Search Results (15,291)

Background: Diabetes-related foot diseases represent a global health problem because of the associated complications, the risk of amputation, and the economic burden on health systems. Negative pressure wound therapy (NPWT) is a technique that uses sub-atmospheric pressure to help promote wound healing by reducing the inflammatory exudate while keeping the wound moist, inhibiting bacterial growth, and promoting the formation of granulation tissue. Objective: This study aimed to assess the effectiveness of NPWT in preventing major amputation in diabetic patients with complicated foot or lower limb infections and to contextualize the results through a review of the existing literature. Materials and methods: We conducted a retrospective study at the First Surgical Department of “Dr. I. Cantacuzino” Clinical Hospital in Bucharest, Romania, over a 15-year period, including 30 consecutive adult patients with diabetes and soft tissue foot or lower limb infections treated with NPWT. Patients with non-diabetic ulcers, incomplete medical data, or aged under 18 were excluded. All patients underwent initial surgical debridement, minor amputation, or drainage procedures, followed by the application of NPWT using a standard protocol. Dressings were changed every 2–4 days for a total of 7–10 days. Antibiotic therapy was adapted according to the culture results. The primary outcome was limb preservation, defined as avoidance of major amputation. Secondary outcomes included in-hospital mortality and wound status at discharge. Results: NPWT was associated with a favorable outcome in 24 patients (80%), defined by wound granulation or healing without the need for major amputation. Five patients (16.6%) underwent major amputation because of failure of the primary lesion treatment, and one patient died. No statistically significant association was observed between the outcomes and standard classification scores (WIFI, IWGDF, and TPI). A comprehensive literature review helped to integrate these findings into the existing pool of knowledge. Conclusions: NPWT may support limb preservation in selected diabetic foot cases. While the retrospective design and the small sample size of the study limit generalizability, these results reinforce the need for further controlled studies to evaluate NPWT in real-life clinical settings. The correct use of NPWT combined with etiological treatment may offer a maximum chance to avoid major amputation in patients with diabetes-related foot diseases. Full article

Legionella is an environmental bacterium capable of causing severe respiratory infections, with outbreaks posing significant public health challenges in developed countries. Understanding public awareness of Legionella transmission, risk perception, and preventive behaviors is crucial for reducing exposure and guiding health education strategies. This study aimed to evaluate the Portuguese population’s knowledge of Legionella infections and their readiness to adopt preventive measures. A structured questionnaire was developed and administered to 239 participants aged 18–76 years across Portugal, collecting socio-demographic data and assessing literacy through statements organized into domains related to Legionella risk, control measures, and public health impact. The results indicate that participants possess moderate to high awareness of Legionella severity, transmission routes, and preventive strategies, yet gaps remain in understanding key risk factors, optimal water system maintenance, and the influence of temperature on bacterial growth. Age, educational attainment, and occupational status were associated with differences in self-assessed literacy levels. Artificial neural network models were applied to classify literacy levels, achieving a near 90% accuracy and demonstrating higher confidence in low and moderate categories. These findings provide insights for designing tailored educational programs, improving public health communication, and enhancing preventive behaviors to reduce Legionella infection risks. Full article

Background: Cardiovascular diseases (CVDs) remain the primary cause of global mortality, with arterial hypertension, ischemic heart disease (IHD), and cerebrovascular accident (CVA) forming a progressive continuum from early risk factors to severe outcomes. While numerous studies focus on isolated biomarkers, few integrate multidimensional visualization with artificial intelligence to reveal hidden, clinically relevant patterns. Methods: We conducted a comprehensive analysis of 106 patients using an integrated framework that combined clinical, biochemical, and lifestyle data. Parameters included renal function (glomerular filtration rate, cystatin C), inflammatory markers, lipid profile, enzymatic activity, and behavioral factors. After normalization and imputation, we applied correlation analysis, parallel coordinates visualization, t-distributed stochastic neighbor embedding (t-SNE) with k-means clustering, principal component analysis (PCA), and Random Forest modeling with SHAP (SHapley Additive exPlanations) interpretation. Bootstrap resampling was used to estimate 95% confidence intervals for mean absolute SHAP values, assessing feature stability. Results: Consistent patterns across outcomes revealed impaired renal function, reduced physical activity, and high hypertension prevalence in IHD and CVA. t-SNE clustering achieved complete separation of a high-risk group (100% CVD-positive) from a predominantly low-risk group (7.8% CVD rate), demonstrating unsupervised validation of biomarker discriminative power. PCA confirmed multidimensional structure, while Random Forest identified renal function, hypertension status, and physical activity as dominant predictors, achieving robust performance (Accuracy 0.818; AUC-ROC 0.854). SHAP analysis identified arterial hypertension, BMI, and physical inactivity as dominant predictors, complemented by renal biomarkers (GFR, cystatin) and NT-proBNP. Conclusions: This study pioneers the integration of multidimensional visualization and AI-driven analysis for CVD risk profiling, enabling interpretable, data-driven identification of high- and low-risk clusters. Despite the limited single-center cohort (n = 106) and cross-sectional design, the findings highlight the potential of interpretable models for precision prevention and transparent decision support in cardiovascular aging research. Full article

Background/Objectives: To delineate integrated lifestyle profiles combining physical activity (PA) and dietary intake (DI) and test their links with lower limb injury in physically active young adults. Methods: We analyzed a cross-sectional convenience sample of university students (men: n = 91, 20.5 ± 1.0 years; women: n = 118, 20.3 ± 0.8 years). PA (IPAQ) and DI (QEB) were assessed alongside self-reported injuries. Latent class modeling derived PA–DI profiles. Injury prevalence across profiles was compared (χ²), and logistic regression examined injury odds adjusting for sex, age, and BMI. Results: Four profiles emerged. Two reflected less healthy patterns (Profiles 2–3) and two healthier ones (Profiles 1, 4). Profile 4 showed higher vegetables/legumes/fermented milk and lower fast food/sugary drinks; Profile 3 combined greater sitting and fried/sweetened items with lower walking/milk intake. Overall injury prevalence was 56.9%, ranging from 44.1% (Profile 2) to 66.7% (Profile 4 exceeded Profile 2 in pairwise comparison (χ² (1) = 5.08, p = 0.024)). In adjusted models, men had higher injury odds (OR = 1.94, 95% CI: 1.09–3.48, p = 0.025); profile membership was not independently predictive, and profile × sex interactions were null. Conclusions: Young adults cluster into distinct PA–DI patterns that differ behaviorally, but sex—rather than profile—was the most consistent correlate of injury. Prevention should integrate lifestyle screening with sex-specific strategies. Full article

Background: Older adults are at elevated risk of falls, especially when prescribed AEDs (AEDs) for neuropathic pain. The sedative and neuropsychiatric effects of these agents contribute significantly to fall-related morbidity. However, existing studies often lack stratification by age and dose. Objective: To systematically evaluate the incidence and drug-specific risk of falls and fall-related adverse events (AEs) in older adults prescribed AEDs for neuropathic pain. Methods: A systematic search was performed across PubMed, Scopus, CINAHL, ScienceDirect, and Cochrane Library databases up to May 2025. Studies were selected using PICOS criteria and included RCTs and controlled cohort studies reporting on AED-related AEs among participants aged ≥60 years. The methodological quality was assessed using RoB 2, ROBINS-I, and GRADE frameworks. Meta-analyses were performed using logit event rates and fixed-effects modeling via Comprehensive Meta-Analysis v3.7. Publication bias was evaluated using Begg’s and Egger’s tests. Results: Twenty-three studies met the inclusion criteria. The pooled logit event rate for falls was −1.693 (95% CI: −1.993 to −1.393), corresponding to a 15.5% incidence. Gabapentin showed the lowest fall risk (~10%), while pregabalin and carbamazepine were associated with higher rates of dizziness (up to 21.6%), sedation (~15.5%), and ataxia (~17.8%). Heterogeneity was low (I² = 0–22.3%) across outcomes. Conclusions: AEDs carry a clinically significant fall risk in older adults, with dose-dependent patterns. Gabapentin may present a safer profile, while pregabalin and carbamazepine warrant cautious use and monitoring. These findings inform individualized prescribing and fall prevention strategies in geriatric neuropathic pain management. Full article

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a fivefold increase in stroke risk. Direct oral anticoagulants (DOACs), including apixaban, are now the preferred therapy for stroke prevention in patients with non-valvular AF (NVAF). However, interindividual variability in drug response and safety remains a major challenge, particularly in elderly patients with comorbidities and polypharmacy. Genetic polymorphisms in drug-metabolizing enzymes and transporters may contribute to variability in apixaban exposure and bleeding risk. This study aimed to evaluate the association of polymorphisms in ABCB1, CYP3A4, and CYP3A5 with steady-state plasma concentrations of apixaban (Cssmin) and hemorrhagic complications in elderly patients with NVAF. Methods: This cross-sectional study included 197 patients (mean age 83 ± 8 years; 67% women) with NVAF treated with apixaban (5 mg twice daily). Genotyping of ABCB1 (rs1045642, rs2032582, rs1128503), CYP3A4*22 (rs35599367), and CYP3A5*3 (rs776746) was performed using allele-specific real-time PCR. Cssmin of apixaban was determined by high-performance liquid chromatography coupled with tandem mass spectrometry. Associations with bleeding events were evaluated. Results: Bleeding events were recorded in 40 patients (20.3%). An association signal was observed for ABCB1 rs1045642, where carriers of the CC genotype had a higher risk of bleeding compared with alternative alleles (OR = 2.805; 95% CI: 1.326–5.935; p = 0.006). After correction for multiple testing, the association remained significant only under the log-additive model (OR = 1.93 per C allele; 95% CI: 1.17–3.20; q = 0.0275; p_adj = 0.044), while recessive and codominant effects did not withstand Bonferroni adjustment. No significant associations were observed for rs2032582, rs1128503, CYP3A4*22, or CYP3A5*3. None of the studied polymorphisms, including rs1045642, significantly affected Cssmin. Concomitant therapy, particularly with antiarrhythmic drugs and statins (rosuvastatin), also increased bleeding risk. Conclusions: The findings highlight the potential contribution of ABCB1 rs1045642 and specific drug–drug interactions to the risk of hemorrhagic complications in elderly NVAF patients receiving apixaban. Full article

Hormone replacement therapy (HRT) has been utilized in clinical practice for decades as a main therapeutic approach for mitigating menopausal symptoms. The symptoms mostly encompass vasomotor and genitourinary issues resulting from the deficiency of estrogen and progesterone. Initially identified as a universally advantageous and indispensable intervention, hormone replacement therapy subsequently became the subject of considerable scientific and clinical debate, especially after the publication of extensive epidemiological studies indicating potential adverse effects associated with cardiovascular and cancer risk. This study aims to reassess the role of HRT in clinical practice by analyzing its historical evolution, expanded clinical uses, and changes in guidelines necessitated by resent scientific studies. Current evidence from clinical studies and meta-analyses unequivocally demonstrates that hormone replacement therapy is the most efficacious treatment for vasomotor and urogenital symptoms, and also acknowledging its potential role in osteoporosis prevention. The administration of HRT requires careful individual assessment, considering the patient’s age, timing of initiation, existence of comorbidities. In this setting, therapy decisions have to be based on a combination of the most up-to-date clinical guidelines, risk stratification, and the patient’s preferences. In conclusion, the assessment of HRT confirms its primary role in reducing menopausal symptoms while also highlighting the imperative for a individual strategy that balances benefits and risks to improve outcomes for women. Full article

Background: Psychological vulnerabilities, including early maladaptive schemas (EMSs), emotion regulation difficulties, perceived stress, and limited social support, are increasingly recognized as drivers of maladaptive eating and obesity. These findings underscore the need for health education and health promotion strategies that address psychological determinants of eating behavior. However, few studies integrate these psychological mechanisms with dietary and lifestyle indicators in both community and medical populations. Methods: A total of 1500 adults (aged 18–65 years; 53% women) recruited from community and medical settings participated in the study. Data were collected between January 2018 and February 2025 using standardized paper-based questionnaires. Participants completed validated measures of EMSs (YSQ-S3), emotion regulation (DERS), stress (PSS-10), social support (MSPSS), eating-related behaviors (QERB), diet (FFQ-6; Unhealthy Diet Index [UDI]), and physical activity (IPAQ-SF). Anthropometric indices included body mass index (BMI) and waist circumference (WC) as an indicator of central adiposity. Analyses involved multivariate regression, mediation, and moderation models. Results: EMSs were associated with emotional overeating and higher UDI scores. Difficulties in emotion regulation mediated the EMS–eating relationship (β_indirect = 0.27, p < 0.001). Perceived stress amplified, while social support attenuated, the association between EMSs and emotion regulation difficulties. UDI was inversely related to physical activity (β = −0.14, p < 0.01) and positively to sedentary time (β = 0.12, p < 0.01). Both BMI and WC were higher among participants reporting greater stress, emotion dysregulation, and unhealthy eating. All effects remained robust after adjustment for age, gender, and BMI. Conclusions: Early maladaptive schemas and emotion regulation difficulties contribute to unhealthy dietary patterns and central adiposity, with stress and social support acting as contextual moderators. Integrating psychological assessment with validated dietary and lifestyle measures provides a comprehensive framework for obesity prevention and schema-informed interventions. From a lifespan perspective (18–65 years), these findings highlight the need for multidomain strategies targeting cognitive–emotional and behavioral mechanisms of weight regulation. Full article

Sex differences are known to influence both micronutrient metabolism and cardiometabolic health outcomes. However, the extent to which these sex-specific factors interact, particularly in the relationship between micronutrient status and cardiometabolic risk, remains insufficiently understood. The present study aimed to investigate sex differences in health and micronutrient status, and their association with blood lipids, body mass index, and body weight. The final sample size included 488 Austrian adults (median age: 38 years; comprising 256 males and 232 females) who successfully met the inclusion criteria. Blood analyses were conducted to measure whole-blood micronutrients and serum levels of various cardiometabolic health biomarkers, including blood lipids. Micronutrient status (including deficiencies and excesses) was calculated using sex-specific reference ranges. There were significant differences between males and females for most (19 out of 28) blood biomarkers of cardiometabolic health (p < 0.05), with females generally showing a healthier cardiometabolic profile. Significant sex differences were also observed in the adjusted values of three micronutrients: copper was higher in females, while iron and vitamin B₁₂ were higher in males (p < 0.05). Sex differences in micronutrient status indicated a higher prevalence of iron deficiency and copper excess among females (p < 0.05). Different patterns were observed between males and females in the association of blood lipids and body composition with micronutrients and demographic factors. These findings highlight the importance of individualized approaches in preventive and therapeutic health interventions based on differences between males and females. Full article

Background/Objectives: Hyponatremia has been associated with mortality and hospital readmissions. Although multimorbid older patients are particularly affected, specific data on this group are lacking. Methods: A prospective cohort was used based on the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial, a European multicenter, cluster-randomized trial among hospitalized patients aged ≥70 years with ≥3 chronic medical conditions taking ≥5 long-term medications, with documented sodium values at admission, excluding participants with hypernatremia (>145 mmol/L). The primary outcome was all-cause 1-year mortality, and secondary outcomes were 30-day mortality and readmission at 1 year and at 30 days. We examined the association between hyponatremia and mortality in comparison to normonatremia using a mixed-effects survival model, with adjustment for age, sex, comorbidities, study intervention arm, study site and cluster; and the association between hyponatremia and readmission using competing risk models with death as the competing risk. Subgroup analyses were performed across sodium hyponatremia categories (mild 134–130 mmol/L, moderate 129–125 mmol/L, severe < 125 mmol/L). Results: Of 2008 OPERAM participants, 1968 had a sodium value at admission, and 33 were excluded due to hypernatremia. In the 1935 participants, the mean age was 79.4 years (standard deviation 6.3), 866 (44.8%) were female, the median number of comorbidities was 11 (IQR 8–16), the median number of drugs was 10 (IQR 7–13), and 401 (20.7%) had hyponatremia at admission. The multivariate-adjusted hazard ratio (HR) for 1-year mortality with hyponatremia was 1.41 (95% confidence interval [CI] 1.11–1.78, 364 deaths) and for 30-day mortality was 1.20 (95%CI 0.74–1.94, 89 deaths). The adjusted sub-HR for 1-year readmission was 0.94 (95%CI 0.79–1.11), and that for 30-day readmission was 1.1 (95%CI 0.78–1.59). There was a linear increase in 1-year mortality across hyponatremia categories (HR from 1.31 to 2.64, p for trend = 0.001). Conclusions: Hyponatremia at admission is associated with increased 1-year mortality in multimorbid older adults, with increasing risk for lower sodium values. These findings support sodium as a useful prognostic marker in this setting, while its potential independent impact on survival remains to be clarified in prospective studies. Full article

Background/Objectives: The global burden of spinal cord injury (SCI) is increasing due to aging populations and persistent regional disparities, highlighting an urgent need for updated epidemiological data. This study quantifies the global, regional, and national burden of SCI from 1990 to 2021 and projects its prevalence to 2050. Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we estimated age-, sex-, and location-specific prevalence and years lived with disability (YLDs). Projections were developed using sociodemographic modeling, with analyses including Bayesian meta-regression (DisMod-MR 2.1) and Das Gupta decomposition. Results: In 2021, approximately 14.5 million people worldwide were living with SCI, including 7.30 million with neck-level and 7.22 million with below-neck-level injuries. The age-standardized prevalence per 100,000 people was 88 for neck-level SCI and 95 for below-neck-level SCI. Although age-standardized rates declined slightly from 1990 (−0.17% for neck-level and −0.18% for below-neck-level), the absolute burden increased substantially. This increase was particularly prominent in East Asia and low- and middle-income countries. The highest prevalence was observed in men aged 50–64 years. Projections indicate that global SCI cases will exceed 14.5 million by 2050. Conclusions: These findings underscore the growing absolute burden of SCI. Targeted prevention strategies, enhanced rehabilitation services, and equitable healthcare access are crucial to mitigate long-term disability and improve the quality of life for affected populations worldwide. Full article

In recent years, the use of silver nanoparticles (AgNPs) in various fields has been investigated due to their highly potent properties. One of these areas is the adaptation of AgNPs to food packaging/preservation technologies. The primary reasons for the use of AgNPs in food preservation studies are their high levels of antibacterial, antioxidant, and antifungal activities. In particular, the slow and controlled release of silver provides a sustained protective effect throughout the contact period of AgNP-integrated packaging with food and reduces microbial load by preventing biofilm formation. Furthermore, high thermal stability of AgNPs provides high protection to foods under various conditions. Their high surface-area-to-volume ratio, making them effective even at low concentrations, further supports AgNPs as a promising alternative in food preservation technologies. Moreover, their ease of surface modification facilitates the integration of these nanoparticles (NPs) into polymer matrices, biodegradable films, and coatings. Additionally, some AgNP-based films are also used in smart packaging applications, providing a color change indicator of degradation. Their broad pH tolerance enhances their applicability to a variety of food types, from dairy to meat products. For all these reasons, AgNPs are considered as one of the essential components of innovative food packaging to slow down food spoilage, prevent microbial contamination, and provide safer, longer-lasting products to the consumer, and studies on them are ongoing. Full article

Background: The purpose of this study was to quantify the incidence of polytrauma cases at a single-center county hospital in Croatia and evaluate the therapeutic approaches currently in use. Methods: Patient data for 54 individuals diagnosed with polytrauma between 2019 and 2022 were retrospectively reviewed using the hospital’s medical records system. The analysis encompassed several aspects, including injury mechanisms, injury timing, Glasgow Coma Scale scores, alcohol levels, therapies, triage classifications, and hospital stay durations. Results: In this study, patient age was not significantly associated with clinical presentation, treatment approach, or outcomes. However, gender showed significant associations with GCS, triage category, and discharge status, with female patients presenting more frequently with severe impairment (GCS 3–8) and higher triage urgency. Blood alcohol levels were more frequently elevated in male patients but showed no association with clinical severity or outcomes. Additionally, lower GCS scores were significantly linked to poorer outcomes, including higher in-hospital mortality, while surgical intervention was associated with longer hospital stays. Conclusions: Collectively, gender and level of consciousness significantly influenced triage urgency and outcomes, highlighting the need for targeted prevention and management strategies. Full article

This paper presents the first exploration of young carers in early childhood (YCEC), in the context of whole family support, through the application of the Power Threat Meaning Framework (PTMF). Existing contributions to young carer research have shaped social policy, legislation, and practice concerned with whole family approaches to the identification, assessment, and support for young carers globally. To date, the literature has predominantly focused on young carers in middle childhood to young adulthood, contributing to socially constructed Eurocentric ideologies of who young carers are likely to be. As such, YCEC remain disempowered in broader young carer and family science discourse. This qualitative exploration centers upon the experiences of three families. Primary data collated retrospective accounts of two adult siblings supported by documentary data obtained by participants through a subject access request (SAR). Secondary data derived from two case studies, drawn from the lead author’s master’s dissertation, offering experiences of families each with a young carer aged four years old. Participants lived in England, United Kingdom (UK). Deductive analysis utilized dual methodological approaches, offering nuanced insight. Thematic codes were synthesized into predetermined themes. ‘Power,’ ‘threat,’ ‘meaning,’ ‘threat responses,’ and ‘strengths’ to explore the application of the PTMF beyond individual experience. Findings show systemic and structural powers held within the lives of YCEC. This disempowers the ethos of whole family support, which should serve to endorse integrated working and foster the autonomous functioning of family life. Findings consider threats, worsening vulnerabilities, and exposure to harm. Meaning is deduced from findings offering recommendations for future research, practice, and policy decisions. In conclusion, opportunities for the prevention of inappropriate caring roles, early identification, and intervention have been missed. This study adds to the growing exploration of the PTMF. It harnesses its potential application as a holistic assessment tool and qualitative data analysis framework, helping to bridge structural and developmental viewpoints which typically frame the current understanding of family functioning and related social policy. Full article

Objective: This study aimed to validate the clinical utility of a salivary molecular platform (Oral Predict^®) for periodontal pathogen detection across preventive, therapeutic, and maintenance settings. Methods: A longitudinal randomized study was conducted involving 78 adults who provided saliva samples at baseline, one month, and three months after professional dental hygiene. Participants were randomized into two groups: control group (n = 39) and probiotic group with Oral Predict^® probiotic supplementation (n = 39). Crude saliva was processed directly without nucleic acid extraction and analyzed by multiplex real-time PCR using either the compact Real-time PCR system or standard thermocyclers. Results: At baseline, Fusobacterium nucleatum was the most prevalent pathogen (84.6%), followed by Tannerella forsythia (53.8%) and Porphyromonas gingivalis (46.2%). The Total Pathogen Burden Score (TPBS) showed progressive increases with age, smoking, and poor oral hygiene, and was significantly higher in participants with gingival bleeding. Among individual pathogens, no significant associations were observed with periodontitis staging or grading. Professional hygiene induced mean reductions of 1–2 logs across all pathogens, with TPBS decreasing from 8.7 ± 3.2 to 4.1 ± 2.8 (p < 0.001). At three months, 69.2% of the control group experienced bacterial rebound, whereas 85% of probiotic users sustained or improved bacterial reductions. Conclusions: Salivary molecular testing provides a robust, non-invasive approach for periodontal pathogen detection, treatment monitoring, and long-term maintenance assessment. The flexibility of the Oral Predict^® platform across point-of-care and laboratory settings, combined with automated interpretation, supports integration into preventive protocols and personalized periodontal care. These findings demonstrate the potential of saliva-based molecular diagnostics to shift periodontal management from reactive to predictive and precision-based strategies. Full article