Search Results (186)

Background: The education process for newly diagnosed Type 1 diabetes mellitus (T1D) patients and their families, primarily led by diabetes specialist nurses, is essential for gaining knowledge about the disease and its management. However, few assessment tools have been employed to evaluate long-term knowledge retention among T1D patients years after diagnosis. Methods: We developed a 20-question test to assess the knowledge of patients and their families at the conclusion of the initial education process and again 6–12 months later. Demographic and clinical data were also collected. Statistical analyses included comparisons between the first and second test results, as well as evaluation of potential contributing factors. The internal consistency and construct validity of the questionnaire were evaluated. Results: Forty-four patients completed both assessments, with a median interval of 11.5 months between them. The average score on the first test was 88.6, which declined to 82.7 on the second assessment (p < 0.001). In univariate analysis, factors positively associated with higher scores included Jewish ethnicity, lower HbA1c levels, and shorter hospitalization duration. Multivariate analysis revealed that parents had lower odds of experiencing a significant score decline compared to patients. Cronbach’s alpha was 0.69, and Principal Component Analysis (PCA) identified eight components accounting for 67.1% of the total variance. Conclusions: Healthcare providers should consider offering re-education to patients and their families approximately one year after diagnosis, with particular attention to high-risk populations during the initial education phase. Further studies are needed to examine this tool’s performance in larger cohorts. Full article

Road density is a key indicator of human activity, causing habitat loss and fragmentation. Soil fungi, essential for ecosystem functioning, are sensitive bioindicators. Yet their responses to road density in urban green spaces are poorly characterized. Here, we analyzed the composition of the dominant fungal community, examined both the direct and indirect effects of road density on soil fungal communities, and identified specialist species. Focusing on Shanghai, China, a rapidly urbanizing city, we considered both edaphic factor and the road network. Through machine learning and Spearman correlation regression analyses, we quantified the relative importance of road density and edaphic factor in shaping fungal community composition and employed occupancy-specificity modeling to identify specialist taxa. Our results revealed that Ascomycota, Basidiomycota, Zygomycota, Rozellomycota, Chytridiomycota, and Glomeromycota were the dominant phyla, accounting for 93% of the retrieved ITS sequences. Road density was found to be the primary driver of fungal community composition, followed by soil lead and potassium concentrations. Notably, opportunistic pathogens (Acremonium spp.) correlated positively with road density (p < 0.001). Specialist species in high-density areas were primarily pathotrophic fungi, while saprotrophic fungi dominated in low-density areas. These findings highlight the need for urban planning strategies to mitigate the ecological impact of road density. Full article

Peatland research has expanded rapidly in the last two decades encompassing a diverse, multi-disciplinary evidence base, as countries seek to manage this resource sustainably along with meeting climate and biodiversity targets. There is growing global interest in the role of peatlands in carbon and water cycles, leading to more interdisciplinary research that applies ecosystem services and other integrative frameworks to generate knowledge and provide guidance for action. These trends have been replicated in Ireland with increasing research in peatland science, applied work on these degraded ecosystems, and a growing interest from civil society, landowners, and communities in the stewardship of this resource. This paper presents evidence-based insights from over two decades of Irish peatland research, with practical lessons for peatland policy and management in other national contexts. Analyses of the evidence from the literature, specialist expertise, and stakeholder knowledge were carried out under ten themes: biodiversity, soil, climate change, water, archaeology and palaeoenvironment, technology and mapping, society and culture, management, growing media and policy and law. The research identified four foundational pillars (accountability, longevity, equity and holistic knowledge) as critical to achieving sustainable peatland management in Ireland, with broader application to other regions. Peatland restoration is widely recognised across research disciplines as a key tool to meet regulatory targets related to climate, biodiversity, and water quality, while also delivering societal benefits. The findings of this research provide accessible, reliable and up-to-date evidence for sustainable peatland management. This study addresses a critical global knowledge gap by developing a novel, interdisciplinary evidence synthesis framework—applied here to Ireland but replicable worldwide—that systematically integrates 20 years of multi-disciplinary peatland research, expert insights, and stakeholder perspectives across ten thematic pillars. Full article

Epilepsy, one of the most common neurological diseases in the world, affects around 50 million people, with a notably disproportionate prevalence in individuals residing in low- and middle-income countries (LMICs). Alarmingly, over 80% of annual epilepsy-related fatalities occur within LMICs. The burden of the disease assessed using Disability Adjusted Life Years (DALYs) shows that epilepsy accounts for about 13 million DALYs per year, with LMICs bearing most of this burden due to the disproportionately high diagnostic and treatment gaps. Furthermore, LMICs also endure a significant financial burden, with the cost of epilepsy reaching up to 0.5% of the Gross National Product (GNP) in some cases. Difficulties in the appropriate diagnosis and treatment are complicated by the lack of trained medical specialists. Therefore, in these conditions, adopting artificial intelligence (AI)-based solutions may improve epilepsy care in LMICs. In this theoretical and critical review, we focus on epilepsy and its management in LMICs, as well as on the employment of AI technologies to aid epilepsy care in LMICs. We begin with a general introduction of epilepsy and present basic diagnostic and treatment approaches. We then explore the socioeconomic impact, treatment gaps, and efforts made to mitigate these issues. Taking this step further, we examine recent AI-related developments and their potential as assistive tools in clinical application in LMICs, along with proposals for future directions. We conclude by suggesting the need for scalable, low-cost AI solutions that align with the local infrastructure, policy and community engagement to improve epilepsy care in LMICs. Full article

Snakebite is a neglected tropical disease, and the high potency of snake venoms has been evolutionary refined for trophic interactions. Hence, understanding the feeding ecology of snakes is a major element needed to meaningfully interpret toxinological data gathered for snake toxins. However, the diet of several medically important snakes is vastly understudied. Here, the first case of in situ observed ichthyophagy in the Malayan Krait (Bungarus candidus), a highly venomous Asian elapid, which is supposedly an ophiophagous specialist, is reported. This report has important repercussions for Krait toxinology as it shows that fish as prey need to be considered when analyzing their venoms in light of eco-evolutionary and functional studies. It also suggests that this snake may be more trophically opportunistic than previously thought, which must be taken into account when calculating distribution ranges in the context of snakebite analyses. Full article

Divine rebaptism occurs when a deity renames an entity with a proper name N*, which is pronounced differently or is orthographically distinct from the proper name N this entity previously had. Genesis 17:5 and 17:15 illustrate this phenomenon or alleged phenomenon while raising two questions not yet addressed. First, the identity question: Are those named “Abram” and “Sarai”, respectively, identical to those named “Abraham” and “Sarah” in Genesis? Second, the semantic question: What picture of the semantics of proper names best accounts for the divine rebaptisms portrayed in Genesis? This essay begins by motivating these questions; it indicates that they should—in an interdisciplinary fashion—appeal to Pentateuch specialists and philosophers interested in the semantics of proper names. Then, a case is made for the claim that though Genesis does not provide sufficient evidence to answer the identity question, it indicates a response to the semantic one: that especially in Genesis 17:5 and 17:15, this text points to gradation semantics. This is the view that proper names have the properties of being meaningful, indirect, flaccid, flexible, and lexically univocal in distinct degrees, depending on their context of use. Full article

Introduction: The differential diagnosis of splenomegaly is a complex process that encompasses a wide variety of diseases. Moreover, it is not always standardized and lacks a definitive consensus on which tests should be performed and in what order. Gaucher disease (GD) and acid sphingomyelinase deficiency (ASMD) are lysosomal diseases (LD) that present with splenomegaly, the diagnosis of which requires a high index of suspicion and specific biochemical and genetic techniques. The aim of the project for the education and diagnosis of Gaucher disease and acid sphingomyelinase deficiency (PREDIGA) was to conduct educational training alongside an observational, multicenter, ambispective, cross-sectional, single-cohort study among patients having an enlarged spleen or undergone splenectomy to further assess these subjects to exclude two lysosomal diseases, namely GD and ASMD. Methods: Using dried blood spot (DBS) testing, we identified patients with abnormally low values of the enzymes glucocerebrosidase and acid sphingomyelinase, who then underwent sequencing of the GBA1 and SPMD1 genes, respectively. The study involved 34 hospitals and 52 medical specialists. Results: We identified 220 patients (208 adults and 12 children under 18 years) with cryptogenic splenomegaly or who had undergone splenectomy (12 patients) without having reached a diagnosis. The median age was 11 years (interquartile range [IQR] 3–16) in the pediatric population and 51 years (IQR 38–65) in the adult population. Lower-than-normal enzyme values were detected in 19 DBSs, confirming eight positive cases, which corresponded to six patients with GD and two with ASMD. The rest of the DBSs with low enzyme activity were not genetically confirmed (58%). We determined that lysosomal diseases accounted for 3.6% of cryptogenic splenomegaly/splenectomy cases in our setting: 2.7% were GD and 0.9% ASMD, in a ratio of 1 ASMD patient to every 3 GD patients. Lyso-GL1 values in patients with GD were elevated in all but one individual, corresponding to a child diagnosed at 4 months old. The variants detected in the GBA1 gene were consistent with the most frequent variants found in Spain. Discussion/Conclusion: The development and implementation of this protocol for the education and diagnosis of cryptogenic splenomegaly/splenectomy, even in asymptomatic patients, constitutes a comprehensive, simple, rapid, and effective screening method for the diagnosis of GD and ASMD. Full article

Background/Objectives: Sjögren’s disease (SjD) is a chronic autoimmune disease primarily affecting exocrine glands, often leading to systemic complications and comorbidities. While SjD is known to impact quality of life, research on hospitalization trends, demographic characteristics, and factors influencing hospital stay duration remains limited. This study aims to analyze hospitalizations due to SjD in Poland between 2012 and 2023, identifying key trends, risk factors, and healthcare implications. Methods: A retrospective analysis was conducted using data from the National General Hospital Morbidity Study, covering 13,999 first-time hospitalizations with an SjD diagnosis (ICD-10: M35.0). Descriptive statistics were applied to evaluate patient demographics, hospitalization trends, and comorbidities. The Mann–Whitney U test and chi-square test were used to compare groups, while a linear regression model identified predictors of hospital stay duration. Results: Women accounted for 90.3% of hospitalizations, with a median age of 57 years, compared to 53 years for men. The hospitalization rate fluctuated over time, with a decline in 2020, possibly due to the COVID-19 pandemic, followed by an increase in 2021–2023. The most common comorbidities included musculoskeletal disorders (17.8%), cardiovascular diseases (16.6%), and endocrine disorders (13.6%). Women had longer hospital stays than men (median 5 vs. 4 days, p < 0.001). Older patients and those admitted in emergency settings had significantly longer hospital stays. The overall mortality rate was low (0.2%), with a slightly higher but statistically insignificant mortality rate among men. Conclusions: The study highlighted the increasing burden of SjD-related hospitalizations and the need for improved outpatient management to reduce inpatient admissions. Factors such as older age, female sex, and emergency admissions were associated with prolonged hospitalization. Strengthening early diagnostic strategies, optimizing access to specialist care, and monitoring comorbidities could enhance patient outcomes and reduce hospital resource utilization. Full article

Background: Breast cancer in women aged 80 years and older accounts for about 12% of cases, but its management is challenging due to the population’s heterogeneity and the lack of relevant evidence-based guidelines. Treatment decisions must consider biological age, comorbidities, life expectancy, therapy-related toxicities, and tumor biology. This study evaluates the clinical outcomes of elderly breast cancer patients treated with a multidisciplinary approach, including oncologists, surgeons, and geriatric specialists. Materials and Methods: A retrospective analysis of breast cancer patients aged ≥80 years treated at Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, from January 2016 to December 2020 was conducted. The study reviewed clinicopathological data, surgery, adjuvant therapies, and clinical outcomes. Treatment decisions were guided by multidisciplinary evaluations, including onco-geriatric assessments (GA) and guided treatment decisions. Primary outcomes included overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). Surgical and treatment-related complications were also documented. Results: A total of 238 patients aged ≥80 years were included in the study. Of these, 203 (85.3%) underwent breast-conserving surgery, while 35 (14.7%) underwent mastectomy. Axillary surgery was performed in 129 (54%) cases. Regarding adjuvant treatments, 93 (39.1%) patients received radiotherapy, and 101 (42.4%) received endocrine therapy alone. Chemotherapy was administered to six high-risk patients following GA, with no reported toxicities. Over a median follow-up of 42.3 months, the study reported one local recurrence (0.5%), one regional node recurrence (0.5%), and 19 cases of distant metastases (9%). A total of 19 patients (9%) died due to breast cancer. The overall complication rate was low, with 10% experiencing wound dehiscence, hematoma, lymphedema, or similar issues. Five-year survival outcomes were OS 73.3%, DFS 66.6%, and CSS 88.5%. Conclusions: This study highlights that a multidisciplinary approach to breast cancer management in patients aged ≥80 years yields favorable clinical outcomes with low recurrence, metastasis, and complication rates. The personalized treatment strategies, guided by onco-geriatric assessments, balance survival benefits with quality of life while minimizing risks of overtreatment or undertreatment. These findings emphasize the importance of individualized care in this complex patient population and offer valuable insights for optimizing management strategies as the elderly demographic continues to grow. Full article

The electrocardiogram (ECG) is a widely used, non-invasive tool for diagnosing a range of cardiovascular conditions, including arrhythmia and heart disease-related structural changes. Despite its critical role in clinical care, racial and ethnic differences in ECG readings are often underexplored or inadequately addressed in research. Variations in key ECG parameters, such as PR interval, QRS duration, QT interval, and T-wave morphology, have been noted across different racial groups. However, the limited research in this area has hindered the development of diagnostic criteria that account for these differences, potentially contributing to healthcare disparities, as ECG interpretation algorithms largely developed from major population data may lead to misdiagnoses or inappropriate treatments for minority groups. This review aims to help cardiac researchers and cardiovascular specialists better understand, explore, and address the impact of racial and ethnic differences in ECG readings. By identifying potential causes—ranging from genetic factors to environmental influences—and exploring the resulting disparities in healthcare outcomes, we propose strategies such as the development of race-specific ECG norms, the application of artificial intelligence (AI) to improve diagnostic accuracy, and the diversification of ECG databases. Through these efforts, the medical community can advance toward more personalized and equitable cardiovascular care. Full article

Artificial Intelligence (AI) is reshaping healthcare through advancements in clinical decision support and diagnostic capabilities. While human expertise remains foundational to medical practice, AI-powered tools are increasingly matching or exceeding specialist-level performance across multiple domains, paving the way for a new era of democratized healthcare access. These systems promise to reduce disparities in care delivery across demographic, racial, and socioeconomic boundaries by providing high-quality diagnostic support at scale. As a result, advanced healthcare services can be affordable to all populations, irrespective of demographics, race, or socioeconomic background. The democratization of such AI tools can reduce the cost of care, optimize resource allocation, and improve the quality of care. In contrast to humans, AI can potentially uncover complex relationships in the data from a large set of inputs and generate new evidence-based knowledge in medicine. However, integrating AI into healthcare raises several ethical and philosophical concerns, such as bias, transparency, autonomy, responsibility, and accountability. In this study, we examine recent advances in AI-enabled medical image analysis, current regulatory frameworks, and emerging best practices for clinical integration. We analyze both technical and ethical challenges inherent in deploying AI systems across healthcare institutions, with particular attention to data privacy, algorithmic fairness, and system transparency. Furthermore, we propose practical solutions to address key challenges, including data scarcity, racial bias in training datasets, limited model interpretability, and systematic algorithmic biases. Finally, we outline a conceptual algorithm for responsible AI implementations and identify promising future research and development directions. Full article

Research into the unio mystica has revealed what seems to be an area of “real discussion” between scholars of different traditions of mysticism, particularly those of Judaism, Christianity, and Islam. Although this research serves as a promising start to the dialogue among scholars, it has also raised many questions about a “shared moment” that is nevertheless expressed in “irreducibly diverse” and distinct ways in each tradition. What purpose, for instance, can generic cross-cultural categories serve when they mean little or nothing to scholars in each tradition? By contrast, tradition-specific vocabularies are profuse and often difficult to represent in interlinguistic contexts without significant explanation. The challenge of translating mystical texts, imagery, and ideas across cultures and linguistic traditions raises obvious concerns about the misrepresentation and distortion of traditions in an environment of post-colonial critique. Nevertheless, the continued promise of dialogue calls for specialists of these traditions—particularly non-western and non-Christian traditions—to approach, assess, re-formulate, and even challenge the categories of mysticism from within the conceptual and theoretical horizons of the traditions that they research. The present study models such an approach to scholarship in mysticism. It offers a (re)formulation of the unio mystica from within the theoretical frame of the 12th/13th-century Muslim/Sufi mystic, Ibn ʿArabī (d. 638/1240) and early members of his school of thought. By unpacking the primary terms involved in such an account—“God”, the “human being/self”, and “union”—from within the conceptual and theoretical horizons of that tradition, it problematizes the prevailing understanding of the unio mystica constructed from the writings of specialists in Christian mysticism. More importantly, it illustrates the payoff in terms of dialogue (incorporating the critique of existing theories) when each tradition operates confidently from its own milieu, developing its own theoretical resources for mysticism rather than prematurely embracing existing ideas or categories. Full article

Background/Objectives: Hypoxic-ischemic encephalopathy (HIE) in late preterm and term neonates accounts for neonatal mortality and unfavorable neurodevelopmental outcomes in survivors despite therapeutic hypothermia (TH) for neuroprotection. The circumstances of death in neonates with HIE, including involvement of neonatal palliative care (NPC) specialists and neurodevelopmental follow-up at 18–24 months in survivors, warrant further evaluation. Methods: A retrospective multicenter cohort study including neonates ≥ 35 weeks gestational age with moderate to severe HIE receiving TH, registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2021. Neurodevelopmental follow-up at 18–24 months in survivors was assessed. The groups of survivors and deaths were compared regarding perinatal demographic and HIE data. Prognostic factors leading to redirection of care (ROC) were depicted. Results: A total of 137 neonates were included, with 23 (16.8%) deaths and 114 (83.2%) survivors. All but one death (95.7%) occurred after ROC, with death on a median of 3.5 (2–6) days of life. Severe encephalopathy was indicated by a Sarnat score of 3 on admission, seizures were more frequent, and blood lactate values were higher on postnatal days 1 to 4 in neonates who died. Lactate in worst blood gas analysis (unit-adjusted odds ratio 1.25, 95% CI 1.02–1.54, p = 0.0352) was the only variable independently associated with ROC. NPC specialists were involved in one case. Of 114 survivors, 88 (77.2%) had neurodevelopmental assessments, and 21 (23.9%) of those had unfavorable outcomes (moderate to severe disability). Conclusions: Death in neonates with moderate to severe HIE receiving TH almost exclusively occurred after ROC. Parents thus had to make critical decisions and accompany their neonate at end-of-life within the first week of life. Involvement of NPC specialists is encouraged in ROC so that there is continuity of care for the families whether the neonate survives or not. Full article

Assessments of the agro-climatic resources of Northern Kazakhstan are urgently needed in the face of climate change and increasing threats to food security in the world, and they can provide valuable information for specialists in the field of agriculture. To assess the agro-climatic conditions of Northern Kazakhstan, the following agro-climatic indices were used: heat availability, moisture availability, and aridity of the growing season for the period 1991–2023. The research results rendered it possible to build maps of the spatial distribution of agro-climatic indicators, and five agro-climatic zones, ranging from “moderately humid moderately warm” in the north to “very arid moderately hot” in the south of Northern Kazakhstan, were identified. Recommendations were developed with respect to the agro-climatic zoning of main crops, taking into account the climatic resources of Northern Kazakhstan. The data obtained will be used for the strategic planning of the agricultural crop industry in Northern Kazakhstan. Full article

Introduction: Epidemiological data are crucial for adopting primary and secondary prevention strategies and to develop screening protocols against prostate cancer (PCa). Despite the comprehensive characterization of PCa across White and Black men, there is a lack of data from the Mexican population. This manuscript presents data from the Can.Prost registry that captures PCa trends over the past two decades in Mexico City; furthermore, we aimed to compare clinical differences and oncological outcomes before and after the promotion of early detection actions through a campaign against PCa that occurred in 2014. Methods: A retrospective observational study on newly diagnosed Mexican PCa patients was carried out at the Instituto Nacional de Cancerología (INCan) in Mexico City. During 2014 and 2015, a project for the early diagnosis of PCa (“OPUS program”) was launched in the aforementioned tertiary hospital. Starting at the age of 45 years, all men were invited for a PSA measurement and a specialist urologist consultation. All individuals with clinical or biochemical suspicion of PCa (PSA > 4 ng/mL), in the context of age and prostate volume, underwent ultrasound-guided transrectal prostate biopsy. Then, patients with pathologically confirmed prostate cancer were stratified according to the year of diagnosis: Group A accounted for those diagnosed between 2000 and 2014 and Group B for those patients diagnosed in the timeframe of 2015–2021. Comparisons of PCa characteristics, treatment modalities and oncologic outcomes between Group A and B were performed. Results: Overall, we collected data from 2759 PCa patients from 2000 to 2021. The median PSA at baseline was 32 ng/mL, and 25% had a family history of PCa. Overall, 25.8% were asymptomatic and 46% had a non-metastatic presentation. After the OPUS campaign, PSA at diagnosis was significantly lower across all age groups. The incidence of PCa diagnosis in asymptomatic men was higher (31.4% vs. 19.9%) and a higher proportion of men were diagnosed with organ-confined, palpable disease (46% vs. 28%) (p < 0.001). The rate of patients eligible for active/radical treatment was higher after the OPUS campaign (patients who received surgery increased from 12.78% to 32.41%; patients who underwent radiation increased from 28.38% to 49.61%). The proportion of patients diagnosed with non-clinically significant disease was negligible and remained stable across time. Conclusions: PCa in Mexican patients displays aggressive features at diagnosis, whereas the rate of non-significant disease is negligible. The introduction of early detection strategies may lead to lower symptomatic and metastatic PCa and higher opportunities for radical treatment. This emphasizes the need for public awareness and for adjustment of screening strategies to the peculiarities of the Mexican population. Full article