Search Results (14,132)

Background and Objectives: Pro-inflammatory diet and high-fat diet (HFD) often coexist in real-world, but their combined impact on the gut–liver axis and potential nutritional countermeasures remain insufficiently studied. This study aimed to evaluate a pro-inflammatory–high-fat composite dietary pattern on the intestine and liver in the population, and to further evaluate the protective potential of astaxanthin (ATX) in complementary experimental systems. Methods: Data from the NHANES 2005–2010 were used to construct four composite exposure groups based on the dietary inflammation index (DII) and energy from fat. Survey-weighted regression analyses were performed to examine associations with systemic inflammation and liver injury. Interaction and C-reactive protein (CRP)-mediated effect analyses were conducted. Fifty SD rats were randomly divided into control group, model group induced by HFD combined with inflammatory factors, and low-, medium-, and high-dose Haematococcus pluvialis (HP) intervention groups. Serum lipids, liver enzymes, liver and colon pathology, and inflammatory and oxidative markers were measured in rats. In an in vitro organ-on-chip barrier model, the effect of ATX was observed when colonic barrier damage was induced using palmitic acid and lipopolysaccharides. Results: The high DII combined with HFD showed the largest increases in CRP, liver enzymes, and fatty liver index. A synergistic interaction was observed between DII and HFD, with CRP mediating approximately 20% of the effect. In rat model, HP-derived ATX improved the lipid profile, attenuated hepatic steatosis and oxidative damage, and reduced colonic pro-inflammatory cytokines, while restoration of tight junction proteins was limited. In colon organoid model, ATX showed limited efficacy in improving inflammation and barrier function. Conclusions: The pro-inflammatory–high-fat dietary pattern synergistically exacerbates gut–liver dysfunction. HP-derived ATX alleviates metabolic and inflammation-induced enterohepatic comorbidity, but its effect on repairing barrier structure is limited. Full article

Background: Postoperative complications following colorectal surgery remain a persistent clinical challenge. Traditional risk stratification has focused on patient characteristics, while conventional modeling approaches treat procedural factors such as operative duration and surgical approach as independent predictors, potentially obscuring interaction effects. Methods: This study developed a machine learning model stratifying 7908 colorectal surgery patients into four distinct procedural risk categories based on combined surgical approach and operative duration (laparoscopic-short, laparoscopic-long, open-short, open-long), rather than treating these factors as separate variables. A gradient boosting ensemble classifier with RUSBoost resampling was trained on predictor variables including patient demographics, comorbidities, and intraoperative factors. Results: Feature importance analysis revealed that the open-long category emerged as the single most important predictor, substantially exceeding all other variables. Weight loss, body mass index, patient age, and electrolyte abnormalities ranked as the next most important predictors. Stratified complication rates demonstrated a critical interaction: prolonged duration more than doubled complication risk in open procedures (short-duration: 9.99%, long-duration: 20.46%), whereas laparoscopic procedures showed only a modest increase from short-duration (10.45%) to long-duration (14.08%) cases. Logistic regression benchmark analysis confirmed the duration-approach interaction (OR = 1.53, 95% CI: 0.97–2.39), achieving comparable discrimination (c-statistic 0.678 vs. 0.665 for the ensemble model). Decision curve analysis demonstrated logistic regression provided superior clinical utility across most threshold probabilities. Conclusions: The dual analytical framework (i.e., statistical inference for quantifying associations and machine learning for predictive feature ranking) offers complementary insights for clinical application. These findings demonstrate that stratified feature engineering can elucidate complex risk phenotypes that may be obscured when procedural factors are analyzed independently. Full article

Therapeutic termination of pregnancy (TToP) represents an intervention that is performed for medical reasons, such as risks to maternal health or severe fetal anomalies. Advances in prenatal screening and diagnostic tools—including serum markers, ultrasound, cell-free fetal DNA, chorionic villus sampling and amniocentesis—have significantly improved early detection and clinical decision-making. This narrative review synthesizes current knowledge on the genetic, environmental and psychosocial determinants that influence the decision of the patients to pursue TToP. The literature search was performed primarily using PubMed database, while Scopus and Google Scholar were used to identify additional relevant studies. Some of the selected studies, as well as certain sections of this review, address both therapeutic and voluntary termination of pregnancy, whereas others focus exclusively on TToP. Moreover, this review describes the types of abortion (medical or surgical/aspiration) along with their management strategies to prevent or address potential complications. It is well known that demographic, cultural and socio-economic factors continue to influence the access to TToP, as well as the perceptions of it. Psychiatric comorbidities (such as anxiety, affective and psychotic disorders) are observed with a higher prevalence among women undergoing TToP and may influence both the decision and psychological outcomes post-procedure. While most women report emotional relief after TToP, some of them experience depression, post-traumatic stress disorder or substance misuse. Legal and ethical considerations further complicate access to safe abortion, leading to situations where patients may resort to unsafe procedures, which result in higher rates of morbidity and mortality. Data from the EUROCAT network show rising trends in congenital anomalies like trisomy 13, trisomy 18 and caudal regression syndrome (conditions commonly associated with TToP). Therefore, it is mandatory to form a multidisciplinary team in these cases, integrating medical, psychological and ethical dimensions. Ensuring safe, evidence-based and compassionate access to TToP remains a critical component of reproductive healthcare. Full article

Background: Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous sleep disorder. This study aimed to investigate age- and sex-specific phenotypes of OSA in a large clinical cohort, with special emphasis on the effects of aging and menopause on disease severity, hypoxemic component, symptom expression, comorbidities, and screening tool performance. Methods: A retrospective cross-sectional analysis was conducted on 3736 patients with confirmed OSA referred to a tertiary sleep clinic in Greece between 2013 and 2023. Participants were stratified by age and sex. Women were further classified as pre- and post-menopausal using age as a proxy. Clinical characteristics, comorbidities, questionnaire data and polysomnographic indices were analyzed using parametric and non-parametric statistical methods. Results: OSA severity peaked in middle age and remained high in older adults, while nocturnal hypoxemia and cardiometabolic comorbidities worsened with age. Women presented at an older age and with higher body mass index but lower Apnea Hypopnea Index (AHI) compared to men, yet experienced significantly longer hypoxemia and more severe insomnia. Women over 45 years exhibited a markedly more severe and hypoxic phenotype and substantially higher rates of comorbidities. Screening tool performance varied across subgroups: STOP-BANG was the most consistent, while symptom-based tools performed poorly in young women and elderly patients. Conclusions: OSA is a dynamic dependent disorder with distinct phenotypes across the lifespan. Current screening strategies fail to adequately capture these variations, particularly in women and older adults. A personalized, sex- and age-specific approach to OSA diagnosis and management is essential to reduce underdiagnosis and improve outcomes. Full article

Background/Objectives: Insulin resistance (IR) is increasingly recognized as a factor associated with metabolic syndrome and various cancers. The metabolic score for insulin resistance (METS-IR) has emerged as a reliable surrogate marker for assessing IR. This study evaluated the association between the METS-IR and the gastric cancer (GC) incidence using data from a nationwide South Korean cohort. Methods: Data were obtained from the National Health Insurance Service (NHIS) cohort. A total of 318,336 participants aged ≥40 years who underwent a nationwide health screening between 2009 and 2010 were included and followed until GC diagnosis, death, or 31 December 2019. The METS-IR was calculated and categorized into quartiles. Hazard ratios (HRs) for GC incidence were estimated using Cox proportional hazards models. The analyses were adjusted for confounders, including age, sex, socioeconomic status, lifestyle factors, and comorbidities. Results: Participants in the highest METS-IR quartile (Q4) exhibited a significantly higher crude incidence of GC (2.26 per 1000 person-years) than those in the lowest quartile (Q1: 1.97 per 1000 person-years). Adjusted HRs showed a modest but statistically significant increase in GC risk in Q4 (HR: 1.10; 95% confidence interval: 1.02–1.19; p = 0.01) compared to Q1. Kaplan–Meier analysis revealed that participants with higher METS-IR levels had significantly shorter GC-free survival times than those in the lower quartiles. Restricted cubic spline analysis revealed a nonlinear relationship between the METS-IR and GC risk, with higher METS-IR levels associated with an increased risk. Conclusions: An elevated METS-IR was associated with an increased GC risk, suggesting its potential utility in stratifying GC risk. The METS-IR may help identify high-risk individuals and support GC prevention. Full article

Candidozyma auris (formerly Candida auris) is frequently multidrug-resistant, resulting in limited treatment options and high mortality. Comparable mortality between C. auris candidemia and non-C. auris candidemia in recent studies requires confirmation in the Middle East after adjustment for confounders. This study aimed to compare mortality rates between patients with candidemia by C. auris and non-C. auris Candida species. We retrospectively analyzed 94 cases with candidemia between January 2019 and October 2025, including C. auris candidemia (n = 30) and non-C. auris candidemia (n = 64). Inverse probability weighting was used to balance baseline confounders between groups. The primary analysis used a weighted Cox proportional hazards model. Patients in the C. auris group had more comorbidities, greater healthcare exposure, and longer hospital stays. Crude 30-day all-cause cumulative mortality was comparable between the C. auris and non-C. auris groups (log-rank test, p = 0.8). The 30-day mortality of C. auris candidemia was similar to that of non-C. auris candidemia (adjusted HR 0.40; 95% CI 0.16–1.04; p = 0.060). Large multicenter studies involving diverse populations across different regions are warranted to validate these findings. Full article

Clostridium tertium is an emerging opportunistic pathogen typically associated with immunocompromised hosts, yet it can also cause serious infections in non-neutropenic individuals. We present a case of postoperative peritonitis and bacteremia caused by C. tertium in a non-neutropenic 75-year-old woman following emergency obturator hernia repair. Diagnosis was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and successful treatment was achieved with piperacillin–tazobactam combined with levornidazole alongside surgical source control. A review of 128 cumulative cases (including ours) revealed two distinct patterns: bacteremia in severely neutropenic patients versus a broader spectrum of localized and bloodstream infections in non-neutropenic hosts, often linked to intestinal barrier disruption. Mortality was largely driven by underlying comorbidities and polymicrobial sepsis. These findings indicate that C. tertium infection should be considered in non-neutropenic patients with postoperative or gastrointestinal barrier-disruptive infections, especially when there is a poor response to initial empiric therapy. Consequently, in such clinical scenarios, empirical therapy should be guided by its unique resistance pattern, favoring carbapenems, vancomycin, or piperacillin–tazobactam, often combined with a nitroimidazole, alongside urgent source control. Full article

Lichen planus (LP) is a chronic immune-mediated inflammatory disease of unknown etiology affecting the skin and mucous membranes and is frequently associated with comorbid conditions, although data from Swedish populations remain limited. This retrospective population-based case–control study included all registered citizens in Region Jönköping, Sweden, between 2013 and 2022, to examine comorbidities, estimate prevalence and incidence, assess diagnostic validity of ICD-10 coding (L43), and evaluate treatment patterns. Incidence and prevalence were calculated, demographic and treatment characteristics were described, and diagnostic validity was assessed through independent medical record review of 70 randomly selected cases to determine positive predictive value (PPV). Associations between LP and predefined comorbidities were analyzed using binomial logistic regression adjusted for age and sex. Among 361,812 individuals, prevalence was 235.5 and incidence 19.6 per 100,000 inhabitants. The PPV of the LP diagnosis was 78.6%, yielding an adjusted prevalence of 184.9 per 100,000 inhabitants. Over one third of prevalent patients received topical therapy, primarily corticosteroids. LP was significantly associated with thyroid, malignant, metabolic, and autoimmune conditions. LP is relatively uncommon, ICD-10 coding shows acceptable validity, and its association with clinically relevant comorbidities highlights the need for comprehensive patient assessment. Full article

Background/Objectives: Autoimmune hepatitis (AIH) is a chronic immune-mediated inflammatory liver disease that, if not diagnosed and treated promptly, leads to cirrhosis and liver failure. Data on AIH in Central Asia, including Kazakhstan, remain limited. The aim of this study was to characterize the clinical profile of AIH in a Kazakhstani patient cohort, determine the timeliness of diagnosis, and develop an interpretable machine learning model for detecting liver fibrosis based on routine clinical and laboratory parameters. Methods: A retrospective observational study of adult patients with a diagnosis of AIH between 2015 and 2025 was conducted. Demographic, laboratory, instrumental, and histological data of patients with AIH were extracted from medical records. All statistical analyses were performed using SPSS 22.0. Results: The study included 240 patients with a mean age of 49.3 ± 14.3 years; 87.1% of patients were women. The Random Forest model showed the best results: ROC-AUC of 0.803 ± 0.057, PR-AUC of 0.868 ± 0.044, Brier of 0.180 ± 0.017, sensitivity of 0.816, and specificity of 0.641. SHAP analysis confirmed that platelet count, age, INR, disease duration, and bilirubin and albumin levels made the greatest contribution to the prognosis. Conclusions: This retrospective observational study of AIH in Kazakhstan identified a patient population characterized by late diagnosis and advanced disease stages at presentation, a high frequency of overlapping autoimmune liver diseases, and a significant burden of metabolic and extrahepatic autoimmune comorbidities. The results demonstrate that an interpretable machine learning model based on routine biomarkers can effectively detect fibrosis and provide clinically interpretable risk factors. Full article

Background: Resistant major depression (RMD) is characterized by persistent depressive symptoms despite adequate pharmacological treatment, leading to functional impairment and increased physical comorbidity. Lifestyle interventions, particularly physical activity, are promising adjuncts, yet factors influencing engagement remain poorly understood. Methods: A purposive sampling approach and thematic analysis informed by a socioecological framework were employed to explore participants’ lived experiences after completing a 12-week supervised combined exercise program. Semi-structured interviews were thematically analyzed. Results: Engagement was influenced by three main themes: intrapersonal (symptoms, lifestyle, medication, program expectations), interpersonal (family, peers, healthcare professionals), and environmental (program location, schedule, session design) factors. Motivation was shaped by emotional, physical, and social goals, while barriers included fatigue, anhedonia, and side effects of medication. Conclusions: Engagement in exercise interventions for RMD is shaped by the interaction of personal, social, and environmental factors. Understanding lived experiences can inform the design of person-centered, sustainable interventions. Full article

Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article

Objective: Nocturia, defined as waking from sleep to void, is a frequent lower urinary tract symptom associated with impaired sleep quality and reduced quality of life. This study aimed to evaluate the prevalence of nocturia episodes and their impact on sleep disturbance and health-related quality of life. Methods: A questionnaire-based cross-sectional study was conducted at the Urology Outpatient Clinic of the General Hospital of Eastern Achaia between November 2023 and May 2024. Participants reporting nocturia were assessed using the Nocturia Quality of Life (N-QOL) questionnaire, the Athens Insomnia Scale (AIS), and the EQ-5D questionnaire. Demographic data and comorbid conditions were also collected. Univariate analyses and multiple linear regression were applied to identify factors associated with nocturia-related outcomes. Results: A total of 89 participants (78 men and 11 women; mean age 68.9 years) were included. Most participants reported 2–3 nocturnal voids per night. The N-QOL score was significantly associated with the frequency of nocturia episodes (r = −0.55, p < 0.0001), and regression analysis confirmed this relationship (coefficient: −6.7; 95% CI: −10.4 to −3.1). Individuals scoring ≥ 8 on the OAB-V8 scale demonstrated significantly lower N-QOL performance. Conclusions: Increasing nocturia frequency is associated with impaired sleep, reduced vitality, and diminished quality of life, particularly among older adults. Nocturia should be recognized as a clinically relevant symptom requiring targeted evaluation and personalized management strategies. Full article

Background: Selective immunoglobulin A deficiency (sIgAD), the most common primary immunodeficiency, is associated with recurrent respiratory infections. Despite the established role of IgA in mucosal immunity, population-based data evaluating COVID-19 susceptibility and severity among individuals with sIgAD are scarce. Objectives: This study aimed to evaluate the association between selective IgA deficiency and the risk of SARS-CoV-2 infection, recurrent infection, COVID-19-related hospitalization, and vaccination uptake. Design and Setting: We conducted a retrospective population-based cohort study using the Clalit Health Services electronic health record database in Israel. Methods: Adults aged ≥18 years with documented serum IgA measurements between 2020 and 2022 were included. Selective IgA deficiency was defined as serum IgA < 7 mg/dL with normal IgG and IgM levels. Individuals with sIgAD were matched 1:4 with controls with normal IgA levels by age and sex. Outcomes included documented SARS-CoV-2 infection, recurrent infection (>2 episodes), COVID-19-related hospitalization, and vaccination status. Multivariable logistic regression models were adjusted for demographic characteristics, comorbidities, and vaccination status. Results: The matched cohort included 61,150 individuals (12,230 with sIgAD and 48,920 controls). The risk of primary SARS-CoV-2 infection did not differ significantly between groups (13.0% vs. 14.0%; adjusted OR 1.03, 95% CI 0.95–1.12). However, individuals with sIgAD had increased odds of recurrent infection (adjusted OR 1.15, 95% CI 1.09–1.22) and COVID-19-related hospitalization (adjusted OR 1.40, 95% CI 1.22–1.60). Booster vaccination uptake was slightly higher among individuals with sIgAD. Conclusions: Selective IgA deficiency was not associated with increased susceptibility to primary SARS-CoV-2 infection but was independently associated with recurrent infection and increased risk of hospitalization. These findings underscore the importance of mucosal immunity in post-infection viral control and suggest that individuals with sIgAD may benefit from closer monitoring after COVID-19 infection. Full article

Background: Recurrence remains a major challenge in the management of Clostridioides difficile infection (CDI), with reported rates of 20–30% after an index episode. Identification of factors associated with recurrence is essential for improved risk stratification. Methods: This retrospective cohort study included 100 adult patients diagnosed with CDI. Factors associated with recurrent CDI were evaluated using univariable analyses, receiver operating characteristic analysis and backward stepwise logistic regression. Results: Eighteen patients (18%) developed recurrent CDI. Baseline demographic characteristics, comorbidity burden, clinical presentation and admission laboratory parameters were not significantly associated with recurrence. Previous hospitalization within the preceding 12 months, longer duration of antibiotic therapy and poor or partial response to initial treatment were independently associated with recurrence. Duration of antibiotic treatment showed the strongest discriminatory performance (AUC 0.712). Predictive models combining treatment response, antibiotic duration and prior hospitalization demonstrated incremental improvement in discrimination, achieving an AUC of 0.775. Associations with specific antibiotic classes did not persist after adjustment for healthcare exposure and treatment duration. Conclusions: Recurrent CDI was associated primarily with healthcare exposure and post-diagnosis treatment characteristics rather than baseline clinical or laboratory features. These findings support the relevance of integrating antibiotic burden and early treatment response into recurrence risk assessment. However, the relatively small number of recurrent cases warrants cautious interpretation of these findings. Full article

Background: Obesity is commonly seen as a condition of overnutrition; however, it is paradoxically associated with micronutrient deficiencies. These deficiencies are clinically relevant and may contribute to the progression of obesity-related comorbidities through interconnected pathways, including chronic low-grade inflammation, oxidative stress, gut dysbiosis, and impaired nutrient absorption. Objectives: This narrative review aims to summarize current evidence regarding the prevalence, underlying mechanisms, and clinical consequences of micronutrient deficiencies in individuals with obesity, with particular emphasis on their metabolic implications and potential therapeutic strategies. Results: Among individuals with obesity, iron, zinc, magnesium, calcium, vitamin D, vitamin B12, and folate are the most frequently reported deficiencies. These deficiencies arise from multiple mechanisms, including poor diet quality, increased metabolic demands, and compromised gastrointestinal absorption. In addition, obesity-related alterations in pharmacokinetics may further interfere with micronutrient distribution and bioavailability. Together, these mechanisms may lead to various clinical outcomes, such as anemia, immune, metabolic, and cardiovascular dysfunctions, along with cognitive impairment. Although several studies suggest that correcting these deficiencies may improve clinical outcomes, findings remain inconsistent, highlighting the complex and multifactorial pathophysiology underlying micronutrient imbalance in obesity. Conclusions: Micronutrient deficiencies represent frequently overlooked contributors to metabolic dysregulation in obesity. Their identification and correction should be considered a central part of the obesity management strategy. A personalized supplementation approach, based on clinical, biological, and pathophysiological characteristics, may provide a complementary support for weight-management treatments. Full article