Search Results (14,351)

Echocardiographic left ventricular (LV) diastolic function assessment represents one of the mainstays for routine, comprehensive transthoracic echocardiography in adults. Estimation of LV filling pressures is an integral part of LV diastolic function evaluation. Additionally, LV diastolic function assessment is crucial for the study of subjects with potential heart failure with preserved LV ejection fraction. Beyond the “old” LV diastolic function parameters, to date, mostly strain-based (and generally artificial intelligence-assisted) additional “new” echocardiographic techniques have emerged to optimize the study of LV diastole. The purpose of the present narrative critical review is to report and discuss the optimal echocardiographic assessment of LV diastolic function in light of the recent literature, with the aim of trying to outline the gaps in the current evidence in view of future developments. To date, multiparametric diastolic evaluation and grading seem advisable, using as many “old and new” measurements as possible—associated with their adequate selection related to the patients’ comorbidities—aiming to cumulatively increase the advantages of diastolic parameters and possibly minimize their limitations. Taking into account the considerable number of echocardiographic measurements to perform and describe, at present, the timing of optimal echocardiography performance and reporting should be adequately adapted to the current technical needs and real-life routine clinical practice. Importantly, contextual clinical and (if needed) multimodality assessment should be included in the diagnostic workflow, in order to enable a more individualized approach. Full article

Urinary tract infections (UTIs) represent a major cause of morbidity among adult women, with a disproportionate burden among postmenopausal patients. Limited data exist from Eastern Europe regarding pathogen distribution, antimicrobial resistance, and treatment patterns in hospitalized women. We conducted a retrospective cohort study of 948 adult female patients hospitalized with symptomatic UTIs between January 2021 and December 2023 in a Romanian multidisciplinary hospital. Demographic, clinical, and microbiological parameters were analyzed. Pathogen identification was performed by MALDI-TOF MS, and antimicrobial susceptibility testing followed EUCAST 2024 standards. Empiric treatment strategies and subsequent therapy modifications were assessed. Postmenopausal women accounted for 78.4% of cases and exhibited higher rates of recurrent UTIs, frailty, diabetes, urinary catheterization, and prior antibiotic exposure. Escherichia coli remained the predominant pathogen (52.6%), followed by Klebsiella spp. (18.4%) and Enterococcus spp. (12.1%). ESBL-producing organisms were found in 21.4% of E. coli and 38.7% of Klebsiella isolates. Pathogen distribution differed by age: younger women had a higher proportion of E. coli, whereas postmenopausal women showed a relative increase in opportunistic/healthcare-associated pathogens, particularly Klebsiella spp. and Enterococcus spp., consistent with higher catheter exposure and comorbidity burden. Carbapenem resistance was rare but present in a small subset of Klebsiella isolates with phenotypes compatible with OXA-48-like carbapenemase production. Empiric therapy most frequently included ceftriaxone or fluoroquinolones, but 27.8% of regimens required adjustment after susceptibility results. Independent predictors of prolonged hospitalization included age > 65 years, recurrent UTI, MDR infection, urinary catheterization, and delayed targeted therapy. UTIs among hospitalized adult women—especially postmenopausal patients—are strongly influenced by comorbidity burden and antimicrobial resistance. Local resistance patterns highlight the need for evidence-based empiric treatment and rapid therapy optimization. Strengthening stewardship and preventive interventions in elderly women is essential. Full article

The COVID-19 pandemic has highlighted the importance of rapid clinical decision-making to facilitate the efficient usage of healthcare resources. Over the past decade, machine learning (ML) has caused a tectonic shift in healthcare, empowering data-driven prediction and decision-making. Recent research demonstrates how ML was used to respond to the COVID-19 pandemic. This paper puts forth new computer-aided COVID-19 disease screening techniques using six classes of ML algorithms (including penalized logistic regression, random forest, artificial neural networks, and support vector machines) and evaluates their performance when applied to a real-world clinical dataset containing patients’ demographic information and vital indices (such as sex, ethnicity, age, pulse, pulse oximetry, respirations, temperature, BP systolic, BP diastolic, and BMI), as well as ICD-10 codes of existing comorbidities, as attributes to predict the risk of having COVID-19 for given patient(s). Variable importance metrics computed using a random forest model were used to reduce the number of important predictors to thirteen. Using prediction accuracy, sensitivity, specificity, and AUC as performance metrics, the performance of various ML methods was assessed, and the best model was selected. Our proposed model can be used in clinical settings as a rapid and accessible COVID-19 screening technique. Full article

Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended. Full article

Background/Objectives: Gambling disorder (GD) is characterized by a high prevalence of co-occurring psychiatric disorders, including personality disorders (PDs), which may negatively influence clinical presentation, treatment outcomes, and relapse rates. The aim of this systematic review was to synthesize recent evidence regarding the association between GD and formally diagnosed PD and/or diagnostically anchored PD symptomatology, and to describe the main personality dimension most frequently reported in affected individuals. Methods: A systematic search was conducted in the PubMed and Dialnet databases for articles published between 30 November 2015 and 30 November 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed was selected as the primary database because it is the most comprehensive source for peer-reviewed biomedical and psychiatric research, while Dialnet was included to complement PubMed by ensuring coverage of peer-reviewed psychiatric and psychological research published in other Romance-language journals, which are often underrepresented in international databases. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies and the Newcastle–Ottawa Scale (NOS) for observational studies. Data extraction and synthesis were performed manually by two independent reviewers. Eight studies, predominantly cross-sectional in nature, assessing exclusively formally diagnosed personality disorders in adult individuals (≥18 years) diagnosed with GD were included. Results: Eight studies met the inclusion criteria, including a total of 4607 patients with GD. Across studies, personality pathology was highly prevalent among individuals with GD, with antisocial and borderline personality disorders most consistently reported. Elevated levels of impulsivity, emotional dysregulation, and narcissistic traits were frequently observed and were additionally associated with greater gambling severity, earlier onset, and poorer clinical outcomes. Antisocial personality symptoms were strongly linked to high-risk gambling subtypes, while obsessive–compulsive personality traits showed a more heterogeneous relationship with gambling severity. Conclusions: These results underscore the importance of personality assessment in individuals with GD and highlight the need for longitudinal studies using standardized diagnostic frameworks to inform tailored prevention and treatment strategies. Full article

Respiratory viruses such as SARS-CoV-2, influenzas A and B, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), human parainfluenza virus type 3 (HPIV-3), and rhinoviruses remain major causes of global morbidity. Their rapid evolution, high transmissibility, and limited therapeutic options, together with the absence of approved vaccines for several pathogens, highlight the need for broad-acting and pathogen-independent antiviral strategies. Nitric oxide exhibits antiviral activity through redox-dependent mechanisms, including S-nitrosylation of cysteine-containing viral proteins and disruption of redox-sensitive structural domains. Clinical studies conducted during the SARS-CoV-2 pandemic demonstrated that a nitric oxide nasal spray (NONS) rapidly reduced nasal viral load and transmission. In this study, we evaluated the in vitro virucidal activity of the NONS against a panel of clinically relevant respiratory viruses representing four major virus families. Virus suspensions of approximately 10⁴ CCID₅₀ were exposed to a full-strength NONS for contact times ranging from 5 s to 2 min at room temperature, followed by neutralization and quantification of residual infectivity using endpoint dilution assays. The NONS rapidly reduced viral infectivity across all viruses tested, achieving >3 log₁₀ reductions within 2 min. SARS-CoV-2 variants including Alpha, Beta, Gamma, Delta, Omicron BA.1, and XBB 2.0 were reduced to levels at or below the assay detection limit within 30 s to 2 min. Influenza A and B viruses showed the fastest loss of infectivity, reaching detection limits within 10–15 s. RSV, hMPV, HPIV-3, and human rhinovirus 14 were similarly inactivated within 1–2 min. These findings demonstrate that the NONS exhibits rapid and broad-spectrum virucidal activity against diverse respiratory viruses and supports its potential role in pandemic preparedness but also seasonal use. Full article

Ocular allergy (OA) is a subtype of seasonal allergy that causes symptoms of itchiness, redness, swelling and irritation of the ocular surface and eyelids, often triggering allergy-induced eye rubbing and sustained inflammation for up to six months of the year during peak allergy season. These symptoms, coupled with reduced sleep quality, impaired daily productivity and decreased mood, highlight a significant yet underrepresented disease burden. Recent advances in tear-based multi-omics have enabled detailed characterisation of OA-associated biochemical changes on the ocular surface, highlighting human tears as a promising biospecimen for diagnostic biomarker and therapeutic target research. This review discusses emerging proteomic, lipidomic, metabolomic and miRNA findings comparing OA sufferers with healthy controls, and, where relevant, with comorbid conditions such as dry eye disease and keratoconus. Differential expression patterns across these analytes implicate key pathways involved in immune response, wound healing, angiogenesis, inflammation, oxidative stress and return to homeostasis on the ocular surface. By integrating these data into a stepwise model of OA biopathway activation, this review outlines candidate biomarkers and highlights methodological advances that may support translation of tear multi-omics into clinical tools for OA management. Full article

Background/Objectives: Finger amputation is frequently followed by complications, with reported revision rates of up to 20%. One of the most disabling sequelae is the formation of painful neuromas, occurring in approximately 3–9% of cases. Several biological and mechanical risk factors have been proposed, but the potential influence of psychological traits remains poorly understood. This study aimed to investigate whether a correlation exists between patients’ personality traits and the development of neuropathic pain or related symptoms. Methods: A retrospective study was conducted at a Level II Hand Trauma Center, including patients who underwent digital amputation between 2021 and 2023. Neuropathic pain and cold intolerance were assessed using the S-DN4 and CISS questionnaires, respectively. Personality traits were evaluated using the BFI-10 scale. Demographic data and other clinical risk factors, including work-related injuries, psychiatric history, infection, treatment delay, and surgical technique, were also analyzed. Results: A total of 54 patients were included. Neuropathic pain, defined by an S-DN4 score ≥ 4, was identified in 10 patients (18.5%). A significant correlation was found between the occurrence of neuropathic pain, cold intolerance, and the “neuroticism” personality trait. Patients with work-related injuries or psychiatric disorders also showed a higher risk of neuropathic pain and cold intolerance. Conversely, infection and delayed treatment were associated with an increased risk of revision procedures, whereas the type of surgical technique used for nerve stump management was not significantly correlated with pain outcomes. Conclusions: The study demonstrated a meaningful association between the neurotic personality trait and both neuropathic pain and cold intolerance after finger amputation. Additionally, work-related injuries and psychiatric comorbidities were identified as potential risk factors. Patients exhibiting these characteristics may benefit from early psychological assessment and multidisciplinary management to prevent further complications and improve postoperative outcomes. Full article

Inflammatory bowel diseases (IBD) are increasingly acknowledged not merely as confined gastrointestinal disorders but as systemic immunometabolic syndromes. Central to this paradigm is the gut microbiota including non-bacterial components such as the virome, whose functional disruption marked by reduced short-chain fatty acids (SCFAs), increasingly implicated in pathogenic processes extending beyond intestinal mucosa. This review outlines how these alternations compromise the epithelial barrier and immune regulation, increasing the risk of recurrent Clostridioides difficile infections to anemia, neuropsychiatric comorbidities, and extraintestinal manifestations. We critically evaluate emerging microbiota-targeted strategies, including fecal microbiota transplantation (FMT), live biotherapeutic products (LBPs), and precision postbiotics, positioning them as potential adjuncts to conventional immunosuppression. Finally, we discuss the current barriers to clinical translation, such as safety and heterogeneity, and propose a future framework for personalized, functionally integrated IBD care aimed at restoring long-term microbiota homeostasis. Full article

Asthma is a multifactorial respiratory condition affected by demographic, clinical, and lifestyle factors. Recognizing sex-related differences in risk factors may help develop personalized preventive strategies and ultimately enhance clinical outcomes. This study aims to compare the characteristics of male and female patients with asthma and to identify the primary risk factors linked to the condition in each group as well. A comparative analysis was conducted using regression models to evaluate the association between asthma and potential risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations for men and women separately. In females, obesity (OR, 1.85; 95% CI, 1.24–2.75), chronic obstructive pulmonary disease (COPD) (OR, 3.37; 95% CI, 1.77–6.43), chronic sinusitis (OR, 4.37; 95% CI, 1.02–18.64), and hypothyroidism (OR, 1.79; 95% CI, 1.09–2.94) were significantly associated with asthma. In males, COPD was the strongest predictor (OR, 4.35; 95% CI, 1.18–15.97), while other factors showed weaker or non-significant associations. Age was not a significant predictor in either sex. The findings highlight important sex differences in the risk profile for asthma. These results underscore the need for sex-specific approaches in the prevention, diagnosis, and management of asthma. Full article

Background/Objectives: The growing population of women aged ≥ 80 years poses a new challenge for urogynecology. Advanced age, comorbidities, and polypharmacy raise concerns regarding the safety of procedures in the management of pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and overactive bladder (OAB). Individualized, frailty-based assessment is essential in this group. The aim of the study was to evaluate the safety profile of urogynecological surgical procedures among women aged ≥ 80 years at a single tertiary center. Methods: In a retrospective observational single-center study, we analyzed the medical documentation of 774 hospitalizations of women aged ≥ 80 years admitted between 2014 and 2023. The analysis included indications, comorbidities, treatment types, anesthesia, and complications. Comorbidity and surgical risk were evaluated using the Charlson Comorbidity Index (CCI) and Clavien–Dindo classification. Results: A total of 720 admissions with complete medical records were analyzed, of which 65% were for urogynecological conditions. In this group, the mean age was 83.0 years and mean BMI was 27.2 kg/m². Most patients (92.9%) had comorbidities, mainly hypertension (84.2%) and diabetes (21.1%). POP was the leading indication (52%), followed by SUI (35%) and OAB (27%). Surgical management was performed in 95% of POP cases, predominantly via vaginal native tissue repair (80%), especially LeFort colpocleisis (20%). The transobturator sling (TOT) was the most frequent SUI surgery. Intraoperative complications occurred in 1.5% of cases and postoperative ones were mainly minor (Clavien–Dindo I–II). No procedure-related deaths were recorded. Conclusions: In this cohort, surgical treatment of urogynecological problems in women ≥80 years was associated with a low rate of major complications, suggesting that it can be safely offered to elderly patients. Careful preoperative assessment based on frailty and comorbidity rather than chronological age remains essential. Full article

Objective: This study aimed to evaluate serum and salivary podoplanin (PDPN) levels in patients with oral cancer (OC) and oral leukoplakia (OL) and to investigate their potential role as diagnostic biomarkers in distinguishing between these conditions. Materials and Method: Ninety participants were enrolled: 30 healthy controls, 30 patients with OL, and 30 patients with histopathologically confirmed OC. All cases were recruited from the Department of Otorhinolaryngology, Cerrahpaşa Medical Faculty and Istanbul Atlas University Hospital. Demographic characteristics, comorbidities, and biochemical parameters were recorded. Serum and salivary PDPN levels were measured using the ELISA method. Results: Serum PDPN levels were significantly higher in the OC group (3.25 ± 0.80 ng/mL) compared with both OL (1.85 ± 0.56 ng/mL) and controls (0.98 ± 0.42 ng/mL) (p < 0.001). Salivary PDPN levels showed a similar pattern, being highest in OC (2.65 ± 0.75 ng/mL), followed by leukoplakia (1.40 ± 0.45 ng/mL), and controls (0.72 ± 0.30 ng/mL) (p < 0.001). Importantly, both serum and salivary PDPN concentrations increased progressively with increasing epithelial dysplasia severity among patients with OL (one-way ANOVA, p < 0.001). ROC analysis demonstrated excellent diagnostic accuracy for OC: AUC = 0.976 for serum PDPN (cut-off: 2.0 ng/mL; sensitivity 93.3%, specificity 100%) and AUC = 0.987 for salivary PDPN (cut-off 1.24 ng/mL; sensitivity 93.3%, specificity 95%). Conclusions: Serum and salivary PDPN levels were significantly elevated in patients with OC and demonstrated excellent diagnostic performance in distinguishing malignant lesions from OL and healthy controls. The observed stepwise increase in PDPN levels with dysplasia severity further supports its role in malignant transformation. Notably, salivary PDPN represents a non-invasive, practical, and reproducible biomarker that may aid in early detection and risk stratification of high-risk oral premalignant lesions. PDPN assessment could therefore complement clinical and histopathological evaluation, although larger prospective studies are warranted to validate its diagnostic and prognostic utility. Full article

Anxiety, depression, and social impairment exhibit high clinical comorbidity, yet their underlying shared neural circuitry remains poorly defined. Using a mouse model of chronic social isolation combined with circuit tracing and chemogenetic tools, we identified a key role for the basolateral amygdala (BLA) in relaying prefrontal cortex (PFC) signals to the bed nucleus of the stria terminalis (BNST) to drive behavioral changes. Further circuit dissection identified two distinct BNST microcircuits segregated by their input sources: one receives indirect PFC input relayed through the BLA (PFC → BLA → BNST), while the other is innervated by direct PFC projections (PFC → BNST). Chemogenetic inhibition of BLA neurons in the indirect pathway ameliorated anxiety-like behavior, depression-like behavior, and social deficits. Within the BNST, however, inhibition of neurons in PFC → BLA → BNST pathway selectively alleviated affective phenotypes without altering social behavior. In contrast, inhibition of neurons in PFC → BNST pathway specifically restored social recognition while leaving emotional behaviors intact. Thus, the BLA integrates PFC-derived signals to broadly modulate behavior, while downstream BNST microcircuits dissociate these influences. The indirect, BLA-relayed pathway within the BNST specifically drives affective symptoms, whereas the direct PFC → BNST pathway selectively governs social recognition. This dissociable circuit model offers a new framework for understanding clinical comorbidity and may inform targeted interventions for distinct symptom dimensions. Full article

Background: Acinetobacter baumannii (AB), particularly carbapenem-resistant strains (CRAB), is a major cause of difficult-to-treat infections associated with substantial mortality. Contemporary data from Central and Eastern Europe remain scarce. We aimed to characterize the epidemiology, clinical features, and survival of patients with AB bloodstream infection in a multicenter Polish cohort. Methods: We conducted a retrospective multicenter study including consecutive adults with microbiologically confirmed AB bloodstream infection. Clinical and demographic data, comorbidities, infection origin, and antimicrobial treatments were collected. Outcomes included all-cause in-hospital mortality and infection-attributed mortality. Survival was assessed using Kaplan–Meier curves and log-rank tests, while factors associated with death were examined with univariable and multivariable Cox regression. Results: Among 245 patients with CRAB bloodstream infection, overall mortality was 69.4%, and infection-attributed mortality reached 51.8%. Most infections (75.1%) were hospital-acquired. In univariable analyses, male sex (HR = 0.66; p = 0.008) and colistin-based therapy (HR = 0.71; p = 0.037) were associated with improved survival. Conversely, hospital-acquired infection (HR = 0.43; p < 0.001) and acute kidney injury (HR = 1.40; p = 0.038) were linked to higher mortality. In the multivariable model, male sex remained protective (HR = 0.61; p = 0.006), while hospital-acquired infection (HR = 0.35; p < 0.001) and COVID-19 (HR = 1.64; p = 0.049) independently predicted death. After adjustment, no other comorbidities or antimicrobial regimens showed significant associations. Conclusions: In this multicenter cohort of patients with CRAB bloodstream infection, mortality remained extremely high. Hospital-acquired infection, acute kidney injury, and COVID-19 were strong independent predictors of poor outcomes, whereas male sex was associated with better survival. Although colistin-containing therapy appeared beneficial in univariable analysis, this effect did not persist after adjustment, underscoring potential confounding. These findings highlight the urgent need for early recognition, optimized antimicrobial strategies, and prevention of healthcare-associated spread to improve outcomes in CRAB bacteremia. Full article

Background: Nintedanib and pirfenidone are two anti-fibrotic agents for diseases within the interstitial lung diseases (ILDs) spectrum. Here, we provide a comprehensive analysis regarding treatment persistence and adherence rates for the Greek territory. Methods: This was a retrospective cohort study of patients initiating anti-fibrotic treatment during the period 2019–2023, utilizing data extracted from the National Electronic Prescription Database. Treatment persistence was defined as the duration from the date of the first prescription to the end of follow-up, death, or switching to another agent. Adherence was estimated based on the Medication Possession Ratio (MPR) metric. Results: Overall, 2112 patients were analyzed. The majority were naive, male patients with a diagnosis of idiopathic pulmonary fibrosis (IPF). The overall median treatment persistence was 40.2 months (95% CI: 35.5–44.6). Women and treatment-naive patients demonstrated longer median treatment persistence compared to their counterparts, while older patients demonstrated the lowest median persistence rates. Adherence levels remained high across the follow-up period (90%). Diagnosis of IPF and gastrointestinal comorbidities were associated with a higher risk of discontinuation. Conclusions: We have generated novel data concerning the factors that affect patients’ outcomes under anti-fibrotic therapy. These findings may provide helpful insights for the therapeutic management of ILDs. Full article