Search Results (3,612)

Background: Toxic shock syndrome (TSS) is a rare but potentially fatal condition most often caused by Staphylococcus aureus or Streptococcus pyogenes. However, other streptococcal species, including Streptococcus agalactiae (group B Streptococcus (GBS)), can also cause TSS, sometimes leading to severe complications, such as multiorgan failure. Case Description: We report the case of a 45-year-old woman who developed TSS associated with tampon use. She presented with fever, chills, hypotension, and leg pain, progressing rapidly to septic shock and multiorgan failure. Blood and urine cultures revealed S. agalactiae group B, while a gynecological examination identified Ureaplasma urealyticum and S. agalactiae. Imaging demonstrated bilateral pneumonic infiltrates and pleural effusion. The patient required intensive care, vasopressor support, and broad-spectrum antibiotic therapy, leading to full clinical recovery. Discussion: Despite advances in tampon design, menstrual TSS remains a significant clinical concern. Early symptoms may be nonspecific, but rapid progression highlights the need for timely recognition and intervention. Although S. agalactiae is an uncommon cause of TSS, it should be considered in relevant clinical scenarios. Prompt empirical antibiotic therapy, followed by targeted treatment based on culture results, along with supportive intensive care, is essential to improve outcomes. Conclusions: Menstrual TSS continues to pose a serious health risk. Physicians should maintain a high index of suspicion in tampon users presenting with fever, rash, and shock. Early diagnosis and rapid initiation of appropriate therapy are crucial to reducing morbidity and mortality. Full article

Background: Emotional disturbances such as anxiety and depression are common in breast cancer patients and may intensify during systemic therapy. This study aimed to assess changes in the severity of anxiety and depression among women undergoing neoadjuvant chemotherapy and to identify factors influencing emotional outcomes. Methods: A total of 211 women with stage I–III breast cancer treated at the Podkarpackie Oncology Center in Brzozów, Poland, were included. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) one week before and three weeks after chemotherapy. Statistical analyses were performed using the Wilcoxon signed-rank test and descriptive statistics (STATISTICA v.13). Results: After chemotherapy, anxiety and depression levels increased significantly. Nearly half of the patients experienced clinically relevant anxiety, and over one-third showed symptoms of depression. The emotional burden appeared particularly high among women reporting financial difficulties. In contrast, no clear associations were found with marital status, place of residence, or cancer stage. Conclusions: Chemotherapy in breast cancer patients is associated with a significant increase in anxiety and depression severity. Routine psychological assessment and psycho-oncological support should be implemented as integral components of oncological care, with particular attention to patients in disadvantaged socioeconomic conditions. Full article

Background/Objective: Nurse educators are central to consolidating nursing as a discipline and shaping professional identity, yet their preparation is heterogeneous. This study aimed to identify profiles of nurse educators based on the value they assign to teaching competencies and to analyze factors influencing these profiles. Methods: A cross-sectional, descriptive research design was applied, using convenience sampling to recruit 326 nurse educators from Spanish universities. Data were collected through a self-administered online questionnaire distributed to nursing faculty from public, private, and affiliated (semi-private) universities across Spain. The instrument included sociodemographic and academic variables, along with nine teaching competencies. Descriptive statistics, cluster analysis, ANOVA, chi-square tests, and multinomial logistic regression were conducted using SPSS. Results: Three distinct profiles of nursing faculty were identified. The academic–pedagogical profile assigned the highest importance to all competencies (means 4.78–4.91), the clinical–pragmatic profile assigned the lowest (3.61–4.04), and the intermediate–researcher profile showed moderate values (4.26–4.50). Doctoral degree (χ² = 65.36, p < 0.001) and pedagogical training (χ² = 33.89, p < 0.001) were the strongest predictors of membership in the academic–pedagogical group, confirmed in multivariate regression (OR for doctorate = 0.07; OR for pedagogical training = 0.13, both p < 0.001). Conclusion: This study delineates three coherent and statistically robust profiles of nursing faculty based on their appraisal of teaching competencies. Academic qualifications and pedagogical training emerged as key determinants of these profiles. Tailored faculty development strategies that reinforce doctoral-level preparation and pedagogical expertise are critical to advancing the quality and consistency of nursing education. Full article

Background/Objective: Job satisfaction is a key determinant of healthcare professionals’ well-being, quality of care, and organisational performance. In Portugal, although validated tools exist for nurses, there is no comprehensive instrument for different professional groups. This study aimed to develop and validate the Health Professionals’ Job Satisfaction Scale (ESPST—Escala de Satisfação dos Profissionais de Saúde no Trabalho), designed to assess job satisfaction across diverse healthcare categories. Methods: A quantitative, descriptive, cross-sectional study was conducted with 549 professionals from a Portuguese hospital. The ESPST was developed from literature review and expert focus groups, comprising 50 Likert-scale items. Construct validity was examined using exploratory factor analysis (EFA), and reliability was assessed via Cronbach’s alpha. Results: The EFA revealed an eight-factor structure, explaining 70.3% of total variance. The KMO value was 0.963, and Bartlett’s test of sphericity was significant (p < 0.001). The factors were: leadership and management, nature of work, colleagues, recognition by service users, career progression, human resources, institutional protocols, and peer recognition. Cronbach’s alpha was 0.973 for the total scale, with subscales above 0.84, indicating excellent reliability. Conclusions: The ESPST is a valid and reliable instrument for assessing job satisfaction among healthcare professionals across different categories. Its multidimensional scope allows clinical and research applications, supporting organisational strategies to improve professional well-being and quality of care. Future studies should include confirmatory analyses to strengthen its psychometric robustness. Full article

Per- and polyfluoroalkyl substances (PFAS) involve multiple per- and polyfluorinated compounds that are widely used globally. Legacy PFAS, including PFOA, PFOS, and PFHxS, were manufactured before 2000 in various industrialized nations, then gradually phased out in accordance with the Stockholm Convention. Due to the substantial accumulation of these legacy PFAS compounds, their concentrations in drinking water are regulated in some countries. This review first summarizes the historical background of PFAS, followed by a description of their chemical properties. The clinical manifestations of legacy PFAS in humans, such as dyslipidemia, attenuated immune function, and chronic kidney disorders, are also summarized. Emerging PFAS involve Gen-X and F-53B as well as numerous newly developed chemicals with their associated precursors/metabolites, including volatile PFAS. Research on these emerging PFAS compounds in the environment continues to grow, building a substantial body of evidence about their effects. The chemical structure of emerging PFAS shows a wide variety: they could contain ether, ester, sulfoneamide, and other halogen atoms rather than fluorine. Volatile PFAS involve the fluorotelomer 6:2 FTOH and other short-chain PFAS compounds, which are best measured by GC-MS. This review also briefly summarizes the assay for total oxidizable precursors of PFAS, an LC-MS-based assay for an emerging assay that will be used for a quantitative estimation of total PFAS, including emerging PFAS. Full article

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, Scopus, and Web of Science (1 January 2019–2025). Eligible populations were adults receiving conventional or zygomatic implants in vivo, plus validated in vitro human-jaw models using plan-versus-placement workflows; studies had to report study-level means with dispersion for ≥1 primary outcome with ≥5 implants per arm. Interventions were r-CAIS, d-CAIS, or s-CAIS; with a baseline as the freehand technique. Risk of bias used RoB 2 (RCTs), ROBINS-I (non-randomized clinical), and QUIN (in vitro). Because of heterogeneity in definitions and workflows, we performed a descriptive synthesis by modality (no meta-analysis). Registration: OSF. Results: Forty-three studies (7 RCTs, 10 non-randomized clinical, 26 in vitro) reported more than 4000 implants. Across studies, typical study-level means for global linear deviation clustered around < 1 mm (r-CAIS), ~1 mm (d-CAIS), ~1.3 mm (s-CAIS), and ~1.8 mm (FH). In clinical contexts, d-CAIS often showed slightly lower angular deviation than s-CAIS. Conclusions: CAIS improves accuracy versus freehand. d-CAIS and s-CAIS show similar linear accuracy, with d-CAIS frequently yielding slightly lower angular deviation; r-CAIS exhibits tight error clusters in our dataset, but limited comparative clinical evidence precludes superiority claims. Limitations: non-uniform registration/measurement, variable operator experience, and absence of meta-analysis. Full article

(1) Podcasts are increasingly used in undergraduate medical education. They differ from traditional learning activities and may influence exam performance. Podcasts also offer insights into learning behaviour and perceptions of family medicine (FM). Despite their frequent use in medical education, it remains unclear how they can best be integrated into competency-based curricula and motivate students to study for FM. This study examines the impact of a medical podcast on learning behaviour and academic performance at Saarland University (UdS). (2) This exploratory mixed-methods study analyzed podcast-related learning behaviour and exam relevance among year-five medical students at UdS in the winter semester 2024/25. Demographic, quantitative, and qualitative data were collected via an online questionnaire (Google Forms^®) in January 2025. Data were descriptively and analytically evaluated and linked to exam results. Qualitative data were analyzed using Kuckartz’s content analysis. (3) Of 123 eligible students, 92 participated. Most listened to episodes in full. Podcasts were seen as low-threshold means to access study content, but they were often not perceived as a separate learning activity. Listening to podcasts did not directly influence exam performance but helped connecting theory with clinical relevance and increased motivation for FM. (4) Podcasts are popular for exploring clinical practice and complex topics. Their didactic value lies in contextual learning and career orientation, rather than improving exam performance. Full article

Background: Fungal keratitis remains a serious threat to vision, often progressing despite medical therapy and requiring surgical intervention. Therapeutic deep anterior lamellar keratoplasty (DALK) and therapeutic penetrating keratoplasty (TPK), are frequently required but carry risks of infection recurrence and graft rejection. As timely identification of the etiological agent is essential for improving the outcomes in infectious keratitis, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are instrumental in providing insights that can guide better therapeutic decision-making and improving outcomes in fungal keratitis. Case Description: We report the cases of two previously healthy patients (case one, 56-year-old woman; case two, 38-year-old man), who have presented in our service with unilateral infectious keratitis after ocular trauma with vegetable matter during outdoor activities, with a visual acuity of counting fingers and hand motion, respectively. Slit-lamp examination revealed unilateral extensive corneal infiltrates suggestive for fungal etiology in both cases. In vivo confocal microscopy (HRT-3, Heidelberg Retina Tomograph 3/Rostock Cornea Module, Heidelberg Engineering, Heidelberg, Germany) identified lesions suggestive for Candida Albicans and Acanthamoeba coinfection in case one and filamentous fungal keratitis in case two. Anterior segment optical coherence tomography (MS-39, CSO, Italy) was used to monitor the extent and morphology of the infiltrates. The patients underwent therapeutic DALK and TPK, respectively, with good results at the one-year follow-up. Conclusions: Our cases illustrate the advantages of incorporating IVCM and AS-OCT as complementary imaging techniques into clinical practice. IVCM and AS-OCT in fungal keratitis could lead to an earlier diagnosis, more accurate dynamic treatment response evaluation, and the identification of high-risk features for aggressive fungi for a more tailored medical and surgical management. Full article

Background/Objectives: Eating disorders (EDs) in adolescents are increasingly prevalent. In South Tyrol, a bilingual region in Northern Italy, not only actual gender and age prevalences can be compared to screening rates, but even the comparability of screening tools across languages can be examined. Methods: A cross-sectional analysis integrated clinical registry data with representative, online school-recruited adolescents (11 to 17) self-reports. 166 clinically diagnosed cases and 1465 screened adolescents (1246 German, 219 Italian), were examined. The SCOFF questionnaire (cutoff ≥ 2 for German and ≥3 for Italian), body mass index, body image perception, psychosocial and lifestyle indicators in proxy and self-reports were examined using descriptive statistics and logistic regression. Results: The clinical dataset for 2024 has a prevalence rate of 0.4%. The SCOFF screening tool identified symptomatic cases in 10.6%, and an age-increasing trend among females. The overall SCOFF-prevalence did not differ between language versions, although responses to individual items varied significantly. Predictors of ED included body image, psychosomatic complaints, problematic social media use, and low social support, with differences between genders. Parents tended to underestimate their children’s perception of being “too thick.” Conclusions: In early adolescence, preventive strategies are needed and targeted interventions in late adolescence. For early detection and intervention, gender-sensitive prevention and active parental involvement is needed. The SCOFF questionnaire demonstrates utility across both languages, but bilingual comparison highlights the need for culturally adapted tools and cross-language validation. Full article

Carotenoid pigments are widely distributed in nature and play a crucial role in protecting organisms from photodynamic damage. However, the characterization of carotenoid production in clinically relevant mycobacteria has been limited due to the low sensitivity of conventional detection methods. We present a descriptive analysis of carotenoid production in seven mycobacterial isolates from the scotochromogenic, photochromogenic, and non-chromogenic groups. To achieve this, we used a combination of High-performance liquid chromatography with diode-array detection (HPLC-DAD) and Ultra-high performance liquid chromatography–mass spectrometry (UHPLC-MS) to detect carotenoids pigments. Mycobacterium tuberculosis (MTB) and Mycobacterium bovis (MB) (non-chromogenic mycobacteria) produced β-carotene when cultured in the absence of light, at levels comparable to those of photochromogenic mycobacteria such as M. marinum (MM) and M. kansasii (MK). The highest levels of carotenoids were found in scotochromogenic species M. avium (MAV) and M. gordonae (MGOR). Conversely, M. abscessus (MABS), a non-chromogenic species in which no β-carotene was detected, served as a negative control for matrix effects. As expected, the use of highly sensitive analytical techniques such as HPLC-DAD and UHPLC-MS significantly enhanced the detection of β-carotene compared to visual pigment assessment. These methods allowed the detection of basal β-carotene levels even in mycobacteria classified as non-chromogenic. The proposed analytical approach provides a robust research tool to understand the effects of different stimulus that may alter the cell physiology in terms of pigment production. Full article

Celiac disease (CD) is a chronic autoimmune condition traditionally recognized for its gastrointestinal symptoms. However, growing evidence indicates that CD can also affect social and emotional health, particularly among children. This narrative review explores how the autoimmunity of CD may contribute to social–emotional dysregulation through mechanisms such as neuroinflammation, nutrient deficiencies, and disruption of the gut–brain axis. It summarizes the current literature on anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and autism spectrum disorder (ASD), highlighting how immune dysregulation may influence children’s social–emotional wellbeing. Delayed diagnosis, poor dietary adherence, and ongoing inflammation were recognized among children with social–emotional dysregulation. While digestive problems are commonly recognized and treated, social–emotional dysregulation among children with CD is frequently overlooked. However, a gluten-free diet without a confirmed diagnosis of CD is not sufficient to improve social–emotional outcomes. Children presenting with social–emotional dysregulation and clinical features suggestive of CD should be screened using standard serology and, when indicated, biopsy. Starting a gluten-free diet (GFD) without a confirmed diagnosis is not recommended. While mechanistic pathways are described, most evidence remains observational and clinically descriptive, underscoring the need for longitudinal and experimental studies to understand the intersectionality of CD with social–emotional dysregulation. Full article

Background: Chronic kidney disease (CKD) requires strict dietary management tailored to disease stage and individual needs. Recent advances in artificial intelligence (AI) have introduced chatbot-based tools capable of generating dietary recommendations. However, their accuracy, personalization, and practical applicability in clinical nutrition remain largely unvalidated, particularly in non-Western settings. Methods: Simulated patient profiles representing each CKD stage were developed and used to prompt GPT-4 (OpenAI), Gemini (Google), and Copilot (Microsoft) with the same request for meal planning. AI-generated diets were evaluated by three physicians using a 5-point Likert scale across three criteria: personalization, consistency with guidelines, practicality, and availability. Descriptive statistics, Kruskal–Wallis tests, and Dunn’s post hoc tests were performed to compare model performance. Nutritional analysis of four meal plans (Initial, GPT-4, Gemini, and Copilot) was conducted using both GPT-4 estimates and manual calculations validated against clinical dietary sources. Results: Scores for personalization and consistency were significantly higher for Gemini and GPT-4 compared with Copilot, with no significant differences between Gemini and GPT-4 (p = 0.0001 and p = 0.0002, respectively). Practicality showed marginal significance, with GPT-4 slightly outperforming Gemini (p = 0.0476). Nutritional component analysis revealed discrepancies between GPT-4’s internal estimations and manual values, with occasional deviations from clinical guidelines, most notably for sodium and potassium, and moderate overestimation for phosphorus. Conclusions: While AI chatbots show promise in delivering dietary guidance for CKD patients, with Gemini demonstrating the strongest performance, further development, clinical validation, and testing with real patient data are needed before AI-driven tools can be fully integrated into patient-centered CKD nutritional care. Full article

Background/Objectives: Long-term follow up of pediatric radiotherapy survivors referred to tertiary and quaternary centers is difficult, limiting outcome monitoring. We implemented an electronic Health Status Survey (HSS) to capture survivorship data. Methods: The Health Status Survey (HSS) was distributed to survivors aged 1 month–25 years treated with curative-intent radiotherapy at our institution. Eligibility required confirmed survival and valid email contact. Survey responses and demographics were summarized with descriptive statistics and comparative tests. Surveys were sent to 876 eligible participants, with 322 responses received (36.8%) between December 2023 and March 2024. Results: Survey completion extended follow up by a median of 18.3 months (about 1.5 years), improving monitoring beyond the last chart-documented visit. Respondents reported 12 recurrences, 5 s malignancies, and 7 deaths not captured in prior records, altering event-free survival statistics by as much as 7.5%. Most respondents (90.1%) reported a medical visit in the past year, and many provided updates on ongoing health issues, provider contact, and social outcomes. Conclusions: The HSS is a replicable method for extended follow up of tertiary and quaternary care center patients, capturing previously unreported clinical, social, and educational outcomes. By supplementing chart data with patient-reported information, this cost-effective tool supports targeted annual follow up and the identification of trends for long-term survivorship care. Full article

Introduction: Adolescent idiopathic scoliosis (AIS) presents not only physical but also psychological challenges for affected patients, frequently requiring comprehensive management that includes psychological interventions. Accurate and transparent reporting of interventions is essential to support reproducibility, facilitate clinical translation, and advance research quality. However, the completeness of intervention reporting and adherence to standardized guidelines in published studies on psychological interventions for pediatric AIS patients remains unclear. Methods: We searched Medline, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies involving psychological interventions in AIS. Intervention reporting was analyzed using the Template for Intervention Description and Replication (TIDieR) checklist. Adherence to reporting guidelines was assessed for different study designs. Results: We identified 18 studies, which had suboptimal reporting of interventions. For key TIDieR items, all studies reported the brief name and rationale, but completeness for other elements varied: methods (14/18 studies), materials (10/18), provider (6/18), and mode of delivery (8/18) were described inconsistently. Setting was reported in only 3/18 studies, whereas the details about tailoring, modifications, and fidelity were largely lacking or deemed non-applicable. For eight randomized trials, several critical CONSORT items, such as trial design, randomization procedures, blinding, and trial registration were often unreported. Among five observational studies, reporting of STROBE key elements such as study design, setting, eligibility criteria, and funding was more consistent, but methods addressing bias, participant flow, missing data, and category boundaries for variables were largely insufficient. Similar gaps were observed for relevant TREND checklist items for nonrandomized intervention studies. Conclusions: The reporting of psychological interventions for AIS in the literature is frequently incomplete, especially for intervention details essential for the reproducibility of the intervention and assessment of risk of bias. Adoption of standardized reporting guidelines is necessary to improve intervention transparency, replicability, and translation into clinical practice. Future research should focus on prospective evaluations of reporting guideline implementation and its impact on research quality in this field. Full article

Background/Objectives: Reports detailing rehabilitative interventions for infants with severe dermatologic disorders are scarce. Epidermolysis Bullosa (EB) is a genetic disorder characterized by skin fragility, which causes blistering after minor trauma. Since there is still no cure in general clinics, symptomatic treatment and developmental support are essential for managing the condition. While physiotherapy and occupational therapy guidelines for EB exist, descriptions of neonatal habilitation/rehabilitation are insufficient. Case: This case report describes the longitudinal habilitation/rehabilitation intervention process for a newborn with Dowling–Meara EB, the most severe form, from admission to the Neonatal Intensive Care Unit (NICU) until discharge. Since maneuvers requiring contact were strictly limited due to skin vulnerability, rehabilitation interventions were implemented utilizing the opportunity afforded by necessary care. Intervention strategies were modified according to developmental stages and skin stability, with a particular emphasis on sensory development, postural control training, and fostering the mother–child relationship. This report is the first to describe the applicability of sensory rehabilitation and the use of behavioral cues to facilitate voluntary movements. In addition, careful respiratory rehabilitation was implemented for comorbid tracheomalacia with specific attention to skin vulnerability. The child achieved stable head/neck control, symmetrical limb movements, reaching, guided rolling, and stable oxygenation by the time of discharge. Conclusions: Balancing skin disorder prevention and motor–neural development requires flexible approaches that minimize contact while utilizing routine care as a training opportunity. Our experience will contribute to the progress in the habilitation, wound rehabilitation and respiratory rehabilitation of infants with severe dermatologic disorders. Full article