Search Results (861)

Climate change is reshaping the epidemiology of vector-borne diseases in Europe by altering the ecological conditions that determine vector survival, seasonal activity and pathogen transmission. Rising temperatures, milder winters, prolonged warm seasons and changing precipitation patterns are increasing the suitability of parts of Europe for competent mosquito, tick and sandfly vectors. These changes, combined with human mobility and land-use change, increase the probability that imported pathogens encounter permissive conditions for local transmission. This Opinion article examines autochthonous vector-borne disease transmission in Europe, using dengue as a sentinel example of a wider climate-sensitive transition. We discuss how imported viraemic cases, established competent vectors, vector–host contact and delayed clinical recognition can converge to enable local outbreaks. Beyond dengue, we consider West Nile virus, chikungunya, tick-borne encephalitis, leishmaniasis and Crimean–Congo haemorrhagic fever as examples of a broader and increasingly heterogeneous European risk landscape. We argue that the public-health impact of this transition is shaped not only by vector expansion, but also by gaps in surveillance integration, diagnostic readiness, workforce preparedness and One Health coordination. Strengthening climate-informed surveillance, rapid laboratory capacity, frontline clinical awareness and cross-sectoral response systems will be essential to prevent repeated introductions from becoming sustained public-health challenges. Full article

Background: Acute exacerbation of obstructive airway disease (AEOAD) is a major cause of hospitalization, morbidity, and premature mortality in India. Hospitalized patients for the same are predominantly treated with short-acting bronchodilators, which require frequent administration and are associated with systemic adverse effects. Despite the availability of nebulized long-acting muscarinic antagonists (LAMAs) with quick onset of action, such as glycopyrronium, their role in acute care remains unclear in India. Methods: A pan-India expert opinion-building initiative was conducted among 220 pulmonologists across Tier I–II cities through 13 structured advisory meetings between April 2025 and July 2025. The final expert perspectives were then categorized into recurrent insights, raised in 75% or more meetings, and variable insights, raised in <75% of all meetings. Results: Experts reported that AEOAD management commonly involved initial stabilization with SABA/SAMA followed by transition to triple therapy with nebulized glycopyrronium, formoterol, and budesonide. Nebulized glycopyrronium was perceived to provide rapid and sustained bronchodilation with fewer cardiovascular side effects compared to short-acting agents. Benefits were reported in patients with frequent exacerbations, high sputum burden, and bronchiectasis. Operational advantages included reduced dosing frequency and nursing workload. Experts also noted potential improvements in hospital stay and readmissions; however, these observations were based on clinical experience rather than controlled data. Conclusions: Indian pulmonologists agreed that early initiation of nebulized glycopyrronium (with formoterol and budesonide) in hospitalized AEOAD may improve symptom control, lower exacerbation burden, reduce reliance on short-acting bronchodilators and corticosteroids, and shorten hospital stays. Full article

Background/Objectives: The clinical management of uterine fibroids in the context of infertility is characterized by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: An online survey was distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: A total of 98 participants completed the survey, of whom 83% (n = 82) practiced in European countries and 43% (n = 42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, hysteroscopic removal was recommended by 94% (n = 92) of participants, although only 27% (n = 26) would do so in all cases, irrespective of the size and submucosal proportion. Anti-adhesion agents were used at least occasionally after the hysteroscopic removal of FIGO 0–II fibroids by 51% (n = 50) of participants. A clinically significant fibroid size was recognized by 57% (n = 56) of participants for FIGO III fibroids and by 51% (n = 50) for FIGO IV fibroids. The opinion was almost evenly divided on whether the distance between an intramural, non-cavity-distorting fibroid and the junctional zone affected the decision for removal: 49% (n = 48) considered that it did not, whereas 51% (n = 50) considered that it did, citing variable cut-off values. Most participants favored minimal-access approaches over laparotomy, whereas the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardized care, based on high-quality evidence. Full article

Salivary gland tumors, although relatively rare, exhibit a wide histological variety. The most modern classifications list over 30 histotypes, both benign and malignant, with widely varying morphological, epidemiological, and clinical characteristics, sometimes even within the same tumor type based on grading. The consequence of these characteristics is that regarding the diagnosis and treatment of salivary gland tumors, there have been, and still are, some certainties, many uncertainties, and some myths not supported by irrefutable studies, but which are cited, repeated, and taken for granted from one article to the next. The purpose of this narrative review is to analyze the most important and controversial opinions regarding the diagnosis and treatment of salivary gland tumors of the head and neck, and, in particular, those of the most frequent and/or problematic histological types, both malignant and benign. To this end, approximately one hundred historical and recent studies on these topics were analyzed. Full article

Glaucoma, the leading cause of irreversible vision loss, often goes undetected in early stages due to its asymptomatic behaviour. Early diagnosis typically involves visual analysis of the optic disc (OD) in eye fundus images. Machine and deep learning techniques have emerged as valuable tools for automating this process; however, their integration into clinical practice still faces limitations. These challenges include the presence of image regions that are not directly related to glaucoma assessment, such as retinal vasculature, the macula, and background structures, which may introduce irrelevant information and negatively affect classification performance, as well as a general lack of transparency in the decision-making process. This article proposes a methodology that enhances both the accuracy and interpretability of glaucoma detection by focusing solely on the OD region. First, a metaheuristic-based strategy is employed for precise OD detection and cropping, generating an OD-centric dataset with glaucoma-labeled images, which is composed of different public datasets. Four convolutional neural networks (CNNs), namely VGG-19, MobileNet-V2, ResNet-50, and DenseNet-161, are trained on this dataset using transfer learning. To address the need for model explainability, Grad-CAM, Score-CAM, and Eigen-CAM are applied to the trained models to generate post hoc visual explanations of their predictions. The experimental results showed that DenseNet-161 achieved the best overall performance on the assembled public dataset, using an 80%-10%-10% training, validation, and testing split, with a test accuracy of 0.9369 and an AUC of 0.9831. By isolating the OD region and incorporating explainability techniques, the methodology provides a robust and interpretable second opinion, supporting more accurate and efficient glaucoma screening. Full article

Dengue Virus (DENV) circulates as four antigenically distinct serotypes whose dominance fluctuates over time in many endemic regions, a phenomenon known as serotype shift that is frequently associated with large outbreaks and increased disease severity. This review, through a synthesis of epidemiological, virological, immunological, entomological, and environmental evidence, observes that serotype shift likely arises from the interaction of multiple determinants rather than solely from viral evolution, with population immunity playing a central role. The accumulation of serotype-specific herd immunity, together with short-lived cross-protection and Antibody-Dependent Enhancement (ADE), reshapes population susceptibility and creates ecological space for heterologous serotypes with higher transmission potential. The synthesis of global dengue studies indicates that these immune dynamics interact with viral genetic diversity, vector competence, climate variability, and human factors such as demography, socioeconomic status, population density and mobility to drive cyclical and sometimes abrupt changes in serotype dominance. Notably, the review indicates that serotype changes often precede or coincide with more clinical severity and patterns of outbreaks, with direct implications for the process of forecasting outbreaks, vaccine performance, and preparedness to respond with appropriate health measures. On the whole, this review confirms the opinion that the change of dengue serotype occurrence becomes a consequence of interconnected biological and ecological processes involved in the transmission of dengue serotype shifts in hyperendemic areas. Full article

Background: Return to play (RTP) after total hip arthroplasty (THA) is increasingly expected by younger and more physically active patients. Current activity recommendations remain heterogeneous and are largely derived from expert opinion and indirect biomechanical modelling approaches, rather than direct in vivo biomechanical evidence. The aim of this article is to systematically map and synthesize the evidence from instrumented hip implant studies and to clarify how direct in vivo telemetry data can inform RTP counselling after THA. Methods: A scoping review was conducted according to a predefined Open Science Framework protocol and reported following PRISMA-ScR guidelines. MEDLINE (PubMed) and Scopus were searched from inception. Peer-reviewed clinical studies reporting direct in vivo biomechanical measurements obtained from instrumented hip implants were included. Conference proceedings, technical notes, reviews, and in vitro or computational-only studies were excluded. Data were extracted and synthesized descriptively according to activity domain, biomechanical variables, and implant technology. Results: Fifty studies met the inclusion criteria. Early investigations established feasibility and evolved from wired strain-gauge systems to fully implantable telemetric prostheses capable of measuring three-dimensional forces, moments, and friction-related parameters. Across cohorts, level walking consistently produced peak hip contact forces of approximately 2–3 times body weight, serving as a clinically meaningful reference loading envelope. Several recreational activities—including cycling, aquatic exercise, Nordic walking, and most gym-machine exercises—generally remained within or close to this range when performed with controlled technique. In contrast, certain rehabilitation tasks, forward-bent postures, lifting maneuvers, and perturbation events generated loads equal to or exceeding those observed during walking. Importantly, frictional moments and load direction showed substantial variability and may be more relevant to implant fixation than peak force magnitude alone. Conclusions: Instrumented hip implants provide objective biomechanical benchmarks that support principle-based and individualized RTP counselling, grounded in directly measured mechanical exposure rather than sport classification alone. Full article

Selenium has played a fundamental role in the evolution of aerobic life, thanks to its unique redox properties and its incorporation into antioxidant selenoproteins such as glutathione peroxidases (GPx). This evolutionary perspective has inspired decades of research aimed at developing small organoselenium compounds as GPx-like antioxidant drugs. However, despite extensive in vitro evidence and numerous publications, no organoselenium antioxidant has been commercialized, and even Ebselen, the most extensively studied selenium-based drug candidate, has repeatedly failed in multiple clinical trials. In this opinion article, we posit the hypothesis that a conceptual bias may underlie a significant proportion of the research conducted to date in this field. The antioxidant activity of GPx is contingent on a highly regulated enzymatic environment that is extremely difficult to reproduce with small synthetic molecules. Consequently, many compounds described as GPx mimetics may behave less like true antioxidants and more like redox-active electrophiles capable of disrupting complex thiol-dependent equilibria. It is recommended that future research should adopt a more holistic approach to the study of selenium pharmacology, moving beyond a reductionist interpretation of GPx-like activity. Instead, the focus should be on the complex network of cellular redox processes and selective redox targeting. It is only through a more profound mechanistic comprehension of selenium chemistry within biological systems that it will be feasible to ascertain whether organoselenium compounds can genuinely establish a presence within the domain of medicinal chemistry, extending beyond their persistent yet predominantly laboratory-restricted achievements. In a similar vein, undertaking a thorough examination of the mechanisms may facilitate a more profound comprehension of the fate of organoselenium compounds in their intricate interaction with biological targets. This, in turn, may enable the conception of novel molecules that function as effective and selective pro-oxidants against specific targets. Full article

Wireless ultrasound (US) probes for point of care (POC) evaluation of horses presented for veterinary evaluation of colic have become widely available in recent years. The availability and performance of this technology mean POCUS is readily available to the equine practitioner and the technology is well suited to patient evaluation or serial monitoring in first opinion practice. In human health care and veterinary contexts, it has been suggested that there is a need for practitioners to better appreciate the value of POCUS for assessment of gastrointestinal structure and function. This study was conducted as a narrative review of the literature relating to the use of abdominal sonography in equine clinical practice, juxtaposed with recent publications on the use of POCUS in human health care settings and extended to include the authors’ experiences of POCUS in the evaluation of horses presenting with select abdominal conditions. Common sonographic views are described and representative images are presented to facilitate practitioner use of the technique. By distillation of the available literature and review of sonographic techniques our aim is to provide a resource for equine practitioners. Full article

Background: Stair climbing is increasingly associated with reduced cardiovascular risk, including a lower incidence of atrial fibrillation and mortality. Objectives: In this opinion paper, we aim to critically evaluate whether these associations reflect a true protective effect or, rather, underlying differences in baseline health status. Methods: After performing a narrative synthesis of recent observational studies and meta-analyses, we prepared this thought-provoking “Opinion paper” considering current clinical guidelines on cardiovascular risk and exertional stress. Results: Habitual stair climbing is consistently associated with reduced risks of atrial fibrillation, cardiovascular mortality, and all-cause mortality, with apparent dose–response relationships. However, these findings may be influenced by reverse causation, as individuals with greater functional capacity are more likely to engage in stair climbing. Conclusions: additional research is required to elucidate the underlying mechanisms and define optimal conditions under which stair climbing may act as a causal protective factor, before its widespread promotion in public health campaigns. Full article

Background: Malabsorption is a frequent and clinically relevant condition associated with a high risk of disease-related malnutrition across multiple gastrointestinal and systemic disorders. Despite its prevalence, standardized nutritional management algorithms remain limited. Following a previously published Delphi consensus on the use of oligomeric enteral formulas, the present study aimed to develop and validate a practical nutritional management algorithm for patients with malabsorption. Methods: A structured expert questionnaire was conducted among 173 physicians with clinical experience in malabsorption, including specialists in endocrinology, gastroenterology, internal medicine, and oncology. Participants gained experience using the preliminary algorithm by applying it to five real-life cases before completing the questionnaire. The survey addressed symptom type, intensity, and duration required for screening, diagnostic criteria for malnutrition, timing of reassessment, indications for oligomeric oral nutritional supplements (ONSs), and criteria for reintroducing polymeric formulas. Statistical analyses were performed using SAS v9.4. Results: Of the 173 participants, 67.1% were women, with a mean age of 39.6 ± 8.2 years and a mean clinical experience of 10.9 ± 7.9 years. In clinicians’ opinion, diarrhea was the most frequently considered symptom to trigger screening (88.6%), followed by abdominal distension (72.6%), abdominal pain (65.4%), and increased gastric residuals (45.8%). Experts agreed that symptoms should present with at least moderate intensity and persist for more than 3 weeks to justify screening. Most respondents agreed with using the GLIM criteria for malnutrition assessment (97.7%). For patients with poor tolerance to polymeric ONSs or moderate-to-severe symptoms, initiation of oligomeric ONSs was recommended, with diarrhea identified as the main indication (31.1%). Symptom severity prompting oligomeric formulas was rated between 2.8 and 3.3 on a 5-point scale. The mean recommended duration of symptom improvement before transitioning back to polymeric formulas was 6.24 ± 4.45 weeks. Conclusions: This study presents a consensus-based, clinically applicable algorithm for nutritional screening, diagnosis, and intervention in patients with malabsorption. The algorithm provides clear guidance on symptom assessment, use of GLIM criteria, selection of ONS type, and follow-up, potentially improving standardization and quality of nutritional care in this high-risk population. Full article

Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonates and also presents major diagnostic challenges. Despite extensive research, NEC still lacks a practical definition and relies on a set of nonspecific clinical, laboratory, and radiological findings rather than a single pathognomonic presentation or test. The modified Bell staging system remains the most widely used framework in clinical practice and research, but it was originally developed to guide treatment decisions rather than aid diagnosis and has important limitations when applied as a diagnostic aid. Clinical and radiological criteria used for early stages of NEC are nonspecific, disease progression is not always linear, radiographic signs are inconsistently present, and histopathological confirmation is unavailable in most of the cases as surgery is not undertaken in all the cases. These limitations have led to the opinion that even the modified Bell staging is “broken” when it is used to define the disease itself. At the same time, increased understanding about gut immunity and microbiome progression, and neonatal hemodynamics make it increasingly clear that NEC is not a single uniform disease. It is now regarded as a heterogeneous syndrome comprising multiple phenotypes that share a final common pathway of intestinal injury and necrosis differing in timing, predisposing factors, mechanism, and clinical course. These presentations overlap with several neonatal conditions including spontaneous intestinal perforation, septic ileus, cow’s milk protein allergy, congenital heart disease-related intestinal hypoperfusion, viral enterocolitis, malrotation with volvulus, and intussusception. This review discusses controversies in the definition and staging of NEC, consolidates alternative diagnostic criteria beyond Bell’s system, and elaborates on a phenotype-based framework for clinical distinction. Also, the review sheds light on the clinical mimickers, practical bedside diagnosis using serial clinical assessment and imaging, consequences of NEC, and emerging precision medicine approaches. A shift from stage-based labeling toward a practical, phenotype-informed framework may improve diagnostic precision, reduce misclassification, and enhance both clinical care and research. Full article

In oncology, body composition (BC) provides clinically meaningful information beyond body mass index, capturing muscle and adipose tissue alterations associated with survival, treatment tolerance, surgical complications and quality of life. Although routine oncologic imaging is widely available, BC assessment remains poorly integrated into daily clinical practice, largely because conventional imaging-based approaches require time-consuming manual analyses, dedicated software and specialized expertise. Artificial intelligence (AI), particularly deep learning-based image segmentation, may automate BC analysis and generate rapid, reproducible, and scalable estimates from routinely acquired imaging, without increasing clinical workload. This opinion paper aims to examine AI-based BC analysis as a potential strategy to integrate BC into routine oncology workflows, outlining its potential clinical benefits and the aspects that need to be addressed before widespread implementation. AI-based BC analysis may improve nutritional assessment, refine clinical and nutritional risk stratification, and help identify patients at increased risk of treatment-related toxicity. In perspective, BC data may also support more personalized nutritional and physical activity interventions and contribute to muscle mass-informed anticancer treatment dosing strategies. Several gaps still limit its clinical implementation, including the need of robust external validation, standardized acquisition and analytical protocols, clinically meaningful cut-offs and ethical, and regulatory and data governance frameworks. AI-based BC analysis is therefore a promising but still evolving approach that may help translate BC from a prognostic marker into a clinically actionable tool in oncology. Full article

Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in patients with cancer. The management of special situations—including recurrent venous thromboembolism (VTE), thrombosis at unusual sites, and central venous catheter-associated thrombosis (CVC-AT)—remains particularly challenging because of the limited availability of high-quality evidence. This narrative review synthesizes recommendations from major international and Spanish clinical practice guidelines and expert consensus documents, including those from SEOM, ESMO, ASCO, NCCN, ITAC and SEMI, to provide a structured framework for the management of these complex scenarios. Our analysis identified substantial heterogeneity across guidelines, particularly regarding anticoagulant selection, dosing strategies, and treatment duration. Although some convergence exists in the management of CVC-AT, important discrepancies and evidence gaps persist in areas such as splanchnic vein thrombosis, hepatic impairment, central nervous system involvement, and recurrent VTE despite treatment. In many cases, recommendations are based primarily on expert opinion rather than robust trial data, and several clinical scenarios are addressed by only a limited number of guidelines. These findings underscore the need for more standardized management strategies and prospective clinical studies to better inform decision-making in daily practice. Overall, this review highlights the growing importance of individualized anticoagulant management aimed at balancing thrombotic and bleeding risks in high-risk oncology patients, thereby helping to bridge the gap between expert consensus and evidence-based precision anticoagulation. Full article

Previous studies have shown that, after postoperative recovery from upper and lower gastrointestinal surgery for cancer, patients use peculiar modalities to describe their health. The purpose of this study is to determine how upper and lower gastrointestinal cancer surgery is considered by patients when they set their health. A structured interview was developed and 47 consecutive patients were interviewed postoperatively. Answers were analyzed through M.A.D.I.T., a quantitative and qualitative methodology that allows for the detection of discursive processes comprising the text, beyond thematic analysis. Four dimensions have been analyzed: representation of the postoperative period in daily life; use of resources; participation in achieving the clinical objective after hospital discharge; and continuing to respect the surgeons’ indications. A corpus of 2374 text occurrences was analyzed. Without differences between types of surgery, surgical patients described the time after surgical intervention as a critical scenario. Patients expressed their personal opinions, expecting normality after surgery and having difficulty envisioning the future: their representation of inflexibility in the postoperative period prevented them from finding new coping strategies. Overall, across all four dimensions, participants used stabilization discursive modalities in more than 50% of cases, representative of a situation bound within strict ties and personal theories. When defining their health, cancer surgery patients tend not to consider their condition as a new and different one from before; they imagine that they will be able to fully resume their previous habits. However, this can risk undermining the achievement of the clinical objective. Thus, during early surgical consultations, as well as in surgical recovery, exploring differences after surgery and solutions could help patients in their engagement with surgical outcomes and consequences. Full article