Search Results (7,656)

Background: Elderly individuals represent one of the populations most affected by COVID-19, exhibiting high vulnerability to malnutrition, sarcopenia, and poor clinical outcomes. The association between nutritional status and disease progression highlights the need for standardized assessment and targeted nutritional interventions. Methods: A systematic review was performed using PubMed, Cochrane Library, and Google Scholar, covering studies published between January 2020 and October 2025. The review followed PRISMA guidelines and included studies evaluating nutritional status, screening tools, and nutritional support strategies for the elderly population (≥65 years old) with COVID-19 across inpatient, outpatient, and institutional care settings. Results: A total of seven studies met the inclusion criteria. Reported malnutrition prevalence ranged from 25% to 65%, increasing with both age and COVID-19 severity. The most frequently applied tools were the Mini Nutritional Assessment–Short Form (MNA-SF), the Global Leadership Initiative on Malnutrition (GLIM) criteria, and the Geriatric Nutritional Risk Index (GNRI). New evidence supports early nutritional screening, high-protein supplementation, and individualized dietary strategies to reduce complications and improve recovery trajectories. Conclusions: Nutritional risk screening and timely intervention are essential in the management of elderly patients with COVID-19. Standardized assessment tools and multidisciplinary nutrition approaches enhance clinical outcomes, minimize disease burden, and should remain integral components of geriatric care in infectious and post-pandemic contexts. Full article

Background: Temporomandibular disorders (TMDs) are the most common source of non-dental orofacial pain, with peak prevalence during adolescence and young adulthood—the same age group when orthodontic treatment is typically initiated. Although orthodontics is not a proven cause of TMD, pre-existing dysfunction may be aggravated during treatment, creating clinical and medico-legal risks. Objective: This paper proposes a structured diagnostic questionnaire and scoring framework for pre-orthodontic TMD assessment. The protocol aims to enhance the early recognition of high-risk patients, facilitate interdisciplinary communication, and lay a foundation for systematic validation. Methods: The framework was developed through synthesis of international diagnostic criteria (DC/TMD), a targeted narrative review of the literature, and expert clinical input. Diagnostic categories were selected based on prevalence, impact on orthodontic outcomes, and medico-legal significance. Weighted scoring stratifies patients into three pathways: (1) proceed with orthodontics without concern, (2) proceed with monitoring, or (3) defer orthodontics until TMD is managed. Results: The proposed questionnaire is designed to address inconsistencies in literature by applying standardized diagnostic items and objective thresholds (e.g., jaw opening < 38 mm), and structured follow-up intervals. Case scenarios illustrate how risk stratification guides decision-making. The questionnaire includes intra-articular and pain-related TMD entities such as disk displacement, degenerative joint disease, myalgia, myofascial pain, arthralgia, headache, and trismus. The framework provides orthodontists with defensible baseline documentation while supporting safe and individualized patient care. Conclusions: Inconsistent diagnostic frameworks, malocclusion classifications, and outcome measures have fragmented the evidence base in orthodontics and TMD. The framework aims to provide orthodontists with structured baseline documentation that may support clinical decision-making and medico-legal risk management. Validation studies are required to establish psychometric reliability and international applicability. Full article

Background: Geohelminthiasis and malaria are major public health problems in Kinshasa. Pregnant women are particularly vulnerable to these conditions due to their weakened immunity, with severe complications such as maternal anemia and low birth weight. This study assessed the prevalence and associated factors of geohelminth–malaria co-infection. Methods: A cross-sectional study was conducted in two hospitals in Kinshasa, Democratic Republic of the Congo, which included 336 pregnant women. The lab analyses included thick smears for malaria, stool examinations for geohelminths, and hemoglobin measurements. Multivariate logistic regression was used to identify associated variables, with a significance level set at p < 0.05. Results: Geohelminth–malaria co-infection was observed in 5.7% of pregnant women, while the prevalence of geohelminthiasis alone was 7.7%. Ascaris lumbricoides was the most frequent parasite (6.3%), followed by Trichuris trichiura (1.5%) and Ancylostoma duodenale (0.3%). The third trimester was associated with a significantly increased risk of co-infection and geohelminthiasis (ORa = 5.8; 95% CI: 1.36–9.23; p = 0.0077). No significant association was found between co-infection and maternal anemia. Conclusions: Although co-infection prevalence was low in Kinshasa, the third trimester is a risk period. Systematic screening and integrated management during pregnancy are recommended. Full article

 Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, continues to be a significant global health issue, especially in Latin America, with increasing international prevalence due to migration. Despite advancements in diagnosis and treatment, it remains a neglected tropical disease characterized by significant morbidity and mortality, mainly influenced by the complex interaction between parasite diversity and host immune responses. Importantly, the remarkable genetic diversity of T. cruzi lineages also contributes to clinical heterogeneity, influencing immune evasion, therapeutic responses, and vaccine feasibility. This review analyzes the impact of immunogenetics on host–parasite interactions in Chagas disease and explores its implications for personalized therapy approaches. Recent research, particularly over the last decade, has indicated that processes including antigenic variation, extracellular vesicle-mediated regulation, and disruption of host signaling pathways facilitate parasite persistence. Host genetic variables significantly influence susceptibility, disease development, and treatment outcomes, including changes in Human Leukocyte Antigen (HLA) genes, cytokine gene polymorphisms, and immunogenetic determinants of cardiac pathology. These findings underscore the potential of immunogenetic markers as tools for prognosis and as targets for personalized therapies. However, there are still considerable research deficiencies. Inadequate comprehension of gene–environment interactions, lack of representation of varied populations, and inconsistencies in study design limit the use of immunogenetic findings in therapeutic settings. At present, the concept of personalized medicine in Chagas disease remains largely aspirational, better understood as a framework for precision public health or stratified interventions guided by host immunogenetic and parasite lineage data. Addressing these issues necessitates comprehensive genomic research, mechanistic investigations of host–parasite interactions, and clinical validation of genetic markers. This study emphasizes the necessity of incorporating immunogenetics into personalized patient management strategies based on existing evidence. This integration has the potential to improve diagnosis, enhance treatment efficacy, and inform preventive interventions, thereby advancing personalized therapy for Chagas disease.  Full article

Background: The high prevalence of overweight and obesity in Singapore necessitates scalable primary prevention strategies. This study evaluated the short-term effectiveness of FitterLife, a 12-week, digitally delivered, group-based behavioural weight management programme targeting at-risk adults without diabetes or hypertension in the community. Methods: In a retrospective matched cohort study, we compared 306 FitterLife participants (enrolled from October 2021 to January 2025) with 5087 controls identified from a population health data mart, matched on age, sex, ethnicity, and baseline body mass index (BMI). The primary outcome was achieving ≥5% weight loss or a ≥1 kg/m² BMI reduction at 12 weeks. Programme effectiveness was analysed using propensity score matching (1:1) and inverse probability weighted regression. Mixed-effects models assessed weight/BMI trajectories and modified Poisson regression identified behavioural factors associated with success. Results: After matching, FitterLife participants were more likely to achieve the weight loss target than controls (45.7% vs. 13.7%, coefficient = 0.32, 95% confidence interval [CI]: 0.26–0.38) and were over three times as likely to succeed (Adjusted incidence rate ratio [aIRR] = 3.37, 95% CI: 2.87–3.93). The programme group showed significant reductions in weight (−2.23 kg, 95% CI: −2.57 to −1.90) and BMI (−0.86 kg/m², 95% CI: −0.95 to −0.73) at the end of programme. Higher session attendance and improved behavioural factors were associated with success. Conclusions: FitterLife was effective in achieving clinically significant short-term weight loss in a real-world setting. The findings demonstrate the potential of a scalable, behavioural theory-informed, virtual group model as a viable primary prevention strategy within national chronic disease management efforts. Full article

Background: Croatia has the highest prevalence of obesity among European Union member states, with more than 65% of adults classified as overweight or obese. Understanding public perceptions and behaviours related to body weight is essential for designing effective prevention and treatment strategies. Objective: This study compared Croatian adults’ satisfaction with body weight, physical fitness, and dietary habits in 2022 and 2024, exploring potential behavioural changes following national awareness campaigns and the introduction of new anti-obesity measures. Methods: Data were collected via computer-assisted web interviews (CAWI) from representative national samples of adults aged 18 years and older (N = 798; 398 in 2022, 400 in 2024). Analyses used descriptive statistics, Chi-square or Fisher’s exact tests for categorical variables, and independent t-tests for continuous variables. Results: In both years, fewer than half of respondents were satisfied with their body weight or physical fitness. Obesity prevalence rose slightly among men (from 18.9% to 25.4%), while rates among women remained stable. Although 93% of women and 78% of men were aware of BMI, only 21% knew their exact value. Individuals with obesity were significantly more dissatisfied with their body shape (p < 0.001). One-third reported dieting within the past six months, and only one in ten sought medical advice for weight management. Lack of time and the high cost of healthy foods were the most frequently cited barriers to healthier lifestyles. Conclusions: Body weight satisfaction and lifestyle habits among Croatian adults remain suboptimal. Targeted, gender-sensitive, and web-based interventions are needed to promote awareness, improve self-perception accuracy, and enhance obesity prevention efforts. Full article

Background: Down syndrome (DS) is strongly associated with a high prevalence of thyroid dysfunction. International guidelines recommend regular screening to ensure early detection and management. This study aimed to determine the prevalence, spectrum, and management outcomes of thyroid dysfunction in children with DS in the Aseer region of Saudi Arabia. Methods: A retrospective cross-sectional study was conducted by reviewing the medical records of 106 children with DS from two major healthcare centers: Abha Maternity and Children Hospital and King Khalid University Medical Center. Data on demographics, clinical symptoms, thyroid function tests, autoimmune status, treatment, and follow-up patterns were collected and analyzed. Results: The prevalence of thyroid dysfunction was 52.8%. Subclinical hypothyroidism was the most common disorder (46.4%), followed by autoimmune hypothyroidism (30.4%). Patients with thyroid dysfunction had a significantly higher symptom burden, particularly in metabolic, dermatological, and gastrointestinal domains (p < 0.01). A strong family history of thyroid disease was a significant risk factor (adjusted odds ratio (aOR) = 4.57, 95% CI: 1.89–11.6, p < 0.001). While adherence to screening and follow-up was high (78.0% and 82.1%, respectively), a critical gap was identified in treatment optimization, with 74.4% of patients treated potentially requiring levothyroxine dose adjustment. Conclusions: Thyroid dysfunction is highly prevalent in the Southern Saudi children with DS, with subclinical hypothyroidism and autoimmune hypothyroidism being the most common types. Despite good screening adherence, there is a substantial need for improved treatment titration and long-term management to optimize patient outcomes in this population. Full article

Background/Objectives: Keratitis–ichthyosis–deafness (KID) syndrome is an exceptionally rare congenital multisystem disorder, with an estimated prevalence below 1:1,000,000 and fewer than 100 reported cases worldwide. It is characterized by hyperkeratosis, alopecia, nail dystrophy, hearing loss, and ocular involvement. While dermatological management is well described, surgical experience with wound treatment in KID syndrome remains extremely limited. The objective of this report is to describe the surgical management and outcomes of a patient with chronic lower-limb wounds associated with KID syndrome. Methods: A 35-year-old male with KID syndrome was referred to the surgical outpatient clinic for chronic traumatic wounds of both lower limbs resistant to conservative dermatological therapy. Initial outpatient treatment included serial sharp surgical debridement under local anesthesia, combined with topical keratolytics and silver sulfadiazine with hyaluronic acid. Due to minimal improvement after three months, an inpatient surgical approach was initiated, involving complete excision of hyperkeratotic tissue, creation of a wide ulcer bed, and adjunct systemic and topical therapies. Results: The inpatient management enabled thorough removal of pathological tissue and better control of local infection and inflammation. Combined systemic antibiotic and antipsoriatic therapy, together with topical sodium hyaluronate and iodine, was associated with gradual wound healing and improved skin condition. The patient tolerated the procedures well, without major complications. Conclusions: Surgical debridement and excision, when combined with targeted dermatological and antimicrobial therapy, can be an effective and safe strategy for managing chronic wounds in KID syndrome. This case highlights the importance of multidisciplinary collaboration and individualized surgical planning in this extremely rare disorder. Full article

Background/Objectives: Body self-image interacts with young adults’ health behaviors in complex ways, yet its role in shaping supplement use is not well defined. This study examined young adults’ body self-image and their use of dietary supplements commonly marketed to enhance physique, fitness, and weight outcomes. Methods: College students (N = 122; 18–28 years) completed the Body Self-Image Questionnaire-Short Form to assess body self-image and answered three dichotomous questions related to general dietary (DS), performance-enhancing (PES), and weight-loss (WLS) supplement use. Student scores were calculated across nine psychological subscale groups and ranked as high, moderate, or low percentile within our study sample. Chi-square analyses examined supplement prevalence in student responses ranked within the highest and lowest tertiles; middle tertile data were excluded as part of the extreme-group design. All responses were included in the logistical regression analysis. Results: Higher scores for the Investment in Ideals and Health-Fitness Evaluation subscales observed significantly higher PES use; both subscales and the male gender were significant predictors of PES use. Higher scores for the Fatness Evaluation, Negative Affect, and Social Dependence subscales observed significantly higher WLS use; Fatness Evaluation and age were significant predictors of WLS use. Subscales were not significantly associated with general supplement use in chi-square or logistical regression analyses. Conclusions: Our findings suggest that internalized appearance ideals, emotional distress, and social approval pressures are linked to weight- and physique-driven supplement behaviors in college students. Targeted, inclusive campus wellness initiatives are needed to address psychological drivers of weight-management practices, including potentially high-risk supplement use. Full article

Background/Objectives: Thalassemia is highly prevalent in Indonesia, and its treatment imposes a significant financial burden. To date, thalassemia management in Indonesia remains largely limited to supportive therapies. This report aims to present the monitoring of the first Indonesian pediatric thalassemia patient to undergo gene therapy. Methods: Medical summaries were gathered across multiple time points. The gene therapy process consisted of several phases: screening, apheresis and cell manufacturing, conditioning, cell infusion, and post-treatment follow-up. The therapy utilized autologous CD34+ hematopoietic stem and progenitor cells (HSPCs), which were genetically modified using a lentiviral vector carrying the beta-globin gene. The primary outcome of this study was transfusion independence, determined through serial assessments of hematological parameters over a six-month period following gene therapy. Results: A 15-year-old female had been diagnosed with thalassemia major at the age of five. DNA analysis revealed compound heterozygous mutations Hb Malay (codon 19, AAC^Asn > AGC^Ser) and IVS1-nt5 (G > C). She had been receiving regular blood transfusions every 3–4 weeks, and hemosiderosis was detected in the liver and pancreas. Given the patient’s age—over 10 years—hematopoietic stem cell transplantation carries increased risks, making gene therapy the most suitable curative option. During the six-month follow-up period after gene therapy, the patient remained transfusion-independent and experienced no complications. Conclusions: In selecting an appropriate curative therapy for thalassemia patients, several factors must be considered. The successful implementation of the first gene therapy in an Indonesian pediatric thalassemia patient should serve as a catalyst for the continued development and expansion of curative treatment options for thalassemia patients across the country. Full article

Background: Inadequate nutrition, poor health care, and limited stimulation constrain early childhood development and cognitive potential. Micronutrient deficiencies during pregnancy and early life are prevalent in low- and middle-income countries (LMICs) and may impair cognitive outcomes. Maternal multiple-micronutrient (MMN) and point-of-use micronutrient powder (MNP) supplements improve birth outcomes and iron status, but their long-term cognitive impact remains unclear. This systematic review assessed the long-term impact of maternal MMN and early-childhood MNP supplementation on cognitive development among children aged 4–14 years in LMICs. Method: Following PRISMA guidelines (PROSPERO CRD42023459846), (cluster) randomized controlled trials were identified from six databases and gray literature (October 2023; updated July 2025). Records were managed in EndNote and screened in Covidence, and data were synthesized using Review Manager. Eligible studies examined MMN or MNP interventions during pregnancy, lactation, or early childhood, reporting cognitive, motor, or socio-emotional outcomes in children aged 4–14. Results: Ten studies met the inclusion criteria: six on maternal supplementation, three on early childhood interventions, and one combining both. Most were conducted in Asia, with one in Tanzania and one in Peru. Although most findings were not statistically significant, two large UNIMMAP-based trials indicated modest long-term improvements in procedural memory and intelligence, while one early childhood point-of-use MNP trial suggested enhanced pre-academic skills. Conclusions: Maternal MMN supplementation may modestly enhance specific domains of cognitive development, whereas evidence on the long-term effects of MMN and point-of-use MNPs on cognitive development remain limited, highlighting the necessity for further research. Full article

Background: Rapid weight loss (RWL) is a widespread practice among judo athletes seeking to compete in lower weight categories. Restrictive nutritional and behavioral strategies used to achieve short-term reductions in body mass may impair physiological and psychological functioning. This study aimed to assess dietary behaviors, weight-cutting methods, and short-term physical and psychological effects of RWL among competitive judo athletes. Methods: A cross-sectional study was conducted between August and December 2024 among 70 judo athletes (17 women, 53 men) competing at national and international levels. Data were collected using an author-designed questionnaire addressing anthropometric variables, training history, RWL strategies, dietary restrictions, hydration manipulation, and post-weigh-in eating behaviors. Physical and psychological symptoms were assessed using frequency-based self-report measures. Results: Most athletes (95.7%) reported engaging in RWL, typically beginning between ages 13 and 16 years (65.7%). Athletes reduced an average of 3.64 ± 1.74 kg (2–5% of body mass). Common strategies included decreasing meal frequency (74.29%), increasing training load (72.86%), restricting fluids (68.57%), and using saunas (62.86%). Reported physical symptoms included weakness (71.43%), headaches (51.43%), and dizziness (45.71%), while psychological symptoms included irritability (57.14%), reduced motivation (40%), and tension (38.57%). Post-weigh-in binge eating occurred in 65.71% of athletes and was significantly associated with higher RWL magnitude (p < 0.05). Discomfort during competition related to overeating (55.71%) or insufficient intake (41.43%) was also frequent. Conclusions: RWL is highly prevalent among judo athletes and often begins early in training history. The strategies used are associated with adverse physical and psychological symptoms and maladaptive compensatory behaviors. These findings highlight the need for evidence-based nutritional education and individualized weight-management approaches to support athlete health and performance. Full article

Co-infection by human papillomavirus (HPV) and human immunodeficiency virus (HIV) facilitates cervical carcinogenesis, and additional cofactors such as other sexually transmitted infections (STI) further aggravate this scenario. This study aimed to validate a molecular detection strategy for Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae and to assess the association of these infections with cervical lesions in HPV-positive women living with HIV in Northeastern Brazil. In total, 155 samples were collected from CRIST/AIDS. After microorganism detection by conventional PCR, a multiplex PCR was standardized and validated. A prevalence of 9.03% was observed for C. trachomatis and 6.45% for T. vaginalis, with 0.64% co-infection. In addition, infection with both STIs showed a prevalence of 0.64%. Among HPV-positive women, high-risk genotypes accounted for 70.9% of cases, with HPV-16 being the most prevalent (35.5%). Overall, 18.2% of women presented cervical lesions, and 13.2% of those with co-detection of C. trachomatis and T. vaginalis were associated with high-grade squamous intraepithelial lesions (HSIL). These findings highlight the clinical relevance of screening for multiple STIs in HPV-positive women living with HIV and support the incorporation of multiplex molecular testing into public health strategies to improve early detection and targeted management. Full article

Urban stray cats are often associated with ectoparasites and zoonotic pathogens due to their unsanitary living conditions and lack of veterinary care. Fleas, especially Ctenocephalides spp., are competent vectors of Bartonella spp., a genus of emerging bacterial pathogens with both public health and veterinary relevance. This study investigated the presence of Bartonella DNA in ectoparasitic fleas infesting stray cats in various urban habitats within the Klang Valley, Malaysia. A total of 204 fleas were collected from 89 stray cats. Fleas were identified morphologically using established taxonomic keys under a light microscope and further validated through PCR amplification of the mitochondrial cytochrome c oxidase subunit I (cox1) gene. Detection of Bartonella spp. was conducted by targeting the citrate synthase (gltA) gene. All fleas were confirmed as Ctenocephalides felis, with an infestation prevalence of 39.33% among the cats sampled. Of 118 C. felis specimens tested, 86.44% were positive for Bartonella DNA, one of the highest worldwide and significantly surpassing previous Malaysian reports. Sequencing of 12 positive samples showed identities with B. claridgeiae (58.3%), B. henselae (25.0%), an uncultured Bartonella species (8.3%) and a Bartonella isolate from a dog in Chile (8.3%). These results highlight the significant presence of Bartonella, causative agent of cat-scratch disease in stray cats, emphasizing their potential role as urban reservoirs and vectors. The findings underscore the need for ectoparasite surveillance and zoonotic pathogen control as integral components of stray animal management in Malaysia’s urban settings. Full article

Heart failure (HF) is a condition with a high clinical and healthcare burden. In Europe, the current incidence is approximately 5 per 1000 persons per year in the adult population, with a prevalence of 1–2%. Prognosis remains poor, with persistently high rates of mortality and hospitalization. The period immediately following hospital discharge is known as the “vulnerable phase,” marked by a heightened incidence of clinical events, including a 30% chance of rehospitalization and a 10% mortality risk. Effective patient management during this time is crucial and should incorporate a risk stratification process, which is vital for designing a personalized follow-up plan and ensuring optimal resource utilization. This review aims to outline the available tools for prognostic risk stratification and propose a structured follow-up model applicable at discharge from an HF hospitalization in patients with HF with reduced ejection fraction and in patients with mildly reduced/preserved ejection fraction. Full article