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Protective Effect of Daily Physical Activity Against COVID-19 in a Young Adult Population on Reunion Island

Journal Description

Medical Sciences

Medical Sciences is an international, peer-reviewed, open access journal, providing a platform for advances in basic, translational and clinical research, published quarterly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, MEDLINE, CAPlus / SciFinder, and other databases.
Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 24.3 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Sections: published in 12 topical sections.

Impact Factor: 4.4 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2076-3271

Latest Articles

11 pages, 1205 KiB

Open AccessArticle

Impact of Catheter Ablation on Functional Capacity and Cardiac Stress Markers in Patients with Premature Ventricular Contractions

by Vasileios Cheilas, Athanasios Dritsas, Antonios Martinos, Evangelia Gkirgkinoudi, Giorgos Filandrianos, Anastasios Chatziantoniou, Ourania Kariki, Panagiotis Mililis, Athanasios Saplaouras, Anna Kostopoulou, Konstantinos Letsas and Michalis Efremidis

Med. Sci. 2025, 13(3), 95; https://doi.org/10.3390/medsci13030095 - 23 Jul 2025

Background: Premature ventricular contractions (PVCs) are common arrhythmias associated with symptoms such as fatigue and, in severe cases, PVC-induced cardiomyopathy. Catheter ablation (CA) is a primary treatment for symptomatic PVCs, particularly when pharmacological therapies fail or are undesired. While improvements in: quality-of-life following [...] Read more.

Background: Premature ventricular contractions (PVCs) are common arrhythmias associated with symptoms such as fatigue and, in severe cases, PVC-induced cardiomyopathy. Catheter ablation (CA) is a primary treatment for symptomatic PVCs, particularly when pharmacological therapies fail or are undesired. While improvements in: quality-of-life following ablation are documented, its impact on functional capacity remains underexplored. Objectives: This study evaluated the impact of CA on functional capacity and cardiac stress markers in patients with symptomatic PVCs using cardiopulmonary exercise testing (CPET) and NT-proBNP levels. Methods: A total of 30 patients underwent successful PVC ablation and completed baseline and follow-up CPET evaluations under the Bruce protocol. PVC burden, left ventricular ejection fraction (LVEF), NT-proBNP levels, and CPET parameters, including VO₂ max, METS, ventilatory efficiency, and anaerobic threshold (AT), were analyzed pre- and post-ablation. Results: PVC burden significantly decreased post-ablation (23,509.3 ± 10,700.47 to 1759 ± 1659.15, p < 0.001). CPET revealed improved functional capacity, with VO₂ max increasing from 24.97 ± 4.16 mL/kg/min to 26.02 ± 4.34 mL/kg/min (p = 0.0096) and METS from 7.16 ± 1.17 to 7.48 ± 1.24 (p = 0.0103). NT-proBNP significantly decreased (240.93 ± 156.54 pg/mL to 138.47 ± 152.91 pg/mL, p = 0.0065). LVEF and ventilatory efficiency metrics (VE/VO₂ and VE/VCO₂) remained stable. Conclusions: Catheter ablation improves functional capacity, reduces cardiac stress, and minimizes medication dependency in patients with symptomatic PVCs. These findings support the utility of ablation in enhancing aerobic capacity and overall exercise performance. Full article

(This article belongs to the Section Cardiovascular Disease)

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12 pages, 218 KiB

Open AccessArticle

The Role of an Educational Program in Reducing Symptom Severity in Women with High Risk for Carpal Tunnel Syndrome

by Amira Elhoufey

Med. Sci. 2025, 13(3), 94; https://doi.org/10.3390/medsci13030094 - 22 Jul 2025

Aim: This study aimed to assess the effect of educational programs on symptom severity for women at high risk of carpal tunnel syndrome (CTS). Methods: A quasi-experimental design was applied. A purposive sample of 250 women at high risk of CTS was [...] Read more.

Aim: This study aimed to assess the effect of educational programs on symptom severity for women at high risk of carpal tunnel syndrome (CTS). Methods: A quasi-experimental design was applied. A purposive sample of 250 women at high risk of CTS was selected from the Faculty of Nursing, Assiut University, Egypt. Data collection instruments included a structured interview questionnaire and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: Most participants were middle-aged (41–50 years), married, and had higher education. At baseline, 61.2% of participants reported mild symptoms, 24.8% moderate, and 11.6% were asymptomatic. Following the educational program, symptom severity was significantly improved (p = 0.007). The proportion of asymptomatic participants increased from 11.6% to 20.4%, while those with moderate symptoms decreased from 24.8% to 6.4%. Functional status also improved significantly, with the percentage of participants reporting no difficulty increasing from 17.6% to 30% (p = 0.008). We found a significant reduction in symptom severity scores (p = 0.05) and functional impairment (p = 0.008). Conclusions: The educational program effectively reduced CTS symptoms and improved hand function, demonstrating its potential as a preventive and therapeutic intervention for women at high risk of CTS. However, this study’s quasi-experimental design without a control group and a short follow-up period limits conclusions regarding long-term effectiveness and causal inference. Full article

(This article belongs to the Section Nursing Research)

21 pages, 913 KiB

Open AccessArticle

An Innovative Strategy for Sustainability Assurance in Orthopedic Surgery

by Flaviu Moldovan and Liviu Moldovan

Med. Sci. 2025, 13(3), 93; https://doi.org/10.3390/medsci13030093 - 22 Jul 2025

Background/Objectives: Due to the aging population, orthopedics has become the surgical field with the fastest and greatest growth, and health systems must therefore ensure the sustainable development of this field. The objective of this study is to identify the key areas and the [...] Read more.

Background/Objectives: Due to the aging population, orthopedics has become the surgical field with the fastest and greatest growth, and health systems must therefore ensure the sustainable development of this field. The objective of this study is to identify the key areas and the most relevant activities for sustainability assurance in orthopedic surgery, as well as appropriate evaluation tools. Methods: Consisted in designing the key areas for sustainable surgery and evaluating them with the support of new indicators. These areas are based on the most current and relevant practices reported by hospitals around the world. This process was followed by practical validation in an orthopedic hospital. Results: Four key areas were revealed: rationalization and reduction of consumption, correct separation and recycling of waste, reuse of textiles and equipment, and anesthetics and alternative interventions. The indicators for the evaluation of these areas were developed with the support of results reported in international studies. Each indicator has five levels of fulfilment. Their importance is evaluated on a scale from 1 to 5. Conclusions: The practical implementation at an orthopedic emergency hospital highlighted the suitability of the indicators within the purpose of the research. Sustaining the values of these changes by surgeons and patients facilitates long-term results and the orientation towards assuring the sustainability of orthopedic surgery. Full article

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10 pages, 3728 KiB

Open AccessTechnical Note

Cervical Lateral Mass and Pedicle Fracture Reduced with a Herbert Screw: A Technical Note

by Antonio Colamaria, Francesco Carbone, Augusto Leone, Giuseppe Palmieri, Savino Iodice, Bianca Maria Baldassarre, Giovanni Cirrottola, Valeria Ble, Uwe Spetzger and Giuseppe Di Perna

Med. Sci. 2025, 13(3), 92; https://doi.org/10.3390/medsci13030092 - 19 Jul 2025

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management [...] Read more.

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

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11 pages, 804 KiB

Open AccessSystematic Review

Efficacy and Safety of Nifedipine Compared to Intravenous Hydralazine for Severe Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis of Randmomized Controlled Trials

by Vaisnavy Govindasamy, Mohammed Amer Kamel, Gabriele Volucke, Aashir Javed, Upayan Palchaudhuri, Sayed Irfan Kazi, Ahmad Albanna, Mays Akileh, Rohit Mukherjee, Rabia Nusrat, Tayyaba Qaiser, Eman Ibrahim Elzain Hassan, Muhammad Muneeb Azhar, Tallal Mushtaq Hashmi, Mushood Ahmed, Ali Hasan and Raheel Ahmed

Med. Sci. 2025, 13(3), 91; https://doi.org/10.3390/medsci13030091 - 13 Jul 2025

Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized [...] Read more.

Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized controlled trials comparing oral or sublingual nifedipine with intravenous hydralazine for the management of severe hypertension, with or without preeclampsia/eclampsia. A random-effects meta-analysis was performed using RevMan. Results: Seven randomized controlled trials were included. The pooled analysis demonstrated no significant difference between the two agents regarding time to achieve optimal blood pressure control (MD = −1.08 min, 95% CI = −6.66 to 4.49), caesarean delivery (OR = 0.62, 95% CI = 0.38 to 1.03), neonatal birth weight (MD = 57.65 g, 95% CI = −209.09 to −324.40), NICU admissions (OR = 0.90, 95% CI = 0.41 to 1.98), and 5-min APGAR scores (MD = 0.1, 95% CI = −0.20 to 0.39). However, patients receiving nifedipine had significantly lower odds of experiencing medication-related adverse events (OR = 0.62, 95% CI = 0.40 to 0.97). Conclusions: Nifedipine and intravenous hydralazine showed comparable efficacy in achieving optimal blood pressure control and similar maternal and neonatal outcomes. However, nifedipine was associated with significantly fewer maternal adverse effects, indicating superior tolerability. Full article

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15 pages, 452 KiB

Open AccessSystematic Review

The Efficacy of Neoantigen-Loaded Dendritic Cell Vaccine Immunotherapy in Non-Metastatic Gastric Cancer

by Menelaos Papakonstantinou, Paraskevi Chatzikomnitsa, Areti Danai Gkaitatzi, Athanasia Myriskou, Alexandros Giakoustidis, Dimitrios Giakoustidis and Vasileios N. Papadopoulos

Med. Sci. 2025, 13(3), 90; https://doi.org/10.3390/medsci13030090 - 11 Jul 2025

Introduction: Gastric cancer (GC) is the third leading cause of cancer-related deaths worldwide. Even though surgery and chemotherapy are the mainstay of treatment, immunotherapy, and more specifically anti-tumor vaccination, has gained popularity over the past years due to the lower related toxicity and [...] Read more.

Introduction: Gastric cancer (GC) is the third leading cause of cancer-related deaths worldwide. Even though surgery and chemotherapy are the mainstay of treatment, immunotherapy, and more specifically anti-tumor vaccination, has gained popularity over the past years due to the lower related toxicity and fewer long-term side effects. Dendritic cell (DC) vaccines have been shown to induce tumor specific cytotoxic T-cell (CTL) responses both in vitro and in vivo; however, due to the nature of the disease, resistance to immunotherapy is often developed. Various modifications, such as the implementation of viral vectors, tumor RNA, or even tumor-specific peptides (neoantigens), have been studied as a means to avoid resistance and enhance the effectiveness of the vaccines. In this review, we aim to assess the effects of neoantigen-loaded DC vaccines (naDCVs) on the immune response against gastric cancer cells. Materials and methods: A thorough literature search was conducted on PubMed and clinicaltrials.gov for studies assessing the efficacy of naDCVs against gastric cancer both in vivo and in vitro. The studies were assessed for eligibility by two independent reviewers based on predetermined inclusion and exclusion criteria. The search was completed following the PRISMA guidelines. Results: Eleven studies were included in our systematic review. In five of the studies, the effects of the naDCVs were tested in vitro; in two and in four they were examined both in vitro and in vivo. The in vitro studies showed that the naDCVs resulted in a more robust immune response against the cancer cells in the study groups compared to the control groups. The in vivo studies conducted on mice showed that tumor volume was reduced in the groups treated with the naDCV compared to the untreated groups. What is more, the cytotoxic effect of CTLs against tumor cells was also increased in the vaccine groups. One of the studies was conducted on humans as a phase I study. The results show increased CTL proliferation and cytokine production in the vaccinated group compared to the control, but no difference regarding the tumor size was observed. Conclusions: Neoantigen-loaded DC vaccines can stimulate a strong immune response against specific gastric cancer cell peptides and enhance tumor cell lysis, therefore hindering or even reversing disease progression, offering great potential for the treatment of patients with gastric cancer. Full article

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

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16 pages, 755 KiB

Open AccessReview

Hip Fracture as a Systemic Disease in Older Adults: A Narrative Review on Multisystem Implications and Management

by Silvia Andaloro, Stefano Cacciatore, Antonella Risoli, Rocco Maria Comodo, Vincenzo Brancaccio, Riccardo Calvani, Simone Giusti, Mathias Schlögl, Emanuela D’Angelo, Matteo Tosato, Francesco Landi and Emanuele Marzetti

Med. Sci. 2025, 13(3), 89; https://doi.org/10.3390/medsci13030089 - 11 Jul 2025

Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of [...] Read more.

Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of 681 per 100,000. Despite improved surgical care, one-year mortality remains high (15–30%), and fewer than half of survivors regain their pre-fracture functional status. Traditionally regarded as mechanical injuries, hip fractures are now increasingly recognized as systemic events reflecting and accelerating biological vulnerability and frailty progression. We synthesize evidence across biological, clinical, and social domains to explore the systemic implications of hip fracture, from the acute catabolic response and immune dysfunction to long-term functional decline. The concept of intrinsic capacity, introduced by the World Health Organization, offers a resilience-based framework to assess the multidimensional impact of hip fracture on physical, cognitive, and psychological function. We highlight the importance of orthogeriatric co-management, early surgical intervention, and integrated rehabilitation strategies tailored to the individual’s functional reserves and personal goals. Innovations such as digital health tools, biological aging biomarkers, and personalized surgical approaches represent promising avenues to enhance recovery and autonomy. Ultimately, we advocate for a shift toward interdisciplinary, capacity-oriented models of care that align with the goals of healthy aging and enable recovery that transcends survival, focusing instead on restoring function and quality of life. Full article

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10 pages, 426 KiB

Open AccessArticle

Pulmonary Function Among COVID-19 Patients in Home Isolation Program

by Narongkorn Saiphoklang, Pitchayapa Ruchiwit, Apichart Kanitsap, Pichaya Tantiyavarong, Pasitpon Vatcharavongvan, Srimuang Palungrit, Kanyada Leelasittikul, Apiwat Pugongchai and Orapan Poachanukoon

Med. Sci. 2025, 13(3), 88; https://doi.org/10.3390/medsci13030088 - 9 Jul 2025

Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: [...] Read more.

Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: A prospective study was conducted in asymptomatic or mild COVID-19 patients with normal chest radiographs at two medical centers in Thailand. Spirometry data, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory flow at 25–75% of FVC (FEF25–75), and bronchodilator responsiveness (BDR), were collected. Spirometry was performed after disease resolution at baseline and 3-month follow-up. Abnormal lung functions were classified into airway obstruction, restrictive defect, mixed defect, small airway disease, and BDR. Results: A total of 250 patients (58% female) were included. The mean age was 37.4 ± 15.2 years. Asymptomatic patients accounted for 7.6%. Common symptoms included fever (55.6%) and cough (60.0%). Abnormal lung functions were observed in 28.4% of patients, with a restrictive lung pattern (14.4%), airway obstruction (4.8%), mixed defect (0.4%), small airway disease (8.4%), and BDR (2.8%). Significant changes from baseline were noted in FVC (1.21%), FEV₁/FVC (−1.51%predicted), PEF (0.06%), and FEF_25–75 (−2.76%). Logistic regression analysis indicated that a higher body mass index was associated with a lower risk of abnormal lung function. Conclusions: Ventilatory defects were observed in one-third of patients with mild COVID-19 who did not require hospitalization, mainly presenting as restrictive patterns and small airway disease. Even mild cases may have residual pulmonary impairment, warranting further long-term studies. Full article

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

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53 pages, 2662 KiB

Open AccessReview

Pathophysiological Mechanisms of Diabetes-Induced Macrovascular and Microvascular Complications: The Role of Oxidative Stress

by Bipradas Roy

Med. Sci. 2025, 13(3), 87; https://doi.org/10.3390/medsci13030087 - 2 Jul 2025

Diabetic vascular diseases have emerged as a significant concern in medical research due to their considerable impact on human health. The challenge lies in the insufficient understanding of the intricate pathophysiological mechanisms associated with different forms of diabetic vascular diseases, which hampers our [...] Read more.

Diabetic vascular diseases have emerged as a significant concern in medical research due to their considerable impact on human health. The challenge lies in the insufficient understanding of the intricate pathophysiological mechanisms associated with different forms of diabetic vascular diseases, which hampers our ability to identify effective treatment targets. Addressing this knowledge gap is essential for developing successful interventions. Unraveling the molecular pathways through which diabetes leads to microvascular and macrovascular complications in vital organs such as the heart, brain, kidneys, retina, and extremities is crucial. Notably, oxidative stress resulting from hyperglycemia is the key factor in initiating these complications. This review aims to elucidate the specific molecular mechanisms by which oxidative stress drives microvascular and macrovascular diseases and to highlight promising therapeutic advancements that offer hope for effective treatment solutions. Full article

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15 pages, 2032 KiB

Open AccessArticle

Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times and Preoperative Admissions: A Prospective Propensity-Matched Cohort Study

by Mohammed Hamid, Omar E. S. Mostafa, Maria Kausar, Amina Amin, Oladapo Olajumoke, Abhinav Singhal, Gowtham Bharnala, Akinfemi Akingboye, Ricardo Camprodon and Chaminda Sellahewa

Med. Sci. 2025, 13(3), 86; https://doi.org/10.3390/medsci13030086 - 27 Jun 2025

Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of [...] Read more.

Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery. Methods: A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes. Results: Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, p < 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, p < 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = −0.219, R² = 0.059, p < 0.001) and preoperative admissions (IQR 0–1, R = −0.223, R² = 0.050, p = 0.002). Conclusions: An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services. Full article

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12 pages, 218 KiB

Open AccessArticle

Sleep Characteristics in Individuals with Ehlers-Danlos Syndrome

by Caitlin Crews-Stowe, Frank Tudini, Min-Kyung Jung, Jake Forman, Bernadette Riley, Stephanie Eton and David Levine

Med. Sci. 2025, 13(3), 85; https://doi.org/10.3390/medsci13030085 - 27 Jun 2025

Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep [...] Read more.

Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep characteristics of people with EDS. Methods: An electronic survey regarding sleep characteristics was created and distributed through the EDS website. Results: Sleep disturbance is common in people with EDS, with 65.3% of respondents sleeping fewer than 8 h and 26.2% averaging fewer than 6 h. Those who slept fewer than 6 h reported more days of poor mental and physical health days. Sleep aids were commonly used with 41.40% of patients regularly taking prescription medication to get to sleep. Sleep latency of greater than 30 min was also found in 67.5% of subjects. Conclusions: The results demonstrate an association between people with EDS and poorer sleep duration, increased sleep latency, and increased use of sleep aids including prescription sleep medication compared to the general population. While more research needs to be completed in this area, sleep may be an important aspect to address in the management of EDS. Full article

12 pages, 1312 KiB

Open AccessSystematic Review

Transcranial Direct Current Stimulation in Episodic Migraine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Faraidoon Haghdoost, Abdul Salam, Fatemeh Zahra Seyed-Kolbadi, Deepika Padala, Candice Delcourt and Anthony Rodgers

Med. Sci. 2025, 13(3), 84; https://doi.org/10.3390/medsci13030084 - 26 Jun 2025

Background: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique for migraine prevention. This study evaluates the efficacy of tDCS compared to sham in preventing episodic migraine in adults. Methods: PubMed and Embase databases were searched until May 2025 to identify randomized [...] Read more.

Background: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique for migraine prevention. This study evaluates the efficacy of tDCS compared to sham in preventing episodic migraine in adults. Methods: PubMed and Embase databases were searched until May 2025 to identify randomized controlled trials comparing tDCS with sham for the prevention of episodic migraine in adults. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool version 2. A random effect meta-analysis was conducted to evaluate the effects of cathodal and anodal tDCS on migraine frequency (days per month and attacks per month). Results: The meta-analysis included six trials with 172 participants (mean age 34 years, 82% females). Both cathodal (three studies, over the occipital area) and anodal (three studies, over the occipital or primary motor area) tDCS reduced the mean number of monthly migraine days and migraine attacks compared to sham. After pooling the outcomes and excluding two studies at high risk of bias, anodal tDCS over the occipital or primary motor area (standardized difference in means = −0.7, 95% CI: −1.7, 0.2, p = 0.124) and cathodal tDCS over the occipital area (standardized difference in means = −0.7, 95% CI: −1.1, −0.3, p = 0.000) reduced headache frequency compared to sham. However, the reduction with anodal tDCS was not statistically significant. Summary: tDCS may be effective in preventing episodic migraine. However, the evidence is limited by the small number of heterogeneous trials, with variation in electrode placement and stimulation intervals. Full article

(This article belongs to the Section Neurosciences)

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15 pages, 2226 KiB

Open AccessArticle

National Trends in Admissions, Treatments, and Outcomes for Dilated Cardiomyopathy (2016–2021)

by Vivek Joseph Varughese, Abdifitah Mohamed, Vignesh Krishnan Nagesh and Adam Atoot

Med. Sci. 2025, 13(3), 83; https://doi.org/10.3390/medsci13030083 - 23 Jun 2025

Background: Dilated Cardiomyopathy (DCM) is one of the leading causes of non-ischemic cardiomyopathy in the United States (US). The aim of our study is to analyze the general trends in DCM admissions between 2016 and 2021, and analyze social and healthcare disparities in [...] Read more.

Background: Dilated Cardiomyopathy (DCM) is one of the leading causes of non-ischemic cardiomyopathy in the United States (US). The aim of our study is to analyze the general trends in DCM admissions between 2016 and 2021, and analyze social and healthcare disparities in terms of treatments and outcomes. Methods: National Inpatient Sample (NIS) data for the years 2016 to 2021 were used for the analysis. General population trends were analyzed. Normality of data distribution was tested using the Kolmogorov–Smirnov test and homogeneity was assessed using Levine’s test. One-way ANOVA was used after confirmation of normality of distribution to analyze social and healthcare disparities. Subgroup analysis was conducted, with the paired t-test for continuous variables and Fischer’s exact t-test for categorical variables to analyze statistical differences. Multivariate regression analysis was conducted to analyze the association of factors that were significant in the one-way ANOVA and paired t/chi square tests. A two-tailed p-value < 0.05 was used to determine statistical significance. Results: A total of 5262 admissions for DCM were observed between 2016 and 2021. A general declining trend was observed in the total number of DCM admissions, with a 33.51% decrease in total admissions in 2021 compared to 2016. All-cause in-hospital mortality remained stable across the years (between 3.5% and 4.5%). A total of 15.3% of admissions had CRT/ICD devices in place. A total of 425 patients (8.07%) for DCM underwent HT, and 214 admissions for DCM (4.06%) underwent LVAD placements between 2016 and 2021 In terms of interventions for DCM, namely Cardiac Resynchronization Therapy (CRT), Left Ventricular Assist Devices (LVADs) and Heart Transplantations (HTs), significant variance was observed in the mean age of the admissions with admissions over the mean age of 55 had lower number of interventions. Significant variance in terms of sex was observed for DCM admissions receiving HT, with lower rates observed for females. In terms of quarterly income, patients belonging to the lowest fourth quartile had higher rates of LVAD and HT compared to general DCM admissions. In the multivariate regression analysis, age at admission had significant association with lower chances of receiving LVADs and HT among DCM admissions, and significant association with higher chances of all-cause mortality during the hospital stay. Conclusions: A general declining trend in the total number of DCM admissions was observed between 2016 and 2021. Significant gender disparities were seen with lower rates of females with DCM receiving LVADs and HT. DCM admissions with mean age of 55 and above were found to have significantly lower rates of receiving LVADs and HT, and higher chances of all-cause mortality during the admission. Full article

(This article belongs to the Section Cardiovascular Disease)

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16 pages, 1117 KiB

Open AccessArticle

Interprofessional Approaches to the Treatment of Mild Traumatic Brain Injury: A Literature Review and Conceptual Framework Informed by 94 Professional Interviews

by John F. Shelley-Tremblay and Teri Lawton

Med. Sci. 2025, 13(3), 82; https://doi.org/10.3390/medsci13030082 - 23 Jun 2025

Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. [...] Read more.

Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 94 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings. Full article

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11 pages, 980 KiB

Open AccessArticle

Trends in MitraClip Placements and Predictors of 90-Day Heart Failure Rehospitalization: A Nationwide Analysis

by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Seetharamaprasad Madala, Ruchi Bhuju, Carra Lyons, Simcha Weissman, Adam Atoot, Dominic Vacca and Budoor Alqinai

Med. Sci. 2025, 13(3), 81; https://doi.org/10.3390/medsci13030081 - 20 Jun 2025

Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ [...] Read more.

Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016–2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76–79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1–3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82–4.23), pulmonary hypertension (OR 3.96, CI 1.49–5.55), and chronic lung disease (OR 1.91, CI 1.32–2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions. Full article

(This article belongs to the Section Cardiovascular Disease)

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24 pages, 2629 KiB

Open AccessReview

Exploring the Interplay Between Kidney Dysfunction and Cardiovascular Disease

by Rajesh Yadav, Aqsa Kaim Abubakar, Richa Mishra, Saurabh Gupta, Neelesh Kumar Maurya, Vivek Kumar Kashyap, Sarvesh Rustagi, Deependra Pratap Singh and Sanjay Kumar

Med. Sci. 2025, 13(2), 80; https://doi.org/10.3390/medsci13020080 - 18 Jun 2025

This article reveals the various types of complications that are associated with dialysis and kidney-associated disease, including left ventricular hypertrophy, heart failure, vascular heart disease, arrhythmias, diabetes mellitus, intradialytic hypertension, and coronary heart disease. The molecular mechanisms underlying the development of cardiovascular disease [...] Read more.

This article reveals the various types of complications that are associated with dialysis and kidney-associated disease, including left ventricular hypertrophy, heart failure, vascular heart disease, arrhythmias, diabetes mellitus, intradialytic hypertension, and coronary heart disease. The molecular mechanisms underlying the development of cardiovascular disease in patients with chronic kidney disease (CKD), including the role of nitric oxide (NO) signaling, have been extensively studied. Patients suffering from CKD need treatment with hemodialysis at the end stages. The kidney is considered the chief excretory organ in humans, which excretes various types of waste materials from the body and balances the acid–base ratio, due to which its role in homeostasis has been considered. When kidneys fail to function properly due to various diseases, hemodialysis plays the role of the kidneys. This procedure involves removing a patient’s blood, filtering it through a dialyzer to remove waste products, and returning the cleaned blood to the body. However, for the hemodialysis procedure, fistula formation is necessary, which is created by specific surgery in which the radial artery and superficial vein are connected in the forearm, near the wrist or elbow. This arteriovenous (AV) fistula creation fails sometimes and causes complications. The prolonged use of hemodialysis procedures and improper care also lead to many complications in chronic kidney patients, which have been discussed in detail in this review article. Full article

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19 pages, 1126 KiB

Open AccessReview

Exploring the Efficacy of Low-Temperature Plasmas on Oral Biofilms: A Scoping Review

by Carson C. Davis, Fabrízio Dias Panariello and Beatriz Panariello

Med. Sci. 2025, 13(2), 79; https://doi.org/10.3390/medsci13020079 - 18 Jun 2025

The rise of antibiotic resistance and the limitations of conventional therapies for managing biofilm-related oral infections highlight the urgent need for novel solutions, with low-temperature plasma (LTP) emerging as a promising alternative due to its potent antimicrobial effects, tissue-safety, and reduced risk of [...] Read more.

The rise of antibiotic resistance and the limitations of conventional therapies for managing biofilm-related oral infections highlight the urgent need for novel solutions, with low-temperature plasma (LTP) emerging as a promising alternative due to its potent antimicrobial effects, tissue-safety, and reduced risk of fostering resistance. This scoping review investigates the efficacy of LTP application for the management of oral biofilms associated with dental caries, peri-implantitis, endodontic infections, and oral candidiasis. This review was conducted in accordance with the PRISMA-ScR guidelines and registered with the Open Science Framework (OSF). Studies were identified through comprehensive searches of PubMed/MEDLINE, EBSCO (Medline Ultimate and e-journals), and Google Scholar, with no publication date restrictions, and were supplemented by manual reference screening. Eligible studies included original research, published in English, examining LTP’s effectiveness in oral biofilms. After systematically screening the literature, 51 studies were included in this scoping review, comprising mostly in vitro research, alongside ex vivo, in situ, and clinical studies. Data extraction revealed LTP’s broad-spectrum antimicrobial potential and promising clinical implications for dentistry. This review highlights key findings, identifies research gaps, and underscores the therapeutic potential of LTP in managing complex oral biofilm-related infections. Full article

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16 pages, 2275 KiB

Open AccessSystematic Review

Intraosseous Versus Intravenous Vascular Access in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Alhareth Alsagban, Omar Saab, Hasan Al-Obaidi, Marwah Algodi, Amy Yu, Mohamed Abuelazm and Chad Hochberg

Med. Sci. 2025, 13(2), 78; https://doi.org/10.3390/medsci13020078 - 14 Jun 2025

Background. Establishing prompt vascular access facilitates resuscitation for out-of-hospital cardiac arrest (OHCA). While intraosseous access may decrease the time to vascular access, the impact on clinical outcomes in OHCA is unclear. Therefore, we aim to compare the effect of intraosseous (IO) versus intravenous [...] Read more.

Background. Establishing prompt vascular access facilitates resuscitation for out-of-hospital cardiac arrest (OHCA). While intraosseous access may decrease the time to vascular access, the impact on clinical outcomes in OHCA is unclear. Therefore, we aim to compare the effect of intraosseous (IO) versus intravenous (IV) vascular access on clinical outcomes after OHCA resuscitation. Methods. A systematic review and meta-analysis were performed to synthesize evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until January 2025. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42024627354. Results. Four RCTs and 9475 patients were included. There was no difference between both groups regarding the prehospital return of spontaneous circulation (ROSC) (RR: 0.97, 95% CI [0.91, 1.03], p = 0.33), maintained ROSC (RR: 0.94, 95% CI [0.87, 1.01], p = 0.09), survival to discharge (RR: 1.03 with 95% CI [0.88, 1.21], p = 0.71), 30-day survival (RR: 0.98, 95% CI [0.82, 1.17], p = 0.79), or favorable neurological recovery (RR: 1.07, 95% CI [0.90, 1.29], p = 0.44). However, IO access significantly increased first-attempt access (RR: 1.24, 95% CI [1.19, 1.29], p < 0.001), decreased time to vascular access (MD: −0.24 min with 95% CI [−0.48, −0.01], p = 0.04), and decreased time to drug administration (MD: −0.38, 95% CI [−0.66, −0.10], p = 0.01). Conclusions. IO and IV vascular accesses showed similar clinical outcomes in OHCA patients, with no difference in ROSC, survival, or neurological recovery. Still, IO access showed a better procedural outcome with increased first-attempt success rates, faster access, and faster drug administration. Full article

(This article belongs to the Section Critical Care Medicine)

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16 pages, 865 KiB

Open AccessArticle

Confidential Audit of Perinatal Mortality in the Republic of Kazakhstan: A Pilot Study

by Aizada Marat, Zaituna Khamidullina, Svetlana Muratbekova, Kulyash Jaxalykova, Bekturgan Karin, Nazerke Samatova, Umit Usmanova, Madina Sharipova, Aknur Kobetayeva, Milan Terzic, Yesbolat Sakko and Gulzhanat Aimagambetova

Med. Sci. 2025, 13(2), 77; https://doi.org/10.3390/medsci13020077 - 13 Jun 2025

Introduction: Perinatal mortality is labeled as the loss of fetuses at or beyond 22 weeks of gestation, deaths during labor and delivery, as well as early neonatal deaths. Appropriate medical care provided in the perinatal period is an integral indicator of high-quality medical care. [...] Read more.

Introduction: Perinatal mortality is labeled as the loss of fetuses at or beyond 22 weeks of gestation, deaths during labor and delivery, as well as early neonatal deaths. Appropriate medical care provided in the perinatal period is an integral indicator of high-quality medical care. Although developed countries managed to decrease perinatal mortality, it remains high in the developing world. This study aims to perform a confidential audit of perinatal mortality (CAPM) across Kazakhstani maternity hospitals. Methods: A descriptive, observational cross-sectional study was conducted from January 2024 to December 2024. The structure of the underlying causes of mortality in the antenatal, intranatal, and early neonatal periods among different maternity hospitals of the Republic of Kazakhstan was analyzed. Results: A total of 116 cases were assessed: 34 antenatal deaths, 6 intranatal, and 76 early neonatal. Most deaths occurred on the second day post-delivery. The analysis revealed that 93% of cases fell into categories indicating substandard or potentially inadequate care (categories 2 and 3). Intraventricular hemorrhage and sepsis emerged as leading causes of neonatal death. Among antenatal and intranatal deaths, significant proportions were associated with comorbid maternal conditions, insufficient antenatal visits, and inadequate perinatal support. Conclusions: CAPM proves to be a critical tool for identifying systemic gaps and guiding improvements in maternity services without attributing blame to health professionals. Findings underscore that many perinatal deaths could have been avoided with timely, evidence-based interventions across antenatal and neonatal care. Broader implementation and institutionalization of CAPM in Kazakhstan could lead to measurable reductions in perinatal mortality and improvements in maternal/newborn care outcomes. Factors such as preconception planning, improving the health of reproductive-age women, administration of folic acid, and reducing primary cesarean sections could assist in achieving the reduction in the perinatal mortality rate. Full article

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7 pages, 170 KiB

Open AccessCommunication

Is It Advisable to Use Probiotics Routinely After a Colonoscopy? A Rapid Comprehensive Review of the Evidence

by Matteo Piciucchi, Alice Rossi, Alissa Satriano and Raffaele Manta

Med. Sci. 2025, 13(2), 76; https://doi.org/10.3390/medsci13020076 - 9 Jun 2025

About 5–20% of patients who undergo colonoscopy, in the days and weeks following the procedure, develop various symptoms (abdominal pain, bloating, and bowel alteration) mainly related to dysbiosis induced by the propaedeutic intestinal preparation. Some studies have positively evaluated the impact of the [...] Read more.

About 5–20% of patients who undergo colonoscopy, in the days and weeks following the procedure, develop various symptoms (abdominal pain, bloating, and bowel alteration) mainly related to dysbiosis induced by the propaedeutic intestinal preparation. Some studies have positively evaluated the impact of the administration of different mixtures of probiotics in preventing and/or limiting this symptomatology. The aim of this review is to evaluate and summarize the available scientific evidence supporting the use of probiotics post-colonoscopy and to define their real efficacy as a routine treatment in a clinical setting. Full article

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