Search Results (3,416)

Chronic ulcers are characterized by impaired tissue repair and frequently harbor antimicrobial-resistant microorganisms, worsening clinical outcomes. The objective of this study is to identify microbial agents in chronic ulcers treated at the Lauro de Souza Lima Institute Wound Care Outpatient Clinic and to evaluate their antimicrobial susceptibility profiles and β-lactamase production. Samples (swab and biopsy) from patients treated at the Lauro de Souza Lima Institute were analyzed. Susceptibility was assessed by disk diffusion. ESBL and AmpC production were confirmed by PCR targeting blaTEM, blaSHV, blaCTX-M1, and blaCMY-2. In Staphylococcus spp., oxacillin and clindamycin resistance were evaluated and confirmed by mecA and ermAC. From 33 patients (mean age 63.4 years), 116 isolates were obtained, mainly Pseudomonas aeruginosa (27%), Proteus mirabilis (18%), and Staphylococcus aureus (13%). P. aeruginosa showed high resistance, with 48% MDR and 29% PDR. Among Enterobacterales, 19% were ESBL producers and 17% AmpC, with 56% carrying blaCMY-2. In Staphylococcus, 33% were oxacillin-resistant and 50% expressed MLSb phenotype. P. aeruginosa was identified as the most prevalent pathogen, with frequent MDR/PDR phenotypes. Resistance genes exhibited a discrepancy between genotypic and phenotypic profiles, suggesting the presence of unexpressed resistance that may be inducible during treatment. Full article

Background: Sepsis and septic shock are associated with high mortality in intensive care units (ICUs), with a substantial risk persisting after ICU discharge. However, it remains unclear whether inflammatory biomarkers retain their prognostic value at the time of ICU discharge. This study aimed to evaluate whether discharge inflammatory biomarkers—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-mean platelet volume ratio (PLT/MPV), and C-reactive protein-to-albumin ratio (CAR)—remain predictive of short- and long-term mortality in patients with sepsis and septic shock. Methods: In this single-center, retrospective cohort study, adult patients with sepsis or septic shock discharged from a tertiary ICU specializing in chest diseases between January 2013 and January 2015 were included. Sepsis and septic shock were retrospectively re-classified according to Sepsis-3 criteria. Inflammatory biomarkers measured at ICU admission and discharge, along with clinical variables and disease severity scores (APACHE II and SOFA), were recorded. Patients were followed for 28-day, 6-month, and 2-year mortality. The prognostic performance of biomarkers was assessed using receiver operating characteristic (ROC) analysis, and optimal cut-off values were determined. Independent predictors of mortality were evaluated using Cox proportional hazards regression analysis. Results: A total of 461 patients were included. In total, 291 (63.1%) had sepsis without shock and 170 (36.9%) had septic shock. The overall male proportion was 62%, with a median age of 65 (IQR 54–74) years in the sepsis group and 70 (63–79) years in the septic shock group. Mortality rates were significantly higher in patients with septic shock compared to those with sepsis at 28 days (24% vs. 10%, p < 0.001), 6 months (44% vs. 27%, p < 0.001), and 2 years (71% vs. 57%, p = 0.003). In unadjusted survivor/non-survivor comparisons, elevated discharge NLR and CAR were associated with early post-ICU mortality. However, in multivariable Cox regression, discharge NLR, but not discharge CAR, remained independently associated with 28-day and 6-month mortality. On ROC analysis, discharge NLR showed moderate discriminative performance for 28-day mortality (AUC 0.67, 95% CI 0.60–0.74), as did discharge CAR (AUC 0.68, 95% CI 0.60–0.76), although CAR did not retain independent prognostic significance after adjustment. An NLR value ≥ 5 was identified as an independent predictor of 28-day mortality (HR 2.44; 95% CI 1.24–4.80; p = 0.010) and was also significantly associated with 6-month mortality (HR 2.02; 95% CI 1.18–3.45; p = 0.011), although its predictive value decreased over longer follow-up periods (HR 1.37; 95% CI 0.93–2.01; p = 0.11 at 2 years). Conclusions: Inflammatory biomarkers measured at ICU discharge, particularly NLR, remain predictive of short-term mortality in patients with sepsis and septic shock, but their prognostic value diminishes over time. Assessment of inflammatory status at ICU discharge may provide a practical tool for early post-ICU risk stratification and may support clinical decisions regarding intensified outpatient surveillance and follow-up scheduling in this vulnerable population. Full article

Background/Objectives: Hand, foot and mouth disease (HFMD) has recently emerged as a serious health threat, as certain serotypes can cause severe illness. Serotype distribution vary by region, and seroprevalence studies helps in developing preventive strategies. This study aimed to determine the seroprevalence of enterovirus type 71 (EV-A71), Coxsackievirus A16 (CV-A16), Coxsackievirus A10 (CV-A10), and Coxsackievirus A6 (CV-A6), the main causative agents of HFMD and to investigate risk factors for seropositivity. Methods: This multicenter, cross-sectional study was conducted across five major cities in Türkiye. Children (6 months–17 years) who presented to outpatient clinics for any reason were included between May 2024 and January 2025. Neutralizing antibodies were measured using a microneutralization assay. Statistical analyses included descriptive methods, appropriate group comparisons (Chi-square/Fisher’s Exact), and backward logistic regression to identify factors associated with HFMD seropositivity. Results: The study included 998 participants (mean age: 8.6 ± 5.2 years; 51.3% male). CV-A6 antibodies were detected in 68.5%, EV-A71 in 66.5%, CV-A10 in 60.2%, and CV-A16 in 46.0% of samples. No viral antibodies were detected in 5.3% of serum samples (All-Negative group); antibodies against at least one HFMD agent were detected in 94.7% (Any-Positive group). HFMD seropositivity increased significantly with age. Handwashing habits did not differ between the groups. The any-positive group more often had a household member aged 12–18 years, a mother with lower education, and higher kindergarten attendance. In logistic regression analysis, age, average monthly household income, and mother’s education level were the factors influencing seropositivity. Conclusions: The seroprevalence of HFMD-causing viruses in Türkiye is high from six months of age onward. Beyond promoting personal protective measures, the implementation of a vaccination program should also be considered. Full article

Background: This study investigated the clinical timeline, patient monitoring behaviors, and cumulative bilateral treatment burden in patients with bilateral neovascular age-related macular degeneration. Methods: We retrospectively analyzed follow-up patterns and treatment intensity from first-eye (FE) diagnosis to second-eye (SE) conversion. Results: SE conversion occurred within a mean of 2.0 years in the FE-active group (62.5%) while the FE remained exudative, contrasting with 6.2 years in the FE-inactive group (37.5%). Upon SE conversion, the total annual intravitreal injection burden escalated 3.4-fold (p = 0.002). Notably, the FE-inactive group exhibited numerically lower annual outpatient visit counts (4.40 ± 2.71 vs. 10.29 ± 5.02; p = 0.116), which potentially widened the monitoring window. Additionally, baseline SE retinal pigment epithelium (RPE) abnormalities independently predicted progression (aOR: 19.04; p = 0.032). Conclusions: While previous literature focuses on individual eyes, our findings highlight a vigilance gap in SE detection based on FE status. Clinicians must maintain proactive surveillance for patients with baseline SE RPE abnormalities, particularly when FE stability or next-generation long-acting therapies extend clinic intervals. Due to the limited sample size, these preliminary findings warrant validation in larger prospective cohorts. Full article

Background: It is important to note that motherwort (Leonurus cardiaca) has especially calming properties, partly due to its chlorogenic acid (CLA) content. While the concentration of this acid in alcoholic or water–alcoholic extracts has been determined in the literature, there is no knowledge about the content of CLA in water extracts. Therefore, the aim of this study was primarily to assess the CLA content in infusions prepared in four different ways and to estimate the actual CLA intake with these infusions. An additionally aim was to assess the content of phenols and their antioxidant properties. Methods: A capillary electrophoresis device equipped with a DAD detector was used to determine CLA in dried motherwort herb, and the DPPH test and the Folin–Ciocâlteu method were used to determine antioxidant properties. Results: The median CLA content in the infusions was 527.26 µg/100 mL. In turn, the total phenol content per glass was 32.88 mg. The mean median DPPH test expressed as Trolox equivalent was 33.65 mg/L TE. Conclusions: The method of preparing infusions affects the content of CLA and phenols in water infusions. However, these changes did not significantly affect the antioxidant properties of the prepared extracts. Full article

Background: This study aimed to evaluate referral reasons, distribution of allergic diseases, atopic status, and comorbidity associations among patients aged 65 years and older presenting to a tertiary allergy clinic. Methods: This retrospective study included all geriatric patients (≥65 years) who attended the Immunology and Allergy outpatient clinic at Ankara Bilkent City Hospital between January 2024 and December 2025. Demographic characteristics, comorbidities, referral complaints, and allergic diagnoses were recorded. Allergen sensitization was assessed using skin tests and/or allergen-specific IgE measurements. Results: A total of 1302 geriatric patients were included (mean age 70.9 years; 59.8% female). At least one comorbidity was present in 62.6% of patients, with hypertension being the most common(39.4%). The leading referral complaints were rhinorrhoea/sneezing (22.8%), pruritus (19.1%), drug allergy/adverse drug reactions (14.8%), and chronic urticaria (10.9%). The most common diagnoses were rhinitis (63.2% non-allergic), non-allergic pruritus, drug allergy, and chronic urticaria. Among inhalant allergens, pollen sensitivity (42.2%) was most frequent, followed by house dust mite (32.5%). The most frequently implicated drug groups were antibiotics (42.4%) and analgesics (21.7%). Chronic urticaria and ACE inhibitor-associated angioedema showed significant gender differences: 68.6% female (p = 0.001) and 66.7% male (p = 0.008), respectively. Patients with asthma, rhinitis, or angioedema frequently had comorbid conditions (91.1%, 55.8%, and 83.7%, p = 0.001, p = 0.013, and p = 0.001, respectively). Conclusions: Allergy clinic presentations in elderly patients reflect a broad clinical spectrum, including non-allergic conditions, frequent drug-related reactions in elderly patients with multiple comorbidities, and age-related immunological changes alongside atopic diseases. A comprehensive, individualized diagnostic approach is essential when evaluating allergic complaints in the geriatric population. Full article

Background and Clinical Significance: Cutaneous paraneoplastic phenomena are infrequently characterised in colorectal cancer (CRC), and chronic pruriginous inflammatory eruptions in particular have received limited attention. In older adults, persistent treatment-resistant dermatoses of unclear aetiology may represent overlooked extraintestinal diagnostic clues to occult malignancy, including potentially curable CRC. Faecal immunochemical testing (FIT) for occult bleeding is a low-cost, non-invasive tool whose role outside conventional alarm-symptom triage remains underexplored. Case presentation: A 72-year-old woman presented for outpatient evaluation with several months of pruriginous, pustular, and crusted symmetric eruption involving the dorsal aspects of the limbs, refractory to standard dermatologic treatment, and without gastrointestinal symptoms. A non-invasive systemic stool-based work-up demonstrated detectable faecal haemoglobin (iFOBT), mildly elevated faecal calprotectin (51.6 mg/kg, ULN 50 mg/kg), markedly elevated faecal alpha-1-antitrypsin (631 µg/mL; 2.3× ULN), and predominance of Escherichia coli on stool culture. Colonoscopy revealed a locally advanced rectal adenocarcinoma; staging classified the lesion as cT3N1M0. The patient received long-course neoadjuvant chemoradiotherapy (50 Gy, concurrent capecitabine) followed by low anterior resection with total mesorectal excision and pathological complete response (ypT0N0, R0), and adjuvant capecitabine. The cutaneous eruption resolved progressively in parallel with antineoplastic therapy without specific dermatologic intervention. The patient remains in remission at over 36 months. Conclusions: Persistent, unexplained, treatment-resistant pruriginous/pustular cutaneous eruptions may, in selected patients, coincide with an underlying malignancy, including colorectal cancer, and should prompt careful individualised clinical assessment, including review of age-appropriate colorectal cancer screening status. This single case raises the hypothesis that quantitative faecal immunochemical testing (FIT) may be prospectively evaluated as a low-cost, non-invasive triage tool in carefully selected patients aged ≥50 years with persistent dermatoses of unclear aetiology, even in the absence of gastrointestinal symptoms. Positive FIT results should be managed according to established local colorectal referral pathways. NICE diagnostics guidance DG56 supports FIT use in symptomatic adults with suspected lower gastrointestinal pathology; however, any extension of FIT to extraintestinal presentations remains investigational and requires formal validation through prospective studies assessing diagnostic yield, cost-effectiveness, and stage distribution. Full article

Background/Objectives: Plant-based diets are increasingly adopted by families with young children, yet their potential effects on bone development and metabolic regulation during early childhood remain insufficiently understood. This study aimed to evaluate body composition, bone mineral density (BMD), biochemical markers of bone turnover, and adipokine profiles in healthy children aged 5–6 years adhering to lacto-ovo-vegetarian or omnivorous diets. Methods: A cross-sectional analysis was conducted in a well-characterized cohort of 90 healthy normal-weight children consuming either lacto-ovo-vegetarian or omnivorous diets. Body composition and bone mineral density were measured using dual-energy X-ray absorptiometry, and circulating markers of bone formation, resorption, and adipokines were determined using ELISA methods. Correlation analyses were performed to examine the relationships between anthropometric variables, bone parameters, and adipokines. Results: No significant differences were observed between vegetarian and omnivorous diets in anthropometric characteristics, bone mineral content (BMC), or BMD, indicating comparable skeletal status. However, vegetarian children exhibited significantly higher levels of bone turnover markers, including bone alkaline phosphatase (BALP) (p = 0.023) and C-terminal telopeptide of type I collagen (CTX-I) (p = 0.035), and a lower osteocalcin OC/CTX-I ratio (p = 0.027). These findings may suggest a subtle imbalance in bone remodeling dynamics in these children, although their clinical significance remains uncertain. Additionally, higher levels of carboxylated osteocalcin (Gla-OC) (p = 0.022) and an increased carboxylated to undercarboxylated OC (Gla-OC/Glu-OC) ratio (p = 0.005) were observed in vegetarian children. Among adipokines, vegetarian children showed lower HMW adiponectin levels (p = 0.05) and a lower HMW/total adiponectin ratio (p = 0.012). Correlation analyses revealed distinct metabolic patterns between groups. In vegetarian children, bone parameters were primarily associated with lean mass, indicating the predominant role of mechanical factors in skeletal development. In contrast, omnivorous children demonstrated a more integrated relationship between bone indices and adipokines. Conclusions: In conclusion, while a lacto-ovo-vegetarian balanced diet supports normal bone mass in early childhood, it may be associated with subtle alterations in bone metabolism and its regulatory pathways, including adipokine profiles. These findings highlight the importance of adequate dietary planning and underscore the need for longitudinal studies to determine long-term effects on bone status. Full article

Background/Objectives: Health outcome determinants affecting Human Papillomavirus (HPV) vaccination among the adult female population are scarce in Spain. This study aimed to describe the health outcomes and determinants of HPV vaccination in women 18–65 years attending lower genital tract outpatient clinics across regions of Spain. Methods: This was a cross-sectional, multicenter, non-interventional, descriptive, and comparative nationwide study. Sociodemographic characteristics and health outcomes included obstetric, gynecological and HPV vaccination antecedents, together with patient-reported outcomes related to HPV infection. Statistical analysis included multivariate logistic regression models. Results: Among 2004 adult women recruited, 1907 (95.2%) were eligible for analysis. Vaccine uptake was 48.8%; 81.6% among women who were ever HPV positive (adjusted OR = 2.16 [95% CI: 1.59–2.93], p < 0.001), but 65.9% among women with an active infection, which acted as a negative factor for vaccination (OR = 0.63 [0.45–0.87], p = 0.005), as did increasing age (OR = 0.92 [0.90–0.93], p < 0.001); the higher the age, the lower the adjusted likelihood of being vaccinated. HPV knowledge and adequate physician-provided information were weakly associated with vaccination likelihood. A history of conization (OR = 7.48 [5.34–10.47], p < 0.001), use of contraception (OR = 1.49 [1.13–1.96], p = 0.004), infection with high-risk or unknown-risk HPV genotypes (OR = 1.86 [1.23–2.82], p = 0.003 and OR = 1.68 [1.17–2.42], p = 0.006, respectively), and Spanish nationality (OR = 2.46 [1.68–3.61], p < 0.001) were identified as factors associated with a higher vaccination likelihood. Conclusions: This study found that HPV vaccination uptake is improvable. Previous HPV infection favored vaccination; however, active infection and increasing age acted against vaccination. HPV knowledge and adequate healthcare professional information appeared to favor vaccination, along with, most notably, a history of cervical surgery (conization), contraceptive use, or infection with high-risk or unknown-risk HPV genotypes. Spanish women had a higher likelihood of receiving HPV vaccination than foreign residents. Full article

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. Methods: A retrospective descriptive study was conducted of pediatric patients aged 1–14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023–October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes. Results: The mean patient age was 4.6 years, with most (57.5%) aged 1–5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1–5-year age group, whereas obesity predominated in the 6–10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health. Conclusions: Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions. Full article

Primary Epstein–Barr virus (EBV) infection in children exhibits substantial clinical heterogeneity, often complicating early diagnosis and leading to unnecessary antibiotic use. This retrospective study evaluated 695 children (0–18 years) diagnosed with primary EBV infection at a tertiary pediatric center between 2010 and 2015, defined by positive viral capsid antigen (VCA) IgM and negative Epstein–Barr nuclear antigen (EBNA) IgG. Clinical, laboratory, and ultrasonographic findings were compared according to age group (≤4 vs. >4 years) and clinical setting (inpatient vs. outpatient). The median age was 3.75 years (IQR: 2–6.25), and more than half of the patients were ≤4 years. Younger children more frequently presented with nonspecific respiratory and gastrointestinal symptoms, whereas older children more commonly exhibited the classic infectious mononucleosis (IM) phenotype, including sore throat, dysphagia, lymphadenopathy, and hepatosplenomegaly (p < 0.001). Antibiotics were prescribed in 64.2% of patients, while 21.7% required hospitalization. Multivariable logistic regression analyses demonstrated that age was not an independent predictor of hospitalization, classic IM phenotype, or antibiotic use. Instead, specific clinical and laboratory findings—such as lymphopenia, lymphadenopathy, vomiting, thrombocytosis, and tonsillar hypertrophy—emerged as the key determinants of clinical outcomes. To enhance diagnostic discrimination, receiver operating characteristic (ROC) analysis of ANC/ALC and AST/ALT ratios was performed, and a composite risk score (0–2) was derived. Although both markers showed modest discriminative ability (AUC 0.607 and 0.575), their high negative predictive values (>90%) suggest potential utility as rule-out tools. The composite score demonstrated a stepwise increase in the probability of classic IM presentation across age groups. In conclusion, primary EBV infection demonstrates a clear age-related clinical spectrum; however, clinical and laboratory features rather than age alone drive key outcomes. These findings highlight the need for age-specific diagnostic strategies and improved antimicrobial stewardship, while the proposed risk score provides a foundation for future validation studies. Full article

Background: Breast cancer (BC) survivors frequently experience depression, which is associated with poorer quality of life (QoL), increased healthcare utilization, and worse prognosis. Although traditional Chinese medicine (TCM) is commonly used as an adjunctive therapy among Chinese populations for cancer-related symptom relief and supportive care, population-based evidence remains limited regarding whether integrated Chinese and Western medicine (ICWM) confers measurable benefits over Western medicine (WM) alone in terms of healthcare utilization and survival. Taiwan’s National Health Insurance (NHI) system offers a unique nationwide setting to address this gap because it reimburses patients for both WM and TCM services and captures care from a large number of TCM clinics across Taiwan, allowing evaluation of adjunctive TCM use in routine clinical practice at a scale rarely possible in prior studies. We used emergency department visits, hospitalization, and length of stay as pragmatic proxy indicators of patients’ daily functioning and disease burden. Leveraging a 10-year enrollment window (2004–2013) and up to 17 years of follow-up, we hypothesized that ICWM would be associated with a reduced risk of acute care events and lower healthcare expenditures compared with WM alone. This hypothesis was examined in a large cohort of breast cancer patients treated across nearly 4000 medical facilities nationwide, encompassing the entire Taiwanese population. Methods: A retrospective cohort study was performed to analyze Taiwan’s National Health Insurance Research Database and Cancer Registry. Women newly diagnosed with breast cancer between 2004 and 2013 who subsequently developed depression (≥3 outpatient diagnoses or 1 hospitalization) were followed until death or 31 December 2021. Patients receiving ≥30 cumulative days of TCM after diagnosis were classified as the ICWM group, whereas those receiving <30 days were classified as the WM group. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for all-cause mortality. Healthcare utilization, including emergency department visits, hospitalization, and medical expenditures, was analyzed on a per-person-year basis. Results: A total of 1193 patients were included, with 488 in the WM group and 705 in the ICWM group. Compared with WM users, ICWM users were younger, had lower body mass index, and were more likely to have stage 0–II disease. ICWM was associated with lower total, inpatient, and emergency healthcare expenditures per person-year, as well as fewer emergency visits per person-year, although outpatient and overall visits were higher. In stage-stratified multivariable analyses, ICWM was associated with lower all-cause mortality in both stage 0–II disease (aHR = 0.61, 95% CI: 0.39–0.94) and stage III–IV disease (aHR = 0.38, 95% CI: 0.21–0.67). Kaplan–Meier analyses likewise showed significantly better overall survival in the ICWM group in both early-stage and advanced-stage disease. Conclusions: In this nationwide retrospective cohort of breast cancer patients with depression, adjunctive ICWM was associated with better survival, lower acute care utilization, and lower healthcare expenditures compared with WM alone. However, because quality of life was not directly measured and the study was based on observational data, QoL-related interpretations should be made cautiously, with healthcare utilization outcomes viewed as indirect proxy indicators rather than direct evidence of improved daily QoL. Full article

Background: A significant percentage of patients with major depressive disorder (MDD) fail to achieve remission with antidepressant monotherapy and frequently experience residual mood and cognitive symptoms that impair their functional recovery. Thus, an augmentation with vortioxetine, a multimodal antidepressant with reported cognitive benefits, might be a useful strategy for such patients. Methods: We conducted a 12-week naturalistic, prospective observational study in a Malaysian university hospital; 40 adults with MDD and inadequate response to at least eight weeks of antidepressant therapy received either adjunctive vortioxetine or optimization of their existing antidepressant as part of treatment-as-usual care. Depressive symptoms were assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS), cognitive symptoms using the Perceived Deficits Questionnaire-5 (PDQ-D5), and global improvement using the Clinical Global Impressions—Improvement (CGI-I) scale. Results: Both groups demonstrated significant improvements in MADRS and PDQ-D5 scores over 12 weeks (p < 0.001). Remission rates at Week 12 were high in both groups (93.8% adjunctive vortioxetine vs. 86.7% control). Both groups demonstrated significant improvements in depressive and cognitive symptoms over 12 weeks. Although between-group differences were not statistically significant, descriptive trends toward earlier symptomatic improvement were observed in the adjunctive vortioxetine group in several core depressive symptoms, including apparent sadness, suicidal ideation, and appetite disturbance. Greater clinician-rated global improvement was observed in the vortioxetine group at Week 12 (87.5% vs. 40.0%, p < 0.001). Conclusions: In this outpatient clinical setting, adjunctive vortioxetine was associated with earlier improvement of core depressive symptoms and greater global clinical improvement compared with optimization of existing antidepressant therapy. Collectively, these findings suggest adjunctive vortioxetine as a clinically relevant option for patients with MDD who show an inadequate response to antidepressant monotherapy; however, findings are exploratory and not causal, and thus larger RCTs are needed for affirmation. Full article

Background/Objectives: Sleep disturbances are highly prevalent in young individuals with eating disorders (EDs) and are associated with increased psychopathology and poorer clinical outcomes. However, sleep alterations in ED populations are heterogeneous and may reflect distinct underlying clinical profiles. The study aimed to identify sleep quality profiles and examine their clinical correlates in youth with EDs. Methods: A total of 288 youth outpatients with EDs completed the Pittsburgh Sleep Quality Index (PSQI), along with measures of eating and general psychopathology. Latent Profile Analysis (LPA) was conducted using PSQI scores to identify distinct sleep profiles. Multinomial logistic regression models were performed to assess clinical variables of profile membership. Results: A four-profile solution was identified: (1) less impaired sleepers, (2) medication-using sleepers, (3) global poor sleepers, and (4) sleep-initiation-difficulty sleepers. Profiles differed significantly in ED severity, affective symptoms, emotion regulation difficulties, and sleep-related eating behaviors. Profiles characterized by greater sleep impairment exhibited higher levels of binge eating, night eating, and psychological distress. Multinomial logistic regression analyses indicated that night eating was the largest contributor to latent profile membership across all comparisons, significantly increasing the likelihood of belonging to more impaired sleep profiles. Conclusions: Sleep in individuals with EDs is characterized by distinct and clinically meaningful profiles rather than a uniform pattern of impairment. These findings support the clinical utility of person-centered approaches to better characterize sleep disturbances in ED populations. Full article

Background: Telemedicine may advance endometriosis care, but few initiatives are integrated in outpatient follow-up. A novel telemedicine approach—tele-patient-reported outcome measures (telePROM)—includes an endometriosis-specific questionnaire and phone and video consultations combined with text messaging (chat) with a multidisciplinary endometriosis team. This study explores how healthcare professionals experience telePROM and its integration in clinical practice. Methods: A qualitative study guided by interpretive description methodology. Data were generated through observations and focus group interviews conducted between January 2023 and March 2024 at a referral centre for endometriosis within a university hospital. A purposive sample of ten healthcare professionals comprising physicians, nurses and a medical secretary participated in the focus group interviews. Inductive analysis was inspired by interpretive description and carried out through an iterative process involving four steps, leading to the development of final themes and interpretation. Results: Three themes were identified from analysis: (1) Balancing Personalised Care With Increased Clinical Complexity; (2) Changing Professional Boundaries in a Digitally Supported Care Model; and (3) System Friction and Flexibility when Integrating TelePROM. Conclusions: Telemedicine improved endometriosis care by supporting patient-initiated and personalised consultations. However, sustainable, effective, and safe integration of telemedicine appears to require clinical experience, interdisciplinary collaboration, and supervision. Text communication (chat) proved to be an important element to ensure collection of additional information to complement patient-reported outcomes and it is essential for patient triage; yet it is rarely described in the literature. Ensuring organisational resilience during the digital transformation of healthcare requires ongoing training of healthcare professionals’ communicative and digital competences and may necessitate restructured technical support, including designated telemedicine experts in clinical practice to eliminate technical disruptions. These initiatives may contribute to and support the future implementation of telemedicine in healthcare. Full article