Search Results (6,514)

Background: Human polyomavirus JC (JCV) causes progressive multifocal leukoencephalopathy (PML), a deadly brain demyelinating illness stemming from oligodendrocyte lytic infection in immunocompromised patients, especially those with untreated HIV infection. Methods: We conducted a case series report on patients with HIV/AIDS who presented progressive multifocal leukoencephalopathy and were hospitalized at the “St. Parascheva” Clinical Hospital of Infectious Diseases in Iasi, northeastern Romania, to emphasize the comorbidities of HIV/AIDS cases. Hospital medical data from 10 January 2025 to 30 September 2025 served as the basis for this investigation. Results: We examined three cases that presented neurological symptoms (ataxia, aphasia, language comprehension, and expression disorders). The cases were evaluated imagistically via nuclear magnetic resonance, and we conducted a polymerase chain reaction test on the spinal fluid to confirm the presence of JCV. It was necessary to take a multidisciplinary approach with a neurologist or pneumologist. All cases were evaluated immunologically, revealing low Ly T CD4 levels and increased HIV viremia levels. Progressive multifocal leukoencephalopathy is an AIDS-defining disease, manifesting in immunocompromised patients, including late presenter cases, and patients who are non-adherent to their antiretroviral treatment. Therefore, it is important to test every patient who has mild to severe neurological symptoms for HIV. Furthermore, some cases require a multidisciplinary approach to ensure a better quality of life. Conclusions: Treating a patient with HIV requires a multidisciplinary strategy that includes a neurology specialist and access to antiretroviral treatment. To boost ART uptake, we must identify and remove barriers that impact patients and the healthcare system. Full article

Background/Objectives: Prediction models are implemented frequently, yet, compared with other study designs, their incorporation of clinical measurements (CMs; i.e., vital signs and laboratory results) is rather underdeveloped. The purpose is to describe methods used and illustrate clinical utility in parameters systematically derived from CMs; as a case study, we use the risk of all-cause mortality following coronavirus disease 2019 (COVID-19) as the basis for prognosis. Methods: We identified cases through the Department of Veterans Affairs COVID-19 Shared Data Resource, utilizing data from the first visit until 14 days before testing positive. Thirteen parameters were derived from each of the 11 CMs, capturing departures from normality considering variability and time. The 143 candidate predictors were used to generate the main logistic regression model. The area under the receiver operating characteristic curve (AUROC) analysis was performed to assess discrimination between those who lived and died for subset and main regressions; for comparison, this was performed for an age-only model and the Charlson Comorbidity and Elixhauser Indices. Results: There were 329,491 patients. The main model’s AUROC (0.785 ± 0.002) was similar to the age-only model (0.783 ± 0.002; p > 0.05) and significantly greater than the comorbidity indices’ (range: 0.675 ± 0.002 to 0.729 ± 0.002; p < 0.001 each). Conclusions: The study found several parameters were significant determinants of mortality following COVID-19, highlighting the importance of a systematic approach for multivariate modeling to obtain informative insights into underlying pathophysiology. The main model outperforms common comorbidity indices as a summary metric for pre-existing conditions in this case study. If validated, this approach could revolutionize the way CMs are handled in multivariate models. Full article

Childhood overweight and obesity represent a major global public health emergency, with a steadily increasing prevalence over recent decades in both developed and developing countries. Approximately one fifth of children and adolescents are overweight or obese, with marked differences across ethnic groups and geographical areas. Accurate estimation of this condition is complicated by the lack of a unique and universally accepted definition of childhood obesity, which is based on different anthropometric criteria. Although body mass index (BMI) remains the most widely used tool, growing evidence indicates that abdominal obesity, assessed by waist circumference and waist-to-height ratio, is a better predictor of cardiometabolic risk, even in children with a normal BMI. Childhood obesity is associated with several comorbidities, including arterial hypertension, non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea syndrome (OSAS). Early diagnosis and an integrated therapeutic approach are essential to reduce the risk of long-term complications. Although lifestyle modifications remain the cornerstone of treatment, new pharmacological options for pediatric obesity have been approved in recent years. This narrative review explores the impact of childhood obesity on the early development of hypertension, NAFLD, and OSAS, emphasizing the implications that can already be observed during childhood and adolescence. It examines the association between pediatric obesity and these conditions by synthesizing current epidemiological evidence, describing the underlying pathophysiological mechanisms linking excess adiposity to disease onset, and reviewing pediatric-specific diagnostic criteria as well as preventive and therapeutic strategies. Full article

Background/Objectives: This study analyzed demographic, clinical, laboratory, and outcome data from patients hospitalized with Coronavirus disease 2019 in eastern Poland between March 2020 and December 2024. This study aimed to assess sex-related differences in clinical features, treatments, and outcomes, and to identify predictors of mortality and mechanical ventilation in hospitalized patients. Methods: A retrospective cohort of 2811 adults hospitalized across four infectious disease centers was examined. Data included demographics, comorbidities, symptoms, laboratory findings, treatments, and clinical outcomes. Multivariable logistic regression was performed to identify predictors of mortality and mechanical ventilation. Results: The cohort comprised 1398 females and 1413 males. Women were older (median 67.5 vs. 63 years, p < 0.0001) and had a higher burden of comorbidities, while men presented with more severe baseline respiratory status and higher inflammatory markers. Oxygen therapy was required more frequently in men (60% vs. 49.9%, p < 0.0001). Overall mortality was 8.9% and did not differ significantly by sex, although men aged 60–79 years had higher mortality than women (11.2% vs. 7.7%, p = 0.0422). Independent predictors of mortality (OR, 95%CI) included age ≥ 80 years (3.78, 2.66–5.39), procalcitonin > 1 ng/mL (OR 4.07, 2.54–6.52), interleukin-6 (IL-6) > 100 pg/mL (OR 2.24, 1.53–3.27), and oxygen therapy at admission (OR 9.41, 5.22–16.97). Predictors of mechanical ventilation were age ≥ 80 years (7.14, 1.75–33.33), procalcitonin > 1 ng/mL (OR 2.09, 1.2–3.63), IL-6 > 100 pg/mL (OR 2.3, 1.4–3.78), and CRP at admission (OR 1.82, 1.15–2.88). Conclusions: Sex-related disparities in clinical presentation, laboratory profiles, and treatment strategies were evident, but mortality differences were driven primarily by age and inflammatory burden rather than sex alone. Elevated procalcitonin, high IL-6, and early oxygen requirement emerged as robust predictors of poor outcomes. Full article

Background: Inflammatory bowel disease (IBD) is associated with chronic pain and reduced quality of life, even in the absence of active intestinal inflammation. International studies suggest that fibromyalgia (FM), a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and multiple somatic symptoms, is more prevalent among patients with IBD than among the general population. However, data from Saudi Arabia are limited. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, during July and August of 2024. Patients with biopsy-confirmed IBD were identified from hospital records and contacted by phone to screen for FM using a validated Arabic version of the Fibromyalgia Rapid Screening Tool. Demographic data, comorbidities, medication exposure, IBD characteristics, disease activity, and laboratory parameters were extracted from the medical records and compared between patients with and without FM. Results: Of 274 patients with IBD (mean age 30.9 ± 9.2 years; 56.9% male), 51 (18.6%; 95% CI 14.2–23.7) met criteria for FM. Patients with FM tended to be older than those without and were more likely to have comorbidities, particularly thyroid disorders, as well as low Vitamin D levels. Prior 5-aminosalicylic acid use was also more common among patients with FM. Inflammatory markers, hematological indices, IBD phenotypes, and disease activity were similar between the groups. Conclusions: Saudi patients with IBD often have comorbid FM. Routine FM screening in IBD clinics may help avoid misattributing central pain to active inflammation and unnecessary treatment escalation. Full article

This narrative review integrates longitudinal cohort studies, neuroimaging and biomarker research, and major clinical trials to examine how depression and cognitive decline interact across the dementia continuum. Depression and cognitive impairment frequently co-occur in late life and exhibit substantial clinical and biological overlap. Meta-analytic and large population-based cohort studies consistently show that late-life depression increases the risk of mild cognitive impairment and dementia, with stronger associations observed for vascular dementia than for Alzheimer’s disease. Neurobiological studies implicate cerebrovascular pathology, neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, and fronto-subcortical circuit dysfunction as key mechanisms linking depressive symptoms to later cognitive decline. In a subset of older adults, new-onset depression—particularly when accompanied by executive dysfunction, subjective cognitive decline, or high white-matter hyperintensity burden—are associated with an increased likelihood of near-term cognitive decline and dementia, although evidence for a definitive prodromal state remains limited. Depression is also highly prevalent as part of the behavioral and psychological symptoms of dementia, occurring in 30–50% of individuals with Alzheimer’s disease and even higher proportions in dementia with Lewy bodies or frontotemporal dementia. Comorbid depression in dementia accelerates cognitive and functional decline, increases neuropsychiatric burden, and worsens quality of life for patients and caregivers. Therapeutically, antidepressant treatment may confer modest benefits on mood and selected cognitive domains (e.g., processing speed and executive function) in non-demented older adults, whereas in established dementia, antidepressant efficacy is limited. In contrast, cholinesterase inhibitors, memantine, and multimodal non-pharmacological interventions yield small but measurable improvements in depressive or apathy-related symptoms. Emerging disease-modifying therapies for Alzheimer’s disease have demonstrated cognitive benefits, but current trial data provide insufficient evidence regarding effects on depressive symptoms, highlighting an important gap for future research. These findings underscore the need for stage-specific, integrative strategies to address the intertwined trajectories of mood and cognition in aging. Full article

Objective: Heart failure (HF) remains a major global health challenge. We evaluated ten-year trends in clinical profiles, diagnostic/therapeutic management, and outcomes in patients hospitalized for de novo acute heart failure (AHF). Methods: We compared two multicenter cohorts of patients admitted to Internal Medicine departments in Spain for a first episode of HF (excluding acutely decompensated chronic HF): a retrospective cohort (CH-2005; n = 600) and a prospective cohort (CH-2015; n = 180). We assessed clinical characteristics, adherence to guideline-recommended diagnostic testing, discharge treatment, and 12-month outcomes (HF readmissions and all-cause mortality). Results: The patients in CH-2015 showed a markedly higher comorbidity burden (Charlson Comorbidity Index > 2: 90.0% vs. 12.8%, p < 0.001) and higher chronic kidney disease prevalence (17.8% vs. 11.8%, p = 0.01), while mean age was similar (75.0 vs. 73.6 years, p = 0.16). Diagnostic adherence improved with higher echocardiography use (92.2% vs. 66.5%, p < 0.001). Discharge beta-blocker prescriptions increased (50.6% vs. 31.3%, p < 0.001). HF readmissions were higher in CH-2015 at 1 month (35.6% vs. 7.3%, p < 0.001) and 12 months (49.4% vs. 21.2%, p < 0.001). One-year mortality was higher in CH-2015 (22.5% vs. 16.3%, p = 0.07). In the multivariable analyses, the between-cohort difference in mortality was not significant, whereas the higher readmission risk in CH-2015 persisted. Conclusions: Over a decade, de novo AHF admissions shifted toward a more complex, multimorbid phenotype. Despite improved diagnostic testing and small advances in evidence-based therapy, the readmission burden increased, highlighting the need for integrated, post-discharge management strategies in older multimorbid populations. Full article

Background: In Parkinson’s disease (PD), a higher prevalence of polyneuropathy (PNP) is increasingly recognized, although the causal association is still under debate. In contrast, PNP in atypical parkinsonian syndromes (APS) has been insufficiently addressed, despite preliminary evidence suggesting elevated prevalence. Methods: Nerve conduction studies were performed on 13 patients with multiple system atrophy (MSA) and 9 patients with progressive supranuclear palsy (PSP) at baseline. PNP was diagnosed according to standard electrophysiological criteria after exclusion of common secondary causes. Comprehensive clinical evaluation included motor and non-motor assessments over two years of follow-up. Results: At baseline, PNP was present in 53.8% of MSA patients and 66.7% of PSP patients. MSA patients with PNP showed greater motor symptom severity (UPDRS III score; p = 0.046) and worse cognitive performance (MoCA; p = 0.044) compared to those without PNP. Over two years, a significant reduction in the tibial nerve amplitude was observed exclusively in MSA patients (p = 0.039), paralleling disease progression. Conclusions: This study provides the first longitudinal evaluation of clinical and electrophysiological PNP progression in MSA and PSP. A high comorbidity of PNP in patients with APS could contribute to motor and sensory impairments in these patients. Our findings indicate that PNP progression may reflect disease progression in MSA. Given the limited sample size, larger-scale longitudinal studies are needed to further investigate biomarker potential of PNP in APS and to clarify differences in peripheral nerve involvement between synucleinopathies and tauopathies. Full article

Background: Pain is a common and clinically important symptom in hemodialysis, yet its functional impact and determinants remain insufficiently characterized. This study examined factors associated with pain interference using the Pain Effects Scale (PES) in maintenance hemodialysis patients. Methods: In a cross-sectional study, 73 adults receiving thrice-weekly hemodialysis completed the PES, assessing the four-week impact of pain on mood, sleep, mobility, work, recreation, and enjoyment of life. Demographic, clinical, and dialysis-related variables—including vascular access type, dialysis vintage, session duration, ultrafiltration volume, predialysis urea, Kt/V, urea reduction ratio, comorbidities, and transplant history—were extracted from medical records. Associations were evaluated using parametric and non-parametric tests. Results: PES scores indicated substantial pain interference. Older age was positively correlated with higher PES scores (r = 0.32, p = 0.006), and patients with ischemic heart disease had significantly higher PES values than those without (23.1 ± 6.7 vs. 17.3 ± 6.2; p = 0.012). Willingness to pursue transplantation showed a non-significant trend toward lower scores. Conclusions: Pain interference in hemodialysis appears largely independent of routine adequacy metrics and most comorbidities, with ischemic cardiovascular disease emerging as an exception. Findings underscore the need for a biopsychosocial approach integrating pain screening with assessment of mood, sleep, neuropathy, musculoskeletal factors, and ischemic symptoms. Full article

The OHI demonstrated moderate internal consistency and consistent associations with oral health-related quality of life and cardiovascular risk indicators. Objective: The primary objective was to propose and internally assess an Oral Health Index (OHI) which integrates multiple clinically assessed oral health variables. The secondary objective was to investigate its association with oral health-related quality of life (OHRQoL) and common clinical cardiovascular risk (CVR) factors. Material and Methods: This observational study included 191 participants. Seven parameters (tooth loss, periodontal disease, endodontic involvement, residual roots, extractions due to periodontitis, inflammatory oral mucosal diseases, and dental maintenance and rehabilitation status) were combined using Z-scores to compute the OHI, with higher scores indicating poorer oral health. CVR factors included age/sex thresholds, education level, BMI, smoking status, diabetes, hypertension, pulse pressure, and lung function. OHRQoL was assessed using the Oral Health Impact Profile. Results: Higher OHI scores were associated with poor oral health-related quality of life. Participants with cardiovascular risk factors had significantly higher OHI scores. The analysis demonstrated that the OHI was directly associated with worse oral health-related quality of life and a greater cardiovascular risk burden, independent of age, sex, and comorbidities. Conclusions: This study proposed and internally assessed the Oral Health Index, designed to integrate multiple clinical parameters into a single standardized measure of oral health. The OHI demonstrated moderate internal consistency and showed consistent associations with poorer oral health conditions, reduced oral health-related quality of life, and a greater cardiovascular risk burden. Full article

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake. Full article

Background: While COVID-19 vaccination significantly reduces acute disease severity, its impact on the incidence of long COVID remains debated, with some observational studies paradoxically suggesting higher symptom rates among vaccinated individuals. This study aimed to resolve this controversy by distinguishing between the protective effects of prior immunity and the confounding influence of reverse causality. Methods: We conducted a retrospective cohort study of 627 adults hospitalised for COVID-19 in London. Participants were stratified into two analytical cohorts based on vaccination timing: a “prevention cohort” (vaccinated ≥ 14 days pre-infection) and a “post-acute cohort” (vaccinated post-infection). Multivariable Bayesian logistic regression was employed to estimate Adjusted Odds Ratios (aOR) for long COVID, controlling for age, gender, BMI, comorbidities, and acute length of hospital stay (LoS). Results: In the prevention cohort, prior vaccination demonstrated a non-significant protective trend against long COVID (aOR 0.81; 95% CI 0.45–1.42; p = 0.45), with no significant difference observed between homologous and heterologous regimens. The post-acute cohort exhibited a strong, significant positive association (aOR 3.41; 95% CI 2.23–5.52; p < 0.001), indicating substantial indication bias, with symptomatic individuals more likely to seek vaccination. The strongest independent predictors of long COVID were comorbidities (aOR 2.78) and prolonged acute hospitalisation (≥4 days; aOR 1.82). Conclusions: Vaccination administered prior to infection demonstrates a protective trend against long COVID, whereas the strong association observed with post-infection vaccination reflects indication bias, with symptomatic survivors being more likely to seek immunisation. Clinical strategies to mitigate post-acute sequelae should prioritise reducing acute disease severity and managing comorbidities, which were identified as the dominant independent predictors of risk in hospitalised patients. Full article

Objective: Due to the increasing prevalence of rheumatological conditions worldwide, especially among women, and their known negative impact on body image, there is a growing demand for cosmetic procedures. Therefore, it is imperative to develop an evidence-based understanding of the safety of these procedures and their potential effects on the disease course to prevent undesirable exacerbations. Methods: An observational cross-sectional survey was conducted among adult patients diagnosed with rheumatic diseases. Data were collected using an electronic questionnaire that addressed demographics, disease characteristics, comorbidities, and perceptions of cosmetic procedures. Ethical approval was obtained from the Institutional Review Board of King Saud University and King Saud University Medical City. Appropriate descriptive and inferential statistical analyses were performed. Results: A total of 212 participants were included; among them, 92 participants considered or underwent cosmetic procedures, while 120 did not. A significant difference was observed between groups regarding disease-related impact on self-confidence (p = 0.01). Factors associated with undergoing cosmetic procedures included gender (female sex) (OR 12.02; 95% CI: 1.55–93.17; p = 0.017), higher educational level (OR 14.00; 95% CI: 1.32–147.42; p = 0.028), a monthly income of SAR 1000–5000 (OR 2.39; 95% CI: 1.03–5.53; p = 0.041) or SAR 5000–10,000 (OR 2.75; 95% CI: 1.19–6.33; p = 0.017), and employment status (OR 1.81; 95% CI: 1.03–3.18; p = 0.038). Conclusions: A substantial proportion of patients with rheumatic diseases considered or had undergone cosmetic procedures, primarily driven by appearance-related concerns and reduced self-confidence. Female sex, higher education, higher income, and employment status were significant predictors. Fear of disease flare-ups and potential side effects were the most common reasons for avoiding cosmetic procedures. Full article

Background: In the era of personalized medicine, the overall therapeutic approach has progressed throughout the years in acromegaly, but biochemical control of the disease is not achieved in a significant proportion of patients. This study aims to systematically record the journey of patients with acromegaly in the context of adenomas characteristics, therapeutic approaches and comorbidities in acromegaly with an emphasis in elderly. Method: In this retrospective study 79 patients were diagnosed with acromegaly between 1971 and 2023. Results: The dataset consisted of 43 (54%) female and 36 male (46%) with an overall mean age ± SD at diagnosis at 45 ± 13 years. 57 (73%) underwent one surgical procedure. Medical treatment with one agent was reported in 36 patients (67%), almost all by somatostatin analogs (89%). Radiotherapy was offered in 14 patients (18%). Disease remission was documented in 67 (85%) patients. IGF1/ULN at diagnosis displayed a tendency to predict non-remission. A diagnostic delay of less than five years was reported in 28 cases (65%) and patients reporting longer delays were older at diagnosis (58 ± 6 years). Patients diagnosed at or above the age of 60 were less likely to undergo a surgical procedure compared to patients diagnosed before the age of 60. Conclusions: Biochemical control was the most frequent disease outcome. A higher IGF-1/ULN ratio tends to predict non-remission. Longer diagnostic delay was reported with advancing age and older patients were less likely to follow surgical procedures. Full article

Background: Atrial fibrillation (AF) is frequently associated with cardiometabolic comorbidities, and increasing evidence suggests a close relationship between AF and liver disease, particularly metabolic dysfunction-associated steatotic liver disease (MASLD); however, the clinical patterns, hepatic phenotypes, and clinical implications of this association remain insufficiently characterized. Therefore, the aim of the present study was to characterize hepatic involvement in patients with paroxysmal AF by integrating a structured literature review with original clinical data. Methods: We performed a retrospective analysis of 253 patients admitted with paroxysmal AF between 2015 and 2025. Demographic data and associated diagnoses were collected with a specific focus on hepatic pathology. Patients were stratified according to the presence and type of liver disease, and descriptive statistics, bivariate analyses, and multivariate logistic regression were used to identify associations and independent predictors. Results: Liver disease was identified in 65.2% of patients, most commonly hepatic steatosis (46.2%), followed by liver cirrhosis or advanced liver disease (19.0%). Patients with liver disease had higher prevalences of type 2 diabetes mellitus, dyslipidemia, obesity, and alcohol consumption. Dyslipidemia (OR 4.51) and obesity (OR 2.54) were independent predictors of hepatic steatosis, whereas liver cirrhosis was inversely associated with age and serum lipid levels. Conclusions: Liver pathology is highly prevalent among patients with paroxysmal AF and is closely associated with adverse metabolic and clinical profiles. Recognition of distinct hepatic phenotypes may support improved risk stratification and multidisciplinary management in patients with AF. Full article