Search Results (31,638)

Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and March 2025, involving 116 hypertensive patients who attended family medicine outpatient clinics at Rize Training and Research Hospital, Turkey. Data were collected using a sociodemographic questionnaire and the Brief Illness Perception Questionnaire (BIPQ). Nonparametric tests, including the Mann–Whitney U test, Kruskal–Wallis H test with Dunn’s post hoc analysis, and Spearman’s correlation analysis, were employed to evaluate the data. Results: The mean age of the participants was 69.01 ± 6.07 years, with 76.7% of the participants aged over 65 years. The median total BIPQ score was 47.0, indicating a moderate illness perception. A significant negative correlation was observed between age and the total BIPQ score (Rho = −0.443, p < 0.001). Higher illness perception levels were significantly associated with lower educational attainment, shorter duration of antihypertensive treatment, and attribution of hypertension to stress, genetic predisposition, diet, and occupational factors (p < 0.05). Conclusions: Illness perceptions among patients with hypertension are shaped by various sociodemographic and clinical determinants. Enhancing awareness of these perceptions in primary care may support improved treatment adherence and better health outcomes. Interventions that strengthen health literacy and offer psychosocial support may contribute to more effective hypertension management. Full article

Background/Objectives: Heart failure (HF) is a leading cause of hospitalization in older adults, with significant sex differences in presentation, treatment, and outcomes. Transitional care models may benefit women more, yet they often receive less follow-up. This study assessed whether the clinical impact of the UMIPIC multidisciplinary HF management program differs by sex. Methods: This prospective, multicenter, observational cohort study included HF patients enrolled in the UMIPIC program or followed through conventional care in the RICA registry. Outcomes (30-day and one-year mortality and readmissions) were compared between groups, stratified by sex. Multivariate Cox models adjusted for age, HF phenotype, comorbidities, and baseline therapy. Results: A total of 5644 HF patients were included, with 2034 (36%) managed in UMIPIC and 3610 (64%) receiving conventional care. Women represented 55% of UMIPIC patients and were older, with higher prevalence of hypertension, anemia, and HF with preserved ejection fraction (HFpEF) compared to conventional care. At 30 days, women in UMIPIC had lower all-cause mortality (4.0% vs. 8.0%), cardiovascular mortality (2.0% vs. 6.0%), and readmissions (9.0% vs. 18.0%; all p < 0.01); these benefits persisted at one year. In multivariate analysis, UMIPIC enrollment remained protective (HR: 0.79; 95% CI: 0.71–0.87; p < 0.001). In men, UMIPIC patients were older with more comorbidities and higher HFpEF prevalence. They also showed lower 30-day mortality (2.0% vs. 8.0%; p < 0.05) and readmissions (8.0% vs. 18.0%; p < 0.01), with benefits maintained at one year. UMIPIC enrollment remained independently associated with reduced one-year mortality in men (HR: 0.79; 95% CI: 0.71–0.88; p < 0.001). Conclusions: The UMIPIC multidisciplinary care model reduced one-year mortality and readmissions in both women and men with HF, supporting integrated care strategies to improve outcomes in this high-risk population. Full article

Digital transformation in healthcare has introduced data privacy challenges, as hospitals struggle to protect patient information while adopting digital technologies such as AI, IoT, and cloud more rapidly than ever before. The adoption of powerful third-party Machine Learning as a Service (MLaaS) solutions for disease prediction has become a common practice. However, these solutions offer significant privacy risks when sensitive healthcare data are shared externally to a third-party server. This raises compliance concerns under regulations like HIPAA, GDPR, and Australia’s Privacy Act. To address these challenges, this paper explores a decentralized, privacy-preserving approach to train the models among multiple healthcare stakeholders, integrating Federated Learning (FL) with Homomorphic Encryption (HE), ensuring model parameters remain protected throughout the learning process. This paper proposes a novel Homomorphic Encryption-based Adaptive Tuning for Federated Learning (HEAT-FL) framework to select encryption parameters based on model layer sensitivity. The proposed framework leverages the CKKS scheme to encrypt model parameters on the client side before sharing. This enables secure aggregation at the central server without requiring decryption, providing an additional layer of security through model-layer-wise parameter management. The proposed adaptive encryption approach significantly improves runtime efficiency while maintaining a balanced level of security. Compared to the existing frameworks (non-adaptive) using 256-bit security settings, the proposed framework offers a 56.5% reduction in encryption time for 10 clients and 54.6% for four clients per epoch. Full article

Background: In this study, we investigated patients in the early stages of COPD to support the hypothesis that symptoms of anxiety and depression are related to mild and moderate COPD and not only to the chronic complications that accompany severe disease. Methods: A total of 250 mild to moderate COPD patients were randomly selected from a population of 5239 individuals who were part of a study on early COPD detection and smoking cessation that was carried out in Central Macedonia, Greece. An age-matched control group of three hundred current or former smokers was also included. A questionnaire was used for demographic data collection, along with the Hospital Anxiety and Depression Scale (HADS) questionnaire for the evaluation of anxiety (HADS-A) and depressive (HADS-D) symptoms. Results: The COPD and non-COPD groups were similar in age, gender, and socioeconomic background. The majority of COPD patients were classified as Grade 1 or 2 and belonged to Group A or B according to the GOLD classification. Among the COPD patients, 19.6% had a score greater than 7 in the HADS-A subscale, 14% in the HADS-D subscale, and 10.8% in both, compared with 6%, 5%, and 5%, respectively, for the non-COPD individuals (p < 0.01). A regression analysis showed that the presence of at least one comorbidity (β = 0.43, p < 0.001) and the presence of at least one respiratory symptom (β = 0.49, p < 0.001) significantly predicted the total HADS score in the COPD group. Conclusions: The prevalence of depression and anxiety symptoms in early COPD patients was greater in comparison to non-COPD smokers. Implementing routine screening for mood disorders using the HADS in mild to moderate COPD outpatients may improve overall disease management and patients’ quality of life. Full article

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes. Full article

Background: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB) affecting between 5% and 40% of patients, which leads to hemodynamic instability, an increased risk of thromboembolism, decompensated heart failure, prolonged hospitalization, and higher treatment costs. Currently, there are no universally accepted guidelines for preventing POAF. Methods: A single-center, prospective, randomized controlled trial, “The Effect of Colchicine on the Occurrence of Atrial Fibrillation after Cardiac Surgery” (CAFE), ClinicalTrials.gov ID: NCT06798714, was conducted. The study included 140 patients with coronary artery disease randomized into two groups of 70 patients each. Group 1 (control group) received standard postoperative care. Group 2 (intervention group) received colchicine (Colchicum-Dispert at a dose of 500 mcg 4 h before coronary artery bypass grafting (CABG) with CPB and at a dose of 500 mcg twice daily for 10 days postoperatively) and underwent intraoperative pericardial fenestration using an original technique. Results: Perioperative colchicine administration combined with intraoperative pericardial fenestration reduced POAF incidence to 2.9% compared to the control group with POAF incidence of 12.9% (p < 0.05). This management strategy was not associated with an increased incidence of infectious complications, gastrointestinal disorders, or elevated levels of alanine aminotransferase, aspartate aminotransferase, or creatinine. Conclusions: Perioperative colchicine administration combined with pericardial fenestration during CABG with CPB is associated with a reduced POAF incidence, good tolerability, and does not contribute to an increased incidence of infectious complications or impaired liver and renal function. Full article

Background/Objectives: Early evaluation and treatment of osteoporosis following a hip fracture is of paramount importance for secondary fracture prevention. Nevertheless, the extent to which osteoporosis management is documented in studies reporting on operatively treated hip fractures in elderly patients is unclear. This study is the first systematic review aiming to investigate and summarize the reporting of osteoporosis management in studies with operatively treated hip fractures in elderly patients. Methods: This systematic review was conducted in compliance with PRISMA guidelines. A comprehensive search within the last decade of PubMed, Embase, Cochrane Library, Web of Science, and Ovid was performed. Studies reporting on operatively treated hip fractures in patients older than 65 years of age were included. Two reviewers independently screened the studies and performed data extraction. A subsequent descriptive synthesis was performed. Results: Eighty-six (86) articles were included in this study. Osteoporosis management was reported in only twelve (12) studies. Only six (6) of them were conducted in institutions with established orthogeriatric care. Conclusions: Osteoporosis management is underreported in studies involving operatively treated hip fracture patients. This reflects a significant gap in the overall reporting of secondary fracture prevention actions. Consequently, we advocate for both (a) clinical vigilance for adherence to best practice related to osteoporosis management after the first hip fracture and reporting of the results and (b) the research focusing on the outcomes of secondary fracture prevention efforts. Full article

Background: Postoperative ocular inflammation is a frequent complication of eye surgeries commonly managed using corticosteroids or nonsteroidal anti-inflammatory drug (NSAIDs) eye drops. However, poor ocular bioavailability and patient non-adherence due to frequent dosing limit the therapeutic efficacy of conventional eye drops. This study aimed to develop a sustained-release ocular insert containing bromfenac sodium (BS)-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles (MPs) with an initial 3% (w/w) free BS fraction incorporated into a poly(vinyl alcohol) (PVA) matrix designed to achieve a dual-phase release profile for improved postoperative therapy. Methods: PLGA-based MPs were fabricated using a double emulsion solvent evaporation technique and incorporated into PVA films to produce ocular inserts with varying MP content. Formulations were characterized for morphology, particle size, zeta potential, drug loading, entrapment efficiency, mucoadhesion, drug distribution, and in vitro release. Data were analyzed by an ANOVA and t-tests with p < 0.05 as significance. Results: MPs were smooth, spherical, and well-dispersed in the PVA inserts. Particle sizes ranged from 3.7 to 5.6 µm, with drug loading 7–8% and entrapment efficiencies 47–52%. Multiphoton imaging confirmed uniform drug distribution. In vitro release showed a dual-phase profile with an initial burst followed by sustained release for up to 4 days, with only negligible further release through Day 6 in one formulation (M1-7525). Conclusions: The developed BS-loaded PLGA MP/PVA insert demonstrated a dual-phase release profile relevant to postoperative ocular inflammation. Its biodegradable, single-application design holds promise for enhancing compliance and therapeutic outcomes in ophthalmic care. Full article

Bariatric surgery is considered the most effective treatment for obesity and its associated metabolic disorders, yet the underlying mechanisms are only partially understood. Evidence suggests that the gut microbiota plays an important role in metabolic regulation and can be significantly altered by bariatric and metabolic procedures. This prospective, single-center study aimed to evaluate the dynamic changes in the gut microbiota composition and diversity in obese patients undergoing two types of bariatric surgery: laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). Fecal samples were collected at three time points—before surgery (T0), and at 3 (T3) and 6 months (T6) postoperatively—and analyzed using 16S rRNA gene sequencing targeting the V3–V4 regions with Illumina technology. Significant shifts in microbial diversity and structure were observed over time, indicating a trend toward microbiota normalization post-surgery. Notable changes included a reduction in the Firmicutes/Bacteroidetes ratio and increased relative abundance of Actinobacteria, Proteobacteria, and Verrucomicrobia. These alterations occurred in parallel with improvements in body mass index (BMI) and metabolic parameters. Our findings suggest that bariatric surgery induces favorable and sustained modifications in the gut microbiota, which may contribute to its therapeutic effects in obesity management. Full article

Background/Objectives: Systemic arterial hypertension is a prevalent condition associated with adverse cardiac remodeling. Echocardiography plays a crucial role in assessing cardiac structure and function in hypertensive patients. This study aimed to evaluate the changes in echocardiographic parameters in hypertensive patients over a 3-year follow-up period and assess the impact of blood pressure control and antihypertensive medication use on these changes. Methods: This observational cohort study included 131 adult patients with systemic arterial hypertension who underwent annual echocardiographic assessments. Statistical analyses included paired and unpaired comparisons, regression modeling, and subgroup analyses by BP control and lifestyle behavior. Results: Over the 3-year follow-up, mean left ventricular mass (LVM) increased significantly from 173.99 ± 59.33 g to 183.26 ± 64.19 g (p = 0.018), and the prevalence of LV hypertrophy rose from 29.0% to 40.5% (p = 0.021). Patients with uncontrolled blood pressure at the final visit had significantly greater interventricular septum and posterior wall thicknesses (p = 0.009 and p = 0.012, respectively), but no statistically significant difference in ΔLVM. Those who adopted more healthy lifestyle behaviors showed a dose-dependent reduction in LVM progression, with each additional lifestyle improvement associated with a −3.25 g change in ΔLVM (p = 0.01). Multivariable linear regression identified baseline LVM, sex, and lifestyle score as independent predictors of 3-year LVM change (model R² = 0.318). Conclusions: Our findings indicate that long-term cardiac remodeling may continue in hypertensive patients despite treatment, particularly in the presence of suboptimal BP control. Sustained lifestyle improvements were independently associated with attenuation of LVM progression. These results underscore the importance of integrating behavioral interventions alongside pharmacologic therapy in routine hypertension management. Full article

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical psychologists regarding online psychotherapy for patients with suicidal behavior in the context of the COVID-19 pandemic, to generate a theoretical understanding of this experience. It is a qualitative, exploratory, longitudinal study based on the Constructivist Grounded Theory framework. Ten clinical psychologists who conducted online psychotherapy for patients with suicidal behavior during the pandemic were interviewed at two moments, with an interval of approximately two years: the first round was conducted from December 2020 to March 2021, followed by a second round between November and December 2022. Data analysis led to four categories: (1) Reflecting on suicidal behavior; (2) Addressing specificities of online interventions; (3) Managing suicidal behavior in online psychotherapy; (4) Evaluating online psychotherapy for patients with suicidal behavior. The theoretical model “Pathways of care: main roads and access routes in online psychotherapy for suicidal behavior” was constructed. It was concluded that online psychotherapy for patients with suicidal behavior is complex and requires caution but is feasible and can be important in specific circumstances. This makes it an additional resource for suicide prevention and mental health promotion. Full article

VEXAS syndrome (Vacuoles, E1-enzyme, X-linked, Autoinflammation, and Somatic) is a recently identified late-onset autoinflammatory disorder characterized by a unique interplay between hematological and inflammatory manifestations. It results from somatic mutations in the UBA1 gene, located on the short arm of the X chromosome. Initially, females were considered mere carriers, with the syndrome primarily affecting males over 50. However, recent evidence indicates that heterozygous females can exhibit symptoms as severe as those seen in hemizygous males. The disease manifests as systemic inflammation, macrocytic anemia, thrombocytopenia, chondritis, neutrophilic dermatoses, and steroid-dependent inflammatory symptoms. Due to its overlap with autoimmune and hematologic disorders such as relapsing polychondritis, Still’s disease, and myelodysplastic syndromes, misdiagnosis is common. At the molecular level, VEXAS syndrome is driven by impaired ubiquitination pathways, resulting in dysregulated immune responses and clonal hematopoiesis. A key diagnostic marker is the presence of cytoplasmic vacuoles in myeloid and erythroid precursors, though definitive diagnosis requires genetic testing for UBA1 mutations. Traditional immunosuppressants and TNF inhibitors are generally ineffective, while JAK inhibitors and IL-6 blockade provide partial symptom control. Azacitidine and decitabine have shown promise in reducing disease burden, but hematopoietic stem cell transplantation (HSCT) remains the only curative treatment, albeit with significant risks. This review provides a comprehensive analysis of VEXAS syndrome, examining its clinical features, differential diagnoses, diagnostic challenges, and treatment approaches, including both pharmacological and non-pharmacological strategies. By enhancing clinical awareness and optimizing therapeutic interventions, this article aims to bridge emerging genetic insights with practical patient management, ultimately improving outcomes for those affected by this complex and often life-threatening disease. Full article

In the context of modern healthcare, the integration of sensor networks into electronic health record (EHR) systems introduces new opportunities and challenges related to data privacy, security, and interoperability. This paper proposes a secure distributed web system architecture that integrates real-time sensor data with a custom customer relationship management (CRM) module to optimize patient monitoring and clinical decision-making. The architecture leverages IoT-enabled medical sensors to capture physiological signals, which are transmitted through secure communication channels and stored in a modular EHR system. Security mechanisms such as data encryption, role-based access control, and distributed authentication are embedded to address threats related to unauthorized access and data breaches. The CRM system enables personalized healthcare management while respecting strict privacy constraints defined by current healthcare standards. Experimental simulations validate the scalability, latency, and data protection performance of the proposed system. The results confirm the potential of combining CRM, sensor data, and distributed technologies to enhance healthcare delivery while ensuring privacy and security compliance. Full article

Introduction: The emergence of SARS-CoV-2 Omicron subvariants characterized by increased transmissibility and immune escape has raised concerns about the efficacy of current treatments. This systematic review and meta-analysis evaluated pharmacological and non-pharmacological interventions in Omicron-infected non-hospitalized patients, focusing on key clinical outcomes such as hospitalization, respiratory failure, ICU admission, and 30-day mortality. Methods: Searches were performed in MEDLINE, EMBASE, Web of Science, Cochrane, and ClinicalTrials.gov (last update: 13 July 2025). Eligible studies reported outcomes on antiviral agents, monoclonal antibodies, adjunctive therapies, or telemedicine. Random-effects meta-analyses were conducted when appropriate, with heterogeneity assessed by I². Publication bias was evaluated via funnel plots and Egger’s test. Subgroup analyses explored sources of heterogeneity. Results: Eighty-eight studies were included. Meta-analyses, comparing treatment vs. no treatment, revealed that nirmatrelvir/ritonavir reduced hospitalization by 52% (RR 0.48, 95% CI 0.36–0.63) and all-cause mortality by 84% (RR 0.16, 95% CI 0.11–0.24). Remdesivir reduced hospitalization by 70% (RR 0.30, 95% CI 0.19–0.47) and respiratory failure by 89% (RR 0.11, 95% CI 0.03–0.44). Sotrovimab decreased hospitalization (RR 0.71, 95% CI 0.54–0.93) and mortality (RR 0.34, 95% CI 0.19–0.61). Molnupiravir modestly reduced hospitalization (RR 0.80, 95% CI 0.70–0.91) and respiratory failure (RR 0.45, 95% CI 0.27–0.77). Conclusions: Nirmatrelvir/ritonavir and remdesivir remain important for reducing severe outcomes, while sotrovimab retains partial efficacy. Rapid access to antivirals remains an important factor in mitigating SARS-CoV-2’s burden. Full article

Early diagnosis of lung cancer, essential for reducing its high mortality rate, is currently challenging, partly due to the lack of specific biomarkers. Here, we attempted to develop a noninvasive and potentially sensitive screening method based on the proteomic analysis of unstimulated and stimulated saliva samples, collected by passive drooling and salivary swabs, respectively, from healthy heavy smokers enrolled in a nonprofit screening project. Protein content analyzed before and after sample cryopreservation for various periods and the associated two-dimensional electrophoresis revealed that protein extraction after short-term cryopreservation prevented the loss of detectable proteins. Mass spectrometric analysis of these electrophoretically resolved proteins revealed the presence of salivary proteins whose levels may be dysregulated in various types of lung cancer. Finally, in pilot experiments conducted on stimulated saliva from a patient with a lung cancer nodule, we detected altered content or selective presence of proteins involved in lung carcinogenesis, such as serpin B3 or the proteins S100A14 and aldoketoreductase-A1, respectively. While acknowledging that these findings require further validation, we believe that the use of saliva and related proteomic analyses may contribute to the identification of potential early lung cancer biomarkers, which could hopefully improve clinical management of the tumor and patient survival. Full article