Search Results (410)

Children living with chronic diseases represent a great challenge for the health care system, their families, and communities. These young patients face continuous medical needs that affect not only their health but also their daily routines, emotional well-being, and family dynamics. In response, clinical practice is increasingly integrating psychosocial indicators alongside traditional medical parameters. Consequently, there is a growing consensus that the evaluation of pediatric chronic diseases should address not only clinical dimensions but also the disease’s impact on socialization, emotional health, and daily functioning. This narrative review explores the role of psychosocial variables in the management of pediatric chronic illnesses, including the experiences of parents and siblings, with a focus on effective strategies to improve everyday life. The integration of quality of life and well-being within a multidimensional care model could be instrumental in both symptom management and psychosocial support. Recognizing that children with chronic conditions are at increased risk for long-term adverse outcomes, it is critical to develop interventions that go beyond clinical care, encompassing education, coping reinforcement, and family-centered approaches. Full article

Background: Semaglutide and Liraglutide are medications in the Glucagon-like peptide-1 agonists (GLP-1 RAs) class used to manage type 2 diabetes mellitus and obesity in Saudi Arabia. Although the 1.0 mg once weekly dosage of Semaglutide does not have a labeled indication for the management of obesity, many believe that this dosage is more effective than the 3.0 mg once daily Liraglutide dosage for the management of both diabetes and obesity. Objective: To compare the effectiveness of the dosage of 1.0 mg of Semaglutide administered once weekly versus 3.0 mg of Liraglutide administered once daily in controlling HbA1c levels, promoting weight loss, and evaluating their financial implications among obese patients in Saudi Arabia using real-world data. Methods: A retrospective review of Electronic Medical Records (EMRs) from January 2021 to June 2024 was conducted on patients prescribed Semaglutide or Liraglutide for at least 12 months. Exclusion criteria included pre-existing severe conditions (e.g., cardiovascular disease, stroke, or cancer) and missing baseline data. The primary outcomes assessed were changes in HbA1c, weight, and direct medical costs. Results: Two hundred patients (100 patients on the 1.0 mg once weekly dose of Semaglutide and 100 patients on the 3.0 mg once daily dose of Liraglutide) of those randomly selected from the EMRs met the inclusion criteria and were included in the analysis. Of the 200 eligible patients (65.5% female, mean age 48.54 years), weight loss was greater with Semaglutide (−8.09 kg) than Liraglutide (−5.884 kg). HbA1c reduction was also greater with Semaglutide (−1.073%) than Liraglutide (−0.298%). The use of Semaglutide resulted in lower costs of USD −1264.76 (95% CI: −1826.82 to 33.76) and greater reductions in weight of −2.22 KG (95% CI: −7.68 to −2.784), as well as lower costs of USD −1264.76 (95% CI: (−2368.16 to −239.686) and greater reductions in HbA1c of −0.77% (95% CI: −0.923 to −0.0971) in more than 95% of the cost effectiveness bootstrap distributions. Conclusions: Semaglutide 1.0 mg weekly seems to be more effective and cost-saving in managing prediabetes, diabetes, and obesity compared to Liraglutide 3.0 mg daily. Future studies should examine these findings using a more representative sample and a robust study design. Full article

Background and Objectives: Sleep apnea (OSA) significantly impacts patients’ health, affecting cognitive, emotional, and social functioning, thus reducing overall quality of life (QoL). Despite global research interest, there are limited data on the QoL of Romanian patients with OSA. Aim of study: This study aimed to assess the quality of life of patients diagnosed with OSA using the Sleep Apnea Quality of Life Index (SAQLI), a validated, disease-specific questionnaire. Material and Methods: A cross-sectional study was conducted between January 2021 and February 2022 on 28 adult patients from medical units in Iași (Romania) and Albania. The patients were clinically evaluated and confirmed to have OSA (AHI > 5). QoL was assessed pre-treatment using the SAQLI, covering daily activities, social interactions, emotional status, and symptomatology. Statistical analyses were performed using SPSS v26.0. Results: Most patients had moderate (32.1%) or severe OSA (53.6%). Lower QoL scores correlated with increased disease severity. Significant impairments were observed in daily functioning, social relationships, and emotional well-being. Patients with severe OSA reported the lowest scores across all domains. Conclusions: OSA severely affects quality of life, particularly in patients with moderate to severe forms. Early diagnosis and personalized, multidisciplinary management strategies are essential to improving outcomes and overall patient well-being. Full article

Background/Objectives: Artificial intelligence (AI) offers opportunities to enhance healthcare accessibility for people with disabilities (PwDs). However, their application in Saudi Arabia remains limited. This study explores PwDs’ experiences with AI technologies within the Kingdom’s Vision 2030 digital health framework to inform inclusive healthcare innovation strategies. Methods: Semi-structured interviews were conducted with nine PwDs across Riyadh, Al-Jouf, and the Northern Border region between January and February 2025. Participants used various AI-enabled technologies, including smart home assistants, mobile health applications, communication aids, and automated scheduling systems. Thematic analysis following Braun and Clarke’s six-phase framework was employed to identify key themes and patterns. Results: Four major themes emerged: (1) accessibility and usability challenges, including voice recognition difficulties and interface barriers; (2) personalization and autonomy through AI-assisted daily living tasks and medication management; (3) technological barriers such as connectivity issues and maintenance gaps; and (4) psychological acceptance influenced by family support and cultural integration. Participants noted infrastructure gaps in rural areas, financial constraints, limited disability-specific design, and digital literacy barriers while expressing optimism regarding AI’s potential to enhance independence and health outcomes. Conclusions: Realizing the benefits of AI for disability healthcare in Saudi Arabia requires culturally adapted designs, improved infrastructure investment in rural regions, inclusive policymaking, and targeted digital literacy programs. These findings support inclusive healthcare innovation aligned with Saudi Vision 2030 goals and provide evidence-based recommendations for implementing AI healthcare technologies for PwDs in similar cultural contexts. Full article

Background: Telemonitoring aimed at detecting subclinical heart failure and facilitating medication up-titration offers a promising approach to reducing heart failure hospitalizations. Our team has recently developed a non-invasive metric called “respiratory stability time (RST)”, which quantifies respiratory instability, a surrogate marker of subclinical worsening heart failure. A decrease in RST below 20 s predicts the onset of worsening heart failure within 28 days. However, the clinical utility of RST-guided management in reducing mortality and heart failure hospitalizations remains uncertain. Methods: The Innovative Tele-Monitoring Environment To Halt Ongoing Deterioration of Heart Failure-III (ITMETHOD-HF-III) is a non-blinded, interventional, multicenter, single-arm study. Eighty heart failure patients with a history of at least two prior hospitalizations for heart failure will be enrolled. After validating the robustness of RST measurements, participants will be monitored for 1.5 years through daily RST measurements. Mandatory up-titration of heart failure medications will be started if RST values decrease below 20 s for two consecutive days or decrease progressively below 30 s over 10–90 days from RST values above 45 s maintained for over 1 month, irrespective of the presence of heart failure signs/symptoms. Medication adjustment will continue until RST exceeds 30 s. The study will compare a composite endpoint of heart failure hospitalization and cardiac death between the present RST-guided group and a historical control group from the ITMETHOD-HF-II trial, in which management was based on patients’ symptoms. Results: We anticipate that the precent ITMETHOD-HF-III study will demonstrate that mandatory, RST-guided heart failure management significantly reduces the incidence of the primary composite endpoint—heart failure hospitalization and cardiac death—compared with symptom-guided standard care in the historical control group (ITMETHOD-HF-II). Conclusions: The ITMETHOD-HF-III study aims to demonstrate the clinical efficacy of RST-guided management in reducing heart failure hospitalization rates and cardiac mortality by enabling early detection of subclinical heart failure and facilitating timely medication adjustments, irrespective of heart failure signs/symptoms. If successful, RST-guided management could establish a new standard for telemonitoring heart failure patients in outpatient settings. Full article

Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. Materials and Methods: An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. Results: A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. Conclusions: While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services. Full article

Background and Objectives: Chronic pain (CP), defined as pain persisting for over 3 months, is a significant cause of global disability and affects more than 20% of individuals in Western countries, including Italy. Substantial evidence indicates a higher prevalence of CP among women, who also experience greater sensitivity, increased frequency, and a longer duration of pain. The impact of CP on quality of life, daily functioning, and employment is profound, particularly for women. However, chronic pain research has insufficiently addressed sex and gender differences, contributing to suboptimal and inequitable care. This neglect limits the development of personalized treatment strategies and, when combined with an aging population and women’s longer life expectancy, highlights an increasing societal and economic burden. Materials and Methods: The authors conducted a narrative review of studies examining biological, psychological, or social determinants of sex-related differences in CP perception or treatment. Each thematic area was reviewed by at least two authors, who critically appraised the literature. Their analyses were refined through iterative group discussions to develop concise, evidence-informed recommendations for personalized and equitable pain management. Results: Sex differences in CP arise from a range of factors, including biological mechanisms such as hormonal and genetic influences, psycho-social factors such as depression and anxiety, and socio-economic determinants, such as income and education levels. These factors also affect sex-specific outcomes of analgesic treatments currently available. Identifying these risk factors and tailoring treatment strategies to sex differences can significantly improve CP management. Such a personalized approach is essential for advancing precision medicine in CP management. Even in the absence of molecular or genomic biomarkers, adopting a biopsychosocial model that considers sex and gender differences, symptoms, physiological indicators, medical history, lifestyle, and psychological aspects may substantially enhance patient outcomes. Conclusions: This review provides a comprehensive analysis of sex differences in CP perception, stressing the importance of individualized, interdisciplinary approaches in pain management. Addressing both the biological and psycho-social contributors to pain in men and women is critical for guiding healthcare professionals in implementing precision pain medicine strategies, ultimately fostering more equitable and effective care. Full article

Background/Objectives: Tramadol is an opioid frequently prescribed for moderate to severe pain and has seen a global increase in use. This presents numerous challenges in clinical management. This study aims to elucidate metabolic signatures associated with tramadol consumption, enhancing predictive capabilities for therapeutic outcomes and optimizing patient-specific treatment plans. Methods: Data were obtained from the Qatar Biobank (QBB), focusing on pharmacogenomic variants associated with tramadol use and prescription trends. A cohort of 27 individuals who were administered daily tramadol doses between 100 and 400 mg with available metabolomic profiles were selected. The pharmacokinetics of tramadol were evaluated in relation to specific CYP2D6 genetic variants. Comparative pharmacometabolomic profiles were generated for tramadol users versus a control group of 54 non-users. Additionally, prescription data encompassing tramadol formulations were collected from the electronic medical records (EMR) system of the major public hospital network in Qatar (Hamad Medical Corporation) to discern prescribing patterns. Results: From January 2019 to December 2022, tramadol prescriptions varied, with chronic pain as the primary indication, followed by acute pain. Pharmacogenomic analysis indicated that CYP2D6 allele variations significantly impacted tramadol and O-desmethyltramadol glucuronide levels, notably in ‘normal metabolizers’. Metabolomic analysis revealed distinct metabolic profiles in tramadol users, with significant variations in phosphatidylcholine, histidine, and lysine pathways compared to controls, highlighting tramadol’s unique biochemical impacts. Conclusions: This study underscores the importance of integrating genetic and omics-based approaches to enhance tramadol’s efficacy and safety. These findings support personalized pain management strategies, enhancing treatment outcomes for both chronic and acute pain. Full article

The subway is crucial for urban operations, especially during holidays. Unlike traditional studies using smart card data, this research analyzes National Day holiday subway travel patterns with Hangzhou’s 2021 mobile payment data, covering 42 days from 6 September to 17 October for comprehensive comparison. Considering spatial passenger flow correlations, a Composite Weight (CW) matrix integrating network distance and time is defined and integrated into a Spatial Error Model (SEM), Spatial autoregressive model (SAR), and Spatial Durbin Model (SDM) to create CW-SEM, CW-SAR, and CW-SDM. The CW matrix innovatively considers network distance and time, overcoming traditional spatial weight matrix limitations to accurately and dynamically capture passenger flow spatial correlations. The results show the following: (1) Hangzhou saw 37% and 49% increases in average daily passenger flow during the extended holiday versus workdays and weekends, with holiday peak hour flow declining 16% compared to workdays but increasing 18% versus weekends, likely due to shifted travel purposes from commuting to tourism; (2) strong spatial passenger flow correlations existed in both workdays and weekends, attributed to urban functional zoning and transport network connectivity; (3) key factors such as population, social media activity, commercial facilities and transportation hubs show significant positive correlations with holiday passenger flow. Medical facility reveals significant negative correlations with holiday passenger flow. These findings highlight the need to incorporate spatial variations into major holiday subway travel studies for urban planning and traffic management insights. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by systemic manifestations, including altered body composition, reduced quality of life, and psychological distress. Despite its significance, the relationship between body composition parameters and symptoms of fatigue, anxiety, and depression in patients with COPD remains underexplored. This study aimed to examine the association between detailed body composition metrics and quality of life, fatigue, and anxiety and depression symptoms in male patients with COPD compared to healthy controls. Methods: This cross-sectional study included 49 men with COPD and 51 age-matched healthy controls aged 50–80 years. Body composition was assessed using bioelectrical impedance analysis (BIA). Pulmonary function, dyspnea, activities of daily living, and psychological status were evaluated using spirometry, the Medical Research Council Dyspnea Scale, the London Chest Activity of Daily Living Scale (LCADL), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Compared to the controls, patients with COPD exhibited significantly lower forced expiratory volume in one second (FEV₁: 1.1 vs. 2.16 L; p < 0.001), lower fat mass (15.0 vs. 24.3 kg; p < 0.001), and higher muscle mass (53.8 vs. 42.0 kg; p < 0.001). They also reported significantly greater fatigue (Borg scale: 4 vs. 0; p < 0.001), higher anxiety (8 vs. 5; p = 0.006), and depression scores (11 vs. 5; p < 0.001), along with more pronounced limitations in their daily activities. Conclusions: COPD is associated with profound impairments in body composition, physical function, and mental health. Detailed body composition analysis using BIA provides valuable clinical insights and may aid in tailoring individualized interventions to improve quality of life and psychological outcomes in COPD management. Full article

Background/Objectives: Pain management during minor surgical procedures in wound care across various etiologies is often underestimated in daily clinical practice. Pharmacotherapy remains the most effective and efficient method for pain reduction. However, growing concerns regarding the side effects of traditional analgesics and distressing psychosomatic experiences highlight the need for innovative non-pharmacological pain management strategies. The use of virtual reality (VR) has been suggested as a potential method to alleviate pain during medical procedures. The aim of this study was to assess the feasibility of virtual reality as a non-pharmacological approach to pain reduction during the debridement and dressing of hard-to-heal vascular wounds. Methods: This prospective observational study included a cohort of 100 patients who were consulted and treated at a specialized wound care clinic in the Podkarpacie region, Poland. Participant selection was based on predefined inclusion criteria. Patients were assigned to two groups: Group A, in which VR goggles were used, and Group B, in which standard care without VR was provided. All wounds were pre-treated with Lignocaine 2% gel for approximately 3–5 min before tissue debridement. Pain intensity was measured before the procedure, during the procedure, and 10 min after completion. A structured research questionnaire was used for data collection, consisting of two parts: sociodemographic data, functional assessment, wound characteristics, clinical scales, and the Numeric Rating Scale (NRS) for pain assessment before, during, and after the procedure. Results: A total of 100 participants voluntarily took part in the study, of whom 49.0% (n = 49) were male and 51.0% (n = 51) were female. The age of participants ranged from 43 to 89 years, with a mean age of 68.02 ± 10.0 years. A statistically significant difference in pain perception was observed between the pre-procedure and intra-procedure phases of wound debridement. The average pain increase in the Group with VR was lower than in the Group without VR (p = 0.006, effect size = 0.32). Conclusion: Pain occurrence and intensity during wound debridement are common challenges in clinical practice. The visual perception of a bleeding and treated wound may contribute to the psychogenic pain component. Virtual reality may serve as a simple adjunctive method to medical procedures by diverting attention away from surgical interventions. Further research, including psychological aspects of non-pharmacological pain management, is necessary in the context of wound care prevention and treatment. Full article

Background/Objectives: Spine mobility is essential for overall health and daily functioning. Accurate assessment of spinal mobility is necessary for diagnosing and managing orthopedic, neurological, and rheumatological disorders, particularly in patients experiencing lower back and thoracic pain. The present study evaluates the effectiveness of traditional clinical tests in comparison to the innovative photogrammetric 3D posture assessment for evaluating spinal mobility. Methods: A total of 20 patients from a medical clinic underwent tests to measure lumbar and thoracic spine mobility, including flexion, lateral incline, and axial rotation, using both conventional and 3D posture assessment methods. Results: We found strong correlations between investigated methods, which recommends photogrammetry as a reliable and effective tool for assessing posture in clinical practice. Furthermore, 3D posture assessment offers a faster approach (clinical evaluation: 2:59 ± 0.22 min vs. photogrammetry: 1:03 ± 0.01 min) and a more practical method for assessing spinal mobility, thereby enhancing the patient experience and providing clinicians with objective data for treatment planning. Conclusions: The study highlights the value of modern technologies in clinical assessment and therapeutic intervention, encouraging therapists to integrate photogrammetric methods into their daily practice to improve patient outcomes. Full article

Human papillomavirus (HPV) infection represents one of the most common sexually transmitted infections worldwide. However, the lack of effective therapeutic strategies to counteract viral infection and its persistence still makes the management of HPV a medical concern. Persistence is indeed a crucial issue in the context of HPV, as it may increase the risk of viral DNA integration into the host genome, thus exposing patients to tumoral progression. This clinical study aims to evaluate the effectiveness of a dietary supplement containing epigallocatechin gallate (EGCG), folic acid (FA), vitamin B12 (B12), and hyaluronic acid (HA) in improving HPV clearance and HPV-induced cervical lesions, and in counteracting viral persistence. A total of 106 patients who tested positive for HPV DNA were enrolled in this study and were treated daily for 6 months with a tablet containing EGCG (200 mg), FA (400 μg), B12 (1 mg), and HA (50 mg) (Pervistop^®, Lo.Li. Pharma, Rome, Italy). A 6-month treatment with such combined molecules demonstrated a viral clearance in 85.8% of enrolled patients, while 92.3% of participants exhibited no more cervical lesions. Furthermore, 71.8% of patients with persistent infection tested negative to HPV DNA test after 6 months of treatment. The obtained data in this large population strongly support previous evidence on the efficacy of such molecules in the management of HPV infection by improving both viral clearance and related cervical lesions, and by targeting viral persistence. Full article

Background/Objectives: Current guidelines for the management of type 2 diabetes (T2D) strongly recommend the use of sodium–glucose cotransporter 2 inhibitors (SGLT2is) in patients with chronic kidney disease (CKD) to alleviate cardiorenal risk. However, the implementation of this guidance in daily practice remains limited. In a real-world setting, we evaluated the frequency of SGLT2i use in elderly people with T2D and CKD and compared patient profiles between SGLT2i users and non-users. Methods: We retrospectively analyzed the medical records of individuals over 65 years of age followed in outpatient internal medicine clinics in Greece. Demographic and laboratory parameters, comorbidity profiles, and medication use were recorded and compared between the SGLT2i and non-SGLT2i groups. Results: The analysis included 135 patients with T2D and CKD, of whom the majority (57.8%) did not receive SGLT2i treatment. The patients in the SGLT2i group were younger (p = 0.006), had higher creatinine (p = 0.001) and hemoglobin (p = 0.001) values, and lower levels of uric acid (p = 0.025) than the participants not treated with SGLT2is. Heart failure rates were similar between the groups (p = 0.252). There was no difference in the use of renin–angiotensin–aldosterone system inhibitors (p = 0.210); in contrast, treatment with glucagon-like peptide 1 receptor agonists was more frequent in the group receiving SGLT2is compared to the group not treated with gliflozins (p = 0.002). Conclusions: Real-world data confirm the benefits of SGLT2i treatment for elderly people with T2D and CKD. However, our findings indicate that the use of gliflozins in this population of patients remains suboptimal, highlighting the need for greater vigilance among prescribers to align with existing guidelines. Full article

Effective medical waste management is crucial for minimizing environmental contamination, protecting occupational health, and advancing sustainability goals in healthcare systems. However, microbiology laboratories remain underexplored in waste characterization studies, despite their potential to contribute to sustainable healthcare operations. This study assessed waste generation patterns, classification accuracy, and the impact of training on regulatory compliance in a university hospital microbiology laboratory. Over 45 days, waste from six specialized units was categorized and weighed daily. A survey of 304 healthcare professionals evaluated their knowledge of medical waste handling. Statistical analyses revealed that training frequency (R² = 0.72, p < 0.01) was the most significant predictor of compliance, while years of experience had no measurable impact. On average, the laboratory generated 22.78 kg/day of medical waste, 11.67 kg/day of liquid waste, and 5.61 kg/day of sharps waste, with the bacteriology unit being the largest contributor. Despite adequate general awareness, 15% of staff misclassified hazardous waste—particularly expired pharmaceuticals and cytotoxic vials—indicating critical gaps in practice. The findings support the need for recurring training programs, stricter monitoring systems, improved waste labeling, and the integration of digital tracking tools. These interventions can reduce environmental burdens, enhance healthcare sustainability, and support the development of more resilient waste management systems in medical institutions. Future research should explore how AI and automation can further strengthen sustainable healthcare waste strategies. Full article