Search Results (732)

Background and Objectives: Infective endocarditis (IE) remains a severe infection with high morbidity and mortality, particularly among people who inject drugs (PWID). Data from Eastern Europe are limited, despite the increasing burden of intravenous drug use in the region. Materials and Methods: We conducted a retrospective, observational cohort study of 153 patients diagnosed with IE and admitted to the “Dr. Victor Babeș” Clinical Hospital for Infectious and Tropical Diseases in Bucharest, Romania, between August 2019 and July 2024. Patients were classified into PWID (n = 51) and non-PWID (n = 102). Clinical characteristics, microbiological profiles, echocardiographic findings, complications, and outcomes (in-hospital, 10-week, and 12-month mortality) were compared between groups. Results: PWID were significantly younger (mean 34.0 ± 6.6 years vs. 64.3 ± 13.1 years; p < 0.001), predominantly male (86.3% vs. 62.7%; p = 0.003) and had higher rates of HIV (64.7%) and HCV (98.1%). Right-sided IE and larger vegetations were more common in PWID, whereas non-PWID had more left-sided disease, pre-existing valvular pathology, and prosthetic valve involvement. Staphylococcus aureus predominated in PWID (68.6% vs. 27.5%; p < 0.001), while non-PWID had more Streptococcus spp. and Coxiella burnetii cases. Embolic complications, particularly pulmonary emboli, and valvular rupture were significantly more frequent in PWID, while non-PWID had higher rates of heart failure and surgical interventions. In-hospital mortality was similar (17.6% vs. 11.8%; p = 0.318), but 12-month mortality was higher in PWID (27.5% vs. 13.7%; p = 0.038). Conclusions: IE in PWID shows a distinct clinical and microbiological profile, with more aggressive complications and worse long-term survival. Tailored management, early diagnosis, harm reduction programs, and dedicated follow-up are urgently needed in this high-risk population. Full article

Background/Objectives: The associations between plasma homocysteine and pre-stroke antithrombotic medication and the effects these have on clinical outcomes of patients undergoing ischemic stroke remains unclear. This study aimed to evaluate the combined effect of plasma homocysteine levels and the use of pre-stroke antithrombotic medication on the clinical outcomes of patients experiencing first-ever and recurrent ischemic strokes. Methods: Anonymized data from consecutive patients who experienced ischemic stroke and had their plasma homocysteine levels evaluated were retrospectively analyzed. Pre-stroke antithrombotic medication status, clinical variables potentially influencing homocysteine concentrations, and stroke recurrence data were collected. Clinical outcomes were assessed using the modified Rankin Scale 3 months after stroke onset. The association between hyperhomocysteinemia and clinical outcomes was evaluated using logistic regression models. Results: Hyperhomocysteinemia was significantly associated with unfavorable clinical outcomes (adjusted odds ratio [aOR], 1.32; 95% confidence interval, 1.04–1.69) in the 2767 patients who were analyzed. The absence of pre-stroke antithrombotic medication use was associated with unfavorable outcomes (aOR range, 1.29–1.56), specifically in patients with first-ever stroke (aOR range, 1.45–1.64) but not in patients with recurrent strokes (aOR range, 0.70–1.04). Conclusions: Hyperhomocysteinemia and non-use of pre-stroke antithrombotic medication were significantly related to unfavorable outcomes in patients experiencing their first-ever stroke. These findings might provide prognostic insights into stroke management and patient stratification. Full article

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the risk of HIV transmission. This systematic review aims to provide a deeper understanding of the relationships between various alcohol- and HIV-related risk behaviors among adolescents by synthesizing existing literature that exclusively uses Youth Risk Behavior Survey (YRBS) data. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in PubMed, Web of Science, and PsycINFO. Eligible studies were peer-reviewed, published in English, and analyzed associations between alcohol use (age at first drink, alcohol use, binge drinking) and HIV risk behaviors (number of sexual partners, condom use, HIV testing) using YRBS data from the 2005–2021 collection years. Two authors independently screened 1133 records for eligibility, with 17 studies included in the final review. Results: The included studies consistently found a significant positive association between the frequency of alcohol use and binge drinking and a greater number of sexual partners. However, the evidence for an association between alcohol use and condom non-use was mixed. Limited evidence suggests that age of first alcohol use is not correlated with condom non-use. A key finding was the wide variation in study methodology, including the use of lifetime versus recent and dichotomized versus ordinal measures. Additionally, few studies were guided by a theoretical framework. Conclusions: The findings support a consistent link between alcohol use and having a greater number of sexual partners but highlight mixed evidence regarding condom use and little evidence for an association with HIV testing. This review demonstrates a need for more nuanced, theory-driven analyses that better utilize the multidimensional data available in the YRBS to capture the complex nature of risk behaviors. Full article

Background and Objectives: Performance of robot-assisted total knee arthroplasty (TKA) procedures has continued to increase in popularity. However, tourniquet use is necessary for longer periods of time in robot-assisted TKA than conventional manual TKA because the robot-assisted procedure requires an additional registration process. The use of tourniquets for long periods increases the risk of hidden blood loss and ischemic soft tissue injury in the lower extremity. The purpose of this study was to compare the value of performing robot-assisted TKA without the use of a tourniquet to that of performing this surgery with the use of a tourniquet. Parameters we assessed were blood loss, degree of postoperative thigh and knee pain, and occurrence of early post-operative complications. Materials and Methods: Data from 100 consecutive patients who underwent primary unilateral robot-assisted TKA between July 2024 and July 2025 were included in this study’s analyses. Patients were divided into three groups chronologically. The first 29 patients comprised group 1, the early tourniquet group; the next 30 patients were assigned to group 2, the no tourniquet group; and group 3 was the late tourniquet group and comprised the remaining 41 subjects. However, because allocation was chronological rather than randomized, the outcomes of later groups may partly reflect the surgeon’s accumulated experience (learning curve), which should be considered when interpreting the results. The primary outcome measure was estimated blood loss (EBL). The secondary outcome measures included transfusion rate, visual analog scale (VAS) pain scores for the knee and thigh on the third postoperative day, readmission rate due to surgical complications, superficial and deep infection rate, length of operation, and length of tourniquet use. Results: Group 2 participants, the no tourniquet participants, experienced significantly greater EBL on postoperative days (PODs) 1, 2, and 3 compared to the subjects assigned to groups 1 and 3 (p = 0.003, p < 0.001, and p = 0.005, respectively). However, there were no significant differences in transfusion rates (p = 0.290) among the 3 groups. VAS scores for knee and thigh pain were also not significantly different among the three groups (all p-values > 0.05). Three patients in group 1 (10.3%), one patient in group 2 (3.3%), and one patient in group 3 (2.4%) were readmitted for complications related to wound healing (p = 0.289). Additionally, two patients in group 1 developed superficial wound infections from which the causative bacteria were cultured. No infections were observed in the other groups (p = 0.082), however. Two patients in group 1 and two patients in group 2 experienced symptomatic deep vein thrombosis (DVT) (p = 0.235). No group 3 patients experienced DVT, and only one patient in group 2 was confirmed with DVT using an enhanced CT scan (p = 0.308). Group 3 patients had shorter lengths of surgery (p < 0.001) than group 1 and 2 patients and had shorter periods of tourniquet use (p = 0.034) than group 1 patients. Conclusions: Tourniquet non-use in robot-assisted TKA surgeries was associated with greater EBL in acute postoperative periods, but this finding was not accompanied by any change in transfusion rate. Tourniquet non-use was not clinically beneficial for reducing immediate postoperative thigh and knee pain or reducing the prevalence of early post-operative complications. Tourniquet use in robot-assisted TKA may be beneficial because of the advantages its use provides in maintaining a clear surgical field and in facilitating the cementing process. Full article

Background: It remains unclear whether metformin, a widely used antidiabetic medication, has any influence on the survival outcomes or treatment-related toxicities of radiotherapy in cancer patients. Given metformin’s potential anti-cancer properties, including its ability to inhibit tumour growth through the modulation of cellular metabolism and enhancement of radiosensitivity, its impact on radiotherapy outcomes warrants thorough investigation. This study aimed to evaluate the impact of metformin on survival and adverse events among cancer patients receiving radiotherapy. Methods: Database searches were conducted in MEDLINE, EMBASE, Web of Science, Scopus, and PubMed (2000–2025) to retrieve studies of adults with cancer treated with radiotherapy and concurrent metformin. Metformin users were compared with non-users. The pooled overall survival rate was presented in terms of odds ratio (OR) and 95% confidence interval (95%CI). Diabetic subgroup analyses and meta-regression by cancer type were conducted. ORs and 95%CIs of radiotherapy-related adverse events were presented by cancer type. Results: This study identified 25 articles. The pooled overall survival rate showed no significant difference between metformin users and non-users across subgroups (ORs: 1.00–1.77). Conflicting survival trends were observed for prostate, oesophageal, and non-small cell lung cancer across diabetic conditions. Metformin users with breast cancer exhibited a significantly lower risk of heart failure (OR: 0.72; 95%CI: 0.56–0.94) and heart events (OR: 0.72; 95%CI: 0.59–0.88). Conclusions: Metformin did not significantly impact overall survival but may reduce heart-related adverse events in breast cancer patients based on limited data. Further research is needed on cancer types and diabetic conditions. Full article

Background/Objectives: The association between vitamin C intake and frailty among older adults remains unclear, and evidence from Asian populations is limited. Using nationally representative data, we aimed to examine whether vitamin C supplementation is associated with frailty in Koreans aged ≥65 years. Methods: We analysed 2819 participants from the 2018–2019 Korea National Health and Nutrition Examination Survey. Participants were categorised as non-users of dietary supplements (n = 1517), users of other supplements (n = 1227), and vitamin C-only users (n = 75). Frailty was defined using a modified Fried phenotype comprising five components (weight loss, exhaustion, weakness, slowness, and low physical activity); individuals having ≥3 components were classified as frail. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for frailty by supplement use and total daily vitamin C intake from foods and supplements, adjusting for sociodemographic, lifestyle, and health factors. Results: Compared with non-users (adjusted OR: 0.65, 95% CI: 0.26–1.66) or users of supplements other than vitamin C supplements (adjusted OR: 0.81, 95% CI: 0.26–2.53), vitamin C supplementation was not significantly associated with frailty prevalence. Higher total intake showed a tendency toward lower frailty prevalence in crude analyses, but this was not significant after adjustment (p for trend = 0.120). Conclusions: In this nationally representative study of Korean older adults, vitamin C supplementation was not significantly associated with frailty. These findings contribute to the conflicting evidence on micronutrients and frailty and suggest that broader dietary quality, rather than single-nutrient supplementation, may be more important for healthy ageing. Full article

Zoonotic Campylobacter species (ZCS), particularly C. jejuni and C. coli, cause major foodborne gastroenteritis and poultry is the principal reservoirs. However, there is limited data on Campylobacter transmission risk practices and antimicrobial resistance (AMR) in Nigeria. Therefore, this study determined the prevalence, AMR, and risk practices aiding Campylobacter transmission in two major slaughterhouses processing poultry carcasses in Enugu State, Nigeria. Four hundred poultry faecal samples were analysed for zoonotic Campylobacter organisms using standard protocols. Antimicrobial resistance was profiled via Kirby–Bauer disk diffusion technique, against eight antimicrobial agents. Risk practices were assessed through slaughterhouse observations and interviews with 56 workers. The overall prevalence of Campylobacter infections was 14.5% (58/400), while the species-specific prevalence were 13% (52/400) and 1.5% (6/400) for C. coli and C. jejuni, respectively. Campylobacter colonisation was significantly higher (p < 0.05) in broilers, and during the wet season. The AMR profile of the isolates against the eight antibiotics tested was: Amoxicillin/clauvlanic acid (100%), vancomycin (100%), tetracycline (96.6%), ciprofloxacin (55.2%), chloramphenicol (44.8%), ceftazidime (10.3%), azithromycin (3.4%) and streptomycin (3.4%). All the 58 Campylobacter isolates were multidrug-resistant. The multiple antibiotic resistance indices ranged from 0.4 to 0.9, with a mean of 0.7. Major risk practice associated with ZCS transmission include non-use of personal protective equipment (100%), slaughtering on unsanitary surfaces (100%), using visibly unclean water for meat processing (100%), improper manual evisceration (75%), eating or drinking during processing (64.4%), slaughtering sick animals (37.5%), inadequate cleaning of surfaces and equipment after use (21.4%) and consuming raw meat during carcass processing (19.6%). The findings reflect critical gaps in food safety, occupational health, prudent antimicrobial use in poultry farming and zoonotic disease control, emphasizing the need for antibiotic regulation, training on hygienic meat processing, public education, infrastructural development of slaughterhouse facilities, and inter-sectorial collaboration to curb Campylobacter contamination and spread of antimicrobial resistance. Full article

Background: Obstructive sleep apnea (OSA) is highly prevalent in the early stages of Alzheimer’s disease (AD), and its hallmark, sleep fragmentation, may accelerate cognitive decline. Continuous positive airway pressure (CPAP) improves OSA-related hypoxia during slow-wave sleep, but its cognitive benefits in AD remain unclear. Methods: We performed a 12-month sub-analysis of a prospective, longitudinal pilot study that enrolled 21 adults (median age = 77 yr; 71% women) with Mild Cognitive Impairment (MCI) with AD confirmed biomarkers and polysomnography-diagnosed OSA. All participants underwent baseline overnight polysomnography (PSG) and neuropsychological testing (Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)) that were repeated after 12 months. Twelve participants were CPAP-compliant (moderate/severe OSA) and nine were non-users (mild OSA/intolerance). Cognitive change scores (Δ = 12 months -baseline) were compared with Generalized Linear Models (GLM) adjusted for baseline cognition and Apnea–Hypopnea Index (AHI); associations between baseline sleep parameters and cognitive trajectories were examined. And the association of sleep variables with the use of CPAP was also evaluated. Results: Compared with non-users, CPAP users showed significantly slower global decline (Δ MMSE: p = 0.016) and improvements in overall cognition (Δ RBANS Total: p = 0.028) and RBANS sub-domains (Δ RBANS FC: p = 0.010; Δ RBANS SF: p = 0.045). Longer baseline non-rapid eye movement (NREM) stage 3 and rapid eye movement (REM) sleep, greater total sleep time and sleep efficiency, and right-side sleeping were each linked to better cognitive outcomes, whereas extended NREM stage 2, wakefulness, and supine sleeping were associated with poorer trajectories. Conclusions: Twelve months of CPAP use was associated with attenuated cognitive decline and domain-specific gains in AD-related MCI with OSA. Sleep architecture and body position during sleep predicted cognitive outcomes, underscoring the therapeutic relevance of optimizing breathing and sleep quality. Larger, longer-term trials are warranted to confirm CPAP’s disease-modifying potential and to clarify the mechanistic role of sleep in AD progression. Full article

The use of dietary supplements is widespread among athletes and physically active individuals, yet their impact on health-related quality of life (HRQoL) remains insufficiently understood. This study investigated the associations between supplement use, physical activity patterns, and HRQoL in a heterogeneous sample of 537 adults engaged in sports at amateur, professional, or recreational levels. Participants completed an online survey assessing demographics, supplement use, physical activity habits, and quality of life using the SF-36 questionnaire. Statistical analyses included chi-square tests and independent-samples t-tests to explore relationships between supplement use, body mass index (BMI), motivational variables, and HRQoL outcomes. Results indicated that 46.7% of participants reported consuming at least one supplement or substance, with an average of 1.91 products. The primary motivations included performance enhancement (30.7%) and combined performance and aesthetic goals (12.1%). A significant association emerged between supplement use and the consistency of physical activity over time, as well as the individual’s motivation for engaging in exercise. Participants who maintained stable activity levels and those driven by performance or competitive motives were more likely to use supplements. In contrast, individuals exercising primarily for physical and psychological health were less likely to report supplement use. When comparing HRQoL scores, supplement users showed significantly lower levels of impairment due to emotional issues (RE), social functioning (SF), and bodily pain (BP). Among these variables, only Bodily Pain presented a small effect size, suggesting a meaningful difference between users and non-users. These findings highlight that while supplements are commonly used in athletic contexts, their association with improved quality of life is limited, and may even reflect attempts to manage physical discomfort. Further research is needed to clarify the directionality of these relationships and inform safe and evidence-based consumption. Full article

Background: Since the emergence of e-cigarettes on the market in the early 2000s, the prevalence of e-cigarette use has increased globally. The health risks of using e-cigarettes have been increasingly revealed; however, the health effects on non-users exposed to e-cigarettes are less known. Methods: A systematic review was conducted of peer-reviewed articles from 2004 to October 2024 from PubMed and Embase. We focused on the studies that described health outcome measures among non-smokers/vapers exposed to secondhand e-cigarettes. We excluded animal studies and those that did not include human participants. We also omitted studies with financial conflicts of interest with the tobacco industry. Results: Of the 8635 studies we found in our search, 16 were included in the final review. Study designs included in our review included a case study, a cohort, eight experimental, four cross-sectional studies, and two observational studies. Health outcome measures were self-reported health symptoms and biomarkers. Ten out of fourteen studies examined respiratory health risks, six described immunological effects, two examined cardiovascular risks, and one explored mental health effects. Self-reported health symptoms such as bronchitis, shortness of breath, asthma, throat irritations, ear infections, and mental health disorders were observed among secondhand e-cigarette exposures when compared with controls. Biomarker measures varied among studies, except for cotinine concentrations of non-smokers/vapers exposed to secondhand e-cigarettes, which were likely to be higher than non-exposed. However, all studies encountered potential limitations. Conclusions: Our review found that secondhand e-cigarette exposure is not harmless and may have negative health consequences. However, higher-quality prospective studies remain essential to examine long-term secondhand exposure. Full article

Muscle dysmorphia (MD) is a body image disorder characterized by an obsessive preoccupation with muscularity and compulsive behaviors such as excessive exercise, rigid dieting, and frequent body checking. MD has been linked to obsessive–compulsive traits and the use of anabolic–androgenic steroids (AASs), yet these associations have not been comprehensively synthesized. This systematic review and meta-analysis examined the relationships between MD, obsessive–compulsive symptomatology, and AASs or performance-enhancing drug use. Following PRISMA 2020 guidelines and PROSPERO preregistration (CRD42025640206), we searched four major databases for peer-reviewed studies published between 2015 and 2025. Ten studies (five quantitative, five qualitative) met the inclusion criteria. Meta-analytic findings revealed a moderate positive correlation between MD symptom severity and obsessive–compulsive traits (r ≈ 0.24), and significantly higher MD symptoms among AAS users compared to non-users (Cohen’s d ≈ 0.45). Odds of MD were markedly higher in steroid-using populations. Thematic synthesis of qualitative studies highlighted compulsive training routines, identity conflicts, motivations for AAS use, and limited engagement with healthcare services. These findings suggest that MD exists at the intersection of obsessive–compulsive psychopathology and substance-related behavior, warranting integrated interventions targeting both dimensions. The study contributes to understanding MD as a complex, multi-faceted disorder with significant clinical and public health relevance. Full article

Since the popularization of dating apps, the scientific literature developed in the last decade still has various limitations that concern both the populations studied and the variables evaluated. Therefore, this study aimed to analyze the use of dating apps among adults (25–50 years) and the relationship between the use of these apps and mental, physical and sexual health and substance use. A total of 1004 adults of both sexes (M = 36.61, SD = 7.16; 50.7% women, 49.3% men) participated in the study, filling out a battery of online questionnaires. A 40% prevalence of dating apps use was found. Men, non-heterosexuals, and single people showed higher use of these apps. No relationship was found between the use of dating apps and mental health (self-esteem, anxiety, depression). On the other hand, a direct association was found between being a dating app user and the consumption of substances (tobacco, alcohol, marijuana, cocaine, mental health medication), concern about physical appearance, and the practice of physical exercise. In addition, app users showed better sexual functioning than non-users. The main finding of the study is that there are no differences in mental health (self-esteem, anxiety, depression) between adult users and non-users of dating apps. The results obtained have significant implications both a psychological and social viewpoint. Therefore, they must be considered when implementing prevention and promotion programs for sexual health. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation. Full article

Background/Objectives: This review aimed to evaluate whether patients undergoing dental extractions while taking antidepressants experience increased intra-operative or post-operative bleeding compared to patients not taking these medications. Methods: A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for randomized controlled trials (RCTs) published before 17 August 2025. Studies were included if they compared bleeding outcomes between antidepressant users and non-users undergoing dental extraction procedures. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42025645035). Results: Of 689 studies screened, no RCTs met the eligibility criteria. Only one retrospective study, which did not match the inclusion criteria, identified a 1% incidence of bleeding complications in users of selective serotonin reuptake inhibitors (SSRIs) undergoing invasive dental procedures. However, it lacked a control group and standardized methodology, so this study was included in the discussion section. Conclusions: The lack of high-quality evidence, especially studies examining dynamic coagulation parameters like bleeding time and prothrombin time before and after antidepressant use, highlights a significant gap in the research. These findings emphasize the urgent need for well-designed clinical trials to determine the potential effect of antidepressants on bleeding risk. Full article