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12 pages, 275 KiB  
Article
Factors Associated with Persistent Metatarsal Pain in Patients with Rheumatoid Arthritis in Remission: Clinical Implications and Multivariable Analysis in a Cross-Sectional Study
by Rebeca Bueno Fermoso, Maria Rosario Morales Lozano, Carmen Martínez Rincón, Pablo García-Fernández, Juan Miguel López González and Maria Luz González Fernandez
Biomedicines 2025, 13(8), 2024; https://doi.org/10.3390/biomedicines13082024 - 20 Aug 2025
Abstract
Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The [...] Read more.
Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The aim of this study was to compare the clinical, biomechanical, and radiological characteristics of RA patients in remission with isolated metatarsal pain versus those with pain in other foot regions, and to identify independent predictors of metatarsal pain. Methods: This cross-sectional study included 118 RA patients in remission, classified into two groups: isolated metatarsal pain (n = 61) and pain in other foot regions (n = 57). Clinical variables (demographics, disease duration, treatment, comorbidities), biomechanical measures (ankle, first metatarsophalangeal and subtalar joint mobility, hallux valgus severity, foot type), radiographic findings (erosions, subluxations), and ultrasound-detected synovitis in the 2nd–5th metatarsophalangeal (MTP) joints were recorded. Independent predictors were identified using binary logistic regression. Results: Patients with metatarsal pain had higher rates of severe hallux valgus, MTP synovitis, and dislocations ≥ 50%. Independent predictors were hallux valgus (OR = 5.428, 95% CI: 1.528–19.287, p = 0.009), MTP synovitis (OR = 2.093, 95% CI: 1.337–3.275, p = 0.001), and MTP dislocations (OR = 2.092, 95% CI: 1.275–3.432, p = 0.003). Conclusions: Persistent metatarsal pain in RA remission is associated with a distinct structural and biomechanical profile. Comparing foot pain by location may help identify clinically relevant patterns and support more individualized assessment and treatment strategies. Due to the cross-sectional design, causality cannot be established. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics for Rheumatic Diseases)
13 pages, 1383 KiB  
Article
Surgeon Learning Curve for Minimally Invasive Hemiarthroplasty Using the Direct Anterior Approach for Treatment of Femoral Neck Fractures in Elderly Patients
by Francesco Maruccia, Assad Assaker, Massimiliano Copetti, Serena Filoni, Giacomo Trivellin, Andrea Perna, Franco Gorgoglione and Nicholas Elena
Prosthesis 2025, 7(4), 102; https://doi.org/10.3390/prosthesis7040102 - 20 Aug 2025
Abstract
Background: Femoral neck fractures (FNFs) are common injuries among the elderly and are a significant cause of morbidity and mortality. Hemiarthroplasty (HA) is the most suitable choice for elderly patients with multiple comorbidities and reduced functional demands. The direct anterior approach (DAA) to [...] Read more.
Background: Femoral neck fractures (FNFs) are common injuries among the elderly and are a significant cause of morbidity and mortality. Hemiarthroplasty (HA) is the most suitable choice for elderly patients with multiple comorbidities and reduced functional demands. The direct anterior approach (DAA) to perform HA is widely used because, among other attractive features, it facilitates recovery of functional outcomes by limiting iatrogenic muscle damage. The learning curve for surgeons who perform minimally invasive HA using the DAA approach is unknown. The purpose of the study is to perform this determination. Methods: 850 patients (age: 82 ± 6 years) who had suffered FNFs were enrolled for the study between January 2017 and September 2022. The patients underwent minimally invasive hemiarthroplasty (using the anterior minimally invasive surgical (AMIS) technique) and DAA (AMIS + DAA). The patients were divided into three groups, one operated on by surgeons who have substantial experience in HA using DAA (Group A), another operated on by surgeons who have experience in adult hip arthroplasty (≥5 y) but had not specialized in using DAA (Group B), and surgeons who are being trained to perform adult hip arthroplasty (Group C). The metrics determined were duration of surgery, skin incision length, drop in hemoglobin level, length of hospital stay, complications experienced within 2 y of the procedure and the Harris Hip Score. For each of these metrics, the results were used to determine the learning curve for Groups B and C surgeons. Results: Using the learning curve profiles obtained, it was calculated that in order to achieve the competence of Group A surgeons, Group B and Group C surgeons need to perform 46 and 102 consecutive procedures, respectively. Conclusion: For an HA patient to achieve outcomes when treated for FNF using AMIS + DAA requires that the surgeon should have performed a large number of this procedure. In other words, the surgeon learning curve is modest for Group B surgeons but substantial for Group C surgeons. Full article
(This article belongs to the Special Issue State of Art in Hip, Knee and Shoulder Replacement (Volume 2))
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27 pages, 3939 KiB  
Article
Clinical and Proteomic Associations of SARS-CoV-2 Infection and COVID-19 Vaccination in Multimorbid Patients: A Cross-Sectional Observational Study
by Anett Hudák, Aladár Pettko-Szandtner, Annamária Letoha and Tamás Letoha
Int. J. Mol. Sci. 2025, 26(16), 8007; https://doi.org/10.3390/ijms26168007 - 19 Aug 2025
Abstract
Vaccines played a crucial role in the COVID-19 pandemic, but their long-term biological effects and efficacy in vulnerable populations remain under intensive investigation. This study assessed clinical outcomes, comorbidities, and systemic biomarker and proteomic profiles in 366 multimorbid patients, stratified into four groups [...] Read more.
Vaccines played a crucial role in the COVID-19 pandemic, but their long-term biological effects and efficacy in vulnerable populations remain under intensive investigation. This study assessed clinical outcomes, comorbidities, and systemic biomarker and proteomic profiles in 366 multimorbid patients, stratified into four groups based on SARS-CoV-2 infection and vaccination status (COV+ vac+, COV+ vac−, COV− vac+, COV− vac−). Clinical and laboratory data, including comorbidities and relevant biomarkers, were collected. Proteomic analysis using mass spectrometry was performed to identify molecular changes associated with infection and vaccination. Statistical analyses examined associations between clinical status, biomarkers, and patient outcomes. As most participants received mRNA-based vaccines, the results primarily reflect responses to spike protein-expressing platforms. Biomarkers of cardiac and renal stress—namely proBNP and carbamide—were elevated in vaccinated individuals. Five deaths occurred in the COV+ vac+ group and two in the COV+ vac− group, most of which were attributed to exacerbations of pre-existing chronic diseases rather than to COVID-19 pneumonia. Protection against breakthrough infections waned over time, particularly beyond 200 days post-vaccination. Mass spectrometry identified proteins such as actin, fibrinogen chains, and SAA2 as potential diagnostic targets. Although the cross-sectional observational design limits the ability to draw causal inferences, the observed waning immunity and potential systemic alterations in vaccinated multimorbid patients highlight the importance of longitudinal follow-up to guide tailored immunization strategies and post-vaccination monitoring in high-risk groups. Full article
(This article belongs to the Special Issue Coronavirus Disease (COVID-19): Pathophysiology (6th Edition))
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27 pages, 1734 KiB  
Article
Anemia in Heart Failure: Diagnostic Insights and Management Patterns Across Ejection Fraction Phenotypes
by Otilia Țica and Ovidiu Țica
Diagnostics 2025, 15(16), 2079; https://doi.org/10.3390/diagnostics15162079 - 19 Aug 2025
Abstract
Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular [...] Read more.
Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular ejection fraction (LVEF). Methods: We retrospectively analyzed 443 adult patients hospitalized with concurrent HF and anemia from January 2022 to December 2024. Patients were stratified by LVEF into HFrEF (<40%), HFmrEF (40–49%), and HFpEF (≥50%). All patients included met WHO criteria for anemia. Demographic, clinical, paraclinical, and therapeutic data were extracted, and descriptive statistical methods were used to evaluate intergroup differences. No formal time-to-event analyses (e.g., Kaplan–Meier curves) were performed; instead, exploratory cumulative readmission analyses using fixed follow-up windows were conducted. In-hospital mortality was recorded and stratified by HF phenotype. Results: The cohort comprised 213 (48.0%) HFrEF, 118 (26.6%) HFmrEF, and 112 (25.3%) HFpEF patients. The distribution of anemia severity, management strategies, and comorbidity profiles varied significantly across phenotypes. Severe anemia predominated in the HFmrEF cohort (54.2%), whereas mild anemia was most common in HFpEF (52.1%) and HFrEF (52.1%). Mean hemoglobin concentrations were 8.39 ± 1.79 g/dL (HFmrEF), 9.07 ± 2.47 g/dL (HFpEF), and 8.62 ± 1.94 g/dL (HFrEF). Rates of atrial fibrillation (48.2% in HFpEF), hypertensive ECG changes (63.4% in HFpEF), and ischemic-lesion patterns (>50% in HFrEF) differed by cohort. Echocardiographically, grade III mitral regurgitation and severe pulmonary hypertension each affected 25.4% of HFmrEF patients, whereas HFpEF patients most often exhibited grade II mitral regurgitation (42.9%) and moderate pulmonary hypertension (42.9%). HFrEF patients had severe pulmonary hypertension. Intravenous (IV) iron was the primary treatment modality, with highest utilization in HFmrEF. IV iron use ranged from 69.9% (HFrEF) to 84.8% (HFmrEF), with transfusion rates of 5.6% (HFrEF)–16.1% (HFpEF). Comorbid burdens differed by phenotype: HFrEF was associated with structural heart disease, HFmrEF with vascular and hepatic pathology, and HFpEF with metabolic and degenerative comorbidities. Discharge pharmacotherapy reflected phenotype-specific treatment patterns. Conclusions: This real-world descriptive analysis highlights substantial variation in anemia burden and management across the HF spectrum. While limited to descriptive findings, our analysis highlights the heterogeneity of anemia in HF and describes observed associations across phenotypes, without implying causality. These findings should be interpreted as hypothesis-generating. These findings are observational, exploratory, and cannot establish a causal relationship between intravenous iron use and survival. Full article
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12 pages, 254 KiB  
Article
Healthcare Costs by Comorbidity Patterns in Lung Cancer Patients
by Alessandra Buja, Massimo Rugge, Marcello Di Pumpo, Manuel Zorzi, Federico Rea, Ilaria Pantaleo, Giovanna Scroccaro, Pierfranco Conte, Leonardo Rigon, Giorgio Arcara, Giulia Pasello and Valentina Guarneri
Cancers 2025, 17(16), 2682; https://doi.org/10.3390/cancers17162682 - 18 Aug 2025
Abstract
Introduction: Lung cancer imposes a substantial economic burden on patients, healthcare systems, and societies due to its high prevalence and costs associated with diagnosis, treatment, and palliative care. Comorbidities in lung cancer patients can further complicate clinical management and increase healthcare utilization. This [...] Read more.
Introduction: Lung cancer imposes a substantial economic burden on patients, healthcare systems, and societies due to its high prevalence and costs associated with diagnosis, treatment, and palliative care. Comorbidities in lung cancer patients can further complicate clinical management and increase healthcare utilization. This study investigated the impact of comorbidity patterns on healthcare costs in patients with lung cancer. Methods: A cohort of 1540 lung cancer patients in the Veneto region of Italy was divided into five groups based on comorbidity burden using latent class analysis: no comorbidities, only one comorbidity, and specific comorbidity classes (Class 1: cardiovascular, respiratory, and endocrine diseases; Class 2: multiorgan diseases; Class 3: socio-multifactorial neuro conditions). Using administrative data, both overall healthcare costs and lung cancer-specific costs were analyzed over three years. Results: Patients with one comorbidity class had the highest overall costs over three years from diagnosis (USD 52,039) and the highest lung-specific costs (USD 47,804). In contrast, patients in the Cardiovascular-Respiratory and Endocrine class incurred the lowest overall costs (USD 38,447). Additionally, they had the lowest lung case-specific costs (USD 33,425) over the same three-year period from diagnosis. Higher costs for inpatient medications were observed in patients without any comorbidities or with at most one. Conclusions: The findings emphasize the significant effect of comorbidity patterns on resource use in lung cancer patients. Considering comorbidity profiles is essential for economic assessments and healthcare planning, as it allows for better resource allocation and supports personalized treatment strategies. Full article
19 pages, 2719 KiB  
Article
Next-Generation Sequencing Analysis for HIV-1 Genotyping and Drug Resistance Mutations Mapping in Sicily, Italy
by Luca Pipitò, Sara Cannella, Chiara Mascarella, Domenico Graceffa, Marcello Trizzino, Chiara Iaria, Pietro Colletti, Giovanni Mazzola, Giovanni M. Giammanco, Antonio Cascio, Celestino Bonura and Sicilian GRT Working Group
Viruses 2025, 17(8), 1129; https://doi.org/10.3390/v17081129 - 18 Aug 2025
Viewed by 53
Abstract
Background: The advent and continuous improvement in antiretroviral therapy (ART) have profoundly altered the clinical course of HIV infection, shifting the focus from AIDS-related complications to the management of age-related comorbidities and non-AIDS-related hospitalizations. In this evolving context, optimizing ART is essential, with [...] Read more.
Background: The advent and continuous improvement in antiretroviral therapy (ART) have profoundly altered the clinical course of HIV infection, shifting the focus from AIDS-related complications to the management of age-related comorbidities and non-AIDS-related hospitalizations. In this evolving context, optimizing ART is essential, with genotypic resistance testing (GRT), particularly through next-generation sequencing (NGS), playing a pivotal role. Methods: This multicenter, retrospective cross-sectional study investigated HIV-1 subtypes, resistance mutations, and drug resistance profiles among 367 people living with HIV (PLWH) in Sicily, based on 384 GRTs performed at the Microbiology Laboratory of the University Hospital of Palermo. Results: Subtype B was the most prevalent (50%), followed by circulating recombinant forms (30%). Among treatment-naïve individuals, resistance-associated mutations were infrequent, with prevalence rates of 0.4% for NRTIs, 5.5% for NNRTIs, 1.3% for PIs, and 0.8% for INIs. Conversely, treatment-experienced individuals showed significantly higher resistance rates, especially to NRTIs (16.3%), NNRTIs (10.6%), and INIs (9.6%). No significant differences in resistance patterns were observed between B and non-B subtypes. Conclusions: This study provides the first regional overview of HIV drug resistance across Sicily. Despite the detection of resistance-associated mutations, the overall prevalence of clinically relevant resistance, particularly to currently recommended therapies, remains low, especially among treatment-naïve individuals. Full article
(This article belongs to the Special Issue Antiviral Resistance Mutations)
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14 pages, 553 KiB  
Article
Prevalence, Microbiological Profile, and Risk Factors of Healthcare-Associated Infections in Intensive Care Units: A Retrospective Study in Aljouf, Saudi Arabia
by Issra Taresh Alshammari and Yasir Alruwaili
Microorganisms 2025, 13(8), 1916; https://doi.org/10.3390/microorganisms13081916 - 17 Aug 2025
Viewed by 213
Abstract
Hospital infection prevention is critical to patient safety, yet data on the prevalence and contributing factors of healthcare-associated infections (HAIs) in Aljouf, Saudi Arabia, are scarce. This retrospective cross-sectional study aimed to investigate the prevalence, microbiological profile, and associated risk factors of HAIs [...] Read more.
Hospital infection prevention is critical to patient safety, yet data on the prevalence and contributing factors of healthcare-associated infections (HAIs) in Aljouf, Saudi Arabia, are scarce. This retrospective cross-sectional study aimed to investigate the prevalence, microbiological profile, and associated risk factors of HAIs among intensive care unit (ICU) patients in a referral hospital between January 2020 and December 2023. Medical records of 260 ICU patients were reviewed for demographic details, comorbidities, infection types, pathogens, and invasive device use. Forty patients (15.38%) developed HAIs with the highest prevalence in 2020 (50.0%). Infections were more common in males (56.5%) and those aged ≥56 years (54.6%). The predominant infections were catheter-associated urinary tract infections (47.5%), ventilator-associated pneumonia (35.0%), and central line-associated bloodstream infections (17.5%). Klebsiella pneumoniae (35.0%) and Acinetobacter baumannii (27.5%), pathogens commonly associated with multidrug resistance, were the most frequently isolated organisms. All HAI cases involved invasive device use with the use of three or more devices significantly increasing infection risk (p < 0.05). Additionally, 85% of infected patients had chronic conditions, primarily hypertension or diabetes. These findings emphasize the urgent need for strengthened infection control practices and targeted antimicrobial strategies to reduce HAIs and improve ICU patient outcomes in underreported regions. Full article
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15 pages, 768 KiB  
Article
Cross-Cultural Differences and Clinical Presentations in Burning Mouth Syndrome: A Cross-Sectional Comparative Study of Italian and Romanian Outpatient Settings
by Claudiu Gabriel Ionescu, Gennaro Musella, Federica Canfora, Cristina D’Antonio, Lucia Memé, Stefania Leuci, Luca D’Aniello, Ioanina Parlatescu, Lorenzo Lo Muzio, Michele Davide Mignogna, Serban Tovaru and Daniela Adamo
J. Clin. Med. 2025, 14(16), 5805; https://doi.org/10.3390/jcm14165805 - 16 Aug 2025
Viewed by 347
Abstract
Background/Objectives: Burning Mouth Syndrome (BMS) is a chronic orofacial pain disorder characterized by persistent intraoral burning sensations without visible mucosal lesions. Although its biopsychosocial complexity is increasingly recognized, cross-cultural comparison data remain limited. Methods: This cross-sectional study assessed 60 patients with [...] Read more.
Background/Objectives: Burning Mouth Syndrome (BMS) is a chronic orofacial pain disorder characterized by persistent intraoral burning sensations without visible mucosal lesions. Although its biopsychosocial complexity is increasingly recognized, cross-cultural comparison data remain limited. Methods: This cross-sectional study assessed 60 patients with BMS (30 Italian, 30 Romanian) who underwent standardized clinical, psychological, and sleep evaluations. Data collected included sociodemographics, clinical characteristics, diagnostic history, comorbidities, and symptomatology. The assessment tools used included the Numeric Rating Scale (NRS), Short Form of the McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Statistical comparisons were conducted using Mann–Whitney U and Fisher’s exact tests with Bonferroni correction. Results: No significant differences were observed in age, sex, or body mass index. Italian patients had fewer years of education (p = 0.001), higher pain intensity (NRS, p < 0.001), poorer sleep quality (PSQI, ESS, p = 0.001), and more frequent pre-existing sleep disorders (p < 0.001). Romanian patients showed higher levels of anxiety (HAM-A, p < 0.001), longer diagnostic delays (p = 0.002), and more dysesthetic or perceptual symptoms, including tingling and oral dysmorphism (p < 0.05). Stressful events before onset were more common among Romanians (p < 0.001), while Italians more often received a correct diagnosis at first consultation (p = 0.005). Conclusions: This first cross-national comparison of BMS in Western and Eastern Europe shows that cultural, healthcare, and clinician education differences can shape symptom profiles, comorbidities, and diagnostic delays, underscoring the need for personalized, country-specific management strategies. Full article
(This article belongs to the Special Issue New Perspective of Oral and Maxillo-Facial Surgery)
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23 pages, 2240 KiB  
Article
Multi-Modal Profiling Reveals Contrasting Immunomodulatory Effects of Recreational Marijuana Used Alone or with Tobacco in Youth with HIV
by Samiksha A. Borkar, Guglielmo M. Venturi, Kai-Fen Chang, Jingwen Gu, Li Yin, Jerry Shen, Bernard M. Fischer, Upasana Nepal, Isaac D. Raplee, Julie J. Kim-Chang, David M. Murdoch, Sharon L. Nichols, Lisa B. Hightow-Weidman, Charurut Somboonwit, John W. Sleasman and Maureen M. Goodenow
Cells 2025, 14(16), 1267; https://doi.org/10.3390/cells14161267 - 16 Aug 2025
Viewed by 260
Abstract
The evolving legal landscape has increased marijuana accessibility across the United States, including for medical use to manage clinical symptoms among people with HIV. The effects of marijuana use remain understudied in youth with HIV (YWH), who face lifelong antiretroviral therapy (ART) and [...] Read more.
The evolving legal landscape has increased marijuana accessibility across the United States, including for medical use to manage clinical symptoms among people with HIV. The effects of marijuana use remain understudied in youth with HIV (YWH), who face lifelong antiretroviral therapy (ART) and an elevated risk of developing comorbidities. This study applied a multi-modal approach, including plasma biomarker analysis, peripheral blood cell phenotyping, and transcriptome profiling, to examine the effects of recreational marijuana alone, tobacco alone, or marijuana combined with tobacco in virally suppressed YWH (≤50 RNA copies/mL) on ART compared to youth without HIV and YWH who used no substance. Marijuana use alone was associated with elevated IL-10 levels and normalization of pro-inflammatory genes and pathways, suggesting an immunomodulatory effect. Conversely, tobacco use alone or combined with marijuana was linked to increased IL-1β levels and heightened pro-inflammatory responses, including upregulation of genes involved in inflammasome activation. This study is the first to demonstrate GPR15 upregulation and potential marijuana-associated epigenetic modulation in HIV-suppressed youth. The findings identify potential markers for early detection of inflammation-related comorbidities in YWH, particularly among those exposed to tobacco and underscore the need for targeted profiling to guide personalized monitoring and early substance use intervention strategies for YWH. Full article
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22 pages, 581 KiB  
Article
Age-Related Characteristics of Diastolic Dysfunction in Type 2 Diabetes Patients
by Elena-Daniela Grigorescu, Bogdan-Mircea Mihai, Georgiana-Diana Cazac-Panaite, Adina-Bianca Foșălău, Alina Onofriescu, Mariana Floria, Cristina Gena Dascălu, Alexandr Ceasovschih, Laurențiu Șorodoc and Cristina-Mihaela Lăcătușu
J. Clin. Med. 2025, 14(16), 5772; https://doi.org/10.3390/jcm14165772 - 15 Aug 2025
Viewed by 165
Abstract
Background: Asymptomatic left ventricular diastolic dysfunction (LVDD) occurs in type 2 diabetes mellitus (T2DM) patients, particularly among the elderly. Aim: This study aimed to identify diastolic function changes over a 52-week follow-up and the predictive factors for LVDD in T2DM patients [...] Read more.
Background: Asymptomatic left ventricular diastolic dysfunction (LVDD) occurs in type 2 diabetes mellitus (T2DM) patients, particularly among the elderly. Aim: This study aimed to identify diastolic function changes over a 52-week follow-up and the predictive factors for LVDD in T2DM patients without atherosclerotic manifestations. Methods: Diastolic function, metabolic profile, atherogenic indexes, and subclinical inflammatory markers were assessed at baseline and after one year in 138 T2DM outpatients. All variables were compared in patients with and without LVDD across three age groups. Results: The patients were 57.86 ± 8.82 years old, 49.3% male, with a mean 5-year diabetes duration and a median HbA1c of 7.8%. At baseline, 71 patients had grade 1 LVDD, 12 had grade 2 and 3 LVDD, and 15 had indeterminate LVDD. In the elderly group, 29 patients had LVDD. The logistic regression analysis identified age over 65 as an independent risk factor for LVDD (Exp B = 9.85, 95% CI: 1.29–75.36, p = 0.027). LVDD patients had a longer diabetes duration and a higher prevalence of diabetic neuropathy. Elderly patients had the lowest E/A, e’, lateral s’, atherogenic and Castelli risk indexes, and significantly higher E/e’, EDT, LAVI and TNF-alpha values (p < 0.05). After 52 weeks, diastolic function worsened in 27 patients, who had no significant differences compared to those with stable or improved diastolic function. Conclusions: LVDD was common in our T2DM patients without known cardiovascular disease, and age increases the LVDD risk. Echocardiographic assessment is necessary, especially in elderly T2DM patients with co-morbidities, to identify patients at risk of progression to heart failure early. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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11 pages, 439 KiB  
Article
High Prevalence of Vitamin D Deficiency in Patients Undergoing Total Shoulder or Elbow Arthroplasty
by Miledi Hoxha, Tizian Heinz, Maximilian Rudert, Kilian List, Leonard Achenbach, Gerrit Maier, Manuel Weißenberger and Konstantin Horas
Nutrients 2025, 17(16), 2635; https://doi.org/10.3390/nu17162635 - 14 Aug 2025
Viewed by 180
Abstract
Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is [...] Read more.
Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care. Full article
(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)
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27 pages, 1372 KiB  
Article
Cardiometabolic Comorbidities of Lichen Planus—A Cross-Sectional Comparative Study
by Mihaela Paula Toader, Oana Mihaela Condurache Hrițcu, Cristina Colac Boțoc, Antonia Elena Huțanu, Cătălina Anca Munteanu, Roxana Paraschiva Ciobanu, Ștefan Vasile Toader, Alin Gabriel Colac, Elena Porumb Andrese and Daciana Elena Brănișteanu
Diagnostics 2025, 15(16), 2039; https://doi.org/10.3390/diagnostics15162039 - 14 Aug 2025
Viewed by 255
Abstract
Background/Objectives: Cardiovascular disease (CVD) remains one of the leading causes of death worldwide, with several well-established risk factors. Among dermatological conditions, psoriasis is a well-known contributor to cardiometabolic risk, while lichen planus (LP) remains an underexplored chronic inflammatory disorder in this context. This [...] Read more.
Background/Objectives: Cardiovascular disease (CVD) remains one of the leading causes of death worldwide, with several well-established risk factors. Among dermatological conditions, psoriasis is a well-known contributor to cardiometabolic risk, while lichen planus (LP) remains an underexplored chronic inflammatory disorder in this context. This study aimed to comparatively assess the prevalence and clinical patterns of metabolic syndrome (MetS) components in patients with LP versus psoriasis and healthy controls, focusing on the intrinsic inflammatory burden in patients not receiving systemic therapy. We also examined whether specific clinical subtypes of LP carry distinct metabolic profiles. Methods: We conducted a cross-sectional observational study at a tertiary dermatology center between January 2020 and December 2024. A total of 236 adult patients were included: 78 with LP, 79 with psoriasis, and 79 controls with minor dermatological conditions. Demographic, clinical, and laboratory data were collected. LP subtypes (cutaneous, mucocutaneous, reticular oral, erosive oral) were evaluated using the Lichen Planus Activity Index (LPAI) and Oral Lichen Planus Clinical Index (OLP-CI); psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI). Cardiometabolic comorbidities were assessed according to established guidelines. Results: LP patients showed significantly higher prevalence of hypertension (OR 1.94, p = 0.044) and type 2 diabetes mellitus (OR 3.09, p = 0.015) compared to controls. Compared to psoriasis, LP was associated with a higher prevalence of mixed dyslipidemia (OR 3.41, p = 0.033), while psoriasis showed more abdominal obesity (OR 0.35, p = 0.003). Mucosal LP subtypes, especially erosive and reticular oral LP, were linked to elevated cardiometabolic risk. Conclusions: LP, particularly its oral subtypes, is associated with a distinct cardiometabolic risk profile comparable to or exceeding that of psoriasis. These findings support the need for systematic metabolic screening in LP patients as part of comprehensive care. Full article
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25 pages, 2795 KiB  
Review
Precision Nutrition for Dementia: Exploring the Potential in Mitigating Dementia Progression
by Tara J. Jewell, Michelle Minehan, Jackson Williams and Nathan M. D’Cunha
J. Dement. Alzheimer's Dis. 2025, 2(3), 28; https://doi.org/10.3390/jdad2030028 - 14 Aug 2025
Viewed by 266
Abstract
Precision nutrition is a tailored dietary approach that considers an individual’s genetic and metabolic profile, lifestyle factors, and specific nutritional needs to improve health and potentially modify disease progression. While research is ongoing into precision nutrition approaches for preventing dementia, there is no [...] Read more.
Precision nutrition is a tailored dietary approach that considers an individual’s genetic and metabolic profile, lifestyle factors, and specific nutritional needs to improve health and potentially modify disease progression. While research is ongoing into precision nutrition approaches for preventing dementia, there is no evidence on its targeted application to slow dementia-related disease progression and mitigate functional and cognitive decline. This narrative review addresses this gap by synthesising evidence on nutrient–gene interactions, genotype, gut microbiome, nutritional status and the interplay between metabolic pathways implicated in neuroinflammation and neurodegeneration to modify disease progression in a protective or therapeutic manner. Understanding and addressing comorbidities that share pathological mechanisms with dementia have the potential to enhance the understanding of precision nutrition to inform more effective, tailored approaches to slow dementia progression. To increase the robustness of precision nutrition trials for people with dementia, further research is needed into biomarker discovery, multi-omics technologies, and increasing mechanistic research to map the precise biological pathways underpinning the interactions between diet, gene expression, and neuroinflammation. Moreover, there is a need to evaluate the feasibility of precision nutrition for people experiencing cognitive impairment. Addressing these gaps will determine if people with dementia can benefit from precision nutrition and, subsequently, improve their quality of life and health outcomes. Full article
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24 pages, 1548 KiB  
Review
Onychomycosis in Diabetics: A Common Infection with Potentially Serious Complications
by Aditya K. Gupta, Amanda Liddy, Lee Magal, Avner Shemer, Elizabeth A. Cooper, Ditte Marie L. Saunte and Tong Wang
Life 2025, 15(8), 1285; https://doi.org/10.3390/life15081285 - 13 Aug 2025
Viewed by 435
Abstract
Onychomycosis is a prevalent and clinically relevant complication among individuals with diabetes. It is associated with an elevated risk of secondary fungal and bacterial infections, foot ulceration, and, in advanced cases, amputation. Factors contributing to the increased prevalence of onychomycosis in this population [...] Read more.
Onychomycosis is a prevalent and clinically relevant complication among individuals with diabetes. It is associated with an elevated risk of secondary fungal and bacterial infections, foot ulceration, and, in advanced cases, amputation. Factors contributing to the increased prevalence of onychomycosis in this population include age, peripheral vascular disease, poor glycemic control, neuropathy, suboptimal foot hygiene, and nail trauma. While dermatophytes are the most common pathogens, diabetic patients are more prone to mixed infections involving Candida species with varying antifungal susceptibility profiles, necessitating accurate identification to guide therapy. Prompt diagnosis and early intervention are important to prevent complications. Systemic antifungals such as terbinafine and itraconazole are considered first-line therapies, particularly for moderate to severe onychomycosis. However, drug interactions, renal, hepatic, and metabolic comorbidities may necessitate individualized treatment plans. For patients with mild to moderate disease, or contraindications to oral therapy, topical agents such as efinaconazole or tavaborole offer viable alternatives. Adjunctive measures, including education on foot hygiene, prompt treatment of tinea pedis, and environmental sanitization, are important in preventing recurrence and reinfection. This review summarizes the epidemiology, diagnosis, and treatment considerations for onychomycosis in diabetic patients, emphasizing the need for individualized care to improve outcomes in this high-risk population. Full article
(This article belongs to the Section Medical Research)
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29 pages, 799 KiB  
Review
The Evolving Landscape of Novel and Old Biomarkers in Localized High-Risk Prostate Cancer: State of the Art, Clinical Utility, and Limitations Toward Precision Oncology
by Lilia Bardoscia, Angela Sardaro, Mariagrazia Quattrocchi, Paola Cocuzza, Elisa Ciurlia, Ilaria Furfaro, Maria Antonietta Gilio, Marcello Mignogna, Beatrice Detti and Gianluca Ingrosso
J. Pers. Med. 2025, 15(8), 367; https://doi.org/10.3390/jpm15080367 - 11 Aug 2025
Viewed by 369
Abstract
High-risk prostate cancer (PC) accounts for 50–75% of 10-year relapse after primary treatment. Routine clinicopathological parameters for PC patient stratification have proven insufficient to inform clinical decisions in this setting. Tumor genomic profiling allowed overcoming the limits of diagnostic accuracy in the field [...] Read more.
High-risk prostate cancer (PC) accounts for 50–75% of 10-year relapse after primary treatment. Routine clinicopathological parameters for PC patient stratification have proven insufficient to inform clinical decisions in this setting. Tumor genomic profiling allowed overcoming the limits of diagnostic accuracy in the field of PC, integrated with radiomic features, automated platforms, evaluation of patient-related factors (age, performance status, comorbidity) and tumor-related factors (risk class, volume, T stage). In this scenario, the use of biomarkers to guide decision-making in localized, high-risk PC is evolving actively and rapidly. Additional tests for prostate-specific antigen have demonstrated superior sensitivity and specificity for detecting clinically significant PC, as well as commercially available genomic classifiers improving the risk prediction of disease recurrence/progression/metastasis, in combination with common clinical variables. This narrative review aimed to summarize the state of the art on the utility and evolution of old and emerging biomarkers in the diagnosis and prognosis of localized, high-risk PC, and the potential for their application in clinical practice. We focused on the theoretical molecular foundation of prostate carcinogenesis and explored the impact of genomic profiling, next-generation sequencing, and artificial intelligence in the extrapolation of customized features able to predict disease aggressiveness and possibly drive personalized therapeutic decisions. Full article
(This article belongs to the Special Issue Urological Cancer: Clinical Advances in Personalized Therapy)
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