Search Results (56)

Background/Objectives: Neurodegenerative proteinopathies, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB), are increasingly prevalent worldwide mainly due to population aging. These conditions are marked by complex etiologies, overlapping pathologies, and progressive clinical decline, with significant consequences for patients, caregivers, and healthcare systems. This review aims to synthesize evidence on the healthcare complexities of major neurodegenerative proteinopathies to highlight current knowledge gaps, and to inform future care models, policies, and research directions. Methods: We conducted a comprehensive literature search in PubMed/MEDLINE using combinations of MeSH terms and keywords related to neurodegenerative diseases, proteinopathies, diagnosis, sex, management, treatment, caregiver burden, and healthcare delivery. Studies were included if they addressed the clinical, pathophysiological, economic, or care-related complexities of aging-related neurodegenerative proteinopathies. Results: Key themes identified include the following: (1) multifactorial and unclear etiologies with frequent co-pathologies; (2) long prodromal phases with emerging biomarkers; (3) lack of effective disease-modifying therapies; (4) progressive nature requiring ongoing and individualized care; (5) high caregiver burden; (6) escalating healthcare and societal costs; and (7) the critical role of multidisciplinary and multi-domain care models involving specialists, primary care, and allied health professionals. Conclusions: The complexity and cost of neurodegenerative proteinopathies highlight the urgent need for prevention-focused strategies, innovative care models, early interventions, and integrated policies that support patients and caregivers. Prevention through the early identification of risk factors and prodromal signs is critical. Investing in research to develop effective disease-modifying therapies and improve early detection will be essential to reducing the long-term burden of these disorders. Full article

Antimicrobial resistance is an escalating global threat that undermines the efficacy of modern antibiotics and places a substantial economic burden on healthcare systems—costing Europe alone over EUR 11.7 billion each year due to rising medical expenses and productivity losses. While genomics and transcriptomics have significantly advanced our understanding of the genetic foundations of resistance, they often fail to capture the dynamic, real-time adaptations that enable bacterial survival. Proteomics, particularly mass spectrometry-based strategies, bridges this gap by uncovering the functional protein-level changes that drive resistance, persistence, and tolerance under antibiotic pressure. In this review, we examine how proteomic approaches provide new insights into resistance mechanisms across various antibiotic classes, with a particular focus on β-lactams, aminoglycosides, and fluoroquinolones, highlighting clinically relevant pathogens, especially members of the ESKAPE group. Finally, we examine future directions, including the integration of proteomics with other omic technologies and the growing role of artificial intelligence in resistance prediction, paving the way for more predictive, personalized, and effective solutions to combat antimicrobial resistance. Full article

Physician burnout is a multifaceted syndrome characterized by emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. It affects physicians at various stages of their medical training more prevalently than their peers in the general population. This article aims to explore the systemic challenges contributing to physician burnout and the role of individual resilience as a mitigating factor. The article highlights that burnout not only impacts physician well-being but also patient care, organizational performance and healthcare costs. Factors such as heavy workload, long hours and poor interpersonal relationships significantly contribute to burnout, while personal characteristics and coping mechanisms can influence its prevalence. By examining the interplay between systemic challenges and individual resilience, this article contributes to a deeper understanding of physician burnout. It offers insights into potential strategies for mitigation, highlighting the importance of both organizational and personal interventions in addressing this escalating crisis. Full article

This review aims to summarize the global prevalence of healthcare-associated infections in patients with acute heart failure who have been admitted to coronary care units, highlighting the underrepresented burden of infection in this high-risk population. Coronary care units (CCUs) play a pivotal role in the care of patients experiencing acute or decompensated heart failure, offering a highly monitored environment with immediate access to advanced cardiac interventions. The management of heart failure in CCUs involves a multidisciplinary approach that includes hemodynamic monitoring, pharmacologic therapy, respiratory support, and, in selected cases, mechanical circulatory assistance. The early identification of deterioration, rapid therapeutic escalation, and close monitoring of cardiac function are hallmarks of CCU care. However, the complexity and severity of illness in this population are compounded by a high risk of infections, including hospital-acquired pneumonia, bloodstream infections, and device-related infections. These infections not only increase morbidity and prolong hospitalization but also significantly impact mortality and healthcare costs. The immunocompromised state of many heart failure patients—due to poor perfusion, malnutrition, and the use of invasive devices—further elevates their vulnerability. Effective infection prevention, early diagnosis, and targeted antimicrobial therapy are, therefore, critical components of heart failure management within CCUs. This intersection of advanced cardiac care and infection control highlights the need for integrated, multidisciplinary strategies to improve outcomes in this high-risk population. Full article

Background: Multidrug-resistant bacteria (MDRB) represent a significant challenge in intensive care units (ICUs), as they limit treatment options, prolong hospital stays, and escalate healthcare costs. Respiratory ICUs are particularly affected due to the high prevalence of chronically ill patients with recurrent infections. Understanding the impact of culture positivity and MDRB on clinical outcomes and readmission rates is essential for enhancing patient care and addressing the growing burden of antimicrobial resistance. Methods: This retrospective study was conducted in a specialized respiratory ICU at a tertiary care hospital between 1 January 2019, and 1 January 2020. A total of 695 ICU admissions were analyzed, with patients grouped based on readmission status and culture results. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed using appropriate tests, with p-values ≤ 0.05 considered statistically significant. Results: Among the 519 unique patients, 65 experienced ICU readmissions. Male patients were significantly more likely to be readmitted (p = 0.008). Culture positivity was predominantly observed in respiratory samples, with Klebsiella spp. identified as the most common pathogen. MDRB prevalence exceeded 60% in both groups, significantly prolonging ICU stays (p = 0.013). However, no significant differences in survival rates were observed between MDRB-positive and MDRB-negative groups. Notably, patients with readmissions had lower C-reactive protein (CRP) levels both during admission and at discharge compared to non-readmitted patients (p = 0.004). This paradox may reflect a subclinical inflammatory response associated with bacterial colonization rather than active infection, particularly in patients with chronic respiratory diseases. Conclusions: MDRB infections and culture positivity are key contributors to prolonged ICU stays, resulting in increased healthcare costs. Implementing effective strategies to manage MDRB infections is critical for improving outcomes in respiratory ICUs and reducing associated risks. This study underscores the growing burden of MDRB and highlights the importance of enhanced antimicrobial stewardship in respiratory ICUs. Full article

Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally. Full article

In the face of the limitations in pharmacological and surgical interventions for neurological conditions such as Parkinson’s and Alzheimer’s disease, patients are increasingly turning to non-pharmacological and alternative therapies to manage their symptoms and improve their quality of life. This shift underscores the urgent need for accessible, effective, and affordable treatments. This literature review examines a range of alternative and personalized therapies, including game therapy, animal-assisted therapy, dance therapy, art therapy, music therapy, aroma therapy, and shinrin-yoku therapy. These modalities have demonstrated promising results in mitigating symptoms and enhancing well-being among individuals grappling with neurological disorders. Moreover, these therapies offer a holistic approach that complements traditional medical interventions, underscoring the importance of integrating diverse treatment modalities. Despite their historical roots in non-clinical settings, their potential in modern clinical practice remains untapped. The findings suggest the necessity for further research, particularly large cohort studies, to validate the efficacy of these personalized therapies and advocate for their widespread adoption. In an era marked by escalating healthcare costs, the exploration of alternative therapies presents a compelling avenue for enhancing patient care while simultaneously addressing economic challenges within the healthcare system. Full article

Background: Ventriculoperitoneal shunting (VPS) is the primary treatment for hydrocephalus, significantly improving patients’ outcomes. However, it is marred by high failure rates due to infections, which account for a third of these malfunctions and escalate morbidity, mortality, and healthcare costs. Method: This study focused on evaluating VPS infection rates, pathogens, their resistance patterns, and the impact on clinical outcomes using retrospective data from multiple hospitals in Saudi Arabia. It included data from hydrocephalus patients who underwent VPS and only considered positive cultures that were confirmed from CSF or shunt tip samples. Results: This study excluded patients with prior infections before VPS placement or those treated with alternatives to VPS. Out of 317 patients who met the inclusion criteria, the analysis revealed that 23 patients (7.26%) suffered from VPS infections, mostly within the first two weeks post-surgery (58.06% of cases), with a significant discrepancy in infection rates between hospitals. Infections predominantly involved Gram-positive bacteria (58.08%), especially coagulase-negative staphylococci and Staphylococcus aureus (25.81% and 12.90%, respectively). There was also a substantial presence of Gram-negative bacteria and fungi, accounting for 35.46% and 6.46%, respectively. Despite general antibiotic susceptibility, resistance was significant in certain cases, including multidrug-resistant isolates like Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter ursingii. Importantly, patients with VPS infections had a tenfold increase in the length of hospital stay (70.84 days, SD ± 139.5) compared to non-infected patients (7.69 days, SD ± 20.72), indicating high morbidity and associated treatment costs. Conclusions: Our results emphasize the importance of better VPS infection control and standardized hospital protocols to decrease the incidence of VPS-related infections, both in Saudi Arabia and globally. Full article

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4–4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive–behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients. Full article

Background/Objectives: Falls among the older adult population represent a significant public health concern, often leading to diminished quality of life and serious injuries that escalate healthcare costs, and they may even prove fatal. Accurate fall risk prediction is therefore crucial for implementing timely preventive measures. However, to date, there is no definitive metric to identify individuals with high risk of experiencing a fall. To address this, the present study proposes a novel approach that transforms biomechanical time-series data, derived from gait analysis, into visual representations to facilitate the application of deep learning (DL) methods for fall risk assessment. Methods: By leveraging convolutional neural networks (CNNs) and Siamese neural networks (SNNs), the proposed framework effectively addresses the challenges of limited datasets and delivers robust predictive capabilities. Results: Through the extraction of distinctive gait-related features and the generation of class-discriminative activation maps using Grad-CAM, the random forest (RF) machine learning (ML) model not only achieves commendable accuracy (83.29%) but also enhances explainability. Conclusions: Ultimately, this study underscores the potential of advanced computational tools and machine learning algorithms to improve fall risk prediction, reduce healthcare burdens, and promote greater independence and well-being among the older adults. Full article

The prevalence and mortality associated with breast cancer have forced healthcare providers to leverage surgery, chemotherapy, radiation therapy, and immunotherapy to achieve a cure. Whereas mortality has significantly dropped over the decades, long-term toxicities and healthcare costs are prohibitive. Therefore, a better understanding of tumor biology through molecular profiling is being utilized for de-escalation of treatment where appropriate. As research evolves, there is growing evidence that less aggressive treatment regimens, when appropriately tailored, can be equally effective for certain patient populations. This approach not only enhances the quality of life for patients by reducing the financial, physical, and emotional burdens associated with more invasive therapies but also promotes a more personalized treatment strategy. By focusing on precision medicine and understanding the biological characteristics of tumors, healthcare providers and patients can make informed decisions that balance safety with efficacy. The field of molecular profiling is a promising avenue for precision-targeted de-escalation and escalation of therapy to minimize the risk–benefit ratio. Full article

The growing prevalence of antibiotic-resistant bacteria within the human microbiome has become a pressing global health crisis. While antibiotics have revolutionized medicine by significantly reducing mortality and enabling advanced medical interventions, their misuse and overuse have led to the emergence of resistant bacterial strains. Key resistance mechanisms include genetic mutations, horizontal gene transfer, and biofilm formation, with the human microbiota acting as a reservoir for antibiotic resistance genes (ARGs). Industrialization and environmental factors have exacerbated this issue, contributing to a rise in infections with multidrug-resistant (MDR) bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae. These resistant pathogens compromise the effectiveness of essential treatments like surgical prophylaxis and chemotherapy, increase healthcare costs, and prolong hospital stays. This crisis highlights the need for a global One-Health approach, particularly in regions with weak regulatory frameworks. Innovative strategies, including next-generation sequencing (NGS) technologies, offer promising avenues for mitigating resistance. Addressing this challenge requires coordinated efforts, encompassing research, policymaking, public education, and antibiotic stewardship, to safeguard current antibiotics and foster the development of new therapeutic solutions. An integrated, multidimensional strategy is essential to tackle this escalating problem and ensure the sustainability of effective antimicrobial treatments. Full article

Pandemics of infectious disease and growing anti-microbial resistance (AMR) pose major threats to global health, trade, and security. Conflict and climate change compound and accelerate these threats. The One Health approach recognizes the interconnectedness of human, animal, and environmental health, but is grounded in the biomedical model, which reduces health to the absence of disease. Biomedical responses are insufficient to meet the challenges. The COVID-19 pandemic is the most recent example of the failure of this biomedical model to address global threats, the limitations of laboratory-based surveillance, and the exclusive focus on vaccination for disease control. This paper examines the current paradigm through the lens of polio and the global campaign to eradicate it, as well as other infectious threats including mpox and drug-resistant tuberculosis, particularly in the context of armed conflict. Decades before vaccines became widely available, public health measures—ventilation, chlorination, nutrition and sanitation— led to longer, healthier, and even taller lives. Chlorine, our primary tool of public health, conquered cholera and transformed infection control in hospitals. The World Health Organization (WHO), part of the One Health alliance, focuses mainly on antibiotics and vaccines to reduce deaths due to superbugs and largely ignores the critical role of chlorine to control water-borne diseases (including polio) and other infections. Moreover, the One Health approach ignores armed conflict. Contemporary wars are characterized by indiscriminate bombing of civilians, attacks targeting healthcare, mass displacement and lack of humanitarian access, conditions which drive polio outbreaks and incubate superbugs. We discuss the growing trend of attacks on healthcare and differentiate between types: community-driven attacks targeting vaccinators in regions like Pakistan, and state-sponsored attacks by governments such as those of Syria and Russia that weaponize healthcare to deliberately harm whole populations. Both fuel outbreaks of disease. These distinct motivations necessitate tailored responses, yet the WHO aggregates these attacks in a manner that hampers effective intervention. While antimicrobial resistance is predictable, the escalating pandemic is the consequence of our reliance on antibiotics and commitment to a biomedical model that now borders on pathological. Our analysis reveals the international indenture to the biomedical model as the basis of disease control is the root driver of AMR and vaccine-derived polio. The unique power of vaccines is reduced by vaccination-only strategy, and in fact breeds vaccine-derived polio. The non-specific effects of vaccines must be leveraged, and universal vaccination must be supplemented by international investment in water chlorination. This will reduce health costs and strengthen global health security. While vaccines are an important weapon to combat pandemics and AMR, they must be accompanied by the entire arsenal of public health interventions. Full article

Almost one-fifth of breast cancer cases express Human Epidermal Growth Factor-2 (HER2), and such expression is associated with highly proliferative tumors and poor prognosis. The introduction of anti-HER2 therapies has dramatically changed the natural course of this aggressive subtype of breast cancer. However, anti-HER2 therapy can be associated with substantial toxicities, mostly cardiac, and high cost. Over the past few years, there has been growing interest in de-escalation of anti-HER2 therapies to minimize adverse events and healthcare costs, while maintaining the efficacy of treatment. Data from clinical observations and single-arm studies have eluted to the minimal impact of anti-HER2 therapy in low-risk patients, like those with node-negative and small tumors. Though single-arm, the APT trial, in which patients with node-negative, small tumors received single-agent paclitaxel for 12 cycles plus trastuzumab for 1 year, was a practice-changing study. Several other recently published studies, like the PERSEPHONE trial, have shown more convincing data that 6 months of trastuzumab is not inferior to 12 months, in terms of disease-free survival (DFS), suggesting that de-escalating strategies with shorter treatment may be appropriate for some low-risk patients. Other de-escalating strategies involved an adaptive, response-directed approach, and personalized therapy that depends on tumor genomic profiling. Full article