid profiles and cardiovascular risk factors. Statistical analysis included chi-square tests, ANOVA, and effect size calculations with 95% confidence intervals (CI). Results: A total of 1787 patient responses (9.9%) were collected. Among the respondents, 67.4% (n = 1204) had arterial hypertension, while 7.9% (n = 95) were on non-pharmacological therapy. Only 21.2% (n = 255) of hypertensive patients measured their blood pressure daily, with a significantly higher proportion of men than women (28.6% vs. 12.7%, p = 0.011, Cohen’s d = 0.42). The most frequent users of blood pressure monitoring were in the 31–45 age group (p = 0.001, η² = 0.08). A total of 19.4% (n = 347) of respondents used wearable devices, and 6.3% (n = 113) used blood pressure monitors connected to an application. Smart technology use was significantly more common in the 31–45 age group (p = 0.01, Cramer’s V = 0.15). Moderate interest in telemedicine was expressed by 69.8% (n = 1247) of respondents, though only 27.4% (n = 490) showed strong interest. The majority of patients (73.8%, n = 1319) did not know their LDL-C levels, and 45.7% (n = 817) of those who did had elevated levels. Conclusions: The findings suggest that while interest in telemedicine methods for the management of arterial hypertension and dyslipidemia exists among Slovak patients, it is more moderate than initially assumed. Importantly, expressed willingness to participate in a study should not be directly equated with readiness to adopt new technologies in daily practice. Successful integration of telemonitoring into the Slovak healthcare system will therefore require not only patient engagement but also active support from healthcare providers to overcome practical and motivational barriers. These findings highlight the need for targeted implementation strategies that address the specific barriers identified in the Central and Eastern European healthcare context. Full article

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among healthcare professionals. This study aimed to identify knowledge gaps regarding and evaluate attitudes toward UTx among Hungarian obstetricians/gynecologists and transplantation providers, in anticipation of the first procedure to be performed in the country. Methods: A Microsoft Forms^® questionnaire was distributed electronically among Hungarian medical professionals via e-mail, including members of the Hungarian Society of Obstetrics and Gynaecology and the Hungarian Transplantation Society. Additionally, participants of the “Update 2024” OB/GYN conference (held 28–29 November 2024, in Visegrád, Hungary) were invited to complete the survey through a QR code displayed during the event. Results: A total of 290 medical professionals completed the survey (response rate: 27.6%, 290/1050). Most of the respondents specialized in obstetrics and gynecology (81.7%, n = 237), with the remainder representing transplantation fields (18.3%, n = 53). Over half (56.6%, n = 161) reported they would recommend UTx to patients with AUFI, and 64.1% (n = 186) agreed that UTx should be available as a treatment option. The medical risks associated with the procedure were deemed acceptable for both living donors (58.0%, n = 168) and recipients (54.8%, n = 159). Conclusions: This is the first study to explore perceptions of UTx among Hungarian medical professionals. The findings suggest there is a generally favorable professional attitude toward its future clinical implementation. Full article

Background: Achieving low-density lipoprotein cholesterol (LDL-C) goals is essential for secondary prevention after atherosclerotic ischemic stroke or transient ischemic attack (TIA). This study assessed the prevalence of LDL-C goal attainment and identified associated determinants post-ischemic stroke/TIA. Methods: A cohort of Thai patients discharged on statin therapy after admission with acute ischemic stroke or TIA was evaluated for LDL-C goal attainment within 12 months post-discharge. Logistic regression determines factors associated with LDL-C goal attainment, and the generalized linear model confirmed the association between covariates and LDL-C reduction. Results: Among 487 patients (85.8% with ischemic stroke), the prevalence of LDL-C goal attainment differed across LDL-C target levels: 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction from baseline. Logistic regression identified high-intensity statins as a significant predictor of goal attainment at <70 mg/dL (OR 1.91, 95% CI 1.09–3.34), <100 mg/dL (OR 1.64, 95% CI 1.01–2.67), and ≥50% reduction (OR 2.32, 95% CI 1.14–4.73), but not <55 mg/dL (OR 1.65, 95% CI 0.72–3.79). In the generalized linear model, high-intensity statin and baseline LDL-C were significant determinants of LDL-C reduction. Conclusions: LDL-C target attainment after ischemic stroke/TIA is modest overall, and remains low for the more stringent targets (<55 mg/dL). High-intensity statins improve goal attainment and produce greater LDL-C reductions, supporting wider use of more aggressive lipid-lowering strategies in this high-risk population. Full article

Background/Objectives: Recently, epigenetic mechanisms have been recognized as crucial in atopic dermatitis development. The emphasis of this research was on expanding existing knowledge about the epigenetic aspects of atopic dermatitis, as well as identifying new molecules that could serve as disease biomarkers. Methods: The research was conducted as a cross-sectional study examining two groups: the group with atopic dermatitis (50 patients) and the control group (50 healthy adults). The serum levels of total immunoglobulin E (IgE) and eosinophil count (Eos%) were performed in routine laboratory analyses, and the detection of microRNAs from peripheral blood was performed using RT-PCR. Results: Analysis of selected miRNA expressions in patients with atopic dermatitis and controls revealed that only the expression and the relative expression of miRNA-146a were statistically significantly higher in patients with atopic dermatitis than in the control group (p = 0.042 and p = 0.021, respectively). There was a weak positive correlation between miRNA-146a expression and the eosinophilia/IgE level (r = 0.22 and r = 0.25, respectively). MiRNA-21, miRNA-29b, miRNA-143 and miRNA-223 were significantly upregulated in patients with higher SCORAD (p < 0.001, p < 0.001, p < 0.001 and p = 0.015, respectively). ROC curve analysis revealed the specificity of miRNA-146a as 82% and the sensitivity as 62%. The area under the ROC curve (AUC) was 0.7, indicating its diagnostic potential. Conclusions: Our findings imply that miRNA-146a might serve as a biomarker of atopic dermatitis, suggesting its relevance in the development of the disease, while miRNA-21, miRNA-29b, miRNA-143 and miRNA-223 may have an impact on disease progression. Our findings provide a preliminary basis that should precede validation through larger, multicentric studies and use in diagnostics, targeted personalized treatments and monitoring of treatment efficacy in atopic dermatitis. Full article

Objectives: Evaluate the agreement and interobserver variability between manual segmentation and the ellipsoid formula in estimating single kidney volume (SKV) in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: In this retrospective study, 130 unenhanced CT scans of ADPKD kidneys were analyzed. Three radiologists (one senior, two juniors) measured SKV using manual segmentation and the ellipsoid formula. Statistical analyses included intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland–Altman analysis, and paired t-tests to compare measurement values and computation times. Results: Both methods showed excellent interobserver agreement (ICC ≥ 0.977). No significant difference was observed in volume estimates between the two techniques (Wilcoxon p = 0.295). Bland–Altman analysis confirmed strong agreement between methods for the senior radiologist. The ellipsoid method was significantly faster for all readers (p < 0.05). Conclusions: The ellipsoid formula is a reliable, time-efficient alternative to manual segmentation for SKV estimation in ADPKD, offering comparable accuracy with reduced resource demands in clinical settings. Full article

Background: The number of publications related to rivaroxaban is growing, making it difficult for scientists to review relevant materials. Objectives: This bibliometric analysis is focused on highlighting hot spots and new trends associated with rivaroxaban studies and provides references and guidance for further research. Methods: A comparison between countries, journals, authors, and organizations was performed. Microsoft Excel 2021 and VOSviewer were used to process and visualize data extracted from Web of Science. The time range was set from 1991 to late 2024. A total of 6979 articles were analyzed and bibliometric maps of co-citations of references and co-occurrences of the keywords were built. Results: Relative research interest increased until 2021, when it started to drop. The new trends in publications related to rivaroxaban are associated with a comparison of NOAC therapy outcomes with previously used vitamin K antagonists (warfarin). The research was focused also on new NOAC representatives, medical conditions treated with NOAC, and safety of the therapy. New trending topics are related to ABCB1, peripheral artery disease, direct-acting oral anticoagulants, PCI, and SARS-CoV-2. Conclusions: This bibliometric analysis showed that increasing attention is being paid to the medical conditions treated with NOACs and issues related to the safety of this therapy. Full article

During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues arising in one organ will disrupt this fundamental balance, inevitably involving all associated organs. The purpose of this review is to gather all possible nephrological conditions that may arise during pregnancy, as well as pre-existing conditions that may become apparent or worsen during this period. This review describes the natural history, treatment, and impact of these conditions on pregnancy itself. Among the most common conditions are preeclampsia and HELLP syndrome, severe complications characterized by hypertension, proteinuria, and multiorgan damage that require immediate clinical attention. Additionally, women with chronic kidney disease are at higher risk of developing maternal–fetal complications, such as preterm birth and intrauterine growth restriction. Common causes of acute renal failure are also analyzed, including thrombotic microangiopathy, acute fatty liver of pregnancy, acute onset or flare of systemic lupus erythematosus, and catastrophic antiphospholipid antibody syndrome. Given the importance of proper renal function during pregnancy, it is essential to have a thorough understanding of nephrological diseases that may affect this phase of women’s lives. This knowledge is crucial for managing these conditions effectively to avoid risks to the survival of both the mother and the newborn. Full article

Background/Objectives: Coagulopathy is a common complication of liver cirrhosis, partly due to impaired synthesis of vitamin K-dependent coagulation factors. Despite its frequent use, the efficacy of vitamin K in this setting remains uncertain. This study aimed to evaluate the effect of vitamin K administration on coagulation parameters in patients with cirrhosis. Methods: We performed a retrospective study of 122 cirrhotic patients hospitalized between 2020 and 2024, who received vitamin K for coagulopathy correction. Coagulation and liver function parameters were monitored over time. Results: An early and progressive improvement in INR values was observed, in a subset of patients, following vitamin K administration. INR values across time points were strongly correlated, while only weak associations were observed with bilirubin levels. These findings support a selective therapeutic effect, rather than universal efficacy. Discussion: Despite current guidelines discouraging routine vitamin K use in cirrhosis, our findings suggest that selected patients—particularly those with reversible deficiency—may benefit from supplementation. The observed decrease in INR values supports a targeted, context-based approach rather than empirical management. Conclusions: However, due to the retrospective design and absence of a control group, the observed improvements cannot be conclusively attributed to vitamin K administration. Vitamin K may improve coagulation in cirrhotic patients with reversible deficiency, but its efficacy is not universal. Its use should be individualized and guided by clinical and biochemical context, as part of a broader treatment strategy. Full article

Background: The clinical characteristics of patients who have a first episode of congestive heart failure (CHF) may have changed in recent years. Methods: A retrospective cohort study was performed on 19,796 patients discharged from medical departments with a diagnosis of CHF between 1 January 2000 and 31 December 2022. Data were drawn from two data sets of the Minimum Basic Data Set-Hospital Data Set (MBDS) of the Lucus Augusti University Hospital (Spain): hospitalizations and patients. Patient characteristics (including the period of their first admission) and the association rules between diseases determined using the Apriori algorithm were studied in five consecutive time periods. Results: The general characteristics of patients on first admission for CHF changed over time. There were increases in mean age (75.9 ± SD 11.2 vs. 81.6 ± SD 11.5 years; p < 0.0001), the proportion of women (48.3% vs. 51.4; p = 0.0001), the number of acute diseases (1.1 ± SD 1.4 to 2.7 ± SD 2.5; p < 0.0001), and the number of chronic diseases (3.6 ± SD 1.9 to 6.5 ± SD 2.6); p < 0.001). Accordingly, the median number of diagnoses (from 3 to 7) and itemsets per patient increased (mean number of items 1.75 vs. 3.4; p < 0.0001), and the associations of diseases leading to CHF became more complex. Conclusions: This single-center study shows that in the last two decades, the characteristics of patients with a first hospital admission for CHF have changed. Patients are older, there is a predominance of women, and they have a greater number of acute and chronic concomitant diseases, making their clinical management more difficult. Full article

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: This monocentric study aims to compare the practices regarding vitamin D supplementation before and after the introduction of a nutrition protocol (NP). Methods: We retrospectively analyzed vitamin D administration (time from PICU admission to initiation, amount of supplementation, accordance with existing guidelines) in children aged 0 to 16 who were admitted to the PICU of Lausanne University Hospital for more than 48 h the year before and the year after the introduction of a NP. Results: Vitamin D supplementation increased after NP introduction (95 IU per day more, p < 0.0001). More patients received vitamin D during their stay (95% after vs. 77% before, p < 0.0001). The dose adhered to NP recommendations for children under 12 and was higher for older children. According to Swiss guidelines for the general pediatric population, vitamin D supplementation was accurate in children under one year old before and after NP implementation. However, it was less than recommended for patients over one year old. Conclusions: The implementation of a NP significantly enhanced the scope of vitamin D supplementation. This study also highlights the practical limitations in meeting the recommended requirements with certain galenic formulations. Full article

Background: Granulomatous mastitis (GM) is a rare, chronic inflammatory breast condition with poorly understood etiology and variable clinical presentation. The efficacy of corticosteroid therapy in reducing recurrence remains controversial, particularly in Middle Eastern populations where the condition appears more prevalent. This study aimed to describe the demographic and clinical characteristics of patients with GM, evaluate the efficacy of corticosteroid therapy in reducing recurrence rates, and identify risk factors associated with disease recurrence. Methods: A retrospective cohort analysis was conducted on 56 patients diagnosed with GM between 2003 and 2020 at a single tertiary referral center. Patients were stratified into two groups based on steroid use (n = 14 with steroids and n = 42 without steroids). Results: The mean age of the cohort was 46.3 ± 13.2 years, with no significant differences in baseline characteristics between the steroid and non-steroid groups. The most common presentation was a breast mass (32.69%), often associated with abscess formation (25%). Core biopsy was the primary diagnostic tool used (51.79%). Recurrence of GM occurred in 10 patients (18%) overall: 7 patients (17%) in the non-steroid group and 3 patients (21%) in the steroid group. The difference in recurrence rates between the treatment groups was not statistically significant (HR = 1.40, 95% CI:0.30–6.52, p = 0.671). A history of infection (HR = 5.85, 95% CI: 1.60–21.44, p = 0.008) and hormonal disorders (hyperprolactinemia in one patient) (HR = 13.90, 95% CI: 1.43–135.52, p = 0.024) were significantly associated with recurrence. Conclusions: GM remains diagnostically challenging with an 18% recurrence rate in our cohort. We observed no statistically significant reduction in recurrence with corticosteroids, though our analysis was limited by sample size. These findings suggest that targeted management of these conditions may be beneficial in GM patients, though larger multicenter studies are needed to confirm these associations and establish standardized treatment protocols. Full article