Search Results (5,426)

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed to develop a national expert consensus, endorsed by scientific societies, on multidisciplinary migraine management in women across the lifespan, integrating perspectives from neurology, gynecology, endocrinology, cardiology, and general medicine. Methods: A two-round Delphi survey was conducted among 145 Italian clinicians representing the five specialties. The Scientific Board formulated 50 questions, each consisting of a variable number of statements, covering diagnostic approaches, hormonal therapies, comorbidities, and organizational care pathways. Statements were rated on a nine-point Likert scale, and consensus was defined using pre-specified criteria based on median scores and agreement. Results: Overall, 79 of 145 statements (54%) achieved consensus. High-level agreement emerged on sex-informed diagnostic strategies, including systematic gynecological and endocrinological evaluation and hormonal profiling in women with migraine. Round 2 facilitated consensus on contentious issues, such as avoiding estrogen-containing contraceptives in migraine with aura, individualized thrombotic risk assessment during menopause, and structured interdisciplinary coordination—particularly among neurologists, gynecologists, and general practitioners—during fertility planning and assisted reproduction. Qualitative feedback emphasized the need to update clinical pathways, implement standardized referral models, and strengthen interprofessional communication. However, persistent divergence remained on selected topics, particularly the role of hormonal contraceptives as a first-line approach to migraine management in women of reproductive age, reflecting different priorities between gynecologists and neurologists. Conclusions: This Delphi initiative provides the first national multidisciplinary consensus on migraine management in women in Italy. The findings support the development of sex- and life-stage-specific clinical guidance and integrated care models tailored to the complex needs of women with migraine. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

Motivational interviewing (MI) is gaining traction in veterinary medicine as an evidence-based approach for engaging clients in conversations that strengthen their intrinsic motivation to change behaviours that affect the welfare of animals in their care. While MI has a substantial and well-established evidence base across human healthcare and related fields, the veterinary evidence base remains small and is currently limited by study design challenges, inconsistent fidelity measurement, and outcome measures that rarely extend beyond short-term changes in communication behaviour. Existing methodological guidance addresses treatment integrity and theoretical mechanisms but does not provide an integrated framework for designing robust studies across the range of questions relevant to veterinary practice. This paper addresses that gap by providing practical methodological guidance for researchers designing MI studies in veterinary clinical settings. A novel conceptual model of the MI implementation pathway, mapping the journey from practitioner awareness through training and delivery to client outcomes, is used to organise key research questions that need to be answered in veterinary contexts. Guidance is then provided on selecting appropriate study designs, measuring fidelity and outcomes, estimating sample size, and managing the practical and ethical challenges specific to veterinary clinical settings, alongside minimum reporting standards to support more rigorous and reproducible MI research. Full article

The rapid advancement of laboratory automation, robotics, and digital technologies has significantly transformed laboratory medicine worldwide, improving efficiency, diagnostic accuracy, and quality management. However, the adoption of these technologies in developing countries such as Indonesia remains uneven and is influenced by infrastructural, financial, regulatory, and workforce-related challenges. This structured narrative review aimed to critically examine the current landscape of laboratory automation and robotics in Indonesia, with particular emphasis on implementation challenges, workforce transformation among medical laboratory scientists (Ahli Teknologi Laboratorium Medik, ATLM), and pathways toward equitable integration. Studies published between 2015 and 2025 were identified through PubMed, Scopus, and Google Scholar, complemented by Indonesian regulatory documents, professional guidelines, and relevant grey literature. The review was informed by PRISMA principles and synthesized narratively to explore technological developments, operational impacts, policy contexts, and implementation barriers relevant to Indonesian laboratory systems. The findings indicate that automation and robotics offer substantial benefits, including improved turnaround time, enhanced quality assurance, reduced laboratory errors, and greater operational efficiency. Nevertheless, significant barriers persist, particularly disparities in digital infrastructure, financial constraints, limited workforce readiness, and the absence of comprehensive implementation frameworks. The review further highlights that automation is reshaping rather than replacing the role of ATLM, shifting professional responsibilities toward digital competency, automation oversight, data interpretation, and quality management. Achieving sustainable laboratory automation in Indonesia therefore requires an equity-centered and systems-oriented approach involving regulatory strengthening, workforce development, infrastructure investment, and multi-stakeholder collaboration. With strategic planning and policy alignment, laboratory automation and robotics hold considerable potential to modernize laboratory services and support Indonesia’s broader healthcare transformation agenda. Full article

Collapsin Response Mediator Protein 2 (CRMP2) has emerged as a central node in the pathogenesis of chronic pain, functioning as a multimodal ‘molecular switch’ that regulates microtubule dynamics, ion channel trafficking, and synaptic plasticity. The dysregulation of CRMP2, particularly through aberrant post-translational modifications (PTMs) such as phosphorylation and SUMOylation, is a critical driver of both peripheral and central sensitization. This review systematically examines the structure, regulation, and multifaceted roles of CRMP2 in pain signaling pathways. We then critically evaluate a spectrum of CRMP2-targeted therapeutic strategies, including small-molecule inhibitors, peptide-based agents, and gene silencing, highlighting their promising preclinical efficacy and safety profiles. Despite challenges in targeting specificity and central nervous system delivery, we posit that innovations in delivery systems, precision medicine, and AI-assisted drug design will catalyze the clinical translation of CRMP2-based, non-opioid analgesics, offering a paradigm shift in chronic pain management. Full article

Pregnancy involves profound metabolic, hormonal, and immunological adaptations essential for fetal development; however, disturbances may lead to complications such as preeclampsia (PE), pre-gestational diabetes, and gestational diabetes mellitus (GDM). These conditions are closely linked to oxidative stress, inflammation, endothelial dysfunction, impaired placentation, and metabolic dysregulation. Consequently, dietary strategies capable of modulating these pathways are of increasing interest. Edible and medicinal mushrooms are widely studied as functional food due to the content of bioactive compounds with antioxidant, anti-inflammatory, immunomodulatory, and metabolic regulatory effects. This review summarizes the nutritional composition of mushrooms and highlights key bioactive constituents with antioxidant and metabolic regulatory properties. Among them, ergothioneine has emerged as a key molecule due to its potent redox-buffering capacity and its potential involvement in the activation of the Nrf2 signaling pathway, a master regulator of cellular antioxidant defense. Through modulation of Nrf2-dependent gene expression, mushroom-derived compounds may contribute to improved cellular resilience against oxidative damage relevant to PE and GDM pathophysiology. Mushroom consumption has additionally been associated with improved glycemic control and enhanced antioxidant defenses in experimental and limited clinical studies, although evidence regarding the prevention or management of hypertensive and metabolic pregnancy complications remains insufficient. Although preclinical findings are promising, clinical evidence remains limited. Further well-designed prospective studies and randomized controlled trials are required to determine efficacy, safety, optimal intake, and active compounds responsible for these effects. Nevertheless, current evidence supports the biological plausibility that edible and medicinal mushrooms are promising dietary modulators of the ergothioneine–Nrf2 axis with potential relevance for maternal–fetal health. Full article

Stroke remains one of the leading causes of death and disability worldwide, yet its clinical management is constrained by substantial biological heterogeneity that single-biomarker and single-omics approaches fail to resolve. The integration of multiple molecular data layers, such as genomics, epigenomics, transcriptomics, proteomics, metabolomics, and immunomics, offers a transformative framework for investigating the underlying neuroinflammatory mechanisms of different stroke subtypes and endotypes. In this review, we synthesize the current multi-omics evidence in stroke by examining how genetic variants propagate through regulatory and immune pathways and generate measurable molecular signatures and clinically relevant biomarkers. We investigate the roles of microglia, infiltrating monocyte-derived macrophages, astrocytes, neutrophils, T cells, and endothelial cells as interacting nodes in the neuroimmune network after stroke, and analyze how spatially resolved single-cell transcriptomics illuminate state-specific programs previously undetectable in bulk tissue analyses. We discuss how proteomics and metabolomics translate these cellular programs into actionable circulating biomarkers and examine emerging evidence on blood–brain barrier disruption and neurovascular unit remodeling as multi-omics-defined targets. We then explore AI and machine learning frameworks enabling the integration of heterogeneous, high-dimensional datasets for endotype classification, patient stratification, and therapeutic response prediction. Finally, we address translational barriers, including analytical standardization, multi-ancestry generalizability, and regulatory readiness, and propose a roadmap for precision stroke medicine based on systems immunology. The core conceptual point of this review is the shift from describing omics findings in stroke cases to redefining biologically meaningful neuroinflammatory endotypes and using multi-omics to enable precision cerebrovascular medicine. Full article

Drug recall is a critical regulatory mechanism implemented to protect public health by removing defective, unsafe, or non-compliant pharmaceutical products from the market. Despite stringent regulatory approval processes, issues related to manufacturing defects, contamination, labeling errors, stability failures, and post-marketing safety concerns may lead to drug recalls. Regulatory authorities across the world, including the Central Drugs Standard Control Organization (CDSCO), the United States Food and Drug Administration (US FDA), the European Medicines Agency (EMA), and other national agencies, have developed structured recall guidelines and rapid alert systems to ensure timely withdrawal of defective products. Drug recalls are typically classified based on the level of health risk and may be executed at different levels of the distribution chain, including wholesale, retail, and consumer levels. Effective recall management involves risk assessment, recall communication, product traceability, documentation, and recall effectiveness checks. Pharmacovigilance systems also play an important role in identifying adverse drug reactions and quality defects that may lead to product recalls. This review article provides a comprehensive overview of drug recall systems, including causes of recalls, regulatory frameworks in India and other countries, recall classification, recall procedures, rapid alert systems, and global recall trends. The article also discusses challenges in recall implementation and provides recommendations to strengthen drug recall systems and regulatory coordination worldwide. The review additionally summarizes major official sources of recall information, including recall alerts, safety communications, and regulatory databases maintained by the Food and Drug Administration (FDA), EMA, CDSCO, Medicines and Healthcare products Regulatory Agency (MHRA), and World Health Organization (WHO), and provides a comparative global perspective on contemporary pharmaceutical recall practices. Full article

Background: Fasting plasma glucose, glycated hemoglobin (HbA1c), and oral glucose tolerance testing remain central to the diagnosis and monitoring of dysglycemia, but they mainly reflect the average glycemic exposure or discrete time-point measurements and may not capture intraday and interday glucose fluctuations. Glycemic variability (GV) has been associated with oxidative stress, endothelial dysfunction, inflammation, and diabetes-related complications, although much of the evidence derives from experimental, clinical, and diabetes-care settings rather than occupational cohorts. Aim: This narrative review examines the physiological basis, measurement, and potential occupational relevance of GV and continuous glucose monitoring (CGM) in working populations. Methods: Literature was narratively selected from biomedical databases, major guidelines, consensus statements, and occupational-health sources, prioritizing reviews, clinical guidelines, cohort studies, mechanistic studies, and CGM studies. No systematic search, risk-of-bias assessment, or quantitative synthesis was performed. Main findings: CGM is an established technology in selected diabetes-care contexts and provides metrics such as coefficient of variation, time in range, time above range, and time below range. Its use in occupational medicine, however, remains investigational outside selected clinical circumstances. Work-related factors such as shift work, circadian disruption, sleep loss, psychosocial stress, irregular meal timing, sedentary behavior, and variable physical workload may influence glucose regulation, but direct evidence linking these exposures to CGM-measured GV in workers remains limited. Implications: Potential applications include research on occupational determinants of metabolic health, monitoring of workplace lifestyle interventions, and individualized management of workers with diabetes in safety-sensitive roles, provided that consent, confidentiality, clinical follow-up, equity, and data-governance safeguards are ensured. Conclusions: GV assessment may complement traditional metabolic markers in selected occupational-health contexts, but routine CGM-based surveillance of general worker populations is not currently supported by sufficient evidence. Further longitudinal and interventional studies are required. Full article

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung diseases (ILDs), represent a major global health burden. Their significant clinical and biological heterogeneity complicates diagnosis and limits the efficacy of traditional, one-size-fits-all management approaches. The advent of high-throughput genomic and multi-omic technologies has initiated a paradigm shift from syndromic classification to molecular-based endotyping. A narrative review of the literature was performed, synthesising foundational and recent research in the genomics, epigenomics, and multi-omics of chronic respiratory diseases. Key studies were selected based on their relevance to genetic architecture, biomarker development, and translational applications in precision medicine. We discuss the complex genetic architecture of pulmonary conditions, highlighting the contribution of both rare, high-penetrance variants, such as SERPINA1, CFTR, and BMPR2, and polygenic risk from many common variants, such as HHIP, FAM13A, and IL33. We provide detailed analyses of polygenic risk scores (PRSs) for COPD and asthma, including their construction, validation across ancestries, and predictive performance. We detail how integrative multi-omic approaches, including transcriptomics, proteomics, and metabolomics, are successfully defining molecular endotypes, such as Type 2-high asthma, which, in turn, inform the use of targeted biologic therapies. Finally, we review the development of molecular diagnostics, including metagenomic sequencing of infections and liquid biopsies for lung cancer and the development of prognostic biomarkers. The genomic revolution is transforming pulmonary medicine through the discovery of novel disease pathways, precise molecular classification, and the recognition of new therapeutic targets. Despite major challenges in functional interpretation, data integration, and clinical–translational equity, these technologies hold the key to a new era of personalised respiratory health and precision medicine. Full article

Skeletal muscle dysfunction (SMD) is a critical extrapulmonary comorbidity in chronic obstructive pulmonary disease (COPD), contributing to exercise intolerance, poor quality of life, and increased mortality. Building upon and extending the disuse model, this review synthesizes evidence establishing COPD-induced SMD as a distinct myopathy with intrinsic disease drivers. Its pathophysiology is driven by a self-reinforcing network: mitochondrial energetic crisis featuring bioenergetic failure and dysregulated dynamics, chronic oxidative stress and inflammation fueling catabolic drive via ubiquitin–proteasome system activation, and epigenetic dysregulation through alterations in key histone deacetylases (HDACs) and microRNA expression, which collectively orchestrate a pro-atrophic phenotype. We further explore how these molecular insights are translating into novel diagnostic tools, including circulating biomarkers like myomiRs and C-terminal agrin fragment, and imaging techniques such as shear wave elastography. Although exercise training remains the cornerstone of management, its limited efficacy underscores the need for adjunctive and targeted therapies. We discuss promising strategies from pharmacological and nutritional support to emerging agents targeting specific pathways, including the IL-36 receptor, lipoprotein-associated phospholipase A2, aryl hydrocarbon receptor, and mitsugumin 53. Effective management of COPD-related SMD will hinge on a precision medicine framework, leveraging biomarker-guided stratification to deploy personalized combinatorial interventions aimed at preserving muscle mass and function. Full article

The new therapeutic options now available for patients with hepatocellular carcinoma (HCC) have made their assessment more complex, especially due to the different stages of liver cirrhosis typically associated with this tumor. The management of the disease therefore requires an interdisciplinary approach aimed at identifying the most appropriate treatment based on the risk–benefit profile and residual liver function, as well as in relation to the patient’s age and potential for a full or partial recovery, risk of complications, and cancer recurrence. Another factor to be carefully considered in patients with hepatocellular carcinoma is the frequent comorbidities and the associated socio-health variables (substance abuse, addictions, unfavorable economic or family circumstances), which can impact patient management or the possibilities for long-term monitoring, thus influencing the choice of the most appropriate therapeutic pathway. The healthcare services offered in the Province of Salerno (Campania Region, Southern Italy) to ensure all possible diagnostic and therapeutic options for these patients can be difficult to access due to the territorial extension of the Local Health Authority, characterized by clinics and hospitals located in distant locations, as well as the potential fragmentation of expertise between the University Hospital and ambulatorial facilities or small hospitals. An interdisciplinary consensus conference on the management of patients with HCC has been set with the aim of involving clinicians and surgeons working in healthcare facilities located in Salerno and its Province for the optimal care and effective management of these patients, taking into account all the clinical characteristics of the disease and individual health needs or expectations, from the perspective of personalized medicine. Full article

Diabetes mellitus represents a major global health burden, necessitating the development of safer and more effective therapeutic alternatives. Medicinal plants have gained increasing attention due to their bioactive compounds with potential hypoglycemic and antioxidant effects. The present study aimed to investigate the physicochemical characteristics, phytochemical composition, antioxidant capacity, and toxicological profile of hydroalcoholic tinctures obtained from Agrimonia pilosa Ledeb., Calendula arvensis L., and Polygonum hydropiper L. The tinctures were prepared by simple percolation using 70% ethanol and evaluated according to pharmacopoeial standards, including organoleptic properties, relative density, refractive index, alcohol content, and purity parameters. Phytochemical analysis was performed using thin-layer chromatography and spectrophotometric methods, highlighting the presence of flavonoids and polyphenolcarboxylic acids, with several bands showing chromatographic and spectral similarities to chlorogenic and caffeic acid standards. Antioxidant activity was assessed through total polyphenol and flavonoid content, with Polygonum hydropiper exhibiting the highest values. The hypoglycemic effect was evaluated using the oral glucose tolerance test in normoglycemic mice, demonstrating significant reductions in blood glucose levels, particularly for Agrimonia pilosa at higher doses. Acute toxicity studies indicated a low toxicity profile, with no mortality observed even at high doses (up to 9 g/kg body weight), corresponding to GHS category 5. However, subacute toxicity assessment revealed species-dependent effects, ranging from minimal hepatic changes for Calendula arvensis to moderate hepatotoxicity for Polygonum hydropiper and more pronounced hepatic, renal, and pancreatic alterations for Agrimonia pilosa. These findings suggest that the investigated tinctures possess significant hypoglycemic and antioxidant potential, with generally favorable safety profiles following acute administration. Nevertheless, prolonged use may induce organ-specific toxicity, highlighting the need for further pharmacological and clinical investigations to establish their therapeutic applicability and safety in diabetes management. Full article

Horses in Vietnam have a long historical presence and continue to hold economic, socio-cultural, and medicinal importance across diverse regions. Despite these roles, comprehensive scientific information on equine development, including health and disease patterns, reproductive performance, genetic resources, and biomedical applications, remains limited and fragmented. In this review, we summarize existing knowledge on equine populations, production systems, and their development in Vietnam, as well as their roles in cultural practices, livelihoods, and traditional medicine. We then identify major gaps in surveillance, genetic characterization, and coordinated research capacity by synthesizing evidence from breeding, health, reproduction, and emerging research areas. Finally, we highlight where current efforts fall short and outline key priorities for future work to strengthen equine science, support culturally relevant practices, and guide the sustainable development of Vietnam’s horse sector. Overall, the synthesis information shows (i) native Vietnamese horses belong to the Southeast Asian pony complex and include at least four recognized populations; (ii) the northern mountain provinces account for the substantial majority of the national herd; (iii) strongyle infections, Trypanosomiasis, haemorrhagic septicaemia and the recently confirmed equine piroplasmosis are the principal health challenges; and (iv) genetic characterization, reproductive management, welfare assessment, and capacity building are the four most critical research priorities identified. This information is important for prioritizing future research and conservation activities and enhancing the development of Vietnam’s horse population. Full article

Polygonatum cyrtonema (P. cyrtonema) Hua is an important economic crop with both edible and medicinal value. However, frequent root rot severely restricts its industrial development, resulting in sharp yield reduction and quality deterioration. To clarify the primary pathogenic fungi causing root rot of P. cyrtonema Hua, 58 fungal strains from naturally diseased P. cyrtonema Hua plants in different habitats were isolated in this study. By combining morphological observation and molecular identification based on 18S rDNA and ITS rDNA sequences, the species of 22 pathogenic fungi were identified, among which 10 strains belonged to the genus Fusarium, accounting for 45.45% of the identified isolates. The pathogenicity of 21 pathogenic fungi was verified according to Koch’s postulates, with findings indicating that Fusarium species exhibited significant pathogenic potential. Meanwhile, six previously identified endophytic Paenibacillus strains isolated from P. cyrtonema Hua were employed to perform dual culture assays and antifungal evaluations of their fermentation supernatants against representative strains including F. concentricum F2, Neopestalotiopsis sp. F3 and F. oxysporum F8. The results indicated that the antagonistic activity exhibited by the six strains exceeded 50%, with the inhibition rates of their fermentation supernatants against strains F2, F3 and F8 surpassing 73%. This study confirmed that Fusarium is the dominant pathogenic fungal group causing root rot of P. cyrtonema Hua. Furthermore, highly effective antagonistic endophytes were preliminarily identified, offering candidate strains and a theoretical foundation for the green management of root rot in P. cyrtonema Hua. Full article