Search Results (423)

Objectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test–retest reliability. Internal consistency was measured using Cronbach’s α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test–retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers. Full article

Metabolic dysfunction-associated fatty liver disease (MASLD) is a chronic, non-communicable spectrum of diseases characterized by lipid accumulation. It is often asymptomatic, and its prevalence varies by region, age, gender, and economic status. It is estimated that 25% of the world’s population currently suffer from MAFLD, and 20 million patients will die from MAFLD-related diseases. In the last 20 years, tea and anti-obesity research have indicated that regularly consuming tea decreases the risk of cardiovascular disease, stroke, obesity, diabetes, and metabolic syndrome (MeS). In this review, we aimed to present studies concerning the influence of matcha extracts and epigallocatechin-3 gallate (EGCG) supplements on metabolic functions in the context of MAFLD in human and animal studies. The published data show promise. In both human and animal studies, the beneficial effects on body weight, cholesterol levels, and liver metabolism and function were noted, even in short-period experiments. The safety levels for EGCG and green tea extract consumption are marked. More experiments are needed to confirm the results observed in animal studies and to show the mechanisms by which green tea exerts its effects. The preliminary data from research concerning microbiota or epigenetic changes observed after polyphenols and green tea consumption need to be expanded. To improve the efficiency and availability of green tea or supplement consumption as a treatment for MAFLD patients, more research with larger groups and longer study durations is needed. Full article

Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was to evaluate the prevalence of GERD after MBS in a 10-year follow-up and analyze the endoscopic outcomes. Methods: This retrospective, multicenter study included 368 patients who underwent single bariatric procedure. The data came from five bariatric centers in Poland, part of the BARI-10-POL project. Data on symptoms of GERD, endoscopic findings, demographics, and surgical outcomes were collected for a 10-year follow-up period. Surgical procedures included SG, Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). Results: Of the 305 patients without symptoms of GERD, 12.3% developed de novo GERD postoperatively. There was no statistical significance regarding the new-onset symptoms and the type of MBS (p = 0.074) and the presence of symptoms of GERD and the type of MBS (p = 0.208). However, SG was associated with a significantly lower likelihood of GERD remission after MBS (p = 0.005). Endoscopic evaluation showed abnormal findings in asymptomatic patients in both preoperative (35.8%) and postoperative (14.1%) examinations (p < 0.001). Conclusions: GERD may be a common issue after MBS. One-quarter of patients after MBS may experience symptoms of GERD, regardless of the type of MBS. SG appears to be associated with a higher risk of persistent symptoms of GERD and a lower likelihood of GERD remission after MBS. Asymptomatic patients both before and after MBS may have abnormal findings in gastroscopy. Full article

Background: The long-term impact of SARS-CoV-2 infection on pulmonary function remains insufficiently characterised, particularly among individuals who have experienced mild or asymptomatic disease. This study aimed to assess spirometric changes over a three-year period and evaluate potential associations with demographic and clinical variables. Methods: We retrospectively analysed spirometry data from 103 healthcare workers (HCWs) who underwent pulmonary function tests at three time points: before the pandemic (Time 0), one year post-pandemic (Time 1), and two years post-pandemic (Time 2). Linear regression models were employed to evaluate the impact of various factors, including age, BMI, gender, smoking status, history of SARS-CoV-2 infection, vaccination status prior to infection, and the number of infections, on changes in FVC and FEV₁. Results: A statistically significant decrease in both FVC and FEV₁ were observed at Time 1 and Time 2 compared to baseline (p < 0.05). Smoking habits were significantly associated with a greater decline in both FVC and FEV₁. Multiple infections were associated with larger reductions in FVC at Time 1. No significant associations were found with age, gender, BMI, or vaccination status. Even in the absence of severe symptoms of the disease, healthcare workers exhibited a measurable decline in pulmonary function over time. Smoking and reinfection emerged as relevant factors associated with reduced lung capacity. Conclusions: These findings emphasise the need for ongoing respiratory monitoring in occupational settings and the importance of targeted preventive measures. Full article

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

Background/Objectives: The COVID-19 pandemic highlighted the critical need for accurate predictive models to guide public health interventions and optimize healthcare resource allocation. This study evaluates how the complexity of compartmental infectious disease models influences their forecasting accuracy and utility for pandemic resource planning. Methods: We analyzed a range of compartmental models, including simple susceptible-infected-recovered (SIR) models and more complex frameworks incorporating asymptomatic carriers and deaths. These models were calibrated and tested using real-world COVID-19 data from the United States to assess their performance in predicting symptomatic and asymptomatic infection counts, peak infection timing, and resource demands. Both adaptive models (updating parameters with real-time data) and non-adaptive models were evaluated. Results: Numerical results show that while more complex models capture detailed disease dynamics, simpler models often yield better forecast accuracy, especially during early pandemic stages or when predicting peak infection periods. Adaptive models provided the most accurate short-term forecasts but required substantial computational resources, making them less practical for long-term planning. Non-adaptive models produced stable long-term forecasts useful for strategic resource allocation, such as hospital bed and ICU planning. Conclusions: Model selection should align with the pandemic stage and decision-making horizon. Simpler models are effective for rapid early-stage interventions, adaptive models excel in short-term operational forecasting, and non-adaptive models remain valuable for long-term resource planning. These findings can inform policymakers on selecting appropriate modeling approaches to improve pandemic response effectiveness. Full article

Background/Objectives: Hepatic artery thrombosis (HAT) is a serious vascular complication in patients undergoing orthotopic liver transplantation (OLT). It is associated with a high risk of graft loss, re-transplantation (re-OLT), and mortality. This study aimed to evaluate the incidence and management of HAT, analyzing potential risk factors. The secondary objectives included quantifying 90-day postoperative morbidity and mortality rates. Methods: In this retrospective, observational, single-center study, data from liver transplant donors and recipients who underwent OLT between 2004 and 2024 were analyzed. HAT was classified as early (e-HAT, ≤30 days) or late (l-HAT, >30 days). Univariate statistical analysis was performed to identify the risk factors associated with HAT occurrence. Multivariate analysis was not performed due to the small number of HAT events, which would increase the risk of model overfitting. Results: In the 20 year study period, a total of 532 OLTs were performed, including 37 re-OLTs. The rates of major morbidity, reoperation, and mortality within 90 days were 44.5%, 22.3%, and 7.1%, respectively. HAT occurred in 2.4% of cases (e-HAT: 1.6%; l-HAT: 0.7%). Among e-HAT cases, 66.6% were asymptomatic and identified through routine postoperative Doppler ultrasound. All e-HAT cases were surgically treated, with a re-OLT rate of 33.3%. Three l-HAT cases required re-OLT. Overall, the HAT-related mortality and re-OLT rates were 7.6% and 46.1%, respectively. At a follow-up of 86 months, the rate of graft loss was 9.2%, and the rate of post-OLT survival was 77%. Patients who developed HAT had a higher donor-to-recipient body weight ratio and longer warm ischemia times (WITs). Additionally, patients undergoing re-OLT had a higher risk of developing HAT. Conclusions: Although the incidence of HAT is low, its clinical consequences are severe. Early Doppler ultrasound surveillance is crucial for detecting e-HAT and preventing graft loss. A high donor-to-recipient body weight ratio, a prolonged warm ischemia time, and re-OLT seem to be associated with a high risk of HAT. Full article

Background: Congenital hepatic hemangiomas (CHHs) are typically considered rapidly involuting tumors, similar to their cutaneous counterparts (RICHs). However, non-involuting tumors remain poorly characterized. This study examines the evolutionary patterns and management strategies for non-involuting congenital hepatic hemangiomas (NICHHs). Methods: We conducted a retrospective review of clinical, imaging, histological, and genetic data of children diagnosed with NICHH—defined as showing no signs of involution for at least 18 months—between 1991 and 2022. Results: Seven patients (five females, two males) were identified. The median age at diagnosis was 42 days (range: 0–1440). Five patients had asymptomatic lesions, predominantly located in the right hepatic lobe. Histologic confirmation was available in three cases, and a GNAQ gene mutation was identified in one. The median follow-up period was 75 months (range: 35–191). Three patients with giant NICHH were treated with sirolimus, resulting in partial response in two cases and lesion stabilization in one. The four untreated patients showed diverse evolutionary patterns, including delayed involution and tardive growth. Conclusions: NICHH lesions demonstrate distinct long-term evolution. Accurate diagnosis and regular monitoring are essential to avoid unnecessary interventions. Sirolimus may offer a promising non-surgical treatment for select patients, particularly those with giant lesions. Full article

Background/Objectives: Previous studies have reported satisfactory outcomes and low rates of instrumentation-related complications (IRCs) following nonfusion posterior fixation in patients with metastatic spinal tumors (MSTs). However, to adequately assess the longevity and durability of nonfusion instrumentation in patients with longer life expectancy, an extended follow-up period is essential. This study aims to evaluate the incidence of and risk factors for IRCs in patients with MSTs who underwent nonfusion posterior fixation and had radiographic follow-up data available for at least one year postoperatively. Methods: Consecutive data were collected from patients who underwent pedicle screw-based posterior fixation without fusion for MSTs in the thoracic and/or lumbar region from 2005 to 2018. The IRCs included screw loosening, screw pull-out, and metal breakage. The IRC-free survival and related factors were analyzed by Kaplan–Meier survivorship analysis with the log-rank test within a minimum follow-up period of one year. A multivariate analysis was performed using a Cox proportional-hazards regression model. Results: In total, 61 patients were included. The mean follow-up period was 28.3 months (range: 12.0–102.6 months). There were 27 cases (44.2%) of IRCs, including 22 cases of screw loosening, four cases of screw pull-out, and one case of rod breakage, at an average of 9.6 months (range: 1.0–38.1 months). The median IRC-free survival was 38.1 months (range: 1.0–102.6 months). Only three patients experienced pain aggravation with IRCs. No revision surgery was performed. A multivariate analysis identified that fixation length was a risk factor for IRCs (odds ratio: 0.358, 95% confidence interval: 0.114–0.888; p = 0.027). Conclusions: IRCs are frequent but mostly asymptomatic after nonfusion posterior fixation in patients with MSTs followed up for at least one year. Overall, the IRC-free survival was long enough considering the patient survival. Fixation length was a significant risk factor for IRCs regardless of MST location. Full article

Background: Although abnormal blood pressure is predominantly associated with hypertension, the issue of hypotension remains insufficiently explored. Chronic asymptomatic hypotension, in particular, is rarely addressed in clinical nutrition research. This study aimed to evaluate the impact of targeted dietary modifications on blood pressure as well as selected biochemical, anthropometric, and lifestyle parameters in an individual with low baseline blood pressure. Methods: A single-subject observational study was conducted on a 23-year-old woman with chronic hypotension. Following a 4-week baseline period, a 4-week dietary intervention was implemented involving increased sodium and fluid intake, the introduction of coffee, and overall caloric enhancement combined with increased physical activity. Blood pressure was measured three times daily; anthropometric, biochemical, and lifestyle data were recorded weekly. Results: The intervention resulted in an increase in both systolic (from 93.76 to 101.21 mmHg) and diastolic (from 57.51 to 59.43 mmHg) blood pressure. The subject also reported improved energy levels, longer sleep duration, and reduced daytime fatigue. However, changes in anthropometric parameters were minimal and biochemical outcomes remained inconclusive. Conclusions: The findings suggest that dietary and lifestyle modifications may positively influence blood pressure and subjective wellbeing in individuals with hypotension. There is a clear need for further research focussing on the effects of dietary modifications on blood pressure parameters in individuals with hypotension. Full article

Background: Enteroviruses, members of the Picornaviridae family, typically cause asymptomatic or mild infections. However, they can also result in central nervous system (CNS) involvement, with transverse myelitis (TM) occurring only on rare occasions. TM is a syndrome characterized by acute or subacute spinal cord dysfunction, leading to neurological deficits below the level of the lesion. Case report: We report a case series of eight pediatric patients admitted over a three-month period, June to August 2024. All patients presented with ataxia and/or other neurological symptoms, alongside abnormal cerebrospinal fluid (CSF) findings. Although ataxia is commonly associated with cerebellitis, magnetic resonance imaging (MRI) in this cohort revealed findings consistent with TM. Notably, all patients demonstrated similar MRI abnormalities. The onset of symptoms occurred over a short time during an enterovirus epidemic. Enteroviral RNA was detected, or the virus was isolated in seven patients, while one patient had a close epidemiological link to the virus. All patients achieved full recovery following immunomodulatory therapy. Conclusions: This case series underscores that ataxia may be an atypical symptom associated with TM. Furthermore, there was a notable distinction between the clinical presentation and neuroradiological findings. Immunomodulatory therapy with immunoglobulins and corticosteroids has been shown to be effective and safe, supporting the hypothesis of an immune-mediated pathogenesis in these patients. Full article

Background: Gallbladder cancer (GBC) is a highly aggressive malignancy often diagnosed at an advanced stage due to its asymptomatic onset. Despite surgery being the only potentially curative option, recurrence and poor prognosis remain common, especially in advanced-stage diseases. There is limited consensus regarding the extent of lymphadenectomy, hepatic resection, and the role of adjuvant therapies. Identifying prognostic factors and optimizing treatment strategies are critical for improving outcomes. This multicenter retrospective study was conducted to evaluate the clinical and pathological predictors of survival and recurrence in GBC patients that underwent radical surgery and to assess the potential benefit of adjuvant therapies in advanced stages. Methods: This was a retrospective cohort study of GBC patients who underwent curative-intent resection for GBC between 2010 and 2022 at two tertiary medical centers in China. The baseline characteristics, surgical data, pathology, adjuvant therapy, and follow-up outcomes were analyzed. The survival outcomes were assessed using Kaplan–Meier methods and Cox regression models. Subgroup analyses were conducted to explore the impact of postoperative adjuvant chemotherapy, period of surgical treatment, and extent of resection. Multiple imputation was used to address missing data. Results: The 5-year overall survival (OS) rate was 57.4%. Independent predictors of a poorer OS included CA19-9 > 30 U/mL (HR = 1.861, p = 0.003), poor/moderate-to-poor differentiation (HR = 2.134, p = 0.004), T3–T4 stage (HR = 2.685, p = 0.001), N1–N2 stage (HR = 2.217, p = 0.002), M1 stage (HR = 2.308, p = 0.001), and a high CAN score (HR = 1.875, p = 0.009). Adjuvant chemotherapy improved the OS in the stage III–IV patients (24.8 vs. 17.3 months, p = 0.036), though the DFS improvement was not significant (p = 0.133). No survival difference was observed between the segment IVb + V resection and wedge resection in the T2b patients. The patients treated after 2017 had a better OS (p = 0.024), possibly due to improved surgical techniques and perioperative care. Conclusions: Radical surgery remains critical for GBC. Accurate staging and tailored perioperative strategies, including chemotherapy, may improve outcomes, though further prospective studies are needed to validate these findings. Full article

Background/Purpose: Coronavirus disease 2019 (COVID-19) has become the cause of a global health crisis during the pandemic. This research aimed to study the impact of symptomatic COVID-19 on children’s oral health indices and salivary microbiome composition during the post-COVID-19 period. Methods: An observational, cross-sectional study was conducted in Tbilisi (Georgia) among children aged 7–12 years. A total of 421 children included in the study had a history of laboratory-confirmed COVID-19 within one year of exposure. No participants met the criteria for comorbid conditions or for PCC. A stratified simple random selection of schools and among selected clusters was used. The selected children were divided into two groups: the exposed group, who were patients with a history of symptomatic COVID-19, and the control group, who were patients with a history of asymptomatic COVID-19. The data were collected from August 2022 to December 2023. Oral screening, microbiological examination of saliva, and administration of questionnaires were also performed. Logistic regression was used to calculate ORs with 95% confidence intervals. The statistical processing of the data was performed with SPSS 23.0. This study was approved by the Biomedical Research Ethical Council of the University of Georgia (UGREC–04–22/9 March 2022). Results: Statistically significant differences in the means of the oral health indicators between the studied groups were detected (exposed: DMFT + deft = 5.9; MGI = 0.92; S-OHI = 1.9; control: DMFT + deft = 3.8; MGI = 0.56; S-OHI = 1.4). According to the logistic regression, symptomatic COVID-19 had a significant effect on the following oral health indicators: DMFT + deft (OR = 1.26; 95% CI = 1.14–1.39), MGI (OR = 2.31; 95% CI = 1.50–3.55), and S-OHI (OR = 3.43; 95% CI = 2.03–5.76). The effect of symptomatic COVID-19 on the frequency of eradication of the studied microbiome was also significant (OR = 2.12; 95% CI = 1.23–3.63). Conclusions: A close association was established between symptomatic COVID-19 and microbiome changes in the oral saliva of children, as well as between oral health indicators and symptomatic COVID-19. Considering the research results, it is assumed that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period. Full article

Background/Objectives: We aimed to evaluate the clinical course, demographic characteristics, and risk factors in Polish patients with geographic tongue (GT). Methods: The analysis was based on medical records of 100 patients with GT referred to the outpatient clinic of Poznań University of Medical Sciences (PUMS) from 2013 to 2023. Data regarding age, gender, medical history, habits, subjective complaints, clinical features, localization, histology, and treatment were considered. Results: Patients with GT constituted 11.3% of 887 individuals admitted to the outpatient clinic in the analyzed period. The female-to-male ratio was 52:48. The average age at diagnosis was 51.6 years. Thirteen patients reported smoking, and 2.0% admitted to consuming alcohol excessively. Subjective complaints were reported by 85.0% of patients and mainly included a burning sensation (57.0%), pain (39.0%), xerostomia (22.0%), bleeding (4.0%), and taste disturbance (3.0%), while 15.0% of GT patients were asymptomatic. Comorbidities were found in 76.0% of subjects with GT, and included cardiovascular disorders (37.0%), gastrointestinal and thyroid gland diseases (24.0% and 18.0%), and type II diabetes (15.0%). Psoriasis was observed in one case only. Conclusions: The frequency of GT in a Polish cohort of patients was high and comparable in both genders. The majority of participants reported subjective complaints, and most of the patients were non-smokers. Comorbidities were found in 76.0% of subjects with GT and mainly included cardiovascular and gastrointestinal diseases. GT was often accompanied by other oral conditions, like candidiasis, recurrent aphthous stomatitis, and lichen planus. GT screening should include cardiovascular and gastrointestinal evaluation. Full article

Radical chemoradiotherapy has been used as a frontline treatment for squamous cell cancer of the anus for the last 30–40 years. Considerable acute and chronic adverse effects have been observed following radiotherapy using 2D and 3D techniques. A case of very late-onset severe chronic toxicity in a patient 26 years after radiotherapy is presented. The patient underwent radical chemoradiotherapy for squamous anal cancer stage T3N3M0 in 1998. In the anal region, cumulative doses up to 77.6 Gy (including electron boost) were administered. Durable complete regression of the disease was achieved. Fourteen years after treatment, the patient developed vast fibroatrophy of the anus and perineum, progressing within the subsequent four years to necrosis and sphincter loss. Twenty years after treatment, the asymptomatic osteonecrotic foci in the left femur appeared on MRI scans. Despite two courses of hyperbaric oxygen treatment, the fibroatrophy and subsequent necrosis of soft tissues remained progressive, but the osteonecrosis was stable. Twenty-six years after treatment, the progressive changes induced symptomatic osteomyelitis of the ischium and pubic bone. The patient now requires permanent supportive treatment. The presented case is exceptional in the very late-onset typical chronic adverse effects developing after non-conformal radiotherapy administered at high doses as part of contemporary treatment protocols. There is little evidence regarding the late onset of chronic adverse effects, since the follow-up period is usually shorter than that of the case presented. Moreover, a significant portion of patients do not survive to reach the late-onset period of adverse effects. The presented case shows that there may be long-term survivors of anal cancer in the population who were treated with outdated techniques and who still carry a risk of late-onset severe, progressive adverse effects. Full article