Search Results (2,620)

Background/Objectives: Reports detailing rehabilitative interventions for infants with severe dermatologic disorders are scarce. Epidermolysis Bullosa (EB) is a genetic disorder characterized by skin fragility, which causes blistering after minor trauma. Since there is still no cure in general clinics, symptomatic treatment and developmental support are essential for managing the condition. While physiotherapy and occupational therapy guidelines for EB exist, descriptions of neonatal habilitation/rehabilitation are insufficient. Case: This case report describes the longitudinal habilitation/rehabilitation intervention process for a newborn with Dowling–Meara EB, the most severe form, from admission to the Neonatal Intensive Care Unit (NICU) until discharge. Since maneuvers requiring contact were strictly limited due to skin vulnerability, rehabilitation interventions were implemented utilizing the opportunity afforded by necessary care. Intervention strategies were modified according to developmental stages and skin stability, with a particular emphasis on sensory development, postural control training, and fostering the mother–child relationship. This report is the first to describe the applicability of sensory rehabilitation and the use of behavioral cues to facilitate voluntary movements. In addition, careful respiratory rehabilitation was implemented for comorbid tracheomalacia with specific attention to skin vulnerability. The child achieved stable head/neck control, symmetrical limb movements, reaching, guided rolling, and stable oxygenation by the time of discharge. Conclusions: Balancing skin disorder prevention and motor–neural development requires flexible approaches that minimize contact while utilizing routine care as a training opportunity. Our experience will contribute to the progress in the habilitation, wound rehabilitation and respiratory rehabilitation of infants with severe dermatologic disorders. Full article

Background: Chronic pain (CP) is one of the biggest burdens for health systems across the globe. It frequently presents in conjunction with comorbidities and considerable challenges for the maintenance of homeostasis and well-being. The lack of long-term effective treatments requires further attention and innovative approaches from the health care community. The present observational study aims to prove the feasibility of a breathing protocol focused on long exhalations (LEx) as a complementary treatment for CP populations. Methods: Eighteen CP patients (nine men and nine women) were selected for this observational pilot study. The inclusion criteria were having pain for more than 3 months, not having any previous experience with breathing exercises and not having a clinical diagnosis for the condition suffered. In addition to the usual physiotherapy care, the participants were trained in breathing techniques and the effects of LEx. Before each appointment, the Numeric Pain Rating Scale (NPRS), Pain Catastrophising Scale (PCS) and exhalatory times were registered. The data analysis consisted of a repeated measures ANOVA and a Pearson Correlation Coefficient. Results: A total of 18 participants completed the breath intervention and the assessments. All participants improved their exhalation times by 4.78 s (SD = 3.19) or 64% (F = 45.62, p < 0.001) and their pain scores: NPRS by 2.55 units (SD = 2.2) or 47% (F = 34.19, p < 0.001); and PCS by 11.34 units (SD = 16.05) or 33% (F = 24.05, p < 0.001). There was a moderate positive correlation (r = 0.49, p = 0.05) between exhalation times and NPRS. Conclusions: Breathing techniques focused on LEx in combination with the usual physiotherapy care are a feasible pain management protocol to reduce subjective pain perception and pain catastrophizing scores. Long-term studies with bigger samples might benefit from the inclusion of accurate and reproducible measures for exhalation times. Full article

Epilepsy is one of the most prevalent neurological disorders, severely impacting quality of life. The burden of epilepsy is exacerbated by high rates of neuropsychiatric comorbidities such as depression, anxiety, and post-traumatic stress disorder. The molecular mechanisms linking epilepsy to these comorbidities remain unclear. Epileptogenesis and recurrent seizures implicate multiple processes including changes in the extracellular matrix, structural and functional neuroplasticity, neuroinflammation, and neurodegeneration. The plasminogen activation (PA) system—a complex system of proteins that function as both proteases and signaling molecules—modulates these processes in the central nervous system (CNS) under normal conditions and following potentially epileptogenic insults. Notably, the PA system is also dysregulated in stress-related psychiatric disorders. In this review, we first provide an overview of the role of PA system in the CNS with an emphasis on the mechanisms related to epilepsy. We then explore the hypothesis that the components of the PA system components constitute a shared pathological link implicated in both epileptogenesis and psychiatric disorders. We summarize clinical and preclinical evidence demonstrating that seizures and other brain insults disrupt the PA system, and that similar dysregulation is observed in stress-related psychiatric conditions. We propose that PA system dysregulation is a potential molecular substrate linking epileptogenesis and neuropsychiatric comorbidities, presenting a promising target for future research aimed at understanding the mechanisms underlying the development of behavioral comorbidities in epilepsy. Full article

Background and Objectives: This study aims to comparatively evaluate the outcomes of glaucoma surgeries performed by a single surgeon during the non-pandemic period (2019, 2021, and the first quarter of 2022) versus the pandemic year (2020). The analysis focuses on key surgical outcomes, including intraocular pressure (IOP) reduction, intraoperative and postoperative complications, surgical success and failure rates, and their broader clinical implications. Materials and Methods: Out of a total of 66 patients admitted between November 2019 and March 2022, 45 met the inclusion and exclusion criteria and were enrolled in the study. All patients underwent glaucoma surgery conducted by the same surgeon employing a standardized technique (trabeculectomy ± iridectomy ± mitomycin C). The evaluated clinical parameters included preoperative and postoperative IOP values (with specific assessment on the first postoperative day), early and late intraoperative and postoperative complications, as well as postoperative success and failure rates. Results: The majority of glaucoma cases—particularly those of primary open-angle glaucoma—were recorded in 2021 and 2022, in contrast to 2019 and 2020, when pseudoexfoliative and secondary closed-angle glaucomas predominated. Over the observation period, retrobulbar anesthesia was more frequently utilized in 2019. Statistical analysis indicated that the surgical failure rate was not significantly influenced by the presence of complications, patient age, associated comorbidities, or the specific surgical variant performed. Conclusions: The conduct of glaucoma surgery during the pandemic period was marked by substantial operational and clinical constraints when compared to non-pandemic years, primarily as a consequence of decreased patient accessibility and the reprioritization of healthcare resources, despite the acknowledged emergency status of these procedures. Nonetheless, the overall incidence of early intraoperative and postoperative complications remained minimal, with transient intraocular hypotony emerging as the predominant adverse event, observed in ten cases. Across all study cohorts, more than 80% of patients achieved qualified surgical success, while only 18% exhibited surgical failure, underscoring the robustness of standardized operative protocols under variable healthcare conditions. Consistent with the directives of the American Academy of Ophthalmology (AAO) and the European Glaucoma Society (EGS), glaucoma must be regarded as a genuine ophthalmic emergency necessitating prompt surgical intervention when intraocular pressure cannot be adequately managed through pharmacological or laser-based therapies. The current findings reinforce the imperative of timely glaucoma surgery, irrespective of pandemic or non-pandemic circumstances, as a critical measure for averting irreversible optic nerve damage, mitigating functional visual loss, and sustaining long-term ocular integrity. Full article

Background/Objectives: Schizophrenia Spectrum Disorder (SSD) represents a major challenge for healthcare systems due to its chronic nature, comorbid conditions, and high socioeconomic impact. Ensuring high-quality care for patients with SSD requires well-defined quality criteria based on consensus from healthcare professionals, patients, and caregivers. This study aims to identify and prioritize quality criteria for SSD care. Methods: A qualitative research approach was applied, including incorporating two focus groups—one with patients and caregivers (n = 7) and another with healthcare professionals (n = 8)—alongside the Delphi technique. The Delphi panel included 32 participants from psychiatry, primary care, mental health nursing, social work, and patient associations. The first round had an 88.9% response rate, while the second round achieved full participation (100%). The Delphi process was conducted and reported according to recommended guidelines for consensus methods (ACCORD checklist), specifying panel composition, rounds, predefined consensus thresholds, and controlled feedback between rounds. Results: A total of 26 quality criteria were ultimately selected, categorized into 16 identified barriers to effective care. Key priorities included early diagnosis protocols, coordinated multidisciplinary care, and improved access to specialized mental health services. Conclusions: The findings underscore the necessity of integrating patient experience into healthcare evaluation and highlight the potential for implementing a certification system to standardize SSD care across healthcare settings. Full article

Background/Objective: The SARS-CoV-2 pandemic, emerging in late 2019, led to a global health crisis, with many patients developing prolonged symptoms after infection known as sequelae of COVID-19. This condition is theorized to be driven by systemic inflammation and immune dysregulation and presents with diverse symptoms from cardiovascular, pulmonary, and neurological systems. This study investigates the prevalence, risk factors, and long-term impacts of sequelae of COVID-19. Method: Using Denmark’s healthcare databases, this population-based cohort study included 1,034,093 individuals over 40 years who tested positive for COVID-19 between 1 March 2020 and 28 February 2022. Participants were divided into two age groups: 40–59 years and 60 years or older. Part A examined the risk of sequelae of COVID-19 diagnoses (ICD-10 code B94.8A) based on the Charlson Comorbidity Index (CCI). Part B assessed two-year outcomes for patients diagnosed with sequelae of COVID-19. Results: Results showed a 0.55% prevalence of sequelae of COVID-19 in both age groups. Higher CCI scores correlated with an increased risk of sequelae of COVID-19. During the two-year follow-up, patients with sequelae of COVID-19 faced significantly elevated risks of thromboembolic events, chronic lung diseases, and infections. Adjusted hazard ratios were notably high: 14.50 (7.54–27.86) and 12.50 (6.95–22.49) for thromboembolic events in adults and older adults, respectively; 33.81 (13.30–85.96) and 9.83 (6.09–15.87) for chronic lung disease; and 8.40 (4.49–15.70) and 15.44 (10.47–22.78) for infections. Conclusions: While the overall prevalence of sequelae of COVID-19 was low among individuals over 40, those with higher comorbidity burdens were at greater risk of severe sequelae and subsequent health complications. These findings underscore the need for clinical monitoring, especially for patients with pre-existing comorbidities, to mitigate long-term health risks associated with COVID-19 sequelae. Full article

Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are common comorbid sinonasal conditions. CRS is classically divided into two distinct phenotypes: CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). The purpose of this retrospective observational study is to determine whether aeroallergen sensitization profiles in patients with comorbid CRS and AR can distinguish between CRSwNP and CRSsNP. A total of 241 patients diagnosed with comorbid CRS and AR who underwent skin prick testing or in vitro allergy testing in a single tertiary rhinology practice were included for evaluation. The rates of allergen-specific sensitizations in CRSwNP patients were compared with those in CRSsNP patients. Of the allergens tested in the routine panels, Dermatophagoides pteronyssinus (OR = 1.82, p = 0.03), Alternaria (OR = 2.55, p < 0.01), and animal dander (OR = 1.48 for cat and OR = 3.01 for dog, p < 0.01) were predictive of CRSwNP. Sensitization to any grass allergen was also predictive of CRSwNP (OR = 2.09, p < 0.01). Multiple perennial aeroallergens showed strong associations with CRSwNP; however, broad sensitization to perennial allergens as a whole group was not significantly predictive of CRSwNP (OR = 1.83, p = 0.22). Full article

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that substantially impairs health-related quality of life (HRQoL). Comorbid mental health conditions, particularly depression and anxiety, may further exacerbate this burden, yet evidence from large, population-based studies remains limited. Therefore, this study examined the association between comorbid depression and anxiety and HRQoL among adults with RA using nationally representative data from the United States. Methods: Data were drawn from the 2017–2022 Medical Expenditure Panel Survey. Adults aged ≥18 years with self-reported RA were included. HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12) physical (PCS) and mental (MCS) component summary scores. Multiple linear regression models were used to evaluate associations between depression, anxiety, and HRQoL, adjusting for sociodemographic, behavioral, and health-related covariates. Results: Comorbid depression and anxiety were significantly associated with lower HRQoL scores compared with RA alone. Participants with both conditions exhibited the poorest PCS and MCS scores, indicating a disease burden. Lower income, unemployment, and limited physical activity were also linked to poorer HRQoL, whereas better self-rated health and physical activity were positive predictors. Conclusions: Depression and anxiety independently and jointly contribute to poorer HRQoL among adults with RA, even after controlling for key confounders. These findings highlight the importance of integrated care models that address both psychological and physical health, alongside interventions promoting physical activity to enhance overall well-being. Full article

Background/Objectives: Inflammatory bowel diseases (IBDs) are chronic conditions with significant psychological comorbidities. Research on subclinical psychosomatic syndromes in this category of patients remains limited. This study aimed to identify distinct psychosomatic profiles using the Diagnostic Criteria for Psychosomatic Research—Revised (DCPR-R) framework and to examine their associations with health behaviors. Methods: A total of 111 adult IBD patients in clinical remission or with low disease activity were enrolled and underwent a comprehensive assessment of sociodemographic and clinical variables, psychosomatic syndromes and health behaviors. Hierarchical clustering using complete linkage and Jaccard distance was performed on two subsets of common psychosomatic syndromes in this sample. Associations between psychosomatic syndromes and profiles and health behaviors were examined using multiple regression models, controlling for IBD severity and applying Benjamini–Hochberg correction. Analyses were conducted according to a pre-registered protocol. Results: Six distinct clusters were identified: irritability (9.3%), pure allostatic overload (18.7%), pure alexithymia (26.7%), overwhelmed type A behavior (12%), subclinical depressive mood (13.3%), and alexithymic type A behavior (26.7%). Pure alexithymia patients showed higher smoking odds (OR = 3.85, p = 0.033) and overwhelmed type A behavior patients showed less frequent physical activity (OR = 0.27, p = 0.018). For individual syndromes, irritable mood was associated with lower alcohol consumption (OR = 0.29, p = 0.035) while type A behavior was associated with higher consumption (OR = 1.87, p = 0.030). However, all associations became non-significant after false discovery rate correction. Conclusions: IBD patients with low disease activity exhibit distinct psychosomatic profiles. While specific syndromes and profiles showed trends toward certain health behaviors, associations were not robust to multiple comparison correction. Psychosomatic profiling may inform personalized clinical approaches, though larger studies are needed to establish definitive associations with health behaviors. Full article

Background/Objectives: Machine learning is an extremely important issue, considering the potential to prevent the onset of long-term complications from coronavirus disease or to ensure timely detection and effective treatment. The aim of our study was to develop an algorithm and mathematical model to predict the risk of developing long COVID in children who have had acute SARS-CoV-2 viral infection, taking into account a wide range of demographic, clinical, and laboratory parameters. Methods: We conducted a cross-sectional study involving 305 pediatric patients aged from 1 month to 18 years who had recovered from acute SARS-CoV-2 infection. To perform a detailed analysis of the factors influencing the development of long-term consequences of coronavirus disease in children, two models were created. The first model included basic demographic and clinical characteristics of the acute SARS-CoV-2 infection, as well as serum levels of vitamin D and zinc for all patients from both groups. The second model, in addition to the aforementioned parameters, also incorporated laboratory test results and included only hospitalized patients. Results: Among 265 children, 138 patients (52.0%) developed long COVID, and the remaining 127 (48.0%) fully recovered. We included 36 risk factors of developing long COVID in children (DLCC) in model 1, including non-hospitalized patients, and 58 predictors in model 2, excluding them. These included demographic characteristics of the children, major comorbid conditions, main symptoms and course of acute SARS-CoV-2 infection, and main parameters of complete blood count and coagulation profile. In the first model, which accounted for non-hospitalized patients, multivariate regression analysis identified obesity, a history of allergic disorders, and serum vitamin D deficiency as significant predictors of long COVID development. In the second model, limited to hospitalized patients, significant risk factors for long-term sequelae of acute SARS-CoV-2 infection included fever and the presence of ≥3 symptoms during the acute phase, a history of allergic conditions, thrombocytosis, neutrophilia, and altered prothrombin time, as determined by multivariate regression analysis. To assess the acceptability of the model as a whole, an ANOVA analysis was performed. Based on this method, it can be concluded that the model for predicting the risk of developing long COVID in children is highly acceptable, since the significance level is p < 0.001, and the model itself will perform better than a simple prediction using average values. Conclusions: The results of multivariate regression analysis demonstrated that the presence of a burdened comorbid background—specifically obesity and allergic pathology—fever during the acute phase of the disease or the presence of three or more symptoms, as well as laboratory abnormalities including thrombocytosis, neutrophilia, alterations in prothrombin time (either shortened or prolonged), and reduced serum vitamin D levels, are predictors of long COVID development among pediatric patients. Full article

Objectives: To investigate the clinical value of cerebrospinal fluid (CSF) testing for biogenic amine, pterins, amino acids, and folates in paediatric onset epilepsies. Methods: Retrospective clinical and biochemical phenotyping of patients with epilepsy who underwent diagnostic CSF measurement of monoamine neurotransmitters, pterins, folates, and amino acids between 2009 and 2022. Results: The studied cohort included 123 patients with epilepsy (mean age at the procedure: 4.54 ± 3.65 years). The diagnostic yield for primary neurotransmitter disorders was 1.68% and zero for inherited amino acid and folate metabolism disorders. Patients with higher seizure frequency showed higher levels of CSF homovanillic acid (HVA) and HVA/5-hydroxyindolacetic acid (5HIAA) ratio. Lower levels of 3-O-methyldopa (3-OMD) were found in patients with co-occurring neurodevelopmental disorders, and lower levels of biopterin, 3-methoxy-4-hydroxyphenylglycol (3-MHPG) and 5-methyltetrahydrofolate (5-MTHF) in those with movement disorders. Significantly lower CSF glutamine levels were found in patients receiving antiseizure medications as polytherapy. Patients with a history of status epilepticus had significantly lower levels of CSF aspartic acid, glycine, leucine, ornithine, and valine, and higher levels of CSF serine. Conclusions: CSF analysis disclosed differences in the concentrations of various metabolites that might be related to the severity of the epilepsy, the presence of comorbid conditions, and medications. Full article

Research shows that individuals with heart failure are 60% more likely to develop dementia because of their shared metabolic risk factors. Developing a classification model to differentiate between these two conditions effectively is crucial for improving diagnostic accuracy, guiding clinical decision-making, and supporting timely interventions in older adults. This study proposes a novel method for dementia classification, distinguishing it from its common comorbidity, heart failure, using blood testing and personal data. A dataset comprising 11,124 imbalanced electronic health records of older adults from hospitals in Chiang Rai, Thailand, was utilized. Conditional tabular generative adversarial networks (CTGANs) were employed to generate synthetic data while preserving key statistical relationships, diversity, and distributions of the original dataset. Two groups of ensemble models were analyzed: the boosting group—extreme gradient boosting, light gradient boosting machine—and the bagging group—random forest and extra trees. Performance metrics, including accuracy, precision, recall, F1-score, and area under the receiver-operating characteristic curve were evaluated. Compared with the synthetic minority oversampling technique, CTGAN-based synthetic data generation significantly enhanced the performance of ensemble learning models in classifying dementia and heart failure. Full article

This research represents the first in the Republic of Kazakhstan focusing on Afghan war veterans identified as being at risk for Post-Traumatic Stress Disorder (PTSD). A comprehensive investigation was undertaken regarding the comorbidity of PTSD symptoms, somatic diseases (cardiovascular and others), and mental disorders. The study’s sample comprised 293 Afghan war veterans, while the control group consisted of 149 males without combat experience. The research methodology incorporated data extracted from medical records, a demographic questionnaire, the Mississippi PTSD Scale (military and civilian versions), the Spielberger–Khanin Anxiety Inventory, the Beck Depression Inventory (BDI), and the SCL-90-R questionnaire. Subclinical symptoms indicative of chronic PTSD were identified in 25.2% of veterans, as assessed by the Mississippi PTSD Scale. According to the Spielberger–Khanin questionnaire, veterans with subclinical PTSD exhibited a moderate level of situational (44.96 ± 6.39 points) and personal anxiety (44.14 ± 5.49 points), which were significantly higher than those observed in the control group (29.87 ± 6.50, p₂ < 0.001, 36.13 ± 6.82, p₂ = 0.003). Furthermore, based on the BDI, these veterans demonstrated an elevated level of depression (13.32 ± 1.36) in comparison to veterans without PTSD (8.61 ± 0.65, p < 0.001) and the control group (4.06 ± 0.75, p < 0.0001). The findings indicate that veterans exhibiting a high level of PTSD are characterized by a more pronounced manifestation of psychopathological indicators, as assessed by the SCL-90-R questionnaire. Compared to the control group, veterans exhibiting PTSD symptoms were found to have a comorbidity with somatic diseases: stage 3 hypertension in 45.2% vs. 21.3% (p₂ < 0.001), coronary heart disease in 45.5% vs. 13.4% (p₂ < 0.001), and type 2 diabetes mellitus in 20.3% vs. 6.1% (p₂ = 0.001). Consequently, Afghan war veterans should be regarded as a high-risk group for cardiovascular diseases (including hypertension and coronary heart disease), cerebrovascular diseases, and mental health disorders. Accordingly, a comprehensive approach is necessary to identify PTSD symptoms alongside concomitant anxiety–depressive disorders and somatic diseases in individuals who have experienced traumatic events. Full article

Background: Lichen planus (LP) is a chronic immune-mediated inflammatory disorder affecting skin, mucosae, nails, and appendages, often with significant impact on quality of life. While associations between oral LP (OLP) and other localizations have been described, comprehensive analyses of patients presenting with multiple LP localizations remain limited. The aim of the study was describing the association of multisite LP among our patients in order to contribute to knowledge about this rare, but possible, clinical situation and its clinical implications in terms of follow-up. Methods: We conducted a retrospective observational study including 44 adult patients with histologically confirmed OLP and at least two additional LP subtypes. Data were collected at the joint dermatology–oral pathology clinic of Policlinico Sant’Orsola Malpighi, Bologna, between January 2022 and December 2024. Demographic characteristics, clinical manifestations, comorbidities, and therapeutic approaches were analyzed. Results: The cohort comprised 31 women and 13 men (mean age at first LP diagnosis: 56 years). All patients presented OLP, predominantly erosive (73%). During a follow-up, 39 patients developed three LP subtypes, and 5 patients developed four LP subtypes. Cutaneous LP was universal, while mucosal involvement included genital LP (n = 23), esophageal/pharyngeal/laryngeal LP (n = 8), and vulvar lichen sclerosus (n = 6). Nail LP was diagnosed in seven cases and frontal fibrosing alopecia in ten cases. Autoimmune comorbidities were frequent, including thyroiditis, psoriasis, systemic sclerosis, lupus, and Sjögren’s syndrome. First-line therapy consisted of topical and systemic corticosteroids, with adjuvant retinoids, cyclosporine, or immunosuppressants in refractory cases. No malignant transformation or dysplasia was detected during the observation period, and the mean follow-up period was 24 months (range: 12–36 months). Conclusions: Multisite LP is a complex, underrecognized condition requiring multidisciplinary management. OLP frequently represents the initial manifestation, followed by progressive involvement of cutaneous and mucosal sites. Regular full-body, oral, and genital examinations, together with tailored systemic treatments, are essential to prevent scarring sequelae and improve quality of life. Our findings highlight the need for heightened clinical vigilance and integrated care pathways for patients with multi-site LP. Full article