Search Results (14,642)

Background/Objectives: In patients with spinal cord injury (SCI), quality of life (QoL) is increasingly recognized as an important indicator of their ability to sustain both the rehabilitation process and post-rehabilitation community reintegration, and it plays a crucial role in prognosis. The primary purpose of this study was to identify the demographic and clinical correlates of different QoL domains as perceived by patients hospitalized after SCI. Methods: We conducted a cross-sectional study on a single day in the units of the Montecatone Rehabilitation Institute (MRI), the largest Italian center for intensive rehabilitation of individuals with SCI. We administered the World Health Organization Quality of Life–Short Version (WHOQOL-BREF), which consists of 26 items rated on a five-point Likert scale. Study participants included 88 adults with SCI; a total of 74% were male, with a mean age of 53.3 years (SD = 15.05). The lesion was traumatic in 74% of cases and complete in 59%. Physical health showed a weak negative association with age (r = −0.213, p = 0.05), whereas social QoL demonstrated a significant positive association with age (r = 0.215, p = 0.046). Psychological QoL was significantly lower in females compared with males (46.9 vs. 55.1, p < 0.05) and in patients living alone compared with those not living alone (46.1 vs. 54.6, p < 0.05). Conclusions: Clinicians should consider routine assessment of QoL to personalize post-discharge therapeutic plans and to implement targeted interventions aimed at improving outcomes in patients with SCI. Full article

Background/Objectives: While COVID-19 severity is strongly associated with older age, younger adults may also develop complications. This study investigated factors associated with transfer to ICU in hospitalized younger adults during May–December 2021. Materials and methods: Eighty-six consecutive patients aged ≥18 and <50 years were admitted to the University Multi-profile Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia, Bulgaria between 12 May 2021, and 7 December 2021. Results: Among 86 patients (median age 40 years; 55.8% female), common symptoms included fever (89.5%), cough (91.9%), headache (76.7%), and gastrointestinal symptoms (83.7%). Laboratory abnormalities were frequent: lymphopenia (median 0.94 × 10⁹/L), elevated CRP (28.9 mg/L), LDH (333 U/L), and ferritin (198.5 µg/L). Severe andcritical disease occurred in 17.5% of cases, with 43% requiring oxygen therapy. In descriptive/univariate analyses, ICU transfer was more frequent among patients with hypoxemia (SaO₂ < 90%) and higher CRP, D-dimer, vomiting and ferritin. In a Firth penalized logistic regression model (rare-event setting), endocrine/metabolic comorbidity showed a directionally consistent association with ICU transfer; gastrointestinal comorbidity signals were not interpretable because of extremely small cell counts. Conclusions: Younger adults usually present with mild to moderate COVID-19; however, a substantial minority develop severe illness. Hypoxemia and elevated inflammatory and coagulation markers were consistently associated with worse outcomes. Endocrine/metabolic comorbidity showed the most consistent association with transfer to ICU in this cohort, although all comorbidity estimates should be interpreted cautiously, given the small number of events. Full article

Background: Pharmacovigilance is a critical component of patient safety, particularly among older adults with chronic diseases who are frequently exposed to polypharmacy. In Kosovo, adverse drug reactions (ADRs) reported by patients remain insufficiently recognized within the healthcare system. Polypharmacy, limited access to pharmaceutical counseling, and self-medication practices may contribute to increased medication-related harm. Capturing ADRs directly from patients provides valuable insight into medication safety challenges and communication gaps in clinical care. Objective: To assess the frequency, characteristics, and reporting behavior of adverse drug reactions among adults aged 60–75 years with chronic diseases in Kosovo, and to identify factors associated with awareness and reporting practices. Methods: A multicenter cross-sectional study was conducted between January and September 2025 in four major cities in Kosovo (Prishtina, Prizren, Peja, and Gjilan). A total of 1024 patients receiving continuous therapy for at least one chronic condition were surveyed using a structured questionnaire covering demographic characteristics, drug exposure, ADR experience, and reporting behavior. Statistical analyses included descriptive statistics, chi-square testing, and multivariable logistic regression to identify predictors of ADR reporting. Results: Overall, 47.3% of participants reported experiencing at least one ADR in the preceding 12 months. Among those, 39.5% reported the event to a healthcare professional, whereas 60.5% did not seek professional advice. The most frequently implicated drug classes were antihypertensives (32.8%), analgesics and non-steroidal anti-inflammatory drugs (27.4%), and antirheumatic agents (14.6%), with mainly gastrointestinal (24.1%) and cardiovascular (18.9%) manifestations. Approximately 19.8% of participants reported discontinuing medication due to adverse effects. Female patients were more likely to report ADRs compared to males (p < 0.01). Lack of prior counseling about potential side effects was independently associated with lower reporting (OR = 2.17; 95% CI: 1.41–3.33). Patients using more than six medications had a higher prevalence of ADRs (61.2%). Conclusion: Adverse drug reactions were frequently reported by older patients, while formal reporting to healthcare professionals remained limited. Strengthening patient education, improving patient–provider communication, and integrating clinical pharmacists into primary care may enhance pharmacovigilance practices and medication safety. Full article

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on the psychosocial aspects of living with CF in adults. Methods: Following PRISMA guidelines, a literature search was conducted in November 2024 across several databases, including Scopus, ScienceDirect, Academic Search Complete, MEDLINE, Supplemental Index, Complementary Index, APA PsycInfo, Business Source Complete, SciELO, and the Directory of Open Access Journals via EBSCO. Results: Of the 701 articles retrieved, 24 were analyzed, including a total of 2023 participants (mean age: 31.2 years; 57.2% female). Quantitative findings identified optimistic coping as the most frequent strategy associated with improved survival. High social support and gratitude emerged as key factors for treatment adherence and quality of life, while depression remained the primary mental health concern. Qualitatively, the findings highlighted concerns with adult life transitions and financial stressors. Participants described experiences of social stigma and embarrassment linked to chronic symptoms, often leading to selective disclosure to avoid discrimination. Conclusions: This review confirms that psychosocial factors are central to the adult CF experience, shifting the focus beyond biological survival and highlighting areas that require clinical intervention. As life expectancy increases, clinical care must evolve to incorporate interventions that address these factors to improve mental health and overall quality of life (QoL), ensuring that patients are supported through the unique challenges of extended adulthood. Full article

Canadian real-world data (RWD) regarding palbociclib as a first-line therapy for patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (MBC) is limited. The PALbociclib CANadian (PALCAN) study examined palbociclib utilization patterns as first-line treatment for HR+/HER2− MBC using Alberta health administrative data. The final PALCAN cohort included 472 female patients with a median age of 64 years and a median follow-up time of 22.8 months (IQR: 0.7–88.2). The median (95% CI) duration of treatment was 13.8 (12.7–15.1) months in the overall cohort (IQR: 5.6, 24.8 months), and the probability of treatment discontinuation within the first year was 45%. Aromatase inhibitors (AIs) and fulvestrant were the accompanying endocrine therapies (ETs) in 83% (N = 393) and 14% (N = 64) (15 with unknown accompanying therapy) of patients, respectively. The median duration of treatment for patients receiving an AI as an accompanying therapy was 15.1 (13.6–17.4) months and 7.9 months (5.8–12.6) for patients receiving fulvestrant, which may suggest endocrine resistance in the latter group. The PALCAN data provides insights into practice patterns and the effectiveness of palbociclib as a first-line therapy in female patients with HR+/HER2− breast cancer in the Canadian real-world setting. Full article

Background/Objectives: There is limited empirical evidence on the feasibility of inclusive, community-based exercise programs for older adults with long-term mobility disabilities. This pilot study investigated the feasibility and preliminary effectiveness of a community-based high-intensity functional training (HIFT) intervention. Methods: This single-group pre–post feasibility trial was delivered across four community-based HIFT facilities. Thirteen participants enrolled, and 10 (mean age 69.8 ± 6.7 years; 60% female) completed baseline assessments, two onboarding sessions, and thrice-weekly group-based workouts across 16 weeks. Physical function was assessed using the Canadian Occupational Performance Measure (COPM), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Modified Falls Efficacy Scale (MFES), and standardized tests of mobility, balance, and strength. Exploratory outcomes included body mass index (BMI), waist circumference, work capacity, and quality of life (QOL). Results: Recruitment, retention, and attendance rates were 38%, 77%, and 58% (80% including make-up sessions), respectively. The intervention was safe and well-tolerated, with one fall-related adverse event. Self-reported functional outcomes demonstrated small to large effects, with large improvements in participant-identified functional activities (d = 1.03–1.54) and fall efficacy (d = 0.97), and a small effect for standardized physical function (d = 0.36) Endurance improved substantially (d = 1.01), while mobility, balance, and strength outcomes reflected maintenance or small to moderate gains (d = 0.08–0.55). BMI remained stable (d = 0.05), work capacity increased with moderate to large effects (d = 0.61–1.43), and QOL improved modestly (d = 0.20). Exit interviews reinforced high acceptability, highlighting individualized adaptations, supportive trainers, and the group-based context as motivating contextual factors. Conclusions: A community-based HIFT program is feasible and acceptable for older adults with mobility disabilities. Full article

Immunocompromised patients, including those with advanced HIV infection, hematologic malignancies treated with anti-CD20 monoclonal antibodies, or combined immunodeficiencies, are at increased risk of persistent SARS-CoV-2 infection. While long-term viral shedding has been described in these patients, the extent and nature of intra-host viral evolution during long-term infection remain insufficiently documented. In this study, we report longitudinal genomic analyses of SARS-CoV-2 from three immunocompromised individuals with persistent COVID-19: (i) a female patient with follicular lymphoma receiving bendamustine-rituximab therapy with 9 months of persistence, (ii) a male patient with advanced HIV infection following prolonged antiretroviral therapy interruption with 10 months of persistence, and (iii) a female patient with Good’s Syndrome characterized by combined humoral and cellular immune deficiency with apparently four years of persistence. Replication-competent virus was detected over extended periods. Sequential whole-genome sequencing revealed the gradual accumulation of non-synonymous mutations across multiple viral genes, consistent with ongoing viral replication and intra-host diversification in the absence of effective immune control. Although based on a limited number of cases, these findings provide descriptive evidence that persistent SARS-CoV-2 infection in immunocompromised hosts can be associated with sustained viral evolution. This work highlights the importance of continued virological monitoring in selected patients with prolonged infection and contributes to the understanding of SARS-CoV-2 dynamics in settings of impaired immunity. Full article

Primary biliary cholangitis (PBC) is a chronic, cholestatic disease, with a female predominance and a female-to-male ratio of approximately 10:1, that typically follows a slowly progressive, decades-long disease course. The disease is usually asymptomatic at the time of diagnosis and it is not uncommon for a patient to present with cirrhosis. Patients with PBC may also present with extrahepatic manifestations, including pruritus, chronic fatigue, and osteoporosis, while co-existence of other autoimmune diseases, such as autoimmune hepatitis, Hashimoto’s disease, Sjogren’s syndrome, or systemic sclerosis is not uncommon. The exact pathogenesis of PBC remains elusive with a variety of different factors, including genetic, epigenetic, and environmental ones, alongside immune dysregulation leading to a dysfunction of biliary “bicarbonate umbrella”, a protective mechanism by which cholangiocyte-secreted bicarbonate creates an alkaline microenvironment shielding the epithelium from bile acid-induced injury, and increased biliary epithelial cells apoptosis. Full article

Background and Clinical Significance: Scurvy, caused by chronic vitamin C deficiency, is re-emerging in Western countries, particularly among pediatric patients with highly selective diets. While its musculoskeletal and mucocutaneous manifestations are well-known, its association with pulmonary arterial hypertension (PAH) is rare and poorly understood. Ascorbic acid and iron are essential cofactors for prolyl hydroxylases (PHD), which regulate Hypoxia-Inducible Factors. Their combined deficiency may trigger a “pseudohypoxic” state, leading to pulmonary vascular remodeling and vasoconstriction. Case Presentation: A 30-month-old female presented with a one-month history of limping, lower limb pain, and gingival hypertrophy. Dietary history revealed an almost exclusive cow’s milk-based intake. Physical examination showed diffuse petechiae, pallor, and right knee edema. Laboratory findings confirmed scurvy (undetectable vitamin C), severe iron-deficiency anemia (Hb: 72 g/L; ferritin: 22 mcg/L; RDW: 30%), folate deficiency, and hyperhomocysteinemia. Notably, elevated copper and vitamin B12 levels suggested a state of metabolic dysregulation. Echocardiography revealed moderate PAH phenotype (estimated sPAP: 47–50 mmHg) and a hyperdynamic contractility. A “perfect storm” mechanism was hypothesized, involving iron–ascorbate-dependent PHD impairment, high-output state, and oxidative-stress-induced hepcidin dysregulation (suggested by elevated copper). Following intravenous vitamin C and multivitamin supplementation, pulmonary pressures normalized within one week. Conclusions: PAH phenotype in scurvy represents a reversible metabolic disruption of pulmonary vascular tone rather than a structural disease. This case underscores the synergistic role of vitamin C, iron, and folate in vascular homeostasis. Clinicians should maintain high suspicion for scurvy in children with selective diets and unexplained PAH, as nutritional restoration is curative. Full article

Background: This study aimed to examine correlation between nurses’ assessments of health literacy in older adults, communication skills, and ageism, as well as whether these factors could be key predictors of nurse burnout. Methods: To determine which factors predict burnout among clinical nurses, a structured questionnaire was distributed to 269 clinical nurses. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and multiple regression analysis. Results: Elderly patients’ health literacy assessed by nurses showed significant correlations with communication skills, ageism, and burnout. Communication skills were negatively correlated with ageism and burnout, whereas ageism showed a strong positive correlation with burnout. Multiple regression analysis revealed that ageism (β = 0.287), communication skills (β = −0.251), female gender (β = 0.139), and aging anxiety (β = −0.181)were significant predictors of burnout, collectively explaining 29.3% of the variance in burnout. Conclusions: Ageism was the strongest predictor of burnout among clinical nurses, followed by communication skills. Strategies reducing ageism and enhancing communication competencies are essential for mitigating burnout in geriatric nursing practice. These findings highlight the need for systematic educational interventions related to the elderly tailored for both nursing students and clinical nurses. Full article

Background/Objectives: There is an ongoing search for reliable biomarkers of lung cancer (LC) and its progression, including nervous system involvement. MicroRNAs (miRNAs) play a crucial role in the regulation of gene expression and represent a promising focus of investigation in this field. The aim of this study was to assess the profile of miRNA expression in patients diagnosed with lung cancer, with or without brain metastases. Methods: This study comprised 13 patients diagnosed with non-small cell lung cancer (mean age 64.8 years, 61.5% females): 6 with brain metastases (LC + BM) and 7 without them (LC), and a control group of 6 healthy volunteers (HC). The expression levels of 179 miRNAs were assessed and compared between the study groups using quantitative reverse-transcription PCR (qRT-PCR). Results: In LC + BM subgroup, two miRNAs were found to be downregulated in comparison with HC: miR-409-3p (logFC = −17.42, p = 0.029) and miR-485-3p (logFC = −17.30, p = 0.026). An exploratory, probe-based feature-ranking analysis identified eleven miRNAs that were repeatedly selected across the resampling runs: miR-363-3p, miR-210-3p, miR-194-5p, miR-409-3p, miR-22-3p, miR-2110, miR-326, miR-485-3p, miR-223-5p, miR-16-2-3p, and miR-139-5p. Among these, miR-363-3p, miR-210-3p, and miR-194-5p exhibited the highest empirical stability. Predictive modeling was subsequently evaluated using a fully nested cross-validation framework in which feature selection and model training were repeated within each training fold. Under this stringent evaluation, the classification performance was close to chance across all the evaluated algorithms, indicating a limited predictive utility of the identified miRNAs for distinguishing patients with and without brain metastases in the present dataset. Conclusions: Notable differences in miRNA expression profiles were revealed for the patients with brain metastases from lung cancer, suggesting the role of the selected miRNAs in cancer metastasis to the CNS. However, while our analysis provides exploratory insights, the findings should be interpreted with caution and require validation in larger, independent cohorts before any clinical or translational implications can be established. Full article

We investigated whether antipsychotic treatment response was influenced by the C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase (MTHFR), and A66G of methyltetrahydrofolate–homocysteine methyltransferase reductase (MTRR)—genes central to folate and homocysteine metabolism and methylation, pathways often altered in schizophrenia patients. To our knowledge, no study has examined associations of C677T and A1298C with changes in schizophrenia symptom severity after antipsychotic treatment, while studies on metabolic outcomes remain sparse and inconsistent. The MTRR A66G has been assessed only once for metabolic parameters—not symptom severity—and sex-stratified analyses are lacking for all polymorphisms. A total of 186 antipsychotic-naïve first-episode or nonadherent chronic psychosis patients and 242 controls were genotyped using PCR-RFLP. Clinical assessments—including Positive and Negative Syndrome Scale (PANSS) scores, PANSS factor scores, and metabolic parameters (fasting plasma lipids and glucose levels, and body mass index)—were conducted at baseline and after 8 weeks. Genotype and allele frequencies did not differ between patients and controls. Significant associations emerged only for symptom changes, specifically within PANSS factor domains, in a sex-dependent manner. Female MTHFR 1298-A allele carriers (AA and AC) showed greater improvement in PANSS negative factor scores, whereas male MTRR 66-G allele carriers (GG and AG) showed reduced improvement in PANSS cognitive factor scores. Effect sizes were strong to very strong, with relatively modest contributions. MTHFR A1298C and MTRR A66G have sex-dependent impacts on symptomatic improvement—but not metabolic outcomes—after antipsychotic treatment. Accordingly, folate–homocysteine genetic markers and sex-specific factors can guide the development of personalized antipsychotic treatment approaches. Full article

Objective: In this study, we aimed to develop and internally validate a clinically applicable nomogram for predicting live birth following in vitro fertilization (IVF) using routinely available clinical and embryological parameters. Methods: This retrospective study was conducted at a single tertiary IVF center. Women undergoing IVF/ICSI were included if their baseline demographic and clinical data were available, they had undergone at least one fresh or frozen–thawed embryo transfer, and they had a known live birth outcome. Women with cycles without embryo transfer and those missing key outcome data were excluded from the analysis. As a result, a total of 2119 IVF/ICSI treatment cycles resulting in embryo transfer were included in the analysis. To identify independent predictors of live birth, multivariable logistic regression analysis was performed. Results: Among the 2119 treatment cycles analyzed, 541 resulted in live birth (25.5%). Multivariable logistic regression with backward stepwise selection identified female age (OR: 0.959, p < 0.001), high embryo quality (OR: 2.752, p < 0.001), day of embryo transfer (day 5 vs. day 3, OR: 1.427, p = 0.001), and endometrial thickness on the day of transfer as independent predictors of live birth (OR: 1.086, p < 0.001). These variables were incorporated into a nomogram (the Zübeyde Hanim IVF Nomogram) to estimate individualized live birth probability. The model demonstrated acceptable discrimination, with a bootstrap-corrected area under the receiver operating characteristic curve (AUC) of 0.64 (95%CI: 0.61–0.66), and it showed satisfactory calibration across deciles of predicted risk. Conclusions: The Zubeyde Hanim IVF Nomogram provides an individualized and clinically practical tool for predicting live birth following IVF treatment. Based on routinely available parameters, this model may assist clinicians in patient counseling and treatment planning. Full article

Background: Allograft failure after kidney transplantation remains common despite improving long-term outcomes and persistent organ scarcity. We aimed to develop and internally validate a perioperative risk model for kidney allograft failure within 2 years of transplantation. Methods: We conducted a single-center retrospective cohort study using the Medical Informatics Operating Room Vitals and Events Repository. Adult patients (≥18 years) undergoing kidney transplantation between January 2018 and July 2023 with at least 2 years of follow-up were included. The primary outcome was allograft failure within 2 years, defined as return to dialysis, pre-emptive re-transplantation, or death. Candidate predictors included demographic characteristics, comorbidities, preoperative laboratory values, and intraoperative variables. After univariate screening and variable selection with LASSO-penalized regression, we estimated relative risks using modified Poisson regression and assessed internal validity with 200 bootstrap resamples. Results: Among 319 recipients, 53 (16.6%) experienced early allograft failure. In the final multivariable model, obesity (relative risk [RR] 4.76; bootstrap 95% CI 2.88–9.31) and thrombocytopenia (RR 1.96; bootstrap 95% CI 1.18–3.38) were independently associated with increased risk. Anemia (RR 0.22; bootstrap 95% CI 0.13–0.37), preoperative clonidine use (RR 0.33; bootstrap 95% CI 0.00–0.85), and female sex (RR 0.55; bootstrap 95% CI 0.26–0.83) were associated with reduced risk. Model performance was modest (pseudo-R² 0.21) but identified clinically distinct risk strata. Conclusions: A five-variable perioperative model based on obesity, thrombocytopenia, anemia, preoperative clonidine use, and female sex identified kidney transplant recipients at differing risk of allograft failure within 2 years. These associations highlight potentially modifiable targets that warrant further study and external validation before clinical use. Full article

Background/Objectives: The All-on-4 technique is a minimally invasive approach for full-arch oral rehabilitation. In cases of anterior bone resorption, the classic All-on-4 configuration may be limited by insufficient bone for axial implant insertion. An effective alternative is the “M” configuration, where all four implants are inserted at approximately 30°. This report presents a clinical case of full-arch rehabilitation using personalized surgical guides with internal cooling, designed to optimize irrigation and prevent thermal bone damage. Methods: A 57-year-old female patient underwent digital planning and flapless guided implant surgery. At the maxilla, four DENTIS SQ implants were inserted in an “M”-shaped configuration (4 × 10 mm anterior, 4 × 14 mm posterior). Before insertion, implant beds were prepared using surgical templates with internal irrigation channels. At the mandible, four posterior implants (4 × 8 mm) were placed using dentally supported guides with internal cooling. The surgical guides were designed using Implastation and Blue Sky Plan, 3D-printed in biocompatible resin and sterilized before use. We performed the osteotomies under controlled irrigation with continuous saline flow through the integrated cooling channels. Results: The guides ensured accurate implant positioning. We did not observe intraoperative complications, and all implants achieved primary stability above 35 N·cm. Postoperative healing was uneventful, with minimal edema and no mucosal dehiscence. These indirect clinical indicators suggest that the guide also ensured effective cooling. Radiographic follow-up confirmed correct 3D positioning and intimate bone-implant contact. Conclusions: This case study shows that personalized surgical guides with integrated coolant channels may provide a safe and precise solution for flapless All-on-4 “M” rehabilitations, reducing thermal risks and enhancing surgical accuracy. Full article