Search Results (13,825)

Background and Objectives: Catheter-related bloodstream infection (CRBSI) is a major life-threatening complication among patients undergoing hemodialysis (HD) through central venous catheters. This study was performed to determine mortality risk factors in HD patients with CRBSI. Materials and Methods: Data were collected prospectively from patients with CRBSI using central venous catheters as HD access between November 2022 and November 2023. A total of 60 patients were evaluated with respect to age, sex, catheter dwell time, insertion site, comorbidities, and a range of clinical findings. Demographic and clinical characteristics were compared between survivors and non-survivors. A p-value < 0.05 was considered statistically significant. Risk factors were assessed through univariate and multivariate regression analyses. Results: The median age of the patients was 63 years, and 56.9% were male. The in-hospital mortality rate among the HD patients with CRBSI was 15%. Gram-positive microorganisms were responsible for 55.6% of the cases resulting in mortality. The following factors were associated with mortality: multidrug-resistant (MDR) microorganisms, the presence of a non-tunneled catheter, concomitant pyocystitis, elevated C-reactive protein, qSOFA ≥ 2, and altered consciousness. In multivariate logistic regression, MDR microorganisms, concomitant pyocystitis, and qSOFA ≥ 2 remained significant independent predictors of mortality. Conclusions: Our findings show that the above factors may be useful in predicting mortality in HD patients with CRBSI. Awareness of these factors and prompt intervention can help reduce mortality. Full article

Background: Micronutrient deficiencies, particularly of vitamin D, vitamin B12, and iron, are prevalent worldwide and contribute significantly to morbidity. In Saudi Arabia, these deficiencies are increasingly recognised as public health challenges, yet comprehensive data on prevalence, risk factors, and public awareness remain limited. Objectives: This study aimed to determine the prevalence of laboratory-confirmed deficiency and testing for vitamin D, vitamin B12, and iron among adults in Saudi Arabia; to identify associated sociodemographic, lifestyle, and clinical factors; and to assess public knowledge and attitudes regarding micronutrient status. Methods: A cross-sectional survey was conducted in 2025 among adults residing in Saudi Arabia. Data were collected using a structured, self-administered questionnaire covering demographics, lifestyle, chronic disease history, laboratory testing and supplementation, and knowledge and perceptions regarding micronutrient deficiency. Descriptive statistics, chi-squared tests, and network analysis were used to identify associations and patterns. Results: A total of 1652 participants were included (52.6% female; mean age 41.3 ± 10.2 years). The prevalence of laboratory-confirmed deficiency was 7.6% for vitamin D, 5.5% for vitamin B12, and 7.0% for iron. Most participants had never been tested for these micronutrients. Vitamin D deficiency was significantly associated with gender, age, education, marital status, physical inactivity, and the presence of chronic conditions. Similar patterns were observed for vitamin B12 and iron. Public knowledge was primarily sourced from social media and internet sites; 38.1% of participants considered vitamin deficiency a public health concern, and 96.4% supported awareness campaigns. Conclusions: Micronutrient deficiencies remain common and under-recognised among adults in Saudi Arabia. There is a critical need to improve public awareness, expand routine laboratory testing, and develop targeted interventions to address identified risk groups and knowledge gaps. Our study is the first study to investigate the status of three key micronutrients (vitamin D, vitamin B12, and iron) in a single large sample. We also employed network to explore the complex factors associated with micronutrient deficiencies. Full article

Endoscopic submucosal dissection (ESD) has revolutionized the management of early upper gastrointestinal (GI) carcinomas. While technically demanding, it offers, in experienced hands, definitive local therapy for early GI neoplasia by allowing complete En bloc resection of mucosal and superficially invasive neoplasms, thus enabling precise histopathological risk stratification and organ preservation. Appropriate patient selection relies on meticulous endoscopic assessment using high-definition and image-enhanced endoscopy to define lesion boundaries and predict invasion depth. The principal indications include high-grade intraepithelial neoplasia and early carcinomas without endoscopic evidence of deep submucosal invasion or lymph node metastasis risk factors. Pathological analysis of the resection specimens includes histological typing and grading per WHO classification and precise assessment of invasion depth—in case of submucosal invasion measurement in micrometers—and evaluation of margin status and lymphovascular invasion. The presence of risk factors such as deep invasion in the submucosa, poor differentiation, or lymphovascular invasion may require additional surgery, guided by validated risk scores such as the eCura system. This narrative review summarizes current clinical and pathological practices for ESD in upper GI lesions. This includes the discussion of technical and biological challenges and the need of accurate assessment of risk factors for systemic metastatic spread and local recurrence as a limitation for this sophisticated but highly effective therapeutic method. Full article

Background: The widespread use of antibiotics in dentistry has become a significant driver of the global rise in antibiotic resistance, posing serious risks to both oral and overall health. Objectives: This study aims to review antibiotic use in dentistry, elucidates the mechanisms of resistance development, identifies contributing factors, and discusses strategies to mitigate this growing global health threat. Methods: This narrative review examines current patterns of antibiotic prescribing in dentistry and evaluates evidence showing that antibiotics, although essential for preventing and managing odontogenic infections, are often prescribed unnecessarily or inappropriately. Results: The analysis highlights the growing resistance of key oral pathogens such as Streptococcus spp., Enterococcus faecalis, and Porphyromonas gingivalis, which increasingly limits the effectiveness of conventional treatments. Factors contributing to this trend include inconsistent adherence to clinical guidelines, patient pressure, and insufficient awareness of antibiotics stewardship among dental professionals. To address these challenges, the review emphasizes the importance of evidence-based prescription, strengthened stewardship programs, and the development of alternative therapies, including host-modulating agents and bacteriophage applications. Ongoing education and professional development are equally vital to enhance clinical judgment and promote responsible prescribing habits. Conclusions: Overcoming antibiotic resistance in dentistry requires coordinated effort among clinicians, researchers, educators, and policymakers. Expanding surveillance, enforcing stewardship-driven policies, and supporting innovation in therapeutic research are key to reducing antibiotic misuse and preserving their effectiveness. Through collective commitment and informed practice, the dental profession can play a crucial role in protecting antibiotic efficacy and promoting sustainable, high-quality patient care. Full article

Pediatric food allergies are an escalating public health concern, with nut allergies representing a primary cause of persistent hypersensitivity and anaphylaxis. New data suggests that pediatric populations with multiple nut allergies (MNA) may be at higher anaphylaxis risk than their counterparts with single nut allergies. Despite this, there is an absence of literature posing multiple nut allergies against singular nut allergy cases. The majority of the research in this topic is directed towards singular nut allergy, without any differentiation between children with one versus multiple sensitivities. Epidemiological evidence indicates that multiple nut allergies are associated with lifelong sensitization, high cross-reactivity potential and increased risk and severity of reactions. Compounding clinical risk factors reinforce the already high risk associated with MNA and indicate that these children require careful monitoring and individual management. Diagnostic tools, including component-resolved diagnostics and oral food challenges, enable differentiation between true multi-nut sensitization and cross-reactivity, guiding targeted interventions. Management strategies must therefore be multifaceted, encompassing selective allergen avoidance, emergency preparedness with epinephrine auto-injectors, asthma control, nutritional support, and psychosocial care. Recognizing MNA as a distinct, high-risk phenotype highlights the necessity of precision-based, biomarker-driven clinical approaches to optimize safety, reduce morbidity, and improve quality of life for affected pediatric populations. Full article

Objectives: Strong cervical musculature is recognized as a protective factor against sports-related concussions. Evidence suggests that jaw clenching may activate cervical muscles, potentially reducing head acceleration during impact. Methods: This observational cohort study examined the immediate effects of a customized interocclusal orthotic (CIO) on cervical muscle performance. Forty-two healthy adults (≥18 years) underwent strength and endurance testing with and without a CIO using a digital pressure gauge and six directional isometric contractions. Descriptive statistics and two-way repeated-measures MANOVA models were applied to evaluate condition effects. Results: CIO use produced significant improvements in cervical muscle strength and endurance across all directions compared to non-use. Forward flexion strength increased by 12.96% (p < 0.001, ηp² = 0.185), backward extension by 10.34% (p = 0.017, ηp² = 0.091), right rotation by 19.03% (p < 0.001, ηp² = 0.333) and left rotation by 19.86% (p < 0.001, ηp² = 0.353). Endurance gains demonstrated large effect sizes, with flexor endurance improving by 44.57% (p < 0.001, ηp² = 0.447). Conclusions: Optimized jaw alignment using a customized orthotic can elicit immediate, clinically meaningful enhancements in cervical strength and endurance, suggesting a promising adjunct for concussion risk mitigation in contact sports. Full article

Background and Objectives: Fluid leakage through the biopsy port during endoscopic retrograde cholangiopancreatography (ERCP) is a common procedural challenge that can compromise efficiency and increase the risk of contamination. In this study, we aimed to evaluate factors associated with fluid leakage and describe the performance of a novel leakage-collection device. Materials and Methods: A total of 183 patients who underwent ERCP between June and September 2024 at a single center were included. Fluid leakage was measured using a prototype collection device. Patients were categorized into low- (n = 126) and high-leakage (n = 57) groups based on the mean leakage volume. Logistic regression models were used to identify the clinical and procedural factors associated with high leakage. Results: Higher procedural complexity (Schutz grade) was strongly associated with high leakage (OR per grade increase, 3.66; 95% CI, 2.33–6.07; p < 0.001). In multivariable analysis, prolonged procedure duration (aOR, 1.11; 95% CI, 1.06–1.17) and more frequent duodenal flushing (aOR, 5.38; 95% CI, 1.80–18.75) were independently associated with high fluid leakage. Biliary plastic stenting (aOR, 4.53; 95% CI, 1.54–14.69) and malignancy (aOR, 3.02; 95% CI, 1.13–8.39) also showed significant associations. The device collected a mean fluid volume of 11 mL per procedure. Conclusions: Prolonged procedure duration and frequent duodenal flushing were key predictors of increased fluid leakage during ERCP. The leakage-collection device enabled measurement and containment of biopsy-port fluid but requires further validation to determine its broader clinical utility. Full article

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical prostatectomy. Secondary objectives included examining the association between the GNRI and healthcare resource utilization, specifically the length of hospital stay and hospitalization costs. Methods: This retrospective cohort study included patients aged ≥ 65 years who underwent laparoscopic radical prostatectomy at a single tertiary center between 2022 and 2024. Patients were stratified into a malnutrition group (GNRI ≤ 98) and a normal nutrition group (GNRI > 98). Clinical outcomes were compared using chi-square and t tests. Binary logistic regression was performed to identify independent predictors of complications, hospital stay, and costs. Results: Of the 264 patients included, 34.8% were classified as being at nutritional risk. The malnutrition group had a significantly higher incidence of postoperative complications (OR = 2.859, p = 0.007), longer hospital stays (OR = 4.678, p < 0.001), and greater hospitalization costs (OR = 4.867, p < 0.001). Nutritional risk remained a significant predictor after adjusting for confounders. Conclusions: GNRI-defined nutritional risk is independently associated with increased postoperative complications and higher healthcare resource utilization in older prostate cancer patients. The GNRI may serve as a practical and accessible tool for perioperative risk stratification in this population. Full article

Background: The aim of this study was to investigate the effects of chronic graft-versus-host disease (cGVHD) and its treatment with cyclosporine and extracorporeal photopheresis (ECP) on salivary caries risk factors. Methods: In this exploratory single-centre cross-sectional pilot study, saliva samples from 22 cGVHD patients were analysed for flow rate, pH, buffering capacity, and counts of Streptococcus mutans and Lactobacillus. A detailed dental examination assessed plaque, carious lesions, and their progression. Caries risk was determined based on general health and diet questionnaires and clinical findings. Results: Patients receiving a combination of cyclosporine and ECP had significantly fewer carious teeth, affected tooth surfaces, and non-cavitated carious lesions compared with those treated with ECP alone (Bonferroni test, p = 0.004, p = 0.002, and p < 0.001, respectively). Patients treated with ECP had more carious teeth and affected surfaces than those who did not receive either ECP or cyclosporine (p = 0.008 and p = 0.002), whereas patients treated with cyclosporine only had more non-cavitated lesions than those receiving both cyclosporine and ECP (p < 0.001). A negative correlation was observed between cyclosporine dose and stimulated salivary flow (R = −0.672, p = 0.0486), and a positive correlation between cyclosporine dose and caries risk (R = 0.640, p = 0.0461). Conclusions: The disease and its treatment were associated with reduced salivary flow and increased caries risk. Patients’ oral health should be monitored regularly and managed with care to prevent further deterioration. Full article

Background: Picky eating (PE), also termed food selectivity, is one of the most common feeding concerns in childhood. Although often a transient developmental stage, persistent or severe selectivity may lead to nutritional deficiencies, growth impairment, and psychosocial consequences. Methods: This narrative review is based on literature searches conducted in April 2025 across PubMed, Web of Science, Embase, Medline, and Google Scholar. Articles published between 2015 and 2025 were included if they addressed the epidemiology, etiology, assessment, or management of PE in children aged 0–18 years. Additional seminal references predating this period were also considered. Results: Prevalence estimates of PE vary widely (13–50%), with peak incidence between ages two and six. Contributing factors include genetic predisposition, sensory sensitivities, temperament, family feeding practices, environmental influences, and adverse feeding experiences. Distinction from avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) is essential, as these conditions carry greater risk of nutritional and psychosocial impairment. Assessment relies on caregiver-report instruments, clinical observation, growth monitoring, and targeted nutritional evaluation. Effective management integrates parental education, responsive feeding strategies, repeated exposure to novel foods, and, when indicated, nutritional supplementation or referral to multidisciplinary teams. Sensory-based therapies, behavioral interventions, and psychoeducational programs show particular benefit in persistent cases. Conclusions: While most children outgrow PE without adverse outcomes, a subset remains at risk of long-term nutritional compromise and psychosocial difficulties. Early recognition, family-centered guidance, and evidence-based interventions are essential. Future research should refine diagnostic criteria, develop culturally sensitive assessment tools, and evaluate innovative therapies to improve outcomes. Full article

Personalizing therapy using medical marijuana (MM) is based on understanding the pharmacogenomics (PGx) and drug–drug interactions (DDIs) involved, as well as identifying potential epigenetic risk markers. In this work, the evidence regarding the role of variants in phase I (CYP2C9, CYP2C19, CYP3A4/5) and II (UGT1A9/UGT2B7) genes, transporters (ABCB1), and selected neurobiological factors (AKT1/COMT) in differentiating responses to Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD) has been reviewed. Data indicating enzyme inhibition by CBD and the possibility of phenoconversion were also considered, which highlights the importance of a dynamic interpretation of PGx in the context of current pharmacotherapy. Simultaneously, the results of epigenetic studies (DNA methylation, histone modifications, and ncRNA) in various tissues and developmental windows were summarized, including the reversibility of some signatures in sperm after a period of abstinence and the persistence of imprints in blood. Based on this, practical frameworks for personalization are proposed: the integration of PGx testing, DDI monitoring, and phenotype correction into clinical decision support systems (CDS), supplemented by cautious dose titration and safety monitoring. The culmination is a proposal of tables and diagrams that organize the most important PGx–DDI–epigenetics relationships and facilitate the elimination of content repetition in the text. The paper identifies areas of implementation maturity (e.g., CYP2C9/THC, CBD-CYP2C19/clobazam, AKT1, and acute psychotomimetic effects) and those requiring replication (e.g., multigenic analgesic signals), indicating directions for future research. Full article

Background/Objectives: Glaucoma affects over 70 million people worldwide and is a major cause of irreversible blindness, with elevated intraocular pressure (IOP) as the only modifiable risk factor. Conventional techniques like Goldmann applanation tonometry (GAT) are widely used but cannot provide continuous or nocturnal monitoring, limiting the detection of pressure peaks relevant to disease progression. Emerging technologies, including home-based devices, wearable sensors, such as contact lens-based sensors (CLBS), and implantable biomedical microelectromechanical systems (bioMEMS), offer more comprehensive and continuous assessment of IOP patterns. Thus, this scoping review aimed to map the available evidence on technologies for continuous IOP monitoring, summarizing their performance and agreement with traditional tonometry. Methods: A systematic search of electronic databases was conducted to identify studies published in the last 10 years evaluating self-tonometry devices, CLBS, or implantable systems designed for continuous IOP monitoring. Two reviewers independently screened articles, applied eligibility criteria, charted relevant data, including device characteristics and agreement with GAT, and reported clinical applications. Results: Self-tonometry devices demonstrated generally good agreement with GAT while enabling patients to monitor IOP outside clinical settings. These devices provided valuable information on diurnal and nocturnal IOP fluctuations, especially in individuals with rapid progression or those undergoing postoperative follow-up. BioMEMS-based wearable and implantable sensors showed promise for continuous long-term monitoring and revealed previously unrecognized fluctuation patterns, including activity-related changes. Conclusions: Emerging IOP-monitoring technologies appear to complement standard clinical methods by offering more detailed IOP profiles. Their integration into clinical practice may support individualized risk assessment and improved management of glaucoma progression. Full article

Background: Periodontitis and oral dysbiosis have been linked to systemic inflammation and carcinogenesis. Among oral pathogens, Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) are biologically plausible contributors to colorectal cancer (CRC) via inflammatory and immunomodulatory pathways. However, the magnitude and consistency of these associations remain uncertain. Objective: To evaluate whether periodontitis and key oral pathogens are associated with CRC risk and prognosis through a systematic review, meta-analysis, and trial sequential analysis (TSA). Methods: We searched PubMed, Scopus, and Web of Science from inception to December 2024 following PRISMA 2020. Eligible observational studies assessed periodontitis exposure or detection of oral bacteria in relation to CRC incidence or survival. Effect estimates (RRs/HRs) were log-transformed and pooled using random-effects models; heterogeneity was quantified with I². TSA was conducted to appraise information size and the stability of the primary association. Risk of bias was evaluated with ROBINS-I/QUIPS as appropriate. PROSPERO: CRD420251168522. Results: Five studies evaluating periodontitis/oral-pathogen exposure and CRC incidence yielded a 70% higher risk (HR = 1.70; 95% CI: 1.33–2.19; I² = 0%). Detection of Fn was associated with approximately threefold higher risk of CRC (RR = 3.20; 95% CI: 1.76–5.82; p < 0.001). Pg presence was linked to worse overall survival (HR ≈ 2.4; p < 0.01). TSA suggested that the accrued evidence for the primary incidence association is likely sufficient to reduce random errors; nevertheless, interpretability is constrained by the small number of observational studies and between-study differences in exposure and outcome ascertainment. Conclusions: Current evidence indicates that periodontitis and oral pathogens—particularly Fn and Pg—are significantly associated with CRC development and progression. These findings support the clinical relevance of the oral–gut axis and underscore oral health as a potentially modifiable factor in cancer prevention. Further large, well-designed prospective cohorts and mechanistic studies are warranted to strengthen causal inference. Full article

Background: In this study, we retrospectively analyzed clinical and toxicity outcomes of 67 prostate cancer (PCa) patients undergoing moderately hypofractionated radiotherapy (RT) after prostatectomy, with adjuvant or salvage intent. Methods: Irradiation was delivered by volumetric modulated arc therapy. The median follow-up was 48 months. The 3- and 5-year biochemical relapse-free survival rates were 80% and 69%. The RT schedule consisted of a median total dose of 67.5 Gy with a median number of 25 fractions and a median fraction dose of 2.7 Gy to the prostate bed (PB) and 60% of patients simultaneously received whole pelvis irradiation (WP; fraction dose: 1.8 Gy, median total dose of 46.8 Gy). Results: The rate of acute toxicity was 54% for gastrointestinal (GI) and 36% for genitourinary (GU). No grade 3 acute toxicity was observed. Late toxicity was as follows: G1, G2, and G3 GI events in 25.5%, 3.6%, and 1.8% of the cases, respectively; G1, G2, and G3 GU events in 37.1%, 11.1%, and 7.4%, respectively. The toxicity-free survival (TFS) curves showed a different trend for acute and late toxicity. TFS was significantly associated with RT volume, except for acute GI toxicity. Specifically, the concomitant irradiation of PB and WP appeared to be a significant risk factor for late GI and GU toxicity (p = 0.029 and p = 0.012, respectively). Conclusions: At the 48-month median timepoint considered by our study, postoperative hypofractionated RT achieved promising results in terms of clinical outcomes with acceptable toxicity. Only the irradiated volume seems to be an important predictor for toxicity. Full article

Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with a high mortality rate. Early identification of patients at risk for in-hospital CS is crucial for timely intervention. This study aimed to develop a risk prediction model for CS using admission data. Methods: This retrospective case–control study included AMI patients and classified them into case and control groups, based on the development of in-hospital CS. Clinical information at admission was obtained and 1:1 propensity score matching (PSM) was performed based on age, gender, and diagnosis of ST-elevation myocardial infarction. Factors with p < 0.10 at baseline were incorporated to identify the independent risk factors, which were further used to construct a predictive nomogram. Results: After PSM, 374 patients were finally enrolled in both groups. After relaxed least absolute shrinkage and selection operator and multivariate logistic regression, independent risk factors identified for CS in AMI patients included systolic blood pressure [odds ratio (OR): 0.866; 95% confidence interval (CI): 0.844–0.888, p < 0.001], diastolic blood pressure (OR: 1.031; 95% CI: 1.001–1.063, p = 0.046), triglycerides (OR: 0.561; 95% CI: 0.385–0.820, p = 0.003), creatinine (OR: 1.005; 95% CI: 1.000–1.010, p = 0.048), globulin (OR: 0.915; 95% CI: 0.862–0.972, p = 0.004), left ventricular ejection fraction (OR: 0.951; 95% CI: 0.928–0.975, p < 0.001), and coronary angiography (OR: 0.183; 95% CI: 0.058–0574, p = 0.004). The nomogram incorporating these variables demonstrated an area under the curve of 0.937 (95% CI: 0.952–0.967), indicating good discriminatory ability in the calibration curve and decision curve. Conclusions: Seven independent risk factors for CS in AMI patients were identified upon admission. The proposed nomogram might facilitate early risk stratification and guide clinical decision-making to improve outcomes. Full article