Search Results (27,097)

Background/Objectives: Effective cardiovascular prevention requires improved risk perception and appropriate communication strategies that support cost-effective interventions. This study evaluated one-year changes in cardiovascular risk estimation accuracy and examined associations between communication strategies, accuracy, and health outcomes. Methods: We analyzed 200 participants (mean age: 56.06 ± 6.26; 32.2% male) in a population-based study conducted in Hungary. Cardiovascular risk was calculated using the Framingham Risk Score based on laboratory and anthropometric measures, and subjective risk perception was assessed and categorized as realistic, optimistic, or pessimistic relative to objective risk. All participants received written risk feedback, while subgroups additionally participated in individual or group-based risk communication. Results: After 12 months, the proportion of participants with accurate risk perception increased from 39.0% to 50.5% (p = 0.012), accompanied by a significant reduction in pessimistic estimations (p = 0.013). We could not observe significant differences in estimation accuracy between communication strategies. The written-only communication group showed a significant decrease in cardiovascular risk factors (weight (p = 0.014), BMI (p = 0.042), blood pressure (p = 0.035), and LDL levels (p = 0.001)). No significant differences were found in health outcomes between risk communication groups. Conclusions: These results demonstrate that even written-only communication may be an effective way to improve cardiovascular health outcomes, possibly by correcting risk perception gaps, suggesting that cost-effective, low-intensity communication strategies may be sufficient to support primary prevention efforts. Full article

Background: Emerging evidence has established ferroptosis as a vital factor in the pathogenesis of cardiovascular diseases, especially in septic cardiomyopathy (SCM). Meanwhile, ondansetron (OND), a well-established 5-HT3 receptor antagonist, has gained increasing attention for its pleiotropic effects. However, its potential to modulate ferroptosis in the cardiovascular field remains unexplored. This study aims to fill this gap by exploring the potential of OND as an innovative therapeutic intervention for SCM. Methods: This study utilized both in vitro and in vivo models of septic cardiomyopathy (SCM), which was induced by lipopolysaccharide (LPS) stimulation in neonatal rat cardiomyocytes (NRCMs) and C57BL/6 mice. Through RNA sequencing, as well as molecular and functional assessments—including echocardiography and ferroptosis-related measurements—we revealed the anti-ferroptotic effect of ondansetron (OND). Mechanistically, ATF3 was identified as a pivotal regulator, with its overexpression via AAV9 in vivo and ADV in vitro confirming its role in OND-induced cardioprotection. Results: Ondansetron (OND) showed potent anti-ferroptotic effects in both cellular and murine models of septic cardiomyopathy (SCM). Treatment with OND not only improved cardiac performance but also reduced ferroptotic markers, mitigated lipid peroxidation and iron overload, and bolstered antioxidant defense. Notably, OND administration attenuated oxidative and endoplasmic reticulum (ER) stress while restoring mitochondrial integrity. Mechanistically, the anti-ferroptotic activity of OND was mediated through the HTR3A/ATF3 axis: ATF3 overexpression negated OND’s protective effects, while HTR3A antagonism with VUF10166 recapitulated its benefits. Conversely, HTR3A agonism with PBG attenuated ferroptosis resistance, further implicating this pathway as central to OND’s mechanism. Conclusions: This study demonstrated a novel pharmacological role for ondansetron (OND) in attenuating ferroptosis in septic cardiomyopathy (SCM) via the HTR3A/ATF3 signaling pathway. This finding delineates a novel therapeutic avenue and supports the repurposing of OND beyond its traditional antiemetic use to cardiovascular applications. Full article

Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. Data were collected using the Audit of Diabetes–Dependent Quality of Life (ADDQoL) and the Personal Diabetes Questionnaire (PDQ). Anthropometric and clinical measures included weight, height, body mass index (BMI), blood pressure, and glycated hemoglobin (HbA1c). Results: Most participants (73.5%) were ≤50 years of age, and the majority were obese (56.0%) or overweight (28.0%). Nearly half (54.5%) had HbA1c levels ≥ 8.0%, while (50.5%) were hypertensive. Overall, 96% of participants reported a poor to extremely poor QoL. Female sex (p = 0.003), higher BMI (p = 0.034), diet type (p = 0.039), and satisfaction with glucose control (p < 0.001) were significantly associated with the QoL. Conclusions: T2DM substantially impairs the QoL of affected Saudi adults. Psychosocial and lifestyle-related factors, particularly obesity, gender, dietary practices, and perceived glucose control, are more influential than traditional clinical markers. Culturally tailored interventions targeting these determinants may improve patient outcomes. Full article

The rhotrix, introduced as a rhomboidal extension of traditional matrix theory, offers a unique algebraic framework for the organization and manipulation of numerical arrays. The incorporation of refined neutrosophic concepts into rhotrix theory has enabled the modeling of uncertainty, indeterminacy, and inconsistency within algebraic frameworks. Motivated by these developments, this paper investigates the structure of invertible refined neutrosophic rhotrices, thereby extending the classical theory of rhotrices into the domain of refined neutrosophic. This study is carried out using heart-based multiplication, which acts as the fundamental operation governing interactions among rhotrix elements. This setting facilitates a rigorous analysis of rhotrix algebra, specifically identifying the conditions required for invertibility and exploring the structural response of refined neutrosophic elements to basic operations defined for rhotrices. In addition to the invertibility analysis, this study analyzes the index structures of rhotrices of small orders, establishes the general characterization of the rhotrix index set, and reveals an inherent symmetry of the rhotrix structure under the interchange of indices. It also proposes a rhotrix-based representation of binary relations, illustrating the broader applicability of refined neutrosophic rhotrices in modeling relational and algebraic structures. To demonstrate the practical relevance of the developed framework, a refined neutrosophic decision-making model is applied to the evaluation of selected women empowerment schemes. By incorporating real-valued performance measures together with indeterminacy components reflecting expert uncertainty, the proposed model provides a systematic mechanism for multi-criteria assessment and ranking of policy interventions. The results contribute to the advancement of rhotrix algebra in indeterminate environments and highlight its potential applications in mathematical modeling and decision-making. Full article

Background: Iron deficiency (ID) is a prevalent condition in patients with cardiovascular diseases, irrespective of anemia, associated with adverse outcomes. Its incidence and prognostic value in acute coronary syndromes (ACS) are yet to be established. Current literature on the matter is scarce, and further research is necessary to confirm a clear link between ID and possible adverse outcome prediction in this group. Aims: This study aimed to evaluate the incidence and prognostic value of ID in ACS patients, and associations between iron parameters and patients’ characteristics, comorbidities, hospitalization length, laboratory results, electrocardiographic, echocardiographic assessment, and invasive coronary angiography results. Methods: We conducted an observational prospective study enrolling 214 consecutive patients after ACS. Adverse events were defined as all-cause death or non-elective rehospitalization due to cardiovascular causes. Results: ID patients constituted 46.7% of the studied cohort. ID was associated with higher NT-proBNP on admission (p = 0.03). Higher TSAT was independently associated with lower peak troponin levels (β = −0.03, standardized β = −0.15, p = 0.03). Ferritin < 100 ng/mL was paradoxically associated with shorter in-hospital stay (p = 0.03). In multivariable analysis, ID was an independent predictor of composite endpoint (HR 1.94 [95% CI: 1.02–3.67], p = 0.04); however, no significant differences in event-free survival have been identified between ID and non-ID groups. Conclusions: ID is a common condition in ACS patients, associated with higher values of biomarkers reflecting cardiac damage, and may constitute an important predictor of adverse events after discharge. Further, larger, preferably multicenter studies are required to establish the exact association between ID and mortality among ACS patients treated with percutaneous coronary intervention. Full article

Background: Severe, treatment-resistant Obsessive–Compulsive Disorder (OCD) remains a major clinical challenge. When conventional pharmacological and psychotherapeutic strategies fail, neuromodulatory interventions such as repetitive transcranial magnetic stimulation (rTMS) and psychosurgical approaches are increasingly considered. Although both modalities target nodes within the cortico-striato-thalamo-cortical (CSTC) circuit, their relative effectiveness has not been examined within a unified analytical framework. Objective: We aimed to compare responder rates between rTMS and psychosurgical interventions in adults with treatment-resistant OCD through a systematic review and meta-analysis. Methods: A PRISMA-guided search of PubMed and Scopus (2015–2025) identified clinical studies reporting treatment response. Pooled responder rates were estimated separately for each modality using random-effects models. Between-study heterogeneity and publication bias were systematically assessed. Results: Fourteen studies met inclusion criteria, including 10 rTMS studies (416 participants) and four lesion-based psychosurgical studies (142 participants). Both modalities demonstrated clinically meaningful responder rates. Pooled analyses suggested higher responder proportions in psychosurgical cohorts (RR = 3.06, 95% CI 1.43–6.54); however, this finding was accompanied by substantial heterogeneity (I² = 63%) and signals of publication bias. Follow-up duration differed markedly between modalities (mean 2.4 months for rTMS vs. 33.0 months for psychosurgery), reflecting fundamentally different study designs and outcome assessment timepoints. Conclusions: Differences in pooled responder rates should be interpreted as exploratory rather than as evidence of comparative efficacy. The lack of a shared comparator, differences in patient selection, and large discrepancies in follow-up limit direct comparisons between modalities. These findings support a stepped-care framework for neuromodulation in treatment-resistant OCD and highlight the need for methodologically harmonized studies to better define the role of each intervention across distinct clinical profiles of treatment resistance. Full article

Background: Intensive care units (ICUs) provide management of critically ill patients requiring continuous monitoring and complex therapeutic interventions. The aim of this study was to analyze the clinical and biological characteristics associated with mortality in patients admitted to the intensive care unit. Methods: This retrospective observational study included 108 adult patients admitted to the Anesthesia and Intensive Care Unit of the “Sf. Apostol Andrei” Emergency County Clinical Hospital in Galați, who were in a coma at the time of admission. Demographic data, comorbidities, clinical parameters and biological biomarkers determined at admission were analyzed. Statistical analysis was performed using the SPSS program and included non-parametric tests (Mann–Whitney U), Spearman correlation analysis, multivariate logistic regression and ROC curve analysis to evaluate the predictive performance of biomarkers. Results: Hypertension (60.2%) and diabetes mellitus (35.2%) were the most common comorbidities. Comparative analysis revealed significant differences between deceased and surviving patients for several biological parameters, including leukocytes, C-reactive protein, LDH, D-dimers, INR and APTT. In multivariate analysis, LDH (OR = 0.998; p < 0.001) and APTT (OR = 0.951; p = 0.033) remained independently associated with mortality. ROC analysis revealed good discrimination capacity for LDH (AUC ≈ 0.805) and moderate performance for APTT. Conclusions: Determination of LDH and APTT at the time of admission to the ICU may provide useful information for assessing the prognosis of critically ill patients and for early stratification of mortality risk. Full article

Background: Erectile dysfunction (ED) is a common complication of type 2 diabetes and obesity and significantly affects patients’ quality of life. Nursing care for patients with metabolic multimorbidity requires a holistic, structured approach. The International Classification for Nursing Practice (ICNP^®) enables standardized formulation of nursing diagnoses, interventions, and outcomes and supports structured and individualized ICNP^®-based care planning. Aim: This study aimed to develop and present an ICNP^®-based nursing care plan for a patient with erectile dysfunction associated with type 2 diabetes and obesity and to demonstrate the applicability of ICNP^® in holistic nursing management of chronic disease. Methods: A descriptive single-case study was conducted in 2025 in a cardiology ward in Poland. Data were collected using a nursing interview, observation, medical documentation analysis, and standardized tools (IIEF-5, SF-36v2). Based on a comprehensive assessment of physical, psychological, and social status, nursing diagnoses, interventions, and expected outcomes were formulated according to ICNP^® terminology. Results: The patient presented with poorly controlled diabetes, class I obesity, moderate erectile dysfunction, reduced testosterone levels, and decreased quality of life, particularly in psychosocial domains. Key ICNP^® nursing diagnoses included erectile dysfunction, deficient knowledge, obesity, disturbed psychological status, impaired endocrine function, impaired cardiovascular function, and impaired adaptation. Individualized ICNP^®-based interventions focused on metabolic control, lifestyle modification, sexual health support, education, and psychosocial support. Implementation of the care plan was associated with improvements in health behaviors, disease knowledge, and psychological well-being. Conclusions: ICNP^® provides a useful framework for structured and comprehensive nursing care in patients with diabetes-related erectile dysfunction and multimorbidity. Case-based ICNP^® care planning supports holistic management, interdisciplinary collaboration, and quality improvement in chronic disease nursing. Full article

(1) Background: Previous studies have shown that increased Problematic Internet Use (PIU) is associated with higher Fear of Missing Out (FoMO). However, the role of gender in this association remains unclear. Evidence suggests that males and females may experience PIU and FoMO differently, warranting further examination of gender differences. (2) Methods: In this cross-sectional study, a total of 4370 U.S. adolescents aged 12–17 years (47% female) were recruited through Qualtrics research panels and completed a national online survey on adolescent health and technology. Demographic information collected included age, race, and gender. PIU was measured using the validated three-item Problematic and Risky Internet Use Screening Scale (PRIUSS-3), while FoMO was measured using a validated 10-item FoMO scale. Multiple linear regression analysis examined the relationship between PIU and FoMO, including an interaction term between PIU and gender to assess the potential gender moderation effect while adjusting for age and race. (3) Results: Gender significantly moderated the relationship between PIU and FoMO, indicating that males experience a stronger association between PIU and FoMO compared to females. While higher PIU scores were significantly associated with higher FoMO for both males and females, each unit increase in PIU corresponded to a 0.15 point increase in FoMO for females (SE = 0.01, p < 0.01), and an additional 0.03 point increase for males (SE = 0.01, p < 0.01). (4) Conclusion: These findings illustrate the complex relationship between PIU and FoMO, highlighting the importance of gender-specific strategies and targeted interventions for promoting healthy Internet use. Full article

Psychosis presents significant treatment challenges, and standard Cognitive Behavioral Therapy for psychosis often faces limitations due to patient engagement issues and reliance on subjective self-reporting. The integration of Virtual Reality (VR), physiological biosensors, and artificial intelligence offers a transformative opportunity to address these challenges. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A thorough literature search was performed across seven databases. Twelve randomized controlled trials involving 1504 participants were included to assess VR-assisted CBT, VR treatment, and AVATAR therapy. Meta-analyses showed that VR interventions significantly decreased auditory verbal hallucinations (pooled SMD = −0.24, p = 0.0011) and paranoid thoughts (SMD = −0.26, p < 0.0001) compared to control conditions. This review supports integrating multi-modal biosensors to collect real-time, objective physiological data. Such integration enables the development of AI-driven, closed-loop systems that dynamically adjust the virtual environment based on the patient’s physiological state. VR-assisted therapies effectively reduce positive symptoms of psychosis. Incorporating biosensors is a crucial step toward a data-driven approach for personalized, closed-loop psychiatric care. Future efforts should focus on large-scale clinical trials, biomarker validation, and robust ethical frameworks to ensure safe and effective implementation. Full article

This prospective observational study aimed to estimate the annual service-based incidence of individuals with First Episode Psychosis (FEP) and high-risk states for psychosis presenting to a public Community Mental Health Center within a defined urban catchment area in Northwestern Greece. It offers novel real-world insights into early intervention in psychosis within a resource-constrained, post-crisis health care setting. All individuals aged ≥16 years who presented to the Community Mental Health Center of the University of Ioannina between January 2023 and December 2024 were assessed. Those diagnosed with FEP or identified as being at a high risk for psychosis using the Comprehensive Assessment of At-Risk Mental States were included, while duration of untreated psychosis (DUP) was estimated with the Symptom Onset in Schizophrenia inventory. Among 1115 service users, 51 (4.6%) met criteria for FEP (N = 33) or high-risk states (N = 18), rising to 7.5% among those aged 16–36 years. The annual service-based incidence of FEP was 10.26 per 100,000 in the general population, increasing to 51.62 in individuals aged 16–36 and 63.17 in those aged 16–26. Including high-risk cases, service-based incidence reached 109.71 per 100,000 in the 16–26 age group. Mean DUP was 39.4 weeks but was 7.0 weeks among 80% with DUP < 1 year. Most FEP patients (63.6%) required brief hospitalization, and over half reported family history of mental illness. These findings highlight substantial community caseloads and the need to strengthen early intervention services. Full article

Background: Diabetes mellitus is frequently associated with complications and comorbidities that often require hospitalization and the use of multiple medications for effective management. However, the simultaneous use of these treatments significantly increases the risk of potential drug–drug interactions (pDDIs). Objectives: This study assessed the prevalence, levels, and associated predictors of pDDIs among hospitalized participants with type 2 diabetes mellitus (T2DM) and evaluated their clinical relevance and implications for monitoring and management. Methods: This retrospective cross-sectional study included 430 inpatients with T2DM at Universitas Indonesia Hospital, Indonesia. Lexicomp^® Lexi-Interact™ software Wolters Kluwer was used to analyze and classify pDDIs based on severity, risk rating, and documentation levels. Additionally, logistic regression analysis was conducted to identify the predictors of pDDIs, and the study assessed the clinical relevance of major pDDIs. Results: Of the total participants, 84.7% (n = 364) experienced pDDIs, with 1642 interactions identified. Moderate interactions accounted for 77.5% (n = 1273), whereas major interactions constituted 12.2% (n = 201). The most common risk rating was category C (77.5%, n = 1187), and the predominant evidence support level was ‘fair’ (64.8%, n = 1064). Multivariate logistic regression analysis showed a significant association between pDDIs and of 7–12 medications used (OR = 30.1; p < 0.001), and hospital stays ≥4 days (OR = 9.7; p = 0.001). Major pDDIs were significantly linked to ≥13 medications (OR = 5.5; p = 0.002), ≥4 days hospitalization (OR = 11.3; p < 0.001), and urinary tract infections (OR = 3.5; p = 0.02). Participants with major pDDIs exhibited hypoglycemia, hyperglycemia, electrolyte imbalances, and reduced therapeutic responses. Conclusions: The findings indicate a high prevalence of pDDIs among participants with T2DM, highlighting the impact of polypharmacy, prolonged hospitalization, and comorbidities. Implementing software-based screening, close monitoring, and targeted interventions are essential to reduce adverse clinical outcomes and enhance patient safety. Full article

Background/Objectives: With an increasing number of older adults remaining physically active into later life, there is a growing need to understand how they manage pain and stress without relying on pharmacological treatment. Although regular physical activity supports functional independence and psychological resilience, many active older adults still experience fluctuating pain or stress. However, they often prefer non-pharmacological strategies and avoid analgesics, even when experiencing pain. Yoga interventions are widely used to address both physical and psychological components of health across diverse populations. Methods: Twenty-three adults aged ≥65 years participated in a once-weekly, 60 min yoga program. Pain intensity (VAS), pain vigilance and passive awareness (PVAQ), coping strategies (CSQ), and depression, anxiety, and stress (DASS-21) were assessed pre- and post-intervention. Repeated-measures ANOVA and correlational analyses were conducted. Exploratory moderation analyses examined whether individual characteristics (physical activity, age, and yoga experience) influenced associations between changes in pain-related variables. Results: After participation in a 7-week yoga program, significant differences were observed: perceived stress decreased, and passive pain awareness increased. No significant changes occurred in pain intensity, fear, depression (although a decrease was observed), or coping strategies, although participants predominantly used adaptive coping at both time points. Moderation analyses showed that physical activity buffered the association between increased passive pain awareness and heightened pain, whereas age and prior yoga experience strengthened this association. Conclusions: Even in physically active older adults, yoga participation was associated with changes in passive pain awareness and reduced stress. However, increases in passive pain awareness may differentially influence pain depending on age, physical activity level, and previous yoga experience. Full article

Background/Objectives: The loss of orthodontic microimplants is a common clinical complication that significantly disrupts the continuity of malocclusion treatment. Despite increasing clinical use of microimplant reinsertion, the factors influencing its success remain unclear. The aim of this exploratory systematic review was to examine the available literature regarding clinical outcomes related to the retention of orthodontic microimplants following their reinsertion. Methods: Studies that assessed the success of orthodontic microimplant reinserted were included in the review. Searches were conducted on 27 September 2025, in the following databases: BASE (Bielefeld Academic Search Engine), PubMed, Scopus, and EMBASE. The ROBINS-I (Risk of Bias in Non-randomized Studies—of Interventions) tool was used to assess the risk of bias. Due to heterogeneity of included studies, a narrative synthesis was performed. Results: Four of the 577 studies were included in the review. A total of 305 microimplants were reinserted in 276 patients. The overall success rate ranged from 44.16% to 66%. Analysis indicated a significantly higher success rate in the maxilla (up to 68.60%) compared to the mandible (lowest 36.84%). Furthermore, a narrative synthesis suggests better clinical outcomes for 8 mm long microimplants compared to 6 mm ones, as well as reduced reinsertion success in areas with high cancellous bone density. Regarding the modification of the insertion site, the current data are contradictory; while some studies indicate significant benefits from changing the site (e.g., to the midpalatal suture), others show no statistical difference compared to reinsertion at the same site. Overall, the evidence remains limited and heterogeneous. Conclusions: The current review of the literature on the success of reinsertion of orthodontic microimplants is subject to a high risk of misinterpretation, due to the limited amount of data and the risk of unidentified confounding factors. Further standardized clinical trials are needed to develop unified protocols for these procedures. Other: The review was prospectively registered with the Open Science Framework (OSF); osf.io/tbj2s. Full article

Background/Objectives: Acute kidney injury (AKI) is a clinically important complication among hospitalized urology patients. However, data from general urology inpatient populations remain limited. We aimed to assess AKI frequency in a monitored urology inpatient cohort, identify associated predictors, and develop an exploratory admission-based risk stratification model. Methods: We conducted a retrospective observational cohort study of adults admitted to a tertiary urology ward between June 2023 and May 2024 who had at least two serum creatinine measurements during hospitalization. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Demographic, clinical, laboratory, and procedural data were analyzed. Multivariable logistic regression identified factors associated with AKI and was used to construct a reduced exploratory admission-based risk model. Results: Among 196 monitored patients, 67 (34.2%) developed AKI during hospitalization, and 82.1% had KDIGO Stage 1 AKI. Higher admission serum creatinine, hypertension, nephrolithiasis, and ureteral interventions were independently associated with AKI. AKI was also associated with longer hospitalization (6.4 ± 4.2 vs. 5.1 ± 3.2 days, p = 0.044). The reduced exploratory model identified low-, intermediate-, and high-risk groups with progressively increasing AKI incidence (7.7%, 32.3%, and 76%, respectively; AUC = 0.76). Conclusions: In this monitored cohort, AKI was frequent and associated with admission characteristics and prolonged hospitalization. These findings support targeted renal monitoring in higher-risk patients. The admission-based risk model is exploratory and requires validation in prospective multicenter cohorts before clinical implementation. Full article