Search Results (686)

Biofilms are structured communities of microorganisms encased in a self-produced extracellular matrix, and they represent one of the most widespread forms of microbial life on Earth. Their presence poses serious challenges in both environmental and clinical settings. In natural and industrial systems, biofilms contribute to water contamination, pipeline corrosion, and biofouling. Clinically, biofilm-associated infections are responsible for approximately 80% of all microbial infections, including endocarditis, osteomyelitis, cystic fibrosis, and chronic sinusitis. A particularly critical concern is their colonization of medical devices, where biofilms can lead to chronic infections, implant failure, and increased mortality. Implantable devices, such as orthopedic implants, cardiac pacemakers, cochlear implants, urinary catheters, and hernia meshes, are highly susceptible to microbial attachment and biofilm development. These infections are often recalcitrant to conventional antibiotics and frequently necessitate surgical revision. In the United States, over 500,000 biofilm-related implant infections occur annually, with prosthetic joint infections alone projected to incur revision surgery costs exceeding USD 500 million per year—a figure expected to rise to USD 1.62 billion by 2030. To address these challenges, surface modification of medical devices has emerged as a promising strategy to prevent bacterial adhesion and biofilm formation. This review focuses on recent advances in chemical surface functionalization using non-antibiotic agents, such as enzymes, chelating agents, quorum sensing quenching factors, biosurfactants, oxidizing compounds and nanoparticles, designed to enhance antifouling and mature biofilm eradication properties. These approaches aim not only to prevent device-associated infections but also to reduce dependence on antibiotics and mitigate the development of antimicrobial resistance. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

Antimicrobial resistance (AMR) poses a critical global health threat by rendering existing antibiotics ineffective against infections, leading to increased mortality, prolonged illnesses, and higher healthcare costs. Developing new antibiotics is essential to combat resistant pathogens, safeguard modern medical procedures, and prevent a return to a pre-antibiotic era where common infections become untreatable. We report a series of chiral tricarbonyl rhenium(I) complexes incorporating enantiopure pinene-substituted bipyridine ligands (L#) of the general formula fac-[Re(CO)₃L#X] and fac-[Re(CO)₃L#Py]⁺ (where X = Cl or Br and Py = pyridine). These complexes were isolated as mixtures of two diastereomers, characterized by standard techniques, and evaluated for cytotoxic activity against methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA). The results revealed notable antibacterial efficacy (MIC = 1.6 μM), reflected in high therapeutic indices (Ti > 10). In contrast, analogous complexes bearing non-chiral 2,2′-bipyridine ligands exhibited no activity, underscoring the critical role of chirality in modulating biological interactions at the molecular level. These findings highlight the potential of chiral Re(I) complexes as promising scaffolds for the development of more potent and selective antibacterial agents. Full article

Drug repurposing or drug repositioning is the process of identifying new therapeutic uses for approved or investigational drugs beyond the original treatment indication. The discovery of new drugs for cancer therapy needs this cost-effective and time-saving alternative strategy to traditional drug development for a rapid clinical translation in Phase II/III studies, especially for unmet medical needs and rare diseases. Neuroendocrine tumors (NETs) are a heterogeneous group of rare neoplasms arising from cells of the neuroendocrine system that, though often indolent, can be aggressive and metastatic. In this context, drug repurposing has emerged as a promising strategy to improve treatment options due to the limited number of effective treatments and the heterogeneity of the disease. Indeed, a large number of non-oncology drugs have the potential to address more than one target that could be therapeutic for cancer patients. Although many repurposed drugs are used off-label, efficacy for the new use must be demonstrated in clinical trials. Within regulatory frameworks, both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have procedures to reduce the need for extensive new studies and to expedite the review of drugs for serious conditions when preliminary evidence indicates substantial clinical improvement over available therapy. In spite of several advantages, including reduced development time, lower costs, known safety profiles, and faster regulatory approval, difficulty in obtaining new patents for old drugs with limited protection for intellectual property may reduce commercial returns and disincentivize investments. This review aims to provide comprehensive information on some marketed drugs currently under investigation to be repurposed or used in clinical practice for NETs and to discuss the major clinical challenges. Although drug repurposing is a useful strategy for early access to medicines, the monitoring of the clinical benefit of oncologic drugs during the post-marketing authorization is crucial to support the safety and effectiveness of treatments. Full article

Obesity is a growing global health concern with widespread impacts on physical, psychological, and social well-being. Clinically, it is a major driver of type 2 diabetes (T2D), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), and cancer, reducing life expectancy by 5–20 years and imposing a staggering economic burden of USD 2 trillion annually (2.8% of global GDP). Despite its significant health and socioeconomic impact, earlier obesity medications, such as fenfluramine, sibutramine, and orlistat, fell short of expectations due to limited effectiveness, serious side effects including valvular heart disease and gastrointestinal issues, and high rates of treatment discontinuation. The advent of glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, tirzepatide) has revolutionized obesity management. These agents demonstrate unprecedented efficacy, achieving 15–25% mean weight loss in clinical trials, alongside reducing major adverse cardiovascular events by 20% and T2D incidence by 72%. Emerging therapies, including oral GLP-1 agonists and triple-receptor agonists (e.g., retatrutide), promise enhanced tolerability and muscle preservation, potentially bridging the efficacy gap with bariatric surgery. However, challenges persist. High costs, supply shortages, and unequal access pose significant barriers to the widespread implementation of obesity treatment, particularly in low-resource settings. Gastrointestinal side effects and long-term safety concerns require close monitoring, while weight regain after medication discontinuation emphasizes the need for ongoing adherence and lifestyle support. This review highlights the transformative potential of incretin-based therapies while advocating for policy reforms to address cost barriers, equitable access, and preventive strategies. Future research must prioritize long-term cardiovascular outcome trials and mitigate emerging risks, such as sarcopenia and joint degeneration. A multidisciplinary approach combining pharmacotherapy, behavioral interventions, and systemic policy changes is critical to curbing the obesity epidemic and its downstream consequences. Full article

Hemoglobin plays a critical role in diagnosing various medical conditions, including infections, trauma, hemolytic disorders, and Mediterranean anemia, which is particularly prevalent in Mediterranean populations. Conventional measurement methods require blood sampling and laboratory analysis, which are often time-consuming and impractical during emergency situations with limited medical infrastructure. Although portable oximeters enable non-invasive hemoglobin estimation, they still require physical contact, posing limitations for individuals with circulatory or dermatological conditions. Additionally, reliance on disposable probes increases operational costs. This study presents a non-contact and automated approach for estimating total hemoglobin levels from facial video data using three-dimensional regression models. A dataset was compiled from 279 volunteers, with synchronized acquisition of facial video and hemoglobin values using a commercial pulse oximeter. After preprocessing, the dataset was divided into training, validation, and test subsets. Three 3D convolutional regression models, including 3D CNN, channel attention-enhanced 3D CNN, and residual 3D CNN, were trained, and the most successful model was implemented in a graphical interface. Among these, the residual model achieved the most favorable performance on the test set, yielding an RMSE of 1.06, an MAE of 0.85, and a Pearson correlation coefficient of 0.73. This study offers a novel contribution by enabling contactless hemoglobin estimation from facial video using 3D CNN-based regression techniques. Full article

Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on overall well-being among ambulatory patients in Albania. Methods: A cross-sectional study was conducted in three public urban health centers in Vlora, Albania, between November 2024 and January 2025. A total of 80 ambulatory patients were recruited using convenience sampling. Data were collected through face-to-face interviews using validated questionnaires, including the Adherence Barriers Questionnaire (ABQ), the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and the Patient Health Questionnaire (PHQ-9) for depression screening. Results: The study included 80 ambulatory patients (mean age 66.7 years; 48.7% female), predominantly diagnosed with diabetes (42.5%) and rheumatic diseases (36.3%). All participants reported at least one adherence barrier, with 92.5% experiencing multiple barriers. The most common were financial burden (91.3%) and fear of side effects (77.5%). A significant positive correlation was found between adherence barriers and depression severity (ρ = 0.518, p < 0.0001), while patient satisfaction did not significantly influence adherence barriers (ρ = −0.217, p = 0.053) or depression severity (ρ = −0.004, p = 0.969). Multiple regression analysis showed that higher depression severity (p = 0.0049) was significantly associated with greater adherence barriers, while postgraduate education was associated with fewer barriers (p = 0.0175). Conclusions: Financial burden, fear of side effects, and psychological distress are key barriers to adherence among Albanian ambulatory patients. Although there are limitations inherent to the cross-sectional design and modest sample size, our findings highlight the potential benefit of routine mental health screening, targeted financial support, and improved patient education on medication management within primary care. These insights may help inform future research and interventions aimed at enhancing adherence and overall well-being. Patient satisfaction did not significantly impact adherence or depression. Targeted interventions focusing on financial support, mental health care, and patient education are needed to improve adherence and patient well-being. These findings underscore the need for integrated mental health and adherence support strategies within routine primary care services. Full article

Background: Excessive alcohol consumption constitutes a serious cause of death worldwide. Fatty acid ethyl esters, as metabolites of the non-oxidative elimination pathway of ethanol, have been recognized as mediators of alcohol-induced organ damage. These metabolites serve as potential biomarkers for the assessment of ethanol intake and might be also used in post-mortem studies. Methods: In this study, the development and optimization of a simple, fast, precise, accurate, and cost-effective method with the use of gas chromatography coupled with tandem mass spectrometry for quantitative analysis of six fatty acid ethyl esters, namely ethyl laurate, myristate, palmitate, linoleate, oleate, and stearate, were conducted. Results: The optimized method was fully validated according to ICH guidelines. Additionally, identification of critical method parameters was possible by using the quality by design approach. By carrying out analyses according to the Plackett–Burman plan (design of experiments methodology), the robustness of the analytical method developed was confirmed for four (ethyl palmitate, linoleate, oleate, and stearate) ethyl esters. In the case of ethyl myristate, the variable significantly affecting the results appeared to be the temperature of solvent evaporation after the deproteinization step. Conclusions: Biochemical interpretation of the obtained results with available medical records suggests that plasma concentrations of selected fatty acid ethyl esters are valuable indicators of pre-mortem alcohol consumption and may be one of the key factors helpful in determining the cause and mechanism of death. Full article

Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally. Full article

Background/Objectives: The INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) network introduces an innovative model of psychogeriatric care, combining tertiary mental healthcare with primary care for older adults in low-resource settings in Greece via telemedicine. This study explores viewpoints of healthcare professionals on care delivery within the frames of old-age mental telehealth services in low-resource settings. Methods: All healthcare professionals, including 13 medical and 11 non-medical professionals from diverse healthcare units in urban, rural, and insular areas, participated in a semi-structured survey. Thematic analysis identified key insights. Results: Most participants (N = 19) highlighted the high usability of the INTRINSIC services and their high satisfaction for being members of the network (N = 17) was attributed to the collaborative delivery of integrated, specialized healthcare services in primary healthcare (N = 17). Further identified advantages of the services included the positive impact on timely care delivery (N = 6), cost effectiveness, and alleviation of hospital strain. Healthcare professionals valued the holistic approach of the INTRINSIC services to psychogeriatric care (N = 8) and their role in the improvement of it in communities in low-resource settings (N = 13). However, challenges were also reported, including the low openness and reluctance of service users (N = 7), difficulties in using the INTRINSIC digital platform (N = 5), and increased workload (N = 5). Conclusions: Despite these issues, the INTRINSIC services embody an innovative telehealth model for delivering high-quality, tertiary, mental, and cognitive healthcare services to older adults in underserved areas. Full article

Background: Asthma is the most common chronic respiratory disease in children and adolescents, associated with high morbidity and healthcare costs. Telemedicine has emerged as a strategy to improve access to care, adherence to treatment and symptom control. However, its effectiveness in the pediatric population has not been clearly studied. Objective: To assess the clinical effectiveness of telemedicine interventions in asthma control and health-related quality of life in asthmatic children and adolescents. Methodology: A systematic review and meta-analysis were performed following PRISMA-2020 guidelines, with previous registration in PROSPERO (CRD42025251000837). Sixteen randomized clinical trials (n = 2642) with patients aged 2–18 years were included. The interventions included videoconferencing, mobile applications, web systems, interactive voice response and mobile units in schools. The outcomes were measured using validated quality-of-life (PAQLQ) and asthma control (ACT/c-ACT) questionnaires. Results: Seven studies were incorporated into the PAQLQ meta-analysis, whose overall effect was non-significant (mean difference = 0.06; 95% CI: −0.06 to 0.18; I² = 5.7%). Five studies provided ACT/c-ACT data, showing a significant effect in favor of telemedicine (mean difference = 0.61; 95% CI: 0.32 to 0.90; I² = 73%). Complementary qualitative analysis revealed improvements in adherence, reduction in exacerbations, emergency department visits and use of rescue medication. Conclusions: Telemedicine improves the clinical control of pediatric asthma, although its impact on the quality of life is limited. Multicenter trials with long-term follow-up and cost-effectiveness evaluation are required. Full article

One of the world’s most sustainable solutions is to replace fossil-based polymers with biopolymers. The production of xanthan gum can be optimized using various renewable and cost-effective raw materials, which is a key focus in industrial biotechnology. Xanthan gum is a bioengineered thickening, stabilizing, and emulsifying agent. It has unique properties for use in many industries (food, biotechnology, petrochemicals, agricultural, cosmetics, wastewater treatment) and medical applications. It is tasteless, environmentally safe, non-toxic, and biodegradable. The biotechnological production of xanthan gum depends on several factors: bacterial strain development, culture medium preparation, carbon sources, fermentation parameters and modes, pH, temperature, recovery, purification, and quality control regulations. Bio-innovative strategies have been developed to optimize the production of xanthan gum. A variety of carbon and nitrogen sources, as well as alternative renewable sources, have been used in the production of xanthan gum. The aim of the present study was to optimize the xanthan gum yield using Xanthomonas campestris bacteria and different carbon (D-glucose, D-sorbitol, lactose, sucrose, D-mannitol, D-fructose, erythritol, coconut palm sugar, L-arabinose, unrefined cane sugar), various nitrogen (bacterial peptone, casein peptone, L-glutamic acid, L-arginine, L-methionine, L-tryptophan, malt extract, meat extract, L-phenylalanine, soy peptone) and alternative carbon (orange peels, tangerine peels, lemon peels, avocado peels, melon peels, apple peels, cellulose, xylose, xylitol) sources. The xanthan gum samples were analyzed using antioxidant methods. Our study showed that using L-glutamic acid as the carbon source for 72 h of bacterial fermentation of Xanthomonas campestris resulted in the highest xanthan gum yield: 32.34 g/L. However, using renewable resources, we achieved a very high concentration of xanthan gum in just 24 h of fermentation. According to the reducing power and DPPH methods, the highest antioxidant activities were measured for xanthan gum whose biosynthesis was based on renewable resources. Xanthan gum structures have been verified by FT-IR and ¹H NMR analysis. The sustainable biotechnology study has the advantage of increasing the sustainable production of xanthan gum by using renewable alternative resources compared to other production processes. Xanthan gum continues to be a valuable biopolymer with a wide range of industrial applications while promoting environmentally friendly production practices. Full article

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes. Full article

The development of effective, cost-efficient, and printable solid-state gas sensors for the detection of volatile organic compounds is of great interest due to their wide range of applications, spanning from real-time indoor monitoring to emerging fields such as non-invasive medical diagnostics. However, gas sensors encounter difficulties in discovering materials that have both good selectivity and sensitivity for numerous volatile organic compounds in both dry and humid settings. To expand the class of sensing materials, the current study investigates the sensing performance of solid solutions based on a rare-earth metal oxide. Pr, Fe, and Ti oxide solid solutions were produced using a solid-state technique, with thermal treatments at varied temperatures to tune their structural and functional properties. The powders were used, for the first time, to produce chemoresistive sensors, which showed promising sensing capabilities vs. ethanol, acetone, and acetaldehyde. The sensors were characterized by varying the concentration of the target gases from 1 to 50 ppm in a controlled environment, with the relative humidity ranging from 2 to 40%. The findings bring a turning point, leading to fruitful paths for the development of Pr-based solid solutions-based chemoresistive gas sensors for the detection of volatile organic compounds. Full article

Introduction: The implantation of a left ventricular assist device (LVAD) is a life-saving therapeutic option for patients with advanced heart failure. The treatment goal has to be determined prior to LVAD implantation. However, prognostic evaluation for defining the treatment goal could be improved for a time- and cost-effective medical treatment. Methods: Our study comprised seven patients who were weaned from LVAD (recovery group) and a control group without weaning (non-recovery group; n = 7). Myocardial tissue was analysed for connective tissue content by Masson–Goldner trichrome staining and for collagen I and collagen III expression by quantitative real-time PCR and immunohistochemistry. Results: The histological evaluation revealed comparable values for the percentage of total connective tissue (non-recovery: 46.3% [95% CI: 15.9–76.7], recovery: 43.4% [95% CI: 13.7–73.2], p = 0.43). mRNA expression analysis for collagen I and III expression could not detect a difference in collagen I (p = 0.16) and collagen III expression (p = 0.12) between the non-recovery and the recovery group. Immunohistochemical staining revealed that the percentages of collagen I (p = 0.05) and of collagen III (p = 0.01) were reduced in patients who do not recover compared to patients who recover under LVAD support. Conclusions: Our data indicate that histological evaluation for collagen expression prior to LVAD implantation could detect differences in the collagen content that could be helpful for estimating the weaning success. Full article