Search Results (28)

Dolutegravir-based antiretroviral therapy (ART) simplification is increasingly common, although some patients cannot take this drug due to intolerance or drug resistance. Boosted-protease inhibitors (bPI) might be an option in this scenario. Nevertheless, long-term outcomes have not been studied yet. A controlled cohort study comparing 5-year outcomes of ART simplification bPI-based regimens (without integrase strand transfer inhibitor—INSTI) versus ART maintenance was conducted in a Brazilian referral center. Viral suppression rates and mortality after 5 years were the primary outcomes of the study. Eighty individuals were included in each group; 47.5% were women, and the mean age was 56 years. The five-year survival rate was 88.8% in the simplified group and 87.5% in the maintenance arm (log-rank = 0.41). Viral suppression rate was 78.8% and 70.0%, respectively (p = 0.28). Individuals presented less renal function decline (−5 vs. −10 mL/min/1.73 m²; p < 0.05) in the simplified arm. No difference was observed in metabolic parameters. Based on our findings, ART simplification without INSTI has shown efficacy and safety comparable to maintenance of triple therapy even in the long term, and could be an option in these situations, which might be even more important in settings with limited options. Full article

Background/Objectives: Influenza poses significant risks in children, causing complications like febrile seizures and hospitalizations. Antiviral treatments include oseltamivir and peramivir, both FDA-approved neuraminidase inhibitors. This study aims to compare the effectiveness of intravenous peramivir and oral oseltamivir in pediatric patients presenting to an emergency department, with a primary focus on the revisit rate within 72 h post-treatment. Methods: A retrospective study analyzed 1327 children aged 1–15 years diagnosed with influenza A or B between 1 January 2019 and 29 February 2020, at a single urban hospital. Patients were divided into oseltamivir (n = 1243) and peramivir (n = 84) groups. Data included demographics, clinical symptoms, emergency department stays, and revisit rates. Fisher’s exact test was used for analysis, with p-values < 0.05 considered significant. Results: A total of 1327 pediatric patients were included, with 1243 receiving oseltamivir and 84 receiving peramivir. Patients in the peramivir group were older (median age 5.88 years vs. 4.54 years, p = 0.002) and had higher rates of gastrointestinal symptoms. The emergency department length of stay was significantly longer in the peramivir group (167 min vs. 63 min, p < 0.001). The revisit rate within 3 days was 5.63% for oseltamivir and 9.52% for peramivir, with no statistically significant difference (p = 0.22). Conclusions: Peramivir presents as an effective alternative treatment for influenza in children, particularly in situations where oral administration is not feasible due to gastrointestinal intolerance, highlighting the importance of an alternative route of antiviral administration. Full article

Background: Intolerance of Uncertainty (IU) is a transdiagnostic factor measured using the Intolerance of Uncertainty Scale-Revised (IUS-R). This study evaluated the stability and change in adolescents’ IU over a three-month period using a modified version of the scale. Methods: A two-wave study was conducted, with 290 adolescents responding to an online survey at baseline and 199 at follow-up. The original IUS-R was modified to probe the rating of the current perceived state of IU, rather than typical experience. The link between IU variability and the development of interpretation bias in ambiguous social situations at follow-up was explored. Structural Equation Modeling and Linear Mixed Model analyses were performed to assess the longitudinal measurement invariance and responsiveness of the Modified IUS-R scale. Results: The scale demonstrated good psychometric properties and full measurement invariance. Individual participants showed significant variability in baseline IU levels but not in the degree of change. A reliable change in scores was observed in 8% of adolescents. The Modified IUS-R predicted interpretation bias in social situations at follow-up. Conclusions: Significant inter-individual-level variation in IU suggests this tool may be useful for detecting changes in IU and predicting significant health outcomes. Future studies should further address the assessment of changing IU with longer timeframes. Full article

Acetylsalicylic acid (ASA) represents a cornerstone of antiplatelet therapy for the treatment of atherosclerotic coronary artery disease (CAD). ASA is in fact indicated in case of an acute coronary syndrome or after a percutaneous coronary intervention with stent implantation. Aspirin hypersensitivity is frequently reported by patients, and this challenging situation requires a careful evaluation of the true nature of the presumed sensitivity and of its mechanisms, as well as to differentiate it from a more frequent (and more easily manageable) aspirin intolerance. Two main strategies are available to allow ASA administration for patients with CAD and suspected ASA hypersensitivity: a low-dose ASA challenge, aimed at assessing the tolerability of ASA at the antiplatelet dose of 100 mg, and desensitization, a therapeutic procedure which aims to induce tolerance to ASA. For those patients who cannot undergo ASA challenge and desensitization due to previous serious adverse reactions, or for those in whom desensitization was unsuccessful, a number of further alternative strategies are available, even if these have not been validated and approved by guidelines. The aim of this state-of-the-art review is therefore to summarize the established evidence regarding pathophysiology, clinical presentation, diagnosis, and management of aspirin hypersensitivity and to provide a practical guide for cardiologists (and clinicians) who have to face the not uncommon situation of a patient with concomitant coronary artery disease and aspirin hypersensitivity. Full article

Chronic Obstructive Pulmonary Disease (COPD) is a complex condition with significant impact on prognosis, especially in advanced stages where symptom burden becomes critical. Breathlessness affects patients’ quality of life, and despite various therapeutic strategies, the role of opioids in palliative care for COPD remains under investigation. The acceptance of a therapeutic trial of different types of opioids is increasing not only in end-of-life situations but also for stable COPD patients experiencing intolerable refractory breathlessness despite optimal conventional therapy. Recent clinical trials have raised questions about the overall clinical benefit of opioids in addressing breathlessness in COPD, prompting the need to clarify inconsistencies and identify specific subgroups that may benefit from opioid therapy. In the clinical setting, it is crucial to understand the attributes of patients who exhibit positive responses to opioids and what type of opioids could have a positive impact. This research paper aims to offer an update of the most recent evidence of opioid treatment in managing breathlessness among individuals with COPD with a head-to-head evaluation of the supporting and opposing proof in the medical literature. Full article

In response to the special feature of the east–west oriented road tunnel entrance being easily exposed to direct sunlight, a study was conducted on the glare phenomenon at the access zone for this type of tunnel and on the time-varying characteristics of the L₂₀(S) value outside the tunnel. First, the actual situation of luminance difference inside and outside the tunnel was considered. Field tests were carried out in a 20° field of view of the human eye within a stopping distance. Then, the environment paraments outside the tunnel were collected by combining the environment schematic method with the digital camera method. Finally, the differences and time-varying characteristics between the measured and recommended values of luminance outside the tunnel were analyzed. The PGSV daylight calculation model was used to analyze the glare effect in the 20° field of view of the human eye. The results indicate that the luminance L₂₀(S) outside the tunnel towards the east (west) generally shows a trend of first increasing and then decreasing, and reaches its maximum value in the morning (afternoon). The difference in the contribution ratio of luminance inside and outside the tunnel for this type shows an overall trend of first increasing and then decreasing, and the maximum difference appears in the morning (afternoon), reaching about 97% and 96% respectively. The time-varying characteristics of glare in the access zone of an east (west) oriented road tunnel are roughly consistent with the variation trend of the luminance L₂₀(S) outside the tunnel and exceed the intolerable glare limit. Due to direct sunlight, the luminance outside the tunnel is too high, resulting in an uncomfortable glare that the driver cannot tolerate, becoming more serious after rainfall, and which affects driving comfort and safety. Full article

The popularity of “free-from” food products (FFFPs), which exclude several ingredients such as lactose, gluten, or sugar, is increasing globally. However, experts agree that avoiding these ingredients without medical reasons can lead to nutritional deficiencies. A representative consumer survey was conducted in Hungary (n = 1002); it focused on behaviors related to FFFPs, particularly lactose- and gluten-free products. This study revealed that consumers often consider “free-from” claims during shopping. Lactose- and gluten-free foods were popular, even among those without specific dietary needs. A distinct “free-from consumer group” (7.8% of the sample, predominantly women) was identified, who consume both lactose- and gluten-free foods frequently. However, only 15.4% of the group had medical reasons for their preference, such as lactose intolerance or gluten sensitivity. The majority (75.6%) chose these products without medical justification, relying on self-diagnosis, through the involvement of family members, or the belief that they were healthier. This consumer group accounts for nearly 6% of Hungary’s adult population, exceeding 470,000 individuals. Extrapolating these figures to other European countries suggests that 25–30 million EU citizens might be in a similar situation, highlighting the need for improved health education and awareness-raising campaigns to prevent imbalanced nutrition and foster the recognition and treatment of real health problems. Full article

A key impetus for the implementation of the 1980 Hague Convention on the Civil Aspects of International Child Abduction was the protection of children from the harmful effects of their wrongful removal or retention. This article considers how well the Convention is achieving this aim in light of the challenges it faces in a global society that has changed significantly since its introduction. Two key aspects of the Convention’s operation are addressed in this regard: (i) The intersection between domestic violence and the exception to return in Article 13(1)(b); and (ii) the adoption of practices to enable abducted children to receive information about, and be given effective opportunities to express their views and be heard in, Convention cases. The article discusses why, how, and to what extent the Convention needs to be nurtured to best position it to meet current and future challenges and demands, including the current differences in interpretation and implementation globally. Suggestions are made to help future-proof the Convention so that children can be best protected in the way envisioned by the Convention. Full article

The physiotherapist inevitably experiences clinical uncertainty, as they treat a wide variety of pathologies and, in some situations, will be the first professional contact. However, clinical uncertainty has yet to be sufficiently studied in physiotherapy and is not explicitly contemplated in physiotherapist training. This research aims to evaluate recent physiotherapy graduates’ tolerance to clinical uncertainty to determine their educational needs. A cross-sectional quantitative observational study was conducted in which the sample consisted of 31 recent graduates. They were given a self-developed questionnaire to assess “Tolerance to Uncertainty in Physiotherapy” (TUP). The results showed that the mean score obtained was 57.7 (6.49) points, with a minimum of 43 and a maximum of 69 points. The dimension “sources of uncertainty” scored the highest. The results revealed a profile of novice physiotherapists with a medium intolerance to uncertainty, nervous about unknown diagnoses. It is necessary to consider tolerance to uncertainty in the curricular programmes of physiotherapy degrees that can cover the needs described here. Full article

Decisional procrastination has been one of the main phenomena analysed in university students, together with self-efficacy, during the COVID-19 pandemic. We examined the roles of academic self-efficacy and intolerance of uncertainty on decisional procrastination in 318 Italian university students. Furthermore, the mediating role of the intolerance of uncertainty on the relationships between academic self-efficacy and decisional procrastination was explored. The Academic Self-Efficacy Scale, the Decisional Procrastination Scale, and the Intolerance of Uncertainty Scale were used. Results: Decisional procrastination was predicted by the components of academic self-efficacy and the intolerance of uncertainty (prospective and inhibitory intolerance). Furthermore, the mediating role of the prospective intolerance of uncertainty was confirmed in the relationship between self-efficacy (self-engagement and self-oriented decision-making) and decisional procrastination. Conclusions: This study adds new evidence to findings in the analysis of the role of the intolerance of uncertainty in mitigating the relationships between the self-efficacy of students in the academic context and their tendency to procrastinate in decision-making processes, which has been poorly investigated to date by scholars in this research field. Future research will deal with a specific situation of procrastinating behaviours, such as the completion of a master’s thesis or the respect for the deadline of an article’s submission. Full article

The petrochemical industry is relatively strict regarding safety rules in the workplace. The workplace involves high-risk categories that are intolerant of human error. Especially in the current situation with COVID-19, concerns regarding prevention and safety in the workplace have increased. In light of this pandemic, the company must know whether all employees recognize the implementation of COVID-19 prevention. In addition, employee awareness of safety grounded in the affective domain of human thought is lacking. This study investigates the safety attitudes and COVID-19 prevention in the workplace based on the affective domain of employees. A survey questionnaire based on the Likert scale was utilized to collect data from 618 employees in the petrochemical industry. Descriptive analysis and analysis of variance were used to examine the data. The results reveal that employees in the petrochemical industry have a positive degree of responses to COVID-19 prevention, safety attitudes, and the affective domain, regardless of employment characteristics such as gender, age, position, and work experience. This study concludes that a positive affective domain of employees is followed by a positive safety attitude; thus, effective COVID-19 prevention was established in the workplace based on the perspectives and attitudes of the employees. Full article

Intolerance of Uncertainty (IU) is described as the tendency to avoid uncertain states and exhibit negative responses to uncertain situations on cognitive, emotional, and behavioral levels. It is considered a transdiagnostic cognitive bias that plays a role in developing and maintaining psychopathology. The Intolerance of Uncertainty Scale-12 (IUS-12) has proven to be a sound measure of intolerance of uncertainty with excellent validity and reliability. Although research has supported a two-factor structure of IUS-12, most recent studies also suggest a bifactor model. The present study examines the factorial structure, validity, and reliability of the Greek version of IUS-12 with a sample of 959 university students (66.6% female) aged 19.63 years (SD = 3.20). Confirmatory Factor Analysis showed that although the two-factor solution adequately fit the data, the bifactor model better fit with IU total as an underlying one-factor. Internal consistency and validity were excellent for the total IUS-12 and Prospective and Inhibitory Anxiety subscales. Our findings support recent findings concerning the factorial structure of IUS-12 and the scale’s psychometric qualities in a Greek undergraduate sample. We expect that future research with clinical samples will confirm the screening and clinical utility of IUS-12. Full article

Primary hyperthyroidism is an endocrine disorder characterized by excessive thyroid hormone synthesis and secretion by the thyroid gland. Clinical manifestations of hyperthyroidism can vary from subclinical to overt forms. In rare cases, hyperthyroidism may represent a clinical emergency, requiring admission to an intensive care unit due to an acute and severe exacerbation of thyrotoxicosis, known as a thyroid storm. First-line treatment of hyperthyroidism is almost always based on medical therapy (with thioamides, beta-adrenergic blocking agents, glucocorticoids), radioactive iodine or total thyroidectomy, tailored to the patient’s diagnosis. In cases of failure/intolerance/adverse events or contraindication to these therapies, as well as in life-threatening situations, including a thyroid storm, it is necessary to consider an alternative treatment with extracorporeal systems, such as therapeutic plasma exchange (TPE). This approach can promptly resolve severe conditions by removing circulating thyroid hormones. Here we described two different applications of TPE in clinical practice: the first case is an example of thyrotoxicosis due to amiodarone treatment, while the second one is an example of a severe adverse event to antithyroid drugs (agranulocytosis induced by methimazole). Full article

Healthcare professionals are at higher risk of developing and experiencing burnout. Parents may also suffer from prolonged stressful conditions that lead to physical and emotional exhaustion. Residential youth care workers assume a caregiving role that can lead to persistent stressful conditions that affect their relationship with the youth. In addition, the COVID-19 lockdown has had a negative impact on both the organization and the work, as well as on the lifestyle of workers and minors. In fact, during the pandemic, contact with families was not possible due to restrictions and this increased the need for caregivers to assume a parental role. This research aims to examine the risk of burnout in a sample of 75 healthcare professionals working with youths and the association with psychological traits. Then, we aim to evaluate these aspects during the COVID-19 lockdown The measurements, conducted in both February 2019 and April 2021, included six questionnaires: MBI to assess burnout, TAS_20 to explore alexithymic traits, COPE_NVI to assess coping strategies, FDS_R to quantify frustration intolerance at work, IRI for empathy, and FFMQ to investigate awareness and emotional regulation. Our sample shows a medium-high risk of developing burnout, which worsened during the pandemic. A worsening of emotional skills, paralleled by a greater empathic investment required by the emergency situation, and an assumed parental role is observable. Coping strategies correlate with burnout risk, as avoidance strategies were strongly associated with emotional exhaustion. These findings suggest an urgent need to develop targeted and timely interventions for healthcare professionals in order to prevent long-term consequences. Full article

Obesity is an epidemic disease worldwide, characterized by excessive fat accumulation associated with several metabolic perturbations, such as metabolic syndrome, insulin resistance, hypertension, and dyslipidemia. To improve this situation, a specific combination of metabolic cofactors (MC) (betaine, N-acetylcysteine, L-carnitine, and nicotinamide riboside) was assessed as a promising treatment in a high-fat diet (HFD) mouse model. Obese animals were distributed into two groups, orally treated with the vehicle (obese + vehicle) or with the combination of metabolic cofactors (obese + MC) for 4 weeks. Body and adipose depots weights; insulin and glucose tolerance tests; indirect calorimetry; and thermography assays were performed at the end of the intervention. Histological analysis of epidydimal white adipose tissue (EWAT) and brown adipose tissue (BAT) was carried out, and the expression of key genes involved in both fat depots was characterized by qPCR. We demonstrated that MC supplementation conferred a moderate reduction of obesity and adiposity, an improvement in serum glucose and lipid metabolic parameters, an important improvement in lipid oxidation, and a decrease in adipocyte hypertrophy. Moreover, MC-treated animals presented increased adipose gene expression in EWAT related to lipolysis and fatty acid oxidation. Furthermore, MC supplementation reduced glucose intolerance and insulin resistance, with an increased expression of the glucose transporter Glut4; and decreased fat accumulation in BAT, raising non-shivering thermogenesis. This treatment based on a specific combination of metabolic cofactors mitigates important pathophysiological characteristics of obesity, representing a promising clinical approach to this metabolic disease. Full article