Search Results (4,056)

Background and Objectives: Type 2 diabetes mellitus (T2DM) is increasing in prevalence worldwide, placing a substantial burden on healthcare systems, particularly in resource-limited settings. In Yemen, limited screening and diagnostic capacity contribute to delayed detection and management. Prediabetes, a reversible state of dysglycemia, carries significant cardiovascular risk and frequently progresses to diabetes. Early identification of both conditions is vital for prevention and public health planning. Materials and Methods: This cross-sectional study, conducted from July 2024 to May 2025 in three medical centers in Ibb Governorate, Yemen, assessed 1045 adults aged 18–60 years without known diabetes or prediabetes. Glycaemic status was classified according to the 2025 American Diabetes Association criteria. Undiagnosed diabetes was defined using three diagnostic combinations: FBS + OGTT, FBS + HbA1c, and OGTT + HbA1c. Results: The prevalence of undiagnosed diabetes was 8.4% (FBS + OGTT) and 9.76% (FBS + HbA1c or OGTT + HbA1c). Prediabetes prevalence was 23.4%, 14.7% and 26.4% based on FBS, OGTT, and HbA1c, respectively. Females represented a higher proportion of undiagnosed diabetes and prediabetes cases. Age was significantly associated with glycemic status across all tests, while gender showed significant associations with FBS and HbA1c. Family history of chronic disease was significantly associated with HbA1c-based classification. Approximately 8–10% of adults in Ibb had undiagnosed diabetes, while up to one-quarter had prediabetes. Age and family history were key predictors of dysglycaemia. Conclusions: These findings highlight the need for targeted, multi-marker screening and early intervention strategies, particularly in relatively stable regions of conflict-affected settings, to prevent progression to diabetes and reduce long-term complications and healthcare burden. Full article

Background/Objectives: Bioresorbable polylactic acid (PLA) matrices have shown promise in supporting wound healing through their biocompatibility, tissue integration, and potential involvement in immune regulatory mechanisms. This study aimed to analyze the clinical performance of a PLA-based matrix in the treatment of chronic wounds under real-world conditions in a single-center setting. Methods: This retrospective study included patients with chronic wounds treated with the polylactic acid matrix at Evangelisches Waldkrankenhaus Spandau between February 2023 and February 2025. Wounds were surgically debrided in the operating room prior to matrix application. The matrix remained in place until resorption or detachment, with reapplications occurring at a mean interval of approximately 14 days. Data was anonymized and analyzed descriptively. Results: A total of 14 patients with 16 chronic wounds were treated in this study. The mean patient age was 76.1 years. The most common underlying causes were ischemia and trauma, with an average wound size of 23.6 cm². Complete wound closure was achieved in 15 out of 16 cases (93.8%), with a mean time to complete wound closure of 72.9 days. The average duration of hospitalization was 24.8 days. Conclusions: The polylactic acid matrix demonstrated a high rate of short-term wound closure in a heterogeneous cohort of chronic wounds, with a mean time to closure of 73 days and no requirement for skin grafting. Further prospective studies with standardized long-term follow-up are warranted. Full article

Background: Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the aim of generate preliminary evidence in highlighting unmet needs in this setting. Methods: We retrospectively reviewed medical records of EGC patients who underwent FJ placement during SL at the Fondazione IRCCS Policlinico S. Matteo from January 2022 to December 2023. Patients with missing nutritional data or known metastatic disease were excluded. Results: We included 14 Caucasian patients aged 66 years (IQR: 56.3–69.5) with a median Body Mass Index (BMI) of 23.7 kg/m² (IQR: 21.6–26.3). The tumor location was the gastroesophageal junction in eight cases (57%), the body of the stomach in four cases (29%), and the esophagus in two cases (14%). At the time of diagnosis, all patients had experienced weight loss: 13.4% of body weight (IQR: 8.7–16.8) in the last 6 months; with high malnutrition risk scores: NRS-2002 = 3 (IQR: 2–4) and MUST = 2 (IQR: 1–2). Prior to FJ placement only four (29%) patients had tried oral nutrition supplements (ONS) and nine (64%) had been evaluated by dietitians. Home enteral nutrition (HEN) was started in twelve (86%) cases, with three (21%) providing total enteral nutrition and 9 (64%) as supplemental HEN, providing a median of 45.5% of energy needs (IQR: 32.6–68.2). Due to sufficient oral intake, HEN was not started in two cases (14%) and was discontinued in the first month in another two cases. In this series, FJ was in place but unused for a median duration of 11 days (IQR: 3–91). The median duration of HEN was 97 days (IQR: 40–135); with 5 (35%) patients achieving weight stability/gain. FJ-related complications requiring hospitalization occurred in three (21%) cases. Conclusions: In this case series, we observed a suboptimal utilization of the FJ. Several patients had not undergone ONS trials or dietitian assessment prior to FJ placement, while others retained the FJ for months without using it. Given the potential risks of FJ, standardized selection criteria are warranted; routine preoperative nutritional assessments before SL should be implemented to identify high-risk patients and optimize FJ placement. Full article

Kuwait faces a significant public health challenge from obesity and Type 2 Diabetes Mellitus (T2DM), conditions known to disrupt the natural balance of oral bacteria. This imbalance, or dysbiosis, can promote gum disease and may worsen metabolic health. While the intragastric balloon (IGB) is a common, less invasive weight-loss procedure, its specific effect on the community of bacteria in saliva remains unclear, especially for high-risk groups. The objective of this study was to investigate changes in the salivary microbiota of obese prediabetic patients following IGB placement. We recruited 20 obese patients (11 female, 9 male; average age 31.5) from a clinic in Kuwait. Saliva samples were collected just before IGB (Allurion™) insertion and again 6 weeks after that. Using 16S rRNA gene sequencing, we identified the bacterial species present and used bioinformatic tools to analyze diversity and abundance. Our analysis revealed that the overall diversity and structure of the salivary microbial community remained stable after the procedure. However, we detected notable changes in specific types of bacteria. The relative abundance of several genera, including Veillonella, Porphyromonas, and Fusobacterium, shifted significantly. At the species level, Porphyromonas pasteri and Haemophilus parainfluenzae became less abundant, while certain Veillonella and Streptococcus species increased in number after the IGB was placed. In conclusion, for obese prediabetic patients in Kuwait, the salivary microbiome demonstrates remarkable stability in the weeks following IGB surgery. The procedure did not drastically alter the overall ecosystem, but it did trigger specific, subtle changes in certain bacterial populations. This suggests the oral microbiota is resilient, adapting to the new physiological conditions without a major upheaval. Full article

Despite evidence that exercise improves treatment outcomes, most people living with and beyond cancer (PLWBC) are insufficiently physically active. To address this challenge the Onco-Move Improvement of psychophysical fitness in adult cancer survivors pilot randomized controlled trial aims to investigate the 7-month effects of a 16-week supervised, multicomponent exercise programme on PLWBC adults aged 18–55. The study will include 40 participants currently undergoing cancer treatment or up to 5 years post-treatment with different types of cancer, who will be randomly assigned to the experimental or the control group. The exercise programme will take place three times a week for 16 weeks. We hypothesize that the Onco-Move exercise programme will improve participants’ quality of life, sexual function, and stress-response strategies, as well as their nutrition, physical functions, and body composition. We also expect to observe physiological changes related to the intervention influencing inflammation, metabolism, muscle adaptation, and cellular aging. The Onco-Move exercise programme, once validated, has the potential to be implemented in oncological non-governmental organizations (NGOs) and hospitals in Poland and Spain, among others, as a feasible, effective, and safe non-pharmacological aid for cancer patients and survivors. Full article

Presbyopia is a physiological phenomenon and one of the leading factors contributing to decreased near visual acuity. The prevalence of presbyopia, its social and economic consequences and the prolongation of human life place the correction of presbyopia among the top challenges in modern ophthalmology. Despite the numerous methods currently available for correcting presbyopia, there is still no ideal technique that, by restoring the eye’s age-related loss of physiological accommodation, would provide long-term effectiveness without adverse effects. This article offers an overview of the existing knowledge on the etiology of presbyopia and the available methods of its correction, with particular emphasis on refractive surgery techniques. Full article

Background/Objectives: Population aging in Europe presents significant healthcare, economic, and social challenges, particularly in the care of individuals with chronic diseases and frailty. Advance Care Planning (ACP) fosters patient autonomy and aligns end-of-life care with individual preferences. This study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes. Secondary objectives included exploring clinical characteristics of participants and assessing how frailty is associated with residents’ care goals and preferences. Methods: A prospective observational study was conducted among long-term residents of a Spanish nursing home in 2023. ACP was offered to all new permanent residents, with outcomes assessed through quarterly follow-ups. Acceptance rates, care preferences, and resident satisfaction were primary measures. Clinical data, frailty, functional status, cognitive assessments, and nutritional status were analyzed. The model of ACP is structured into three progressive levels: (1) identification of patients’ values, preferences, and global goals of care; (2) decision-making regarding specific clinical interventions in acute situations; and (3) end-of-life care preferences, including preferred place of death, desired companionship, and comfort-focused measures. Results: From 79 new residents admitted, 93.7% accepted ACP. The process required an average of 139 min to complete, distributed over 3–4 sessions. The main documented preferences included do-not-resuscitate orders (CPR) (79%), hospital transfer decisions (50%), and other individualized care choices. When stratified by frailty level, which was categorized as low, moderate, or high—we observed a clear gradient in care preferences. CPR preference increased from 59.3% (Low) to 87.5% (Moderate) and 95.2% (High). Preference to avoid hospital transfer rose from 22.2% to 50.0% and 85.7%, respectively. Avoidance of instrumentalization increased from 56.2% to 85.0% and 95.0%. Conclusions: ACP in nursing homes is highly acceptable and feasible, with benefits in aligning care with patient preferences and enhancing satisfaction. Full article

Silver tarnishing in museum environments depends on multiple, interacting factors that are not often studied in situ. With the aim of addressing the problem in real-world scenarios, this study presents a one-year assessment at the National Archaeological Museum of Spain, in Madrid, a museum that houses a significant collection of silver objects. Pure Ag coupons were placed in four display cases—two designs with different airtightness—and in an adjacent gallery. Tarnishing was quantified by colorimetry, gravimetry, and galvanostatic reduction, and analyzed in relation to environmental parameters (T/RH) and gaseous pollutants (H₂S, SO₂, HF, HCl, formic and acetic acids), measured with passive samplers. Coupons showed different degrees of tarnish, with annual corrosion rates ranging from IC1 (very low) to IC2 (low), without a straightforward relation to hydrogen sulfide concentrations. Electrochemical profiles and XPS on representative coupons identified Ag₂S as the dominant product, with AgCl and minor Ag₂SO₄ in the coupons exposed outside the airtight cases, indicating different contributions inside and outside the cases. Findings highlight that sulfide concentration is not the sole driver; case airtightness, internal materials, cleaning products used on adjacent areas, and, possibly, other aspects influence silver tarnishing. Full article

Background/Objectives: Emotional eating is defined as a coping mechanism characterized by food consumption in response to negative emotions, and it typically involves overconsumption and a preference for energy-dense and highly palatable foods. The aim of this study was to analyze the influence of experienced stress and emotional eating on body mass in a population of Polish female adolescents. Methods: This study included 816 participants (aged 15–20 years) recruited within the nationwide PLACE-19 Study using random quota sampling of Polish secondary schools, and data were collected by the Computer-Assisted Web Interview (CAWI). Perceived stress was measured with the Adolescent Stress Questionnaire (ASQ), emotional eating was measured with the Emotional Eating Subscale (EE-3) of the Three-Factor Eating Questionnaire (TFEQ), and self-reported body mass was also recorded. Body mass was interpreted either using standard BMI values for adults or growth reference values for minors. Results: Adolescents with excessive body weight reported higher levels of stress on the peer pressure (p = 0.0011 for continuous variables; p = 0.0016 for categories) and financial pressure component scales (p = 0.0319 for continuous variables) than their normal-weight and underweight counterparts. They also displayed higher emotional eating scores across all subscales and for the total emotional eating score (p < 0.05 for continuous variables), particularly for anxiety (p = 0.0345 for categories). The association was confirmed within mediation analysis, as the direct influence explained 79% of the influence of stress on body mass, and the indirect influence, mediated by emotional eating, explained 21% of the influence of stress on body mass. Conclusions: Adolescents with excessive body weight are more prone to stress and emotional eating. The stress itself affects body weight not only directly, but also by affecting emotional eating; therefore, adolescent girls should be taught how to cope with negative emotions using strategies other than increasing food consumption in response to negative emotions. Further studies should assess the mediating role of emotional eating among adolescent girls and evaluate the impact of stress management interventions on body weight. Full article

Background/Objectives: The increasing rate of complex patients with multiple chronic somatic and/or mental disorders in modern medicine is challenging, necessitating special management programs. The aim of the present study was to identify clinical variables and the use of health services associated with the primary-physician-driven inclusion of complex patients in the “Team Management for Complex Patients” (TMCP) special program. Methods: Using validated electronic medical records of a nationwide health maintenance organization, a case–control study was performed. The study compared parameters before enrollment of complex patients included in the TMCP program with those of complex patients during the same time period who were not included, and were matched using a propensity score for age, sex, socioeconomic status, place of residence, ethnicity, smoking status, physical activity, and the balance before the day of enrollment for the major body measurements and laboratory results. Results: The control group was well-balanced, except for the South region and no physical activity. Several respiratory, cardiac, gastrointestinal, neurological, inflammatory and autoimmune diseases were significantly more common among patients included in the TMCP program than among those not included. Complex patients included in the program presented significantly higher previous rates of attending outpatient urgent care centers, visiting hospital emergency departments, hospitalization, and medication use. Conclusions: Although limited by subjective inclusion criteria and potential confounding, the present comparative study identified clinical variables associated with the identification of complex patients for enrollment into a special managed program. These associations may inform future work to develop and validate criteria to support physician decision-making in selecting complex patients for managed programs and designing healthcare resources for patients who need them most. We currently meticulously follow the outcomes of the patients included in the special managed program. Full article

Purpose: This study evaluated the accuracy of arm-based photoplethysmography (PPG) wearable heart rate (HR) monitors in comparison to a validated chest strap reference across various activity levels. Methods: Twenty-eight healthy adults (14 males, 14 females; aged 23.8 ± 1.1 years) wore six HR monitors: Polar H10 chest strap, Polar Verity Sense on the forearm, Garmin Forerunner on the wrist, and three identical Whoop 4.0 devices placed on the left wrist, forearm, and upper arm. Participants completed rest, warm-up, high-intensity burpees, and graded treadmill exercise. HR data were analyzed using mean absolute percentage error (MAPE), Bland–Altman analysis, concordance correlation coefficient (CCC), and Deming regression. Results: Accuracy was highest at rest and gradually decreased as movement intensity increased. During rest, all devices showed minimal bias and high agreement (CCC > 0.99), with Verity Sense recording the lowest MAPE. In warm-up, Whoop-upper arm and Verity Sense outperformed wrist and Garmin positions, while the Whoop-forearm showed proportional and systematic bias. Burpees resulted in the lowest accuracy across devices (CCC < 0.50), but Whoop-upper arm performed better than other placements. During the Modified Bruce protocol, Verity Sense and Whoop-upper arm had the strongest agreement with the chest strap. Placement of identical Whoop units affected accuracy, with the upper arm outperforming forearm and wrist positions. Conclusions: PPG wearables provided accurate HR monitoring at rest, during warm-up, and during steady-state graded exercise, particularly when positioned proximally (forearm or upper arm). Accuracy declined during short, high-intensity, full-body activities due to motion artifacts. Both the forearm-mounted Verity Sense and the upper-arm Whoop demonstrated the closest agreement with the chest-strap reference. The intra-device comparison of identical Whoop units confirmed that anatomical placement alone significantly affects accuracy. Full article

Objective: This study aimed to assess the psychosocial impact of stainless steel crowns (SSCs) among primary school children in Dammam, Saudi Arabia, focusing on bullying experiences, child satisfaction, and parental perception. Methods: A cross-sectional survey was conducted in June 2025 among 123 children (mean age 7.8 years; 52% male) from two randomly selected schools. Schools were chosen using simple random sampling from a Ministry of Education-approved list. All children aged 6–10 years with at least one SSC placed for six months or more were eligible. A validated, self-administered questionnaire completed by children and their parents assessed bullying related to SSCs, satisfaction with the crown’s appearance, and perceived impact. Statistical analyses included descriptive statistics, Chi-square tests, and logistic regression to evaluate associations between variables (p < 0.05). Results: Bullying was reported by 39.0% of children, primarily verbal (58.1%), followed by social exclusion (29.1%). Although gender differences in bullying were not statistically significant (p = 0.829), boys more often reported nickname-based teasing (p < 0.001). Only 35.0% of children were satisfied with the crown’s shape and 29.3% with its color. Nearly half (48.8%) felt uncomfortable when asked about it. In contrast, parental satisfaction was higher (69.1%), though only 42.3% believed their child had fully accepted the crown. Conclusions: While SSCs are clinically effective and accepted by most parents, a notable proportion of children experience bullying and aesthetic dissatisfaction. These findings highlight the need for child-centered care and consideration of esthetic alternatives. Full article

Background: In Canada, 30 percent of the older adult population is foreign-born. Immigrant older adults are more likely to experience significant social isolation due to a variety of factors. However, limited research exists on the influence of specific factors. The objective of this study is to understand the economic factors that contribute to social isolation among older immigrants in the Greater Toronto Area (GTA), Canada. Methods: A qualitative interpretive description method was used. Following research ethics boards’ approval, semi-structured individual interviews were conducted with a total of 47 Arabic, Mandarin, and Punjabi-speaking older immigrants in the GTA. The interviews were conducted in their preferred language, audio-recorded, and translated (when needed) into English and transcribed. Thematic analysis of the data was informed by an ecosystemic framework. Results: Six themes were identified: (1) barriers to finding employment; (2) living a “hand-to-mouth life” due to limited income/pension; (3) housing costs that eliminate choices and options; (4) costs (and availability) of transportation as a barrier to getting around; (5) lack of “essential” healthcare coverage; and (6) costs of community programs that prevent “getting out of the house.” These economic factors at micro, meso, and macro levels of society intersected to create desperate situations that contributed to social isolation among older immigrants in the GTA. Conclusions/Implications: Addressing these economic factors is critical to immigrant older adults’ aging in place. Service providers must advocate for accessible physical and financial resources and services including affordable housing and transportation, old age security, and comprehensive healthcare coverage for older immigrants. Future research should focus on economic challenges faced by older adults across other immigrant communities in the GTA as well as in other cities, provinces, and territories. Full article

Aging is a complex degenerative process characterized by the accumulation of molecular damage and a heightened susceptibility to disease. The oxidative stress theory of aging identifies endogenous reactive oxygen species (ROS) as primary drivers of this cellular deterioration. This review provides a comprehensive analysis of the critical, yet underappreciated, interplay between oxidative stress and the complement system, a powerful effector of innate immunity. We detail the mechanistic pathways through which redox imbalance directly activates complement components and, conversely, how complement activation amplifies oxidative stress, creating a vicious cycle that accelerates tissue damage. A central focus is placed on how this redox–complement axis contributes to the pathophysiology of age-related conditions, including neurodegenerative, cardiovascular, and metabolic diseases. Furthermore, the review explores emerging therapeutic strategies that target this interaction, highlighting the potential of antioxidant and complement-inhibitory approaches to disrupt this cycle and promote healthy aging. By synthesizing current evidence, this work underscores the significance of the redox–complement network as a key mechanistic link in aging and its associated diseases. Full article

Frailty assessment and monitoring are essential for supporting independent living and preventing adverse outcomes among older adults. This study aimed to develop and evaluate the concurrent validity of a high-accuracy home-monitoring system for assessing and tracking frailty in older adults. The system integrated off-the-shelf, zero-effort technologies, including ultra-wideband (UWB) indoor positioning, a smart scale, a connected hand dynamometer, and a Bluetooth speakerphone, to measure the five components of Fried’s Frailty Phenotype criteria. Twenty-one participants (aged 21–90 years) completed frailty assessments using both traditional clinical measures and the sensor-based system within a simulated home environment within a major rehabilitation hospital. The developed system demonstrated very strong and statistically significant correlations between the sensor-based system and the Fried’s Frailty Phenotype criteria, strong correlations with the Clinical Frailty Scale, and moderate-to-strong correlations with the Edmonton Frailty Scale, confirming the system’s strong concurrent validity. These findings indicate that high-accuracy, home-based monitoring technologies can provide reliable, objective, and non-invasive assessment of frailty in older adults, supporting early detection and continuous monitoring. This approach shows promise for future integration into smart home environments to enhance proactive frailty management and aging-in-place strategies. Full article