Search Results (31,572)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

SARS-CoV-2 has an affinity for binding to the human Angiotensin-converting enzyme 2 (ACE2) receptor through cleavage and conformational changes at the S1–S2 boundary and the receptor binding domain of the spike protein, which is also the most variable part of SARS-CoV-2. This study aimed to investigate the expression of Angiotensin-converting enzyme 2 (ACE2), spike protein, and CD68+ markers in placental tissue to demonstrate a possible correlation with the level of systemic oxidative stress biomarkers in patients who were infected with SARS-CoV-2 during pregnancy. A prospective clinical cohort study was designed to investigate the presence of CD68+ macrophages, ACE2, and spike proteins in placental tissue using immunohistochemical methods and to compare these results with oxidative stress from our previous study. Spike and CD68+ macrophages’ immunoreactivity were more pronounced in the placental tissue of patients from the SARS-CoV-2 group. Placental tissue spike protein and CD68+ immunoreactivity correlate with maternal and fetal Thiobarbituric Acid Reactive (TBARS) levels. This study has confirmed that spike protein expression in placental tissue is associated with the newborn’s stay in intensive neonatal care. Therefore, immunoreactivity analysis for the Spike antigen is important in detecting newborns at risk of early neonatal complications. Full article

Background: Small airway dysfunction (SAD) plays a critical role in the management of severe asthma, particularly in patients at risk of requiring biological therapies (BTs). Short-term studies have shown that switching to single-inhaler triple therapy (SITT) with extrafine beclomethasone–formoterol–glycopyrronium improves outcomes and helps achieve quiet asthma, a state marked by symptom control, no exacerbations or oral steroids, reduced inflammation, and better small airway function. This study investigated whether, over one year, patients could maintain this state as Steady Quiet Asthma (SQA) and whether baseline measures could predict this sustained response. Methods: Twenty-six patients with severe asthma and SAD were transitioned from open triple-inhaler therapy to a closed, single-inhaler triple therapy containing extrafine beclomethasone–formoterol–glycopyrronium. Assessments at baseline (T0) and at one-year follow-up (T12) included clinical evaluations, spirometry, and impulse oscillometry, with a focus on Fres as a predictor for the need for BT. When prescribed, biologic therapies included mepolizumab, benralizumab, and dupilumab. Results: Of the 26 patients, 9 (34.6%) achieved SQA and did not require biologic therapy at the one-year follow-up, while 17 patients (65.4%) initiated biologic treatment. At T0, patients who required biologics had significantly higher median Fres (21 (19.47; 24.58) vs. 17.61 (15.82; 20.63); p = 0.049) compared to those who remained biologic-free. They also exhibited higher residual volume to total lung capacity ratio (%RV/TLC) values and lower forced expiratory volume in one second/forced vital capacity ratios (FEV₁/FVC). At T12, patients spared from BT showed significant reductions in Fres (p = 0.014) and improvements in small airway function (difference in airway resistance between 5 Hz and 20 Hz (R5–20), forced expiratory flow between 25% and 75% of FVC (%FEF25–75), and better asthma control (ACT). In contrast, patients on BT demonstrated less favorable changes in these parameters. Conclusions: Baseline Fres, FEV1/FVC ratio, and %FEV25–75 are valuable predictors of achieving Steady Quiet Asthma (SQA) and sparing biologic therapy. These findings support the use of SITT in severe asthma and highlight the importance of early functional assessments to guide personalized management. Full article

Obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH), is strongly associated with metabolic syndrome and metabolic dysfunction-associated steatotic liver disease (MASLD). IH exacerbates MASLD progression through oxidative stress, inflammation, and lipid accumulation. This study aims to investigate the impact of oxygen normalization on metabolic dysfunction in OSA patients using continuous positive airway pressure (CPAP) therapy, and in mice exposed to IH followed by a reoxygenation period. In the clinical study, 76 participants (44 OSA patients and 32 controls) were analyzed. OSA patients had higher insulin resistance, triglycerides, very low density lipoprotein (VLDL) content, and liver enzyme levels, along with a higher prevalence of liver steatosis. After 18 months of CPAP therapy, OSA patients showed significant improvements in insulin resistance, lipid profiles (total cholesterol and VLDL), liver function markers (AST and albumin), and steatosis risk scores (Fatty Liver Index and OWLiver test). In the experimental study, IH induced hepatic lipid accumulation, oxidative stress, and inflammation, and reoxygenation reversed these deleterious effects in mice. At the molecular level, IH downregulated fatty acid oxidation (FAO)-related genes, thus impairing the FAO process. Reoxygenation maintained elevated levels of lipogenic genes but restored FAO gene expression and activity, suggesting enhanced lipid clearance despite ongoing lipogenesis. Indeed, serum β hydroxybutyrate, a key marker of hepatic FAO in patients, was impaired in OSA patients but normalized after CPAP therapy, supporting improved FAO function. CPAP therapy improves lipid profiles, liver function, and MASLD progression in OSA patients. Experimental findings highlight the therapeutic potential of oxygen normalization in reversing IH-induced liver damage by FAO pathway restoration, indicating a metabolic reprogramming in the liver. Full article

Background: Super morbid obesity (SMO), defined as a body mass index (BMI) ≥ 50 kg/m², represents a distinct and increasingly prevalent subgroup of patients undergoing bariatric surgery. Compared to individuals with lower BMI, patients with BMI ≥ 50 kg/m² often exhibit unique clinical, psychological, and social characteristics that may influence treatment outcomes. Objective: This study aimed to compare demographic, metabolic, and psychiatric profiles of patients with BMI ≥ 50 kg/m² and non-super morbid obesity (NSMO; BMI < 50 kg/m²) who were evaluated prior to bariatric surgery. Methods: A total of 319 patients were recruited between December 2022 and December 2023 at a bariatric center in Gdansk, Poland. All participants underwent a comprehensive preoperative assessment, including laboratory testing, psychometric screening (BDI, PHQ-9), and psychiatric interviews. Patients were stratified into class IV obesity and NSMO groups for comparative analysis. Results: Patients with BMI ≥ 50 kg/m² were significantly older and more likely to report a history of lifelong obesity, family history of obesity, and childhood trauma. They had higher rates of obesity-related health problems such as hypertension, obstructive sleep apnea, and chronic venous insufficiency, as well as worse liver function and lipid profiles. Although the overall psychiatric burden was high in both groups, patients with BMI ≥ 50 kg/m² reported fewer prior diagnoses of depression and eating disorders, despite similar scores on screening tools. Conclusions: Patients with BMI ≥ 50 kg/m² represent a clinically distinct population with elevated metabolic risk, complex psychosocial backgrounds, and possibly underrecognized psychiatric burden. These findings underscore the need for multidisciplinary preoperative assessment and individualized treatment strategies in this group of patients. Full article

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes mellitus and obesity. However, their sustained effect on delaying gastric emptying raises new challenges in gastrointestinal endoscopy performed under sedation. This narrative review aims to summarize current evidence on the impact of GLP-1 RAs on gastric motility and to propose clinical strategies to mitigate associated procedural risks. Methods: A narrative review was conducted integrating findings from scintigraphy, capsule endoscopy, gastric ultrasound, and existing clinical guidelines. Emphasis was placed on studies reporting residual gastric content (RGC), anesthetic safety outcomes, and procedural feasibility in patients undergoing endoscopy while treated with GLP-1 RAs. Results: GLP-1 RAs significantly increase the prevalence of clinically relevant RGC, despite prolonged fasting, with potential implications for airway protection and sedation safety. Although the risk of pulmonary aspiration remains low (≤0.15%), procedural delays, modifications, or cancellations can occur in up to 30% of cases without adapted protocols. Several professional societies (AGA, ASGE, AASLD) advocate for individualized management based on procedure type, symptomatology, treatment phase, and point-of-care gastric ultrasound (POCUS), in contrast to the systematic discontinuation recommended by the ASA. Conclusions: Effective management requires personalized fasting protocols, risk-based stratification, tailored anesthetic approaches, and interprofessional coordination. We propose a clinical decision algorithm and highlight the need for training in gastrointestinal pharmacology, POCUS, and airway management for endoscopists. Future priorities include prospective validation of clinical algorithms, safety outcome studies, and the development of intersocietal consensus guidelines. Full article

Background/Objectives: Acute severe ulcerative colitis (ASUC) is often managed by tacrolimus induction therapy followed by maintenance therapy. We compared the effectiveness of ustekinumab versus vedolizumab as maintenance therapies after tacrolimus induced improvement in patients with ASUC. Methods: This single-center retrospective cohort study included patients with ASUC who received tacrolimus induction therapy followed by ustekinumab or vedolizumab between January 2018 and November 2024. The primary outcome was clinical remission at week 16. Secondary and exploratory outcomes included clinical remission at week 8, biologic persistence, and relapse risk. An inverse probability of treatment weighting (IPTW) analysis was performed using the following covariates: male sex, prior biologics or JAK inhibitors, partial Mayo score, CRP, and albumin. Results: Among 235 tacrolimus-treated patients, 29 received ustekinumab and 22 received vedolizumab. After IPTW adjustment, the clinical remission rates were significantly higher in the ustekinumab group at both week 8 (82.1% vs. 51.8%, p = 0.02) and week 16 (85.4% vs. 36.8%, p = 0.02). Biologic persistence was significantly higher in the ustekinumab group (p = 0.004), and ustekinumab significantly reduced the hazard of relapse in multivariable analyses (HR 0.42 [95% CI: 0.20–0.88], p = 0.02). Conclusions: Ustekinumab showed greater effectiveness than vedolizumab in terms of achieving remission at 16 weeks after tacrolimus induction therapy in patients with ASUC. Full article

Background: Plant-based protein supplementation in supporting muscle recovery following resistance exercise remains an area of growing interest, particularly among vegan athletes, as a potential alternative to animal-based proteins. This systematic review aimed to evaluate the effectiveness of plant-based proteins on recovery from resistance exercise-induced muscle damage in healthy young adults. Methods: A systematic and comprehensive search was administered in eight databases up to 1 May 2025, identifying 1407 articles. Following deduplication and screening, 24 studies met the eligibility criteria, including 22 randomized controlled trials and 2 non-randomized studies, with the majority from high income western countries. Results: Interventions primarily involved soy, pea, rice, hemp, potato, and blended plant protein sources, with doses ranging from 15 to 50 g, typically administered post resistance exercise. Outcomes assessed included muscle protein synthesis (MPS), delayed-onset muscle soreness (DOMS), inflammatory biomarkers, muscle function, and fatigue. The review findings reaffirm that single-source plant proteins generally offer limited benefits compared to animal proteins such as whey, particularly in acute recovery settings, a limitation well-documented consistently in the literature. However, our synthesis highlights that well-formulated plant protein blends (e.g., combinations of pea, rice, and canola) can stimulate MPS at levels comparable to whey when consumed at adequate doses (≥30 g with ~2.5 g leucine). Some studies also reported improvements in subjective recovery outcomes and reductions in muscle damage biomarkers with soy or pea protein. However, overall evidence remains limited by small sample sizes, moderate to high risk of bias, and heterogeneity in intervention protocols, protein formulations, and outcome measures. Risk of bias assessments revealed concerns related to detection and reporting bias in nearly half the studies. Due to clinical and methodological variability, a meta-analysis was not conducted. Conclusion: plant-based proteins particularly in the form of protein blends and when dosed appropriately, may support muscle recovery in resistance-trained individuals and offer a viable alternative to animal-based proteins. However, further high-quality, long-term trials in vegan populations are needed to establish definitive recommendations for plant protein use in sports nutrition. Full article

Atherosclerosis is a progressive, multifactorial disease driven by the interplay of lipid dysregulation, chronic inflammation, oxidative stress, and maladaptive vascular remodeling. Despite advances in systemic lipid-lowering and anti-inflammatory therapies, residual cardiovascular risk persists, highlighting the need for more precise interventions. Targeted drug delivery represents a transformative strategy, offering the potential to modulate key pathogenic processes within atherosclerotic plaques while minimizing systemic exposure and off-target effects. Recent innovations span a diverse array of platforms, including nanoparticles, liposomes, exosomes, polymeric carriers, and metal–organic frameworks (MOFs), engineered to engage distinct pathological features such as inflamed endothelium, dysfunctional macrophages, oxidative microenvironments, and aberrant lipid metabolism. Ligand-based, biomimetic, and stimuli-responsive delivery systems further enhance spatial and temporal precision. In parallel, advances in in-silico modeling and imaging-guided approaches are accelerating the rational design of multifunctional nanotherapeutics with theranostic capabilities. Beyond targeting lipids and inflammation, emerging strategies seek to modulate immune checkpoints, restore endothelial homeostasis, and reprogram plaque-resident macrophages. This review provides an integrated overview of the mechanistic underpinnings of atherogenesis and highlights state-of-the-art targeted delivery systems under preclinical and clinical investigation. By synthesizing recent advances, we aim to elucidate how precision-guided drug delivery is reshaping the therapeutic landscape of atherosclerosis and to chart future directions toward clinical translation and personalized vascular medicine. Full article

Alkyladenine DNA glycosylase (AAG) is a critical enzyme in the base excision repair (BER) pathway, responsible for removing a broad spectrum of alkylated DNA lesions. While AAG maintains genomic stability, dysregulated activity has been implicated in cancer development, drug resistance, and neurodegenerative diseases. This review synthesizes the current knowledge on AAG’s structure, catalytic mechanism, and polymorphic variants, highlighting their potential roles in disease pathogenesis. A comprehensive bioinformatics analysis of over 370 AAG single-nucleotide polymorphisms (SNPs) is presented, identifying ~40% as high-risk variants likely to impair enzymatic function. Notably, 151 SNPs were predicted to be damaging by multiple algorithms, including substitutions at catalytic residues and non-conserved sites with unknown functional consequences. Analysis of cancer databases (COSMIC, cBioPortal, NCBI) revealed 93 tumor-associated AAG variants, with 18 classified as high-impact mutations. This work underscores the need for mechanistic studies of AAG variants using structural biology, cellular models, and clinical correlation analyses. Deciphering AAG’s polymorphic landscape may unlock personalized strategies for cancer prevention and treatment. Full article

Background: Undercover police work is a psychologically high-risk profession that exposes officers to chronic stress, identity conflicts, and moral dilemmas. The aim of the present review is to evaluate the psychological consequences associated with undercover police work, focusing on specific psychopathological risk factors. Methods: A systematic search was conducted in PubMed, PsycINFO, Web of Science, and Scopus databases. Studies were conducted in the United States, the United Kingdom, New Zealand, and Canada. The present systematic review analyzed data from 380 current undercover operatives, 372 former UCOs, 578 officers without undercover experience, and 60 pre-operational agents. Results: From an initial pool of 365 records, 10 studies were identified, of which 6 met the inclusion criteria. The most frequently reported psychological risk factors included anxiety, hypervigilance, identity issues, dissociative symptoms, and substance misuse. These were assessed using validated self-report instruments (e.g., SCL-90), structured interviews, and clinical evaluations. Long-term consequences were more prominent post-deployment, particularly among former UCOs. Conclusions: Undercover work is associated with an elevated risk of mental health problems, especially after the end of operations. Future research should focus on standardizing assessment tools and identifying protective factors. The findings support the development of targeted interventions such as pre-deployment psychological screening, ongoing monitoring, and structured reintegration programs to safeguard UCOs’ well-being. Full article

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, surgical procedures, complications, and mortality associated with DVIE in our tertiary hospital in Italy. The Endocarditis Registry STEADY includes patients admitted with IE from January 2009 to March 2024 (n = 398). Sixty-three of them (16%) had DVIE. Methods: We conducted a retrospective single-center observational study, analyzing demographic, clinical, and microbiological data in DVIE patients, comparing those treated surgically (surgical group, SG) with those treated medically (non-surgical group, NSG). Results: The groups were homogeneous in age, microbiological yields, type of valve involved, and risk factors for infective endocarditis. The surgical group presented significantly more cancer history, intracardiac complications, and new-onset arrhythmias compared to the non-surgical group. Median hospital stay was similar in both groups. In SG, the most common postoperative complication was new rhythm disorders; other complications such as cardiac tamponade, pericardial effusion, and pneumothorax were rare. In-hospital mortality was similar between groups; however, one-year survival was higher in the surgical group (72% vs. 54%, p = 0.031). In our series, 16 patients were over 75 years old (25%), and 7 of them (44%) underwent cardiac surgery. One-year survival in the surgical group was also higher in this subgroup. Conclusions: Surgical treatment, when indicated, may improve the prognosis of patients with DVIE, including elderly patients. Full article

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this population remain largely underexplored, particularly concerning suicidal ideation and self-injurious behaviours. The purpose of this review is to synthesise the existing literature on suicidality in individuals with CP, explore theoretical and clinical risk factors, and identify key gaps in the current evidence base. Methods: A narrative literature review was conducted focusing on studies addressing suicidal ideation, self-harm, or related psychiatric outcomes in individuals with CP. Additional literature on risks and protective factors was included to support theoretical inferences and clinical interpretations. Results: Only a limited number of studies addressed suicidality directly in CP populations. However, several reports document elevated rates of depression, anxiety, and emotional distress, particularly among adults and individuals with higher levels of functioning. Communication barriers, chronic pain, social exclusion, and lack of accessible mental health services emerged as critical risk factors. Protective elements included strong family support, inclusive environments, and access to augmentative communication. Conclusions: Suicidality in individuals with CP is a neglected yet potentially serious concern. Evidence suggests underdiagnosis due to factors such as communication barriers and diagnostic overshadowing. Future research should prioritise disability-informed methodologies and validated tools for suicidal ideation, while clinicians should incorporate routine, adapted mental health screening in CP care to ensure early detection and person-centred management. Full article

Background/Objectives: Iron deficiency without anemia (IDWA) is common among female patients with chronic kidney disease (CKD), yet the clinical implications of iron therapy in this population remain uncertain. While iron supplementation is frequently used in anemic CKD patients, evidence regarding its outcomes in non-anemic, iron-deficient individuals is limited and conflicting. Methods: This retrospective cohort study utilized the multi-institutional TriNetX database to examine the 5-year outcomes of iron therapy in adult women with stage 3 CKD, normal hemoglobin (≥12 g/dL), normal mean corpuscular volume (MCV), and low serum ferritin (<100 ng/mL). Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), pneumonia, progression to advanced CKD (estimated glomerular filtration rate ≤30 mL/min/1.73 m²), and gastrointestinal (GI) bleeding. Results: We identified 53,769 eligible non-anemic patients with stage 3 CKD, low serum ferritin levels, and normal MCV. Propensity score matching (1:1) was conducted on demographic variables to compare iron-treated (n = 6638) and untreated (n = 6638) cohorts. Over the 5-year follow-up, iron therapy in non-anemic females with stage 3 CKD, low ferritin levels, and iron supplementation was significantly associated with increased risks of MACE, AKI, pneumonia, CKD progression, and GI bleeding (log-rank p < 0.0001). No significant difference in all-cause mortality was observed. Data on transferrin saturation and the dosage of iron supplementation were unavailable. Conclusions: In non-anemic women with stage 3 CKD and low ferritin levels, iron supplementation was linked to increased MACE, renal, and pneumonia risks without evident survival benefits. These findings suggest that iron therapy in this group of patients may not confer cardiovascular benefit and may pose risks. Full article