Search Results (14,223)

Background: Addictive disorders are highly heterogeneous and frequently comorbid, limiting the clinical utility of categorical diagnoses. Transdiagnostic pharmacology seeks to address these limitations by targeting symptom dimensions and shared neurobiological processes across addictions. Methods: We conducted a theory-driven narrative review of studies indexed in MEDLINE, PubMed, LILACS, and Web of Science (October–November 2025), integrating clinical, mechanistic, and dimensional evidence. Findings were organized using the Dysregulation Phenomena of the Three Main Modes of the Predostatic Mind and the Advanced Cognitive Emotional Regulation Therapy (DREXI3/ACERT) framework, which conceptualizes addiction as dysregulation across three interacting systems—Alarm, Seeking, and Balance—and six transdiagnostic symptom dimensions, with a proposed expansion into twenty clinically observable domains (TDPM-20). Results: Pharmacological interventions consistently target neurobiological systems related to stress, reward, impulsivity, and compulsivity. Across studies, the most clinically relevant outcomes remain abstinence, reduction in substance use, and treatment retention. While these outcomes are essential, expanding outcome frameworks to incorporate dimensional and mechanistically informed measures may enhance the identification of clinically meaningful subgroups. Across studies, multiple pharmacological classes show transdiagnostic potential, but their clinical application remains variably aligned with dimensional clinical profiles. Conclusions: A dimensionally oriented approach grounded in neurobiological principles may improve alignment between clinical processes and therapeutic strategies. The DREXI3/ACERT model provides a structured framework for individualized treatment planning and research integration. This approach should be understood as complementary to, rather than a replacement for, established evidence-based treatments for specific substance use disorders, particularly in contexts where therapeutic options remain limited or insufficient. Advancing transdiagnostic pharmacology will require broader dimensional stratification, expanded outcome frameworks capable of capturing patient heterogeneity, and integrative trial designs to strengthen precision psychiatry in addictive disorders. Full article

Background: The Canada Health Act (CHA), enacted in 1984, guarantees universal access to medically necessary care, yet inequities in hospital use persist. Acute length of stay (ALOS) is a key indicator of hospital efficiency, patient recovery, and healthcare system performance, with prolonged stays linked to higher costs, avoidable infections, and strain on acute care capacity. Understanding patterns in ALOS is critical not only for hospital management but also for public health, as extended stays can limit timely access to care and exacerbate population-level health inequities. Objective: This study examines social, geographic, and clinical gradients in ALOS and investigates whether the effects of admission urgency vary by sex, neighbourhood income, and rural–urban residence within a universal healthcare system. Methods: Using 2024–2025 hospital discharge data from the Canadian Institute for Health Information, this study examined ALOS as a function of comorbidity, sex, socioeconomic status, rural–urban residence (geography), and admission type (urgent versus elective). Interaction effects between admission urgency and key social and geographic variables were evaluated to assess subgroup differences in ALOS. Results: Disparities in ALOS were evident. Older age, male sex, urgent admission, and greater comorbidity were associated with longer stays, whereas higher neighbourhood income and urban residence were linked to shorter stays. Interaction analyses revealed substantial heterogeneity: compared with elective rural admissions, urgent urban admissions had 30.4% longer ALOS. Urgent admissions also amplified socioeconomic and sex-based differences, with male patients experiencing 27.9% longer stays than females. Conclusions: From a public health perspective, these findings highlight how system capacity constraints and social inequities jointly shape hospital use. Reducing avoidable variation in ALOS will require policies that strengthen acute care surge capacity, improve coordination for urgent admissions, and address upstream socioeconomic and geographic barriers to care, thereby promoting more equitable and efficient hospital services. Full article

Traumatic Brain Injury (TBI) is a major contributor to mortality among older adults, with geriatric patients facing disproportionately high risk due to age-related physiological vulnerability and comorbidities. Early and accurate prediction of mortality is essential for guiding clinical decision-making and optimizing ICU resource allocation. In this study, we utilized the MIMIC-III database and identified a final analytic cohort of 667 geriatric TBI patients, on which we developed a machine learning framework for 30-day mortality prediction. A rigorous preprocessing pipeline—including Random Forest-based imputation, feature engineering, and hybrid selection—was implemented to refine predictors from 69 to 9 clinically meaningful variables. CatBoost emerged as the top-performing model, achieving an AUROC of 0.867 (95% CI: 0.809–0.922), with a sensitivity of 0.752 and a specificity of 0.888 on the independent test set. SHAP analysis confirmed the importance of the GCS score, oxygen saturation, and prothrombin time as dominant predictors. These findings highlight the potential value of interpretable machine learning tools for early mortality risk stratification in elderly TBI patients and support further validation for future clinical use. Full article

Obsessive-compulsive disorder (OCD) is a chronic mental disorder characterized by distressing thoughts and repetitive behaviors that significantly impair daily functioning and quality of life. Many patients fail to achieve sufficient symptom relief with first-line treatments, such as cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs). Dopaminergic dysregulation has been implicated in the pathophysiology of OCD, providing a rationale for pharmacological augmentation strategies. This article presents a narrative review of the evidence regarding the efficacy, safety, and clinical applicability of antipsychotic agents and emerging pharmacological augmentation approaches, including extended-release methylphenidate (MPH-ER), in SSRI-resistant OCD. A literature search was conducted using PubMed, EBSCO, and Embase databases, with an additional search of Google Scholar, focusing on studies examining pharmacological augmentation in treatment-resistant OCD. Overall, the evidence base is limited by small sample sizes, short follow-up durations, heterogeneous response criteria, and a lack of head-to-head comparisons versus CBT augmentation, which constrains the generalizability of conclusions. Dopamine receptor antagonists, particularly risperidone, as well as the partial agonist aripiprazole, remain the most consistently supported augmentation strategies, while olanzapine and quetiapine may be considered in selected cases. Evidence for MPH-ER is currently limited—supported by one small RCT and two recent case series—and may be considered in carefully selected adults with comorbid ADHD or marked executive dysfunction, although larger controlled studies and long-term safety data are required before firm clinical recommendations can be made. Full article

Purpose: The purpose of this preliminary study was to investigate the prevalence of Charles Bonnet Syndrome (CBS) among patients attending the National Centre of Service and Research for the Prevention of Blindness and Vision Rehabilitation of the Visually Impaired, Rome, Italy. Furthermore, the research aimed to delineate the psychological profile of these individuals to determine whether significant differences exist compared with visually impaired patients who do not experience hallucinatory phenomena and to identify likely predictors. Methods: A preliminary cross-sectional analysis was conducted on a convenience sample of patients recruited between January 2025 and December 2025. Prevalence was calculated based on structured clinical interviews, while the psychological profile was assessed by comparing the CBS group with a control group (non-CBS) matched for visual acuity. Participants underwent comprehensive ophthalmological and psychological assessments, including best-corrected visual acuity (BCVA), reading acuity (RA), contrast sensitivity (CS), fixation stability, and retinal sensitivity (RS). Psychological status was evaluated using the Symptom Check List-90-Revised (SCL-90-R), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Questionnaire (GAD-7). Patients experiencing CBS were further interviewed regarding the specific characteristics and patterns of their hallucinations. The association between CBS and both psychological profiles and visual function parameters was evaluated using regression analysis. Results: Out of 385 individuals screened, 120 participants (58% women; mean age 55.4 ± 18.8 years) were included; CBS was detected in 19%. No significant differences were observed between participants with and without CBS in demographic variables or psychological questionnaire scores (p > 0.05). Mean SCL-90-R, PHQ-9, and GAD-7 scores indicated mild psychological distress, depression, and anxiety, with no significant group differences (p > 0.05). Using standard cut-off values, depressive and anxiety symptoms were prevalent in 65% and 88% of participants, respectively, but were not significantly associated with CBS in chi-square or logistic regression analyses (p > 0.05). Logistic regression analysis of SCL-90 scores showed that only anxiety was significantly associated with hallucination occurrence among the visually impaired participants (OR = 0.27; 95% CI = 0.08–0.87; p < 0.05). Among the visual function parameters, poorer RA in the worse eye was significantly associated with CBS (p < 0.05). Conclusions: This study confirms that CBS is a prevalent, yet frequently under-reported, condition within rehabilitation settings. While overall visual function did not differ significantly between patients with and without CBS, reduced reading acuity (RA) in the worse eye emerged as a potential specific risk factor. Characterizing the psychological profile of these patients is essential to differentiate the syndrome from psychiatric disorders and to develop tailored support pathways. Despite its preliminary nature, this research underscores the necessity of systematic screening to enhance clinical management and the emotional well-being of visually impaired individuals. Consequently, integrating psychological support into visual rehabilitation programs is vital to addressing the high prevalence of comorbid anxiety and depression. Full article

Toxoplasma gondii establishes latent infection in a substantial proportion of the global population, yet the long-term health consequences of this infection remain incompletely characterized. We conducted a retrospective observational matched cohort study using longitudinal electronic health record data from a nationwide integrated healthcare provider, including members aged 18–45 years who underwent routine Toxoplasma serologic screening, typically performed in obstetric evaluation, excluding patients with clinical toxoplasmosis, immunosuppression, or HIV. Seropositive individuals were matched 1:1 without replacement to seronegative controls to align demographic, temporal, and socioeconomic variables. Time-to-event associations with predefined medical conditions were evaluated using Cox proportional hazards models with false discovery rate correction. The final cohort included 19,443 seropositive individuals and 19,443 matched controls (96.7% female), with a tight baseline balance of demographic and temporal characteristics. During follow-up, seropositivity was associated with increased risks of tobacco dependence (aHR 1.65), alcohol dependence (2.32), suicide attempt (1.82), motor vehicle accidents (1.22), and work accidents (1.27), as well as multiple infectious conditions, including hepatitis B (1.55), hepatitis C (2.15), and syphilis (2.43), with an overall trend toward increased all-cause mortality (1.32, 95% CI [1.00–1.74]). These findings suggest that asymptomatic Toxoplasma infection in young adults is associated with increased long-term behavioral and medical comorbidity. Full article

Background: Helicobacter pylori (H. pylori) infection is an established risk factor for gastric cancer. However, treatment efficacy and the underlying mechanisms in elderly patients with H. pylori infection remain incompletely characterised. This study aimed to compare the eradication efficacy and safety of four amoxicillin-containing regimens for H. pylori infection in elderly patients. Methods: Elderly patients (age ≥ 60 years) with Helicobacter pylori infection treated at five hospitals in Beijing between January 2018 and June 2025 were enrolled. Participants were stratified into four groups according to the prescribed regimen: vonoprazan–amoxicillin (VA) dual therapy, rabeprazole–amoxicillin (RA) dual therapy, rabeprazole–Jinghua Weikang (a Chinese herbal medicine, granules)–amoxicillin–furazolidone (RJAF) quadruple therapy, and rabeprazole–bismuth–amoxicillin–furazolidone (RBAF) quadruple therapy. The primary endpoint was the eradication rate for each regimen. Secondary outcomes included the incidence of adverse events (AEs) and data on comorbidities. In addition, serological testing for H. pylori virulence-associated antibodies (CagA, VacA, UreA, and UreB) was performed in 32 patients at baseline, prior to treatment initiation. Results: A total of 312 patients were screened. The eradication rates with VA, RA, RJAF, and RBAF were 96.3%, 94.0%, 86.8%, and 86.6%, respectively (χ² = 6.92, p = 0.075). The incidence of AEs was 13.8%, 15.5%, 17.9%, and 19.1% in the VA, RA, RJAF, and RBAF groups, respectively (p = 0.391). Conclusions: In elderly patients with Helicobacter pylori infection, dual therapy demonstrates non-inferior efficacy compared with triple therapy and conventional quadruple therapy. More complex regimens do not confer additional clinical benefit. Among the two dual-therapy regimens, VA dual therapy shows superior overall performance and is therefore recommended as the first-line treatment of choice. Full article

Vulvodynia is a chronic gynecological condition characterized by unexplained vulvar pain, which may significantly impact every aspect of women’s quality of life, encompassing physical, psychological, and social well-being. Due to its heterogeneous clinical presentation and associated comorbidities, vulvodynia is often misdiagnosed and/or not adequately treated. This descriptive observational study was conducted using an anonymous questionnaire, which was distributed through social media channels and included 29 questions (25 multiple-choice and four open-ended questions) and aimed to investigate participants’ most frequent symptoms, comorbidities, impact on quality of life, and treatment efficacy and costs. Analyzing a total of 221 answers, we found that burning (85%) and abrasion/irritation sensation (73%) are the most common symptoms, and they are most frequently localized in the vestibular area, while irritable bowel syndrome (35%) is the most common comorbidity. A significant negative effect on individual functioning was confirmed, also due to a noticeable diagnostic delay (4.5 years on average) and treatments’ prohibitive costs potentially impairing participants’ compliance. Our study provides valuable insights into self-reported aspects of women affected by vulvodynia, raising healthcare professionals’ awareness of this issue. Better knowledge of peculiar aspects of vulvodynia may help improve its diagnosis and promote a more personalized and efficient therapeutic approach. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Attention-deficit/hyperactivity disorder (ADHD), brain–derived neurotrophic factor (BDNF), and enuresis are interconnected in several ways, primarily through their potential links to neurodevelopmental factors and brain function. ADHD is considered a neurobehavioral and neuropsychiatric condition characterized by numerous comorbidities, and it represents one of the most frequently encountered neuropsychiatric disorders in clinical practice. Enuresis constitutes a subgroup of intermittent incontinence occurring during sleep that can be further subdivided into monosymptomatic (MNE) and non-monosymptomatic enuresis (NMNE). BDNF plays a crucial role in neurodevelopment, including neuronal growth, proliferation, survival, differentiation, and synaptic plasticity. This narrative review synthesized available literature identified through a systematic search of PubMed/MEDLINE, Science Direct, and Scopus databases (January 2000–December 2025). However, the evidence base is heterogeneous, and findings regarding BDNF in ADHD are inconsistent. Studies examining BDNF in enuresis often involve urinary BDNF, which reflects local bladder production rather than central BDNF activity. Further research is needed to clarify the specific roles of BDNF in the development and manifestation of these conditions and to fully elucidate the complex relationship between BDNF, ADHD, and enuresis. Full article

Background/Objectives: Gabapentinoids are first-line treatments for neuropathic pain (NP); however, real-world evidence regarding their safety and effectiveness in complex clinical populations remains limited. This study aimed to evaluate the effectiveness and safety profile of gabapentinoid therapy in patients managed within a specialized pain relief institution. Methods: A retrospective cohort study (n = 109) was conducted (January 2024 to December 2024). Effectiveness was assessed via DN4 and VAS over one year. Time to improvement was analyzed using Kaplan–Meier curves. Results: The cohort (mean age 66.2 ± 15.3 years) presented 100% comorbidity and polypharmacy (66.1% opioids; 67.9% antidepressants). Although all patients showed improvement, only 35.8% achieved “maximal improvement.” Pregabalin demonstrated faster VAS reduction than gabapentin (p = 0.029), though long-term success was comparable (p = 0.30). Significantly, 100% of patients reported at least one adverse drug event (ADE), primarily somnolence (66.1%), though no serious ADEs occurred. Lower baseline pain scores were significant predictors of therapeutic success. Conclusions: Gabapentinoids are effective for long-term NP management; however, their use is consistently associated with non-serious ADEs. In specialized settings characterized by extensive CNS-active polypharmacy, proactive pharmacovigilance and multidisciplinary oversight are essential to balance analgesic effectiveness with medication safety. Full article

Background/Objectives: Vaccination against respiratory viruses—such as respiratory syncytial virus (RSV), pneumococcal disease, influenza, and COVID-19—may reduce the risk of adverse outcomes in older adults with cardiovascular disease. This study conducted a scoping review of the effects of respiratory vaccines in older adults with cardiovascular disease. Methods: We included studies evaluating adults aged ≥ 60 years with cardiovascular disease who received different types of respiratory vaccines. Eligible designs comprised clinical trials, observational cohort studies, and other relevant studies. Editorials, commentaries, and non-original publications were excluded. A comprehensive and targeted literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science from database inception through January 2026. Results: A total of 25 studies were included, encompassing 1,782,787 adults aged ≥ 60 years with cardiovascular disease who received various respiratory vaccines. RSV vaccines were associated with a lower incidence of cardiorespiratory hospitalization and stroke among vaccinated individuals. Pneumococcal vaccines showed that sequential dual vaccination strategies were associated with a lower risk of cardiovascular events. Influenza vaccination was associated with improved cardiovascular outcomes, lower mortality, and reduced adverse events. COVID-19 vaccines were associated with reductions in mortality and hospitalizations. These benefits are particularly relevant in an older population with a high burden of comorbidities; therefore, complete vaccination schedules, including booster doses, should be considered a central strategy for prevention and comprehensive management in this high-risk group. Conclusions: Vaccination against respiratory viruses in older adults with cardiovascular disease demonstrates an overall favorable/acceptable profile of efficacy and safety, with reductions in mortality, hospitalizations, and cardiovascular events, without a significant increase in serious adverse events. Full article

Background: Postoperative patients are at risk of pulmonary embolism. They typically exhibit multiple contributing factors such as comorbidities, immobility, blood loss, increased hematocrit, dehydration, long hospital stays, and a higher bleeding risk. PE management in this vulnerable group is challenging. Although current guidelines provide differing recommendations, many clinical questions remain unanswered. Decisions regarding periprocedural anticoagulation management must balance the thromboembolic and procedural higher bleeding risks. In addition, a recent major surgery is an absolute contraindication to systemic thrombolysis. Small doses of local lytics or a mechanical percutaneous embolectomy in the era of catheter-based therapy may be a safer option. However, the safety and efficacy of CDT have not been evaluated in this particular PE-vulnerable population. Methods: We performed a retrospective study of 35 postoperative patients with intermediate–high-risk PE treated with the EkoSonic Endovascular System. Operative bleeding risk, different management modalities, and post-PE-therapy presumptive complications were assessed before PE treatment. Results: Procedural success was achieved in 100% of cases. We observed a marked improvement in clinical and PE hemodynamics. One major bleeding, defined as life-threatening, required surgical intervention; four moderate bleedings, defined as bleeding without hemodynamic compromise, required intervention such as drainage. Minor bleeding was managed conservatively. Conclusions: Catheter-directed therapies may be an alternative to systemic reperfusion therapies for selected postoperative intermediate–high-risk PE-vulnerable populations. Full article

Background and Objectives: This study aimed to evaluate the safety and feasibility of reduced-port laparoscopic distal gastrectomy (RPLDG) in elderly patients. Materials and Methods: Electronic medical records of 226 patients who underwent RPLDG performed by a single high-volume surgeon at a single institution (Chonnam National University Hospital) between January 2015 and April 2020 were retrospectively analyzed. Among these patients, 60 were aged ≥ 75 years (elderly group), and 166 were younger than 75 years (non-elderly group). Patient characteristics, surgical outcomes, and short-term postoperative outcomes were compared between the two groups. Results: Surgical outcomes were comparable between the age groups. However, medical complication events, assessed using an event-based approach allowing multiple events per patient, were more frequent in patients aged ≥ 75 years. Compared with the non-elderly group, the elderly group demonstrated a higher frequency of overall postoperative complication events (18 [30%] vs. 29 [18%], p = 0.040), primarily attributable to medical complications (9 [15%] vs. 6 [4%], p < 0.01). The elderly group also showed a delayed time to first gas passage (3.5 [3.0–4.0] vs. 3.0 [3.0–3.0] days, p < 0.001). However, no statistically significant differences were observed in length of hospital stay (7.0 [6.0–10.0] vs. 6.0 [6.0–8.0] days, p = 0.262) or intraoperative blood loss (p = 0.831). No significant differences were found in surgical complication events (p = 0.05) or Clavien–Dindo grade ≥ 3 complication events (p = 0.13). In the risk factor analysis for complications, univariate analysis identified age ≥ 75 years as a significant factor. However, in the multivariate analysis, only respiratory comorbidities, liver disease, and poor ECOG performance status remained independent risk factors, whereas age ≥ 75 years was no longer statistically significant (p = 0.193). The finding regarding liver disease should be interpreted with caution because of the extremely small sample size. Conclusions: RPLDG appears to be a viable surgical option for patients aged ≥ 75 years, demonstrating acceptable surgical outcomes and severe complication rates comparable to those observed in non-elderly patients. Full article

Background and Objectives: Hip fracture surgery is considered a major operation due to the risk of complications and increased mortality. COVID-19 is a newly recognized risk factor for increased mortality in regard to various diseases. Materials and Methods: The aim of this retrospective observational study, conducted from January 2018 to April 2022, was to analyze mortality among rehabilitation ward patients after surgical treatment of acetabular or femoral fractures in both the COVID-19 and pre-COVID-19 periods. The association between mortality and age, gender, comorbidity status, and number of complications during hospital stay was also examined. Results: Higher mortality was observed in the COVID-19-period group during all analyzed periods: cumulative three-year mortality was 2.3 times higher (14.2% vs. 6.2%, p = 0.013); two-year mortality was 3.7 times higher (9.2% vs. 2.5%, p = 0.005); and first-year mortality was 8.3 times higher (5.0% vs. 0.6%, p = 0.006). The Charlson Comorbidity Index (CCI) and admission during the COVID-19 period were strong predictors of mortality, while the number of complications, age, and gender did not significantly influence the mortality rate. An increase of one point in CCI resulted in a 42% increase in the likelihood of mortality, while hospitalization during the COVID-19 period was associated with an odds ratio of 2.44 for death compared to the pre-COVID-19 period (p = 0.013, 95% CI [1.19, 4.94]). Conclusions: The excess mortality may be attributed to the COVID-19 pandemic because the groups were comparable in all other aspects (Barthel index, CCI, complications, age, and gender). Additional five-year mortality data will be useful for analyzing mortality dynamics, as pre-COVID-19 patients will enter the COVID-19 period and COVID-19 patients will enter the post-COVID-19 period. Full article