Search Results (786)

Helicobacter pylori is a well-established causative agent of gastritis, peptic ulcers, gastric adenocarcinoma, and primary gastric lymphoma. It colonizes the human stomach and expresses numerous virulent factors that influence disease progression. Among these factors is the cytotoxin vacA gene, which encodes the vacuolating capacity of the cytotoxin and plays a key role in the bacterium’s pathogenic potential. This study investigated the allelic diversity of the vacA among H. pylori strains infecting patients in Jordan with various gastric conditions and examined potential associations between vacA s-and m- genotypes, histopathological and endoscopic findings, and the development of gastric diseases. Gastric biopsies were collected from 106 patients at two hospitals in Jordan who underwent endoscopic examination. The collected biopsies for each patient were subjected to histopathological assessment, urease detection using the Rapid Urease Test (RUT), a diagnostic test for H. pylori, and molecular detection of the vacA gene and its s and m alleles. The histopathology reports indicated that 83 of 106 patients exhibited gastric disorders, of which 81 samples showed features associated with H. pylori infection. The RUT was positive in 76 of 106 with an accuracy of 93.8%. Real-time polymerase chain reaction (RT-PCR) targeting the 16S rRNA gene confirmed the presence of H. pylori in 79 of 81 histologically diagnosed cases as infected (97.5%), while the vacA gene was detected only in 75 samples (~95%). To explore genetic diversity, PCR-amplified fragments underwent sequence analysis of the vacA gene. The m-allele was detected in 58 samples (73%), the s-allele was detected in 45 (57%), while both alleles were not detected in 13% of samples. The predominant genotype combination among Jordanians was vacA s2/m2 (50%), significantly linked to mild chronic gastritis, followed by s1/m2 (35%) and s1/m1 (11.8%) which are linked to severe gastric conditions including malignancies. Age-and gender-related differences in vacA genotype were observed with less virulent s2m2 and s1m2 genotypes predominating in younger adults specially males, while the more virulent m1 genotypes were found exclusively in females and middle-aged patients. Genomic sequencing revealed extensive diversity within H. pylori, likely reflecting its long-standing co-evolution with human hosts in Jordan. This genetic variability plays a key role in modulating virulence and influencing clinical outcomes. Comprehensive characterization of vacA genotypic variations through whole-genome sequencing is essential to enhance diagnostic precision, strengthen epidemiological surveillance, and inform targeted therapeutic strategies. While this study highlights the significance of the vacA m and s alleles, future research is recommended in order to investigate the other vacA allelic variations, such as the i, d, and c alleles, to achieve a more comprehensive understanding of H. pylori pathogenicity and associated disease severity across different strains. These investigations will be crucial for improving diagnostic accuracy and guiding the development of targeted therapeutic strategies. Full article

Background/Objectives: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism that results in hepatic, neurological, and psychiatric manifestations. Despite being described globally, data from the Middle East remains limited. This study presents the first comprehensive national cohort analysis of WD in Oman, examining clinical features, diagnostic challenges, treatment patterns, and long-term outcomes. Methods: A retrospective cohort study was conducted on 36 Omani patients diagnosed with WD between 2013 and 2020 at Sultan Qaboos University Hospital using AASLD diagnostic criteria. Clinical presentation, biochemical parameters, treatment regimens, and progression-free survival were analyzed. Results: The median age at diagnosis was 14.5 years, with a slight female predominance (55.6%). Clinical presentation varied: 25% had hepatic symptoms, 22.2% had mixed hepatic-neurological features, and 16.7% presented with neurological symptoms alone. Asymptomatic cases identified via family screening accounted for 33.3%. Diagnostic delays were most pronounced among patients presenting with neurological symptoms. A positive family history was reported in 88.9% of cases, suggesting strong familial clustering despite a low rate of consanguinity (5.6%). Regional distribution was concentrated in Ash Sharqiyah North and Muscat. Chelation therapy with trientine or penicillamine, often combined with zinc, was the mainstay of treatment. Treatment adherence was significantly associated with improved progression-free survival (p = 0.012). Conclusions: WD in Oman is marked by heterogeneous presentations, frequent diagnostic delays, and strong familial clustering. Early detection through cascade screening and sustained treatment adherence are critical for favorable outcomes. These findings support the need for national screening policies and structured long-term care models for WD in the region. Full article

Background and Clinical Significance: Angioleiomyoma (ALM) is a benign tumor that generally presents as a single lesion and, according to the updated WHO classification, includes the following three histological subtypes: solid (or capillary), cavernous, and venous. Typically, ALMs are described as well-defined nodules in the lower extremities but are unusually located in the acral locations and toes. We summarize two cases of ALM and perform a systematic review to provide foot surgeons with the most up-to-date and useful information on the epidemiological aspects, anatomical distribution, and specific histological subtypes of ALM in the foot. Materials and Methods: A systematic review was carried out according to the criteria of a PICO framework, and a systematic search and data processing were carried out according to the PRISMA guidelines. We analyzed patient demographics, clinical characteristics, diagnostic workup, treatment, and clinical outcomes. Each one of the included articles was independently assessed for methodological quality and risk of bias by an independent evaluator. The risk of bias of the included studies was assessed based on their characteristics. Results: This systematic review included 14 case series with 172 reported cases of ALM. One hundred and seventy-two (18.57%) were cases of ALM located on foot, excluding the ankle region. The female-to-male ratio was 1.48. The most common location was the hindfoot (41.5%), followed by the forefoot (20.2%) and the midfoot (8.9%). In 29.4% of cases, the location of the lesions could not be determined. The most frequent location of the lesions was subcutaneous (69%), followed by subaponeurotic (16.5%) and skin (14.5%) locations. The most frequent histological presentation was the solid histologic subtype (65%), followed by the venous subtype (21%) and the cavernous subtype (14%), respectively. Of the total reported cases of ALM located in foot, 63.1% presented as solid painful lesions. Calcified presentations occurred in 7% of cases, with more than half of the cases located in the hindfoot. Surgical excision was the treatment of choice in the two herein reported cases of solid ALM located in the hindfoot, one of them with a calcified presentation. No recurrence was observed in either case after two and five years of follow-up, respectively. All cases reviewed after surgical excision showed a low recurrence rate with a favorable prognosis regardless of the histological subtype and a very rare tendency toward malignancy. Conclusions: ALMs of the foot present as well-defined, painful nodules in the subcutaneous tissue of middle-aged women. Solid histological subtypes are the most prevalent. Histopathological analysis is usually essential for confirmation. Treatment consists primarily of direct excision, with remarkably low recurrence rates. Full article

Background/Objectives: Hispanic adolescents experience elevated rates of disordered eating behaviors and body dissatisfaction, yet limited research has examined how gender and weight status interact to shape these risks within this population. Methods: A cross-sectional survey was conducted among 680 Hispanic adolescents (ages 9–15) from a predominantly Mexican-American middle school. Participants completed the Modified Kids Eating Disorder Survey (M-KEDS), and height and weight were objectively measured to determine BMI-for-age percentile. Chi-square tests, Mann–Whitney U tests, and logistic regression were used to assess differences by gender and weight status, including interaction effects. Bonferroni correction was applied for multiple comparisons. Effect sizes (Cramér’s V, odds ratios with 95% CI) were reported. Results: Approximately 73% of participants reported body dissatisfaction, with significant differences observed by gender and weight status. Adolescents with overweight/obesity reported significantly higher negative weight attitudes and extreme weight control behaviors than healthy-weight peers (p < 0.001), with large effect sizes. Females endorsed more disordered attitudes and behaviors, except for exercise to lose weight, which was more common among overweight/obese males. Conclusions: These findings underscore the high prevalence and significance of disordered eating behaviors in Hispanic adolescents, including those at a healthy weight. Results highlight the importance of culturally tailored, gender-sensitive screening and prevention strategies. Schools serve as critical settings for early identification, and tools like the M-KEDS can help address disparities in care access and improve outcomes among Hispanic youth. Full article

Background: Stroke recovery is influenced not only by clinical but also sociodemographic factors (SDFs). However, data on how variables such as age, sex, marital status, education, and employment status affect rehabilitation outcomes remain limited, particularly in structured inpatient settings. This study aimed to analyze the impact of key SDFs on functional recovery after stroke. Methods: A retrospective cohort of 289 stroke patients undergoing structured inpatient rehabilitation was analyzed. Functional status was assessed at admission, after three weeks, and at discharge using five standardized outcomes: gait speed (primary outcome), Barthel Index, Berg Balance Scale, Action Research Arm Test, and Ashworth scale. Repeated measures ANOVA and multivariable logistic regression were used to evaluate within-subject changes and associations with SDFs. Results: The cohort consisted predominantly of middle-aged to older adults (58% female, 62% married, 60% retired, 60% with primary education or less). Most patients (88%) had ischemic strokes of moderate severity. Significant improvements were observed across all functional measures. Employed, married, younger, and male patients achieved better outcomes. Interaction models indicated that older and female patients with moderate stroke severity demonstrated greater improvement than younger and male counterparts with milder strokes. Mean gait speed increased by +0.32 m/s, exceeding the minimal clinically important difference (MCID) of 0.16 m/s. Conclusions: Age, sex, marital status, education, and employment status are relevant predictors of stroke rehabilitation outcomes. These findings emphasize the importance of incorporating sociodemographic profiles into individualized rehabilitation planning to optimize functional recovery and reduce disparities among stroke survivors. Full article

This study aimed to longitudinally analyze changes in body mass index (BMI) among Korean middle and high school students before and after the COVID-19 pandemic. Data were obtained from the national-level Physical Activity Promotion System (PAPS), collected between 2018 and 2024. A total of 171,705 adolescents aged 13 to 18 were included in the analysis (86,542 males and 85,163 females), with a mean age of 15.2 years (SD = 1.68). Time-series analysis and two-way analysis of variance (ANOVA) were conducted to examine differences in BMI by year, sex, region (capital vs. non-capital), and urban–rural classification. The results indicated a significant increase in BMI during the pandemic period (2020–2022), peaking in 2022, followed by a gradual decline thereafter. Notably, male students and those living in rural or non-capital areas consistently exhibited higher BMI levels, suggesting structural disparities in access to physical activity opportunities and health resources. This study employed the Socio-Ecological Model and the Health Equity Framework as theoretical lenses to interpret BMI changes not merely as individual behavioral outcomes but as consequences shaped by environmental and policy-level determinants. The findings underscore the need for equity-based interventions in physical education and health policy to mitigate adolescent health inequalities during future public health crises. Full article

Background: Bertolotti syndrome describes a painful lumbosacral transitional vertebra (LSTV) with a pseudoarticulation between an enlarged lateral process of the caudal lumbar vertebra (L5) and ilium or sacrum. It often presents with chronic lower back pain with or without radiculopathy. The current literature emphasizes Bertolotti as a differential diagnosis in young adults. However, it is presumably underdiagnosed in middle-aged and older patients. Treatment ranges from conservative treatment with physiotherapy, infiltration, and radiofrequency ablation to surgical interventions. Case Description: In this case illustration, we present the diagnostic and therapeutic challenges in a 48-year-old female triathlete with persistent left gluteal pain caused by Bertolotti syndrome. When conservative treatment with physiotherapy, infiltrations, thermocoagulation, and radiofrequency ablation of the pseudoarticulation failed, microsurgical reduction of the hypertrophic transverse process was performed. This minimally invasive intervention achieved satisfactory pain relief of at least 70% one year after surgery, allowing the patient to resume her athletic activities. Conclusions: Bertolotti syndrome should be considered a potential differential diagnosis in patients of all ages. Since many patients endure years of misdiagnosis, adequate treatment is crucial upon diagnosis. If conservative measures fail, surgical treatment such as “processectomy” or spinal fusion should be evaluated. This case follows the CARE reporting guidelines. Full article

Antimicrobial resistance (AMR) represents a critical global health threat, with inappropriate antibiotic self-medication (ASM) being a key contributor. China—as the world’s largest antibiotic consumer—faces significant challenges despite regulatory efforts, compounded by limited contemporary data during the COVID-19 pandemic. A nationwide cross-sectional study was conducted using the 2021 China Family Health Index Survey (n = 11,031 participants across 120 cities). Trained investigators administered face-to-face questionnaires assessing ASM practices, decision-making factors, and sociodemographic characteristics. Multivariate logistic regression identified determinants of ASM. Overall, ASM prevalence was 33.7% (n = 3717), with no urban-rural difference (p > 0.05). Physician advice (78.2%), drug safety (67.1%), and efficacy (64.2%) were primary selection criteria; rural residents prioritized drug price and salesperson recommendations more than their urban counterparts (p < 0.01). Key predictors included higher ASM odds among females (OR = 1.30, 95%CI:1.18–1.43), middle-aged adults (46–59 years; OR = 1.20, 95%CI:1.02–1.42), those with health insurance (resident: OR = 1.33; commercial: OR = 1.62), and individuals with drinking histories (OR = 1.20, 95%CI:1.10–1.31). Lower odds were associated with primary education (OR = 0.69, 95%CI:0.58–0.81), unemployment (OR = 0.88, 95%CI:0.79–0.98), and absence of chronic diseases (OR = 0.56, 95%CI:0.47–0.67). One-third of Chinese residents engaged in ASM during the pandemic, driven by intersecting demographic and behavioral factors. Despite converging urban-rural prevalence rates, distinct decision-making drivers necessitate context-specific interventions, including strengthened pharmacy regulation in rural areas, tailored education programs for high-risk groups, and insurance system reforms to disincentivize self-medication. Full article

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

Traditional color vision tests lack the sensitivity to detect subtle differences in individuals with normal color vision. The Konan ColorDx Cone Contrast Threshold (CCT) HD test allows the quantitative measurement of color discrimination thresholds for each cone type. This cross-sectional study established normative values for L-, M-, and S-cone contrast sensitivities and evaluated the effects of age and sex on color discrimination thresholds. Participants aged 15–79 years with normal color vision were included (n = 216; 55% female). CCTs were measured monocularly using the Konan ColorDx CCT HD test under standardized conditions, and the influences of age and sex on L-, M-, and S-cone sensitivities were evaluated. In all groups, L-cone sensitivity was the highest, followed by the M- and S-cone sensitivities. Overall contrast sensitivity was significantly higher in females than in males (mean difference = −0.041), especially for adolescents and young adults (20–24 years). Young adults outperformed middle-aged and older adults, with age-related decline most pronounced for S-cone sensitivity in those over 60. The right and left eye sensitivities did not differ. This study provides age- and sex-stratified normative data for the Konan Color Dx CCT HD test, supporting its use for clinical and occupational assessments. Full article

Background/Objectives: Dietary patterns vary with age and sex. The aim of this study was to clarify the differences in dietary patterns among young and middle-aged Japanese individuals by age group and sex via statistical methods such as alpha diversity and beta diversity analyses. Methods: Using data from a dietary survey of 10 food items during health checkups of 2743 Fujita Health University employees, we examined the effects of age and sex on alpha diversity (Shannon index) and beta diversity (nonmetric multidimensional scaling (NMDS) and RDA). Unlike principal component analysis which assumes linear relationships, redundancy analysis (RDA) incorporates explanatory variables to directly assess how external factors shape multivariate patterns. Results: The Shannon index increased with age and was greater in males across age groups. Type III ANOVA revealed significant main effects of age (p < 0.001) and sex (p < 0.001), and the effect of the interaction between age and sex approached significance (p = 0.08). Visualization of the NMDS data revealed that women aged 20–29 years and women aged 30 years and older and men aged 20–39 years and men aged 50–59 years have different dietary patterns. The RDA model accounted for 2.01% of the variance (adjusted R² = 1.94%), with age and sex contributing 56.7% and 43.3%, respectively. RDA1 and RDA2 were correlated with age (r = 0.26, −0.14) and sex (r = 0.15, 0.21). The RDA1 values increased with age and were greater in females, whereas the RDA2 values decreased with age and were greater in females. RDA1 (1.41% of the total variance in food group intake, 70.1% of the constrained variance) was positively associated with fruits, milk, and seaweed and negatively associated with meat and eggs. In RDA2 (0.60% of total variance, 29.9% contribution), fruits, potatoes, and vegetables had positive effects, whereas fish had negative effects. Conclusions: Dietary patterns vary by age and sex, with meat, fish, eggs, and fruit as key determinants. Nutritional guidance must account for variations in dietary patterns influenced by age and sex. Full article

Running enjoys worldwide popularity across age groups and sexes. Because of this, it serves as an excellent benchmark to compare male and female performance across the lifespan with respect to developmental progression, peak athletic performance, and age-related regression. The purpose of this review is to examine and discuss how sex and aging affect running performance in sprints, middle-distance running, and long-distance running. Based on the scientific literature and running world records from age 5–99, male running performance exceeds that of females across the lifespan, with the greatest divide beginning at puberty, which remains through old age. However, there appear to be few differences in the rate of progression in youth and the age of peak performance, but it is unclear whether the rate of decline, beginning in middle age, differs by sex and sport for record performances. Future analyses should examine changes in all running performances across the lifespan. Full article

Background: Cheerleading is an emerging and increasingly popular sport among girls. The figures performed during routines require a high level of balance from the athletes. The aim of the study was to analyze the impact of participation in cheerleading classes on body balance in girls during early adolescence. Methods: A total of 35 female cheerleaders from the Power Stars Sząbruk Club (Poland) were divided into three age groups: 8–9 years (n = 15), 10–11 years (n = 11), and 12–14 years (n = 9). Balance assessment was performed using the E.P.S R/1 pedobarographic platform. The Kruskal–Wallis test with Bonferroni post hoc correction was used to analyze intergroup differences in foot load distribution and balance parameters. Results: The analysis revealed statistically significant differences in the pressure on the forefoot area of the right foot (p = 0.007) between the 8–9 and 12–14 age groups, and in the balance level between the youngest group (8–9 years) and the oldest group (12–14 years) at p = 0.028, as well as between the middle group (10–11 years) and the oldest group (p = 0.004). Conclusions: Participation in cheerleading classes may influence the increase in balance, particularly in terms of the distance of center of pressure (C.O.P.) shifts and the average speed of these shifts. In adolescence, muscle development is crucial, and when closely linked with motor coordination, it helps maintain body stability. Full article

Objective: The aim of this study is to present the initiation of robotic-guided (RG) spine surgery into routine clinical care at a single center with the use of intraoperative CT (iCT) automatic registration-based navigation. The workflow included iCT with automatic registration, fusion with preoperative imaging, verification of preplanned screw trajectories, RG introduction of K-wires, and the insertion of pedicle screws (PSs), followed by a control iCT scan. Methods: All patients who underwent RG implantation of pedicle screws using the Cirq^® robotic arm (BrainLab, Munich, Germany) in the thoracolumbar spine at our department were included in the study. The accuracy of the pedicles screws was assessed using the Gertzbein–Robbins scale (GRS). Results: In total, 108 patients (60 female, mean age 68.7 ± 11.4 years) in 109 surgeries underwent RG PS placement. Indications included degenerative spinal disorders (n = 30 patients), spondylodiscitis (n = 24), tumor (n = 33), and fracture (n = 22), with a mean follow-up period of 7.7 ± 9 months. Thirty-seven cases (33.9%) were performed percutaneously, and all others were performed openly. Thirty-three operations were performed on the thoracic spine, forty-four on the lumbar and lumbosacral spine, thirty on the thoracolumbar, one on the cervicothoracic spine, and one on the thoracolumbosacral spine. The screws were inserted using a fluoroscopic (first 12 operations) or navigated technique (latter operations). The mean operation time was 228.8 ± 106 min, and the mean robotic time was 31.5 ± 18.4 min. The mean time per K-wire was 5.35 ± 3.98 min. The operation time was lower in the percutaneous group, while the robot time did not differ between the two groups. Robot time and the time per K-wire improved over time. Out of 688 screws, 592 were GRS A screws (86.1%), 54 B (7.8%), 22 C (3.2%), 12 D (1.7%), and 8 E (1.2%). Seven screws were revised intraoperatively, and after revision, all were GRS A. E screws were either revised or removed. In the case of D screws, screws located at the end of the construct were revised, while so-called in-out-in screws in the middle of the construct were not revised. Conclusions: Brainlab’s Cirq^® Robotic Alignment Module feature enables placement of pedicle screws in the thoracolumbar spine with high accuracy. A learning curve is shown through improvements in robotic time and time per K-wire. Full article

Background: Fundamental movement skills (FMS)—including muscular strength, endurance, and mobility—are linked to better health-related quality of life and higher physical activity in children. Rural children often score lower on FMS tests than urban peers due to resource limitations rather than ability. Thus, increasing access to FMS activities in under-resourced rural areas is essential. The primary objective was to test the feasibility of Hoosier Strength in a rural middle school sample, and the secondary objective was to observe the preliminary changes in FMS-related outcomes pre- to post-intervention and at follow-up. The exploratory objective was to explore how participants responded to different coaches on the Hoosier Strength coaching team (i.e., gender, coaching style during activities). Methods: This study used a Hybrid Type 3 design to evaluate feasibility and FMS outcomes, integrating qualitative and quantitative data. The four-week intervention included a test group (n = 24; 14 females, 10 males; mean age: females 12.4 ± 0.5 years, males 12.7 ± 0.4 years) and a control group (n = 12; 8 females, 4 males; mean age: females 12.9 ± 0.3 years, males 12.7 ± 0.3 years). Data analysis included descriptive statistics for feasibility indicators (Acceptability of Intervention Measures [AIM], Intervention Appropriateness Measure [IAM], and Feasibility of Intervention Measure [FIM]), linear regression for mobility and muscular endurance changes, t-tests for psychological need satisfaction and frustration, and regression analysis for squat knowledge and post-intervention confidence. Results: (1) There was high feasibility across the 4-week Hoosier Strength intervention and at follow-up; (2) there were no statistically significant changes in squat performance; (3) participants’ confidence in their ability to squat at the end of the intervention was significantly predicted by their squat knowledge at baseline; and (4) participants prioritized leadership and team management over tactical analysis, highlighting a preference for coaches who foster teamwork. Conclusions: The findings offer a transparent approach for evaluating the feasibility and preliminary outcomes of the Hoosier Strength intervention in an under-resourced rural middle school, thereby encouraging further investigation into strength training interventions in rural schools. Full article