Search Results (36,613)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Congenital portosystemic shunts (CPSSs) are often associated with life-threatening systemic complications, which may be detected by identifying hypergalactosemia in newborn screening (NBS). However, diagnosing CPSS at an early stage is not easy. The purpose of this study was to predict CPSS early using screening values and general blood tests. The medical records of 153 patients with hypergalactosemia who underwent NBS in Saitama Prefecture between 1 December 1997 and 31 October 2023 were retrospectively analyzed. We provided the final diagnosis of the analyzed patients. Of the 153 patients, 44 (29%) were in the CPSS group and 83 (54%) were in the transient galactosemia group. Using the initial screening items and the six blood test items, we attempted to extract a CPSS group from the transient galactosemia group. Finally, a model for CPSS prediction was established. From multiple logistic regression analysis, filtered blood galactose-1 phosphate/galactose, serum total bile acid, and ammonia were adopted as explanatory variables for the prediction model. If the cut-off value for predicted disease probability value (P) was >0.357, CPSS was identified with 86.4% sensitivity (95%CI 72.6–94.8%) and 81.9% specificity (95%CI 72.0–89.5%). This predictive model might allow prediction of CPSS and early intervention. Full article

Background: Patients with ankylotic spines suffering from vertebral column fractures are frequently operated on to maintain spinal stability and prevent secondary displacement and nerve damage. The aim of this study was to identify a subset of patients that may be treated non-operatively, thus avoiding operative complications in this group of patients. Methods: Extension-type injuries in patients with DISH (diffuse idiopathic skeletal hyperostosis) not involving the posterior elements of the spine comprised the study group. Results: Twenty two extension fractures occurred in 21 patients with DISH in SZMC (Shaare Zedek Medical Cente) between 2014–2025. All patients were treated non-operatively. Patients were allowed free mobilization, and no orthosis was used. The only limitation was keeping the bed inclined to 20–30 degrees to prevent extension at the fracture site. All fractures healed uneventfully, and no patient required late surgical intervention, and no neurological complications were noted. Conclusions: Patients with DISH who sustain extension-type injuries of the thoracolumbar spine, with no involvement of the posterior elements, may be treated non-operatively, with good results. Full article

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed with pelvic fractures from 1 January 2020 through 31 December 2023 were retrospectively reviewed. Demographic data, mechanism of injury, fracture pattern, associated injuries, treatment modalities, and outcomes were analyzed. Results: A total of 13 patients were included in the study, with ages ranging from 18–95 years. Six of the patients were male and seven were female. The most common mechanisms of injury were falls and pedestrians struck by vehicles. Associated injuries included traumatic brain injury (TBI), fractures including extremities, ribs, and vertebrae, visceral injury, and spinal cord injury. Treatment strategies ranged from conservative, non-surgical management to operative intervention, including interventional radiology embolization, external traction, open reduction and internal fixation (ORIF), and percutaneous screw stabilization. Additional interventions included chest tube placement, exploratory laparotomy, and craniectomy. Two patients died while in the hospital, one was discharged to a shelter, and the remaining 10 were discharged to various inpatient rehab facilities. Conclusions: Pelvic fractures pose significant clinical challenges due to their complexity and associated injuries. This case series underscores the importance of multidisciplinary intervention and treatment strategies in optimizing outcomes. Further studies should focus on the effectiveness of interventions, utilization of new technology, and multidisciplinary team planning. Full article

Endotoxins, lipopolysaccharides released from the outer membrane of Gram-negative bacteria, pose a significant risk in healthcare environments, particularly in Central Sterile Supply Departments (CSSDs), where the delivery of sterile pyrogen-free medical devices is critical for patient safety. Traditional methods for controlling endotoxins in water systems, such as ultraviolet (UV) disinfection, have proven ineffective at reducing endotoxin concentrations to comply with regulatory standards (<0.25 EU/mL). This limitation presents a significant challenge, especially in the context of reverse osmosis (RO) permeate used in CSSDs, where water typically has very low conductivity. Despite the established importance of endotoxin removal, a gap in the literature exists regarding effective chemical-free methods that can meet the stringent endotoxin limits in such low-conductivity environments. This study addresses this gap by evaluating the effectiveness of the eBooster™ electrochemical technology—featuring proprietary electrode materials and a reactor design optimized for potable water—for endotoxin removal from water, specifically under the low-conductivity conditions typical of RO permeate. Laboratory experiments using the B250 reactor achieved >90% endotoxin reduction (from 1.2 EU/mL to <0.1 EU/mL) at flow rates ≤5 L/min and current densities of 0.45–2.7 mA/cm². Additional real-world testing at three hospitals showed that the eBooster™ unit, when installed in the RO tank recirculation loop, consistently reduced endotoxin levels from 0.76 EU/mL (with UV) to <0.05 EU/mL over 24 months of operation, while heterotrophic plate counts dropped from 190 to <1 CFU/100 mL. Statistical analysis confirmed the reproducibility and flow-rate dependence of the removal efficiency. Limitations observed included reduced efficacy at higher flow rates, the need for sufficient residence time, and a temporary performance decline after two years due to a power fault, which was promptly corrected. Compared to earlier approaches, eBooster™ demonstrated superior performance in low-conductivity environments without added chemicals or significant maintenance. These findings highlight the strength and novelty of eBooster™ as a reliable, chemical-free, and maintenance-friendly alternative to traditional UV disinfection systems, offering a promising solution for critical water treatment applications in healthcare environments. Full article

Objective—To identify effective data analytics and machine learning solutions that can help in the decision-making process in the medical domain and contribute to the understanding of COVID-19 disease. In this study, we analyze data from anonymized electronic medical records of 4711 patients with COVID-19 disease admitted to hospital in Atlanta. Methods—We used random forest, LightGBM, XGBoost, CatBoost, KNN, SVM, logistic regression, and MLP neural network models in this work. The models are evaluated depending on the type of prediction by relevant metrics, especially accuracy, F1-score, and ROC AUC score. Another aim of the work was to find out which factors most affected severity and mortality risk among the patients. To identify the important features, different statistical methods were used, as well as LASSO regression, and explainable artificial intelligence (XAI) method SHAP values for model explainability. The best models were implemented in a web application and tested by medical experts. The model for prediction of mortality risk was tested on a validation cohort of 45 patients from the Department of Infectiology and Travel Medicine, L. Pasteur University Hospital in Košice (UNLP). Results—Our study shows that the best model for predicting COVID-19 disease severity was the LightGBM model with accuracy of 88.4% using all features and 89.5% using the eight most important features. The best model for predicting mortality risk was also the LightGBM model, which achieved a ROC AUC score of 83.7% and a classification accuracy of 81.2% using all features. Using a simplified model trained on the 15 most important features, the ROC AUC score was 83.6% and the classification accuracy was 80.5%. We deployed the simplified models for predicting COVID-19 disease severity and for predicting the risk of COVID-19-related death in a web-based application and tested them with medical experts. This test resulted in a ROC AUC score of 83.6% and an overall prediction accuracy of 73.3%. Full article

Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer entity in Germany, following basal cell carcinoma. Its incidence has increased fourfold over the past three decades. Early diagnosis and treatment are essential for achieving favorable outcomes. Our study aims to identify prognostic factors based on real-world data to improve follow-up protocols and raise clinical vigilance. Methods: We conducted a retrospective, monocenter analysis with a total of 124 patients with at least one cSCC thicker than 3 mm, treated at the Department of Dermatology, University Medical Center Mainz, between 2010 and 2020. Tumor-specific criteria were correlated with patient-specific data, such as gender, age, immunosuppression, UV exposure and mortality. Results: A higher incidence of cSCC was found on UV-exposed skin (91.1%); however, tumors on non-UV-exposed skin were on average thicker (6.55 mm vs. 9.25 mm, p = 0.011) and associated with higher metastasis rates (10.6% vs. 63.3%, p < 0.001). Immunosuppression was strongly associated with a younger age at diagnosis (74 years vs. 81 years), a higher metastasis rate (29% vs. 10.8%, p = 0.021) and a worse 5Y-OS-rate (36.1% vs. 97.8%, p = 0.04). SLNB was performed in eight patients, with one positive SLN identified (12.5%). Local recurrence was observed in 18.1% (n = 21) of patients who did not experience SLNB, whereas no local recurrences (0%) were reported in patients with SLNB (p = 0.349). Discussion: Tumors on non-UV-exposed areas were thicker and more often metastatic, suggesting delayed detection or more aggressive tumor subtypes. Immunosuppression was associated with worse outcomes, underscoring the need for intensified follow-up. SLNB was rarely performed, and larger studies are needed to assess its role. Full article

DIALOGUE (DIagnostic AI Learning through Objective Guided User Experience) is a generative artificial intelligence (GenAI)-based training program designed to enhance diagnostic communication skills in medical students. In this single-arm pre–post study, we evaluated whether DIALOGUE could improve students’ ability to disclose a type 2 diabetes mellitus (T2DM) diagnosis with clarity, structure, and empathy. Thirty clinical-phase students completed two pre-test virtual encounters with an AI-simulated patient (ChatGPT, GPT-4o), scored by blinded raters using an eight-domain rubric. Participants then engaged in ten asynchronous GenAI scenarios with automated natural-language feedback. Seven days later, they completed two post-test consultations with human standardized patients, again evaluated with the same rubric. Mean total performance increased by 36.7 points (95% CI: 31.4–42.1; p < 0.001), and the proportion of high-performing students rose from 0% to 70%. Gains were significant across all domains, most notably in opening the encounter, closure, and diabetes specific explanation. Multiple regression showed that lower baseline empathy (β = −0.41, p = 0.005) and higher digital self-efficacy (β = 0.35, p = 0.016) independently predicted greater improvement; gender had only a marginal effect. Cluster analysis revealed three learner profiles, with the highest-gain group characterized by low empathy and high digital self-efficacy. Inter-rater reliability was excellent (ICC ≈ 0.90). These findings provide empirical evidence that GenAI-mediated training can meaningfully enhance diagnostic communication and may serve as a scalable, individualized adjunct to conventional medical education. Full article

Restenosis is the main cause of failure after stent implantation during angioplasty. The localized, sustained delivery of an antirestenotic drug may reduce smooth muscle cell (SMCs) proliferation and thereby limit neointimal hyperplasia. The aim of this study was to develop degradable sirolimus-eluting polymer coatings that can be applied on bioresorbable polymer-based scaffolds via an ultrasonic coating system. This is a novel approach because the detailed analysis of the coating procedure on bioresorbable polymeric scaffolds with the use of an ultrasonic system has not been reported thus far. It has been observed that the ultrasonic technique facilitates formation of a smooth coating, well-integrated with the scaffold. However, the drug dose is affected by the concentration of the coating solution and the number of layers. Therefore, these parameters can be used for tailoring the drug dose and release process. Although all types of the developed coatings provided sirolimus elution for at least 3 months, a more uniform, diffusion-controlled release profile was observed from coatings obtained from the 1.0% polymeric solution. The released drug showed antiproliferative activity against vascular SMCs, without any hemolytic or thrombogenic effects. The results of the study may be advantageous for further progress in the development and medical translation of polymeric vascular scaffolds with antirestenotic activity. Full article

Serious games that integrate educational content with engaging gameplay mechanics hold promise for reducing cognitive load and increasing student motivation in STEM and health science education. This preliminary study presents the development and evaluation of the Medimon NASA Demo, a game-based learning prototype designed to teach undergraduate students about the musculoskeletal and visual systems—two critical domains in space medicine. Participants (n = 23) engaged with the game over a two-week self-regulated learning period. The game employed mnemonic-based characters, visual storytelling, and turn-based battle mechanics to reinforce medical concepts. Quantitative results demonstrated significant learning gains, with posttest scores increasing by an average of 23% and a normalized change of c = 0.4. Engagement levels were high across multiple dimensions of situational interest, and 74% of participants preferred the game over traditional formats. Qualitative analysis of open-ended responses revealed themes related to intrinsic appeal, perceived learning efficacy, interaction design, and cognitive resource management. While the game had minimal impact on short-term STEM career interest, its educational potential was clearly supported. These findings suggest that mnemonic-driven serious games like Medimon can effectively enhance engagement and learning in health science education, especially when aligned with real-world contexts such as space medicine. Full article

Metabolic syndrome comprises a constellation of comorbidities, including obesity, hypertension, and disorders in carbohydrate and lipid metabolism, associated with an elevated risk of cardiovascular mortality. Obesity is regarded as the principal cause of metabolic syndrome (both collectively and in relation to its components), frequently linked in previous scientific studies with a deficiency of magnesium, one of the most important cations found in the human body. Objectives: The objective of this study was to assess the prevalence of hypomagnesemia in patients with metabolic syndrome and to determine the most significant risk factor among its components for this nutritional deficiency. Methods: Retrospective medical data from 403 patients admitted to the hospital for conditions unrelated to magnesium levels from 2015 to 2019 were evaluated, encompassing serum magnesemia and specific data about components of metabolic syndrome. Data underwent statistical analysis, including linear and logistic regression, to assess the principal risk variables of hypomagnesemia. Results: Hypomagnesemia was observed in 14.89% of the patients with metabolic syndrome, exhibiting a 2.42-fold greater risk of this deficiency (95%CI: 1.40–3.40). Among the components of metabolic syndrome, hyperglycemia emerged as the most significant determinant affecting both the incidence and severity of hypomagnesemia, elevating the risk by a ratio of 2.72 (95%CI: 1.52–4.87). In the multivariate regression model, hyperglycemia was the sole factor independently influencing magnesium concentration (β = −0.145; p < 0.001). Conclusions: Patients presenting signs of metabolic syndrome are at heightened risk for hypomagnesemia. Hyperglycemia appears to be the most important variable affecting the risk of magnesium insufficiency; however, additional research is needed in this area. Full article

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, surgical procedures, complications, and mortality associated with DVIE in our tertiary hospital in Italy. The Endocarditis Registry STEADY includes patients admitted with IE from January 2009 to March 2024 (n = 398). Sixty-three of them (16%) had DVIE. Methods: We conducted a retrospective single-center observational study, analyzing demographic, clinical, and microbiological data in DVIE patients, comparing those treated surgically (surgical group, SG) with those treated medically (non-surgical group, NSG). Results: The groups were homogeneous in age, microbiological yields, type of valve involved, and risk factors for infective endocarditis. The surgical group presented significantly more cancer history, intracardiac complications, and new-onset arrhythmias compared to the non-surgical group. Median hospital stay was similar in both groups. In SG, the most common postoperative complication was new rhythm disorders; other complications such as cardiac tamponade, pericardial effusion, and pneumothorax were rare. In-hospital mortality was similar between groups; however, one-year survival was higher in the surgical group (72% vs. 54%, p = 0.031). In our series, 16 patients were over 75 years old (25%), and 7 of them (44%) underwent cardiac surgery. One-year survival in the surgical group was also higher in this subgroup. Conclusions: Surgical treatment, when indicated, may improve the prognosis of patients with DVIE, including elderly patients. Full article

Background: Maxillary sinus puncture (MSP), once a cornerstone for diagnosing and treating acute rhinosinusitis (ARS), has declined with the rise in less invasive techniques. This study explores MSP trends, its association with age, and long-term effects on quality of life using data from the Study of Health in Pomerania (SHIP). Methods: Data from SHIP-START-2 (n = 2332), SHIP-START-3 (n = 1717), and SHIP-TREND-0 (n = 4420) cohorts were analyzed to assess MSP prevalence, demographic correlations, and quality- of-life impacts using SNOT-20-D, EQ-5D-3L, and SF-12. Results: MSP prevalence was higher in older SHIP-START cohorts (11.2% in START-2) compared to SHIP-TREND-0 (9.5%), reflecting its historical decline. The procedure was more frequently reported by participants aged > 60 years (e.g., 14.0% in START-2) than by younger groups (<40 years: 3.5% in START-2). MSP was associated with increased SNOT-20-D scores across cohorts (e.g., +0.28 in START-2, p < 0.001) and minor reductions in EQ-5D-3L and SF-12 mental health scores, indicating greater symptom burden but limited general health impact. The age- and time-related decline in MSP highlights its diminishing role in modern practice. Conclusions: While MSP offers diagnostic insights and serves as an indicator for ARS, its modest impact on long-term quality-of-life underscores the need for alternative, minimally invasive techniques for sinonasal conditions. Full article

Background and Objectives: Exclusive breastfeeding offers optimal nutrition and health benefits for infants, yet many mothers face challenges that impact their ability to breastfeed. This study aimed to explore breastfeeding practices among Romanian mothers and identify factors associated with successful exclusive breastfeeding. Materials and Methods: A cross-sectional online survey was conducted from February to March 2025, targeting Romanian mothers via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographics, birth and neonatal variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. A total of 874 valid responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: While 87.2% of mothers intended to breastfeed, only 56.1% reported exclusive breastfeeding. Factors significantly associated with reduced likelihood of exclusive breastfeeding included maternal age ≥ 30 years (OR = 1.40, p = 0.042), Cesarean delivery (OR = 1.78, p < 0.001), absence of rooming-in (OR = 2.32, p < 0.001), and pacifier use (OR > 4.7, p < 0.001). Protective factors included non-smoking status (OR = 0.52, p < 0.001) and encouragement to breastfeed by medical staff (OR = 1.60, p = 0.004). Despite external advice to use formula, many mothers continued breastfeeding. Conclusions: Although breastfeeding intention was high, exclusive breastfeeding remains suboptimal in Romania. Targeted support—particularly in maternity hospitals and for mothers recovering from Cesarean sections—alongside prenatal education and consistent postnatal guidance are essential to bridge the gap between intention and practice. Full article

Background: Fibromyalgia syndrome (FMS) is a complex condition with poorly understood pathophysiology, characterized by widespread pain and an increasing recognition of its associations with genitourinary symptoms. The objective of this study was to characterize the prevalence, phenotype, and common comorbidities of lower urinary tract symptoms (LUTS) in women with FMS. Methods: A retrospective observational study was conducted using electronic medical records of 440 women diagnosed with FMS at a single institution between 1 January 2018, and 1 January 2024. Study subjects were evaluated for diagnoses associated with LUTS, including interstitial cystitis (IC), overactive bladder (OAB), and stress urinary incontinence (SUI), alongside comorbidities such as irritable bowel syndrome (IBS), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Multivariate analyses were performed to assess predictors of conditions associated with LUTS. Results: LUTS were identified in 37.0% of FM patients. GAD and IBS were significantly associated with conditions associated with LUTS (OR = 4.62; OR = 8.53, p < 0.001). SUI was present in 17.05% of patients, falling between survey-based and confirmed prevalence rates in the general population. IC was diagnosed in 2.95% of FMS patients. OAB was observed in 6.8% of patients and associated with GAD (OR = 5.98, p < 0.001). Conclusions: This study highlights a substantial burden of diagnoses associated with LUTS in patients with FMS. There is relatively high prevalence of SUI and IC in this dataset. IBS and GAD were commonly found to co-occur with one or more LUTS-associated condition. Future prospective studies are needed to investigate a multimodal approach to the treatment of LUTS in these patients. Full article