Search Results (7,485)

Disordered eating has been identified as a concern among individuals with type 1 diabetes mellitus (T1DM) and is associated with poorer glycaemic control, which may result in vascular complications and increased morbidity and mortality. Despite this, there is a paucity of research examining disordered eating behaviour (DEB) among individuals with T1DM in Ireland. This study aimed to examine the prevalence of DEB among adults with T1DM attending an Irish hospital outpatient clinic. This cross-sectional study recruited 95 adults with T1DM attending an outpatient diabetes clinic at Sligo University Hospital. Screening for DEB was conducted using self-reported measures, including the Diabetes Eating Problem Survey–Revised (DEPS-R) and the Eating Disorder Examination Questionnaire (EDE-Q 6.0). DEB was identified in 16.3% (n = 15) of the participants using the DEPS-R and in 3.2% (n = 3) using the EDE-Q 6.0. Higher levels of DEB were observed among the female participants; however, a notable prevalence was also identified among the male participants. DEB demonstrated a weak positive correlation with body mass index (BMI) and a negative correlation with age and height. No association was found between DEB and glycated haemoglobin (HbA1c). The substantial prevalence of DEB among adults with T1DM, with nearly one in six participants affected, highlights the presence of clinically relevant disordered eating symptoms in this population. The findings suggest potential differences in case identification between diabetes-specific and generic screening tools. These results support further evaluation of diabetes-specific screening instruments such as the DEPS-R in adult T1DM populations within larger studies before routine clinical implementation. Full article

Upper respiratory tract infections and inflammatory nasal disorders are highly prevalent in childhood and represent a major cause of morbidity and healthcare utilization. Humans are continuously exposed to airborne microorganisms, allergens, and pollutants. Although the nasal mucosa provides effective mechanical and immunological defenses, these mechanisms may be impaired by inflammation, environmental pollutants, and mucociliary dysfunction, increasing susceptibility to infection and airway inflammation. Nasal irrigation (NI) contributes to the restoration of nasal homeostasis by mechanically removing mucus, pathogens, allergens, and inflammatory mediators, while also improving mucociliary clearance (MC), mucus rheology, and epithelial barrier function. Hypertonic solutions (HS) may provide additional osmotic and decongestant effects. Current evidence suggests that NI is a safe and well-tolerated adjunctive intervention that may improve symptoms and support mucosal function in acute and chronic upper airway diseases. This narrative review provides an updated overview of NI, with particular focus on pediatric populations. This paper integrates the pathophysiological mechanisms of mucociliary dysfunction, environmental exposures, and pediatric-specific anatomical and functional characteristics into a unified framework to understand the role of NI in childhood respiratory diseases. Clinical indications, administration techniques, solution selection, safety aspects, and age-specific practical considerations are discussed, highlighting the importance of appropriate technique, caregiver education, and adherence to basic hygiene principles. Full article

Endometrial hyperplasia (EH) is an estrogen-driven proliferative disorder with a measurable risk of progression to endometrial carcinoma. Although many guidelines have been issued over the years, clinical practice remains heterogeneous. In this paper, we aim to compare and summarize key recommendations and disagreements among major international guidelines for managing endometrial hyperplasia, focusing especially on conservative and fertility-sparing strategies. All guidelines align with some key principles: they all adopt the 2020 WHO classification, strongly prefer hysteroscopy-directed sampling, and recommend progestin therapy as the first-line treatment for non-atypical EH, favoring the levonorgestrel-releasing intrauterine system (LNG-IUS) over oral regimens. They designate total hysterectomy as definitive management for atypical hyperplasia/intraepithelial endometrial neoplasia (AEH/EIN) due to the substantial prevalence of concurrent carcinoma. Nevertheless, several key discrepancies appear, mainly concerning how long to continue progestin therapy and when to escalate treatment; and how intensively and for how long to conduct post-treatment surveillance. Variations in diagnostic and therapeutic protocols reflect evidence gaps and differences across healthcare settings. Future research should focus on harmonized outcomes, comparative studies of conservative strategies, and the integration of new pathology tools for personalized management. Full article

The most persistent biomedical challenges of the 21st century are neurodegenerative disorders (NDs), where molecular alterations lead to devastating clinical consequences and progressive neuronal loss. The prevalence of neurodegeneration is continuously rising and becoming the main contributor to chronic disability and mortality. Despite their clinical differences, many conditions share pathogenic processes, including oxidative stress, protein misfolding and aggregation, mitochondrial dysfunction, and neuroinflammation. Instead of functioning independently, these processes cooperate to form a self-reinforcing network that gradually weakens synapses and ultimately leads to neuronal death. This study redefines neurodegeneration as a disorder of system-level failure by emphasizing poor cellular stress integration. In addition to demonstrating how gut microbiome gene networks impact inflammation and amyloid production, new research highlights the relationships between mitochondrial–lysosomal interactions, endoplasmic reticulum stress responses, and transcriptionally driven synaptic vulnerability. A key molecular topic is the interaction and pathogenic convergence of the JAK/STAT, HIF-1α, and Notch signaling pathways. Under ongoing metabolic stress, prolonged stimulation of this triad increases inflammation, hinders the regenerative processes, and maintains pseudo-hypoxic conditions, explaining why single-target treatments have mostly been unsuccessful. This review also explores progress in fluid, digital, and imaging biomarkers that facilitate early diagnosis and patient stratification, and assesses new disease-modifying approaches such as antisense oligonucleotides, immunomodulators, gene therapies, and small-molecular agents. Artificial intelligence is emphasized as an essential tool for integrating multimodal data, drug discovery and predictive modeling. Full article

Background: Avoidant/restrictive food intake disorder (ARFID) and selective eating are increasingly recognized in pediatric nutrition, but food selectivity has been predominantly studied in dedicated eating disorder settings and in underweight children, potentially underestimating its prevalence across broader clinical populations. This study aimed to characterize food selectivity as a transdiagnostic feature in children referred to a tertiary pediatric nutrition center, regardless of referral diagnosis or BMI status. Methods: This retrospective observational study included 417 consecutive children and adolescents (median age 9.3 years, IQR 4.1–12.9; 47.5% male) assessed at the General Pediatric Eating Disorders Outpatient Unit of Bambino Gesù Children’s Hospital IRCCS, Rome, Italy, between May 2024 and April 2026. Food selectivity was defined as clinician-documented avoidance of at least one of four food groups (vegetables, fruit, fish, and legumes). Patients were classified as having primary selective eating/ARFID (Group A, n = 141), unrecognized selective eating (Group B, n = 163), or no selectivity (Group C, n = 113). Results: Food selectivity was identified in 293 patients (70.3%), including 70.8% of those referred for obesity or overweight and 50.0% of those referred for eating disorders. Prevalence did not differ across BMI categories (p = 0.554), confirming that selective eating is independent of anthropometric status. Ferritin deficiency showed a significant gradient across groups (Group A 32.2%, Group B 17.9%, Group C 10.8%; p = 0.002). Screen use during meals and ultra-processed food consumption were similarly elevated in Groups A and B and significantly higher than in Group C (p = 0.002 and p < 0.001, respectively), with no difference between the two selective groups. Conclusions: Food selectivity is a transdiagnostic and BMI-independent feature affecting the majority of children referred for pediatric nutritional evaluation. Children with unrecognized selective eating share the same nutritional risks and behavioral correlates as those formally diagnosed with ARFID, supporting the integration of a brief food group avoidance screen into routine nutritional assessment regardless of the primary referral diagnosis. Full article

Background: Polyendocrine metabolic ovarian syndrome (PMOS/PCOS) is the most common hormonal disorder in women of reproductive age and is linked to infertility as well as long-term metabolic and psychological problems. In the Gulf Cooperation Council (GCC) region, rising obesity, dietary changes, and sedentary lifestyles may be increasing its burden. However, prevalence estimates remain highly inconsistent due to differences in diagnostic criteria and measurement methods rather than true variation in disease rates. Objective: This study aimed to describe the situation by systematically pooling available evidence on the prevalence of PMOS among women in GCC countries and by summarizing the range of clinical features reported across included studies. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched five major bibliographic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) and the Google Scholar search engine for observational studies published up to 1 June 2026. Studies were eligible if they reported PMOS prevalence and related clinical features among women of reproductive age residing in GCC countries. After removing duplicates and screening 570 initially identified records, 25 studies met our inclusion criteria; 24 were included in the quantitative meta-analysis after excluding one high-risk study. Risk of bias was appraised using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects meta-analysis using the DerSimonian-Laird method, combined with the Freeman-Tukey double arcsine transformation, was used to estimate the pooled prevalence. Heterogeneity was quantified using the I² statistic and Cochran’s Q test. Subgroup analyses explored differences by country, diagnostic method, study setting, and publication period. Meta-regression was used to identify study-level factors that explained between-study variability. Results: Across 24 studies involving 77,890 women, the pooled prevalence of PMOS was 17.59% (95% CI: 12.98–23.40%). Country-level estimates ranged from 6.56% in Oman to 23.0% in Saudi Arabia. Heterogeneity across all analyses was extremely high (I² = 99.6%), and meta-regression identified the diagnostic tool as the single most important source of variation, explaining 42.7% of between-study variance. Studies using structured clinical criteria (Rotterdam or NIH) yielded prevalence estimates around 13–14%, while those relying on self-report or physician diagnosis without standardized criteria reported considerably higher figures (20–37%). Common clinical features included menstrual irregularity (up to 100% of PMOS cases in clinical cohorts), hirsutism (5–100%), acne and oily skin (17–74%), and obesity (17–73%). Awareness of PMOS among women in the region was highly variable, ranging from under 3% to nearly 100%. Conclusions: PMOS is a significant public health concern across the GCC region. The markedly higher pooled prevalence combined with high rates of obesity and metabolic risk in this population calls for urgent, coordinated action. Standardizing diagnostic practices, investing in population-level screening, and developing culturally tailored awareness programs are essential steps toward reducing the clinical and social burden of PMOS. Full article

Natural therapeutic alternatives are increasingly explored in endometriosis, a highly prevalent gynecological disorder with limited therapeutic options. Rosmarinus officinalis (rosemary) has attracted increasing scientific interest due to its biological activity. This study aimed to characterize a hydroethanolic rosemary extract (RE) and evaluate its effects on key cellular processes involved in endometriosis pathophysiology. Major phenolic compounds in RE were quantified by RP-HPLC, and antioxidant activity was assessed using DPPH, ABTS, and FRAP assays. After RE treatment, cell viability (WST-1), migration (wound healing assay), cell cycle distribution (DAPI staining), apoptosis (Annexin V/PI), p21 and cyclin A expression (Western blot), and intracellular ROS levels (DCFH-DA) were evaluated in endometrial stromal (t-HESC, St-T1b) and endometriotic epithelial (12-Z) cells. Phytochemical analysis revealed rosmarinic acid (RA) at 4.2%, while carnosic acid (CA) and carnosol (CS) together accounted for 23.7% of the extract. RE reduced cell viability and cell migration in 12-Z and t-HESC cells (p < 0.05). S-phase accumulation with a concomitant reduction in the G1 phase was observed across all evaluated cell lines (p < 0.05), along with increased p21 and cyclin A expression in stromal cells (p < 0.05). RE induced cell death in both 12-Z (p < 0.05) and St-T1b cells (p < 0.0001). In t-HESC cells, RE reduced both basal and H₂O₂-induced ROS levels (p < 0.01). These findings indicate that RE modulates key mechanisms involved in endometriosis pathophysiology, supporting its multi-target therapeutic potential as a nutraceutical approach for endometriosis management. Full article

The rising prevalence of neurodevelopmental, emotional, and behavioral disorders in children has prompted interest in dietary strategies that target neuroinflammation, oxidative stress, and gut dysbiosis. Blueberries (Vaccinium spp.) contain substantial amounts of anthocyanins and other neuroactive polyphenols that may confer neuroprotective effects. We summarize the literature published between 2016 and 2025 to examine how the bioactives in blueberries affect symptoms relevant to children with diagnosed neurodevelopmental or emotional–behavioral disorders, including ADHD, mood problems, and cognitive difficulties. Mechanistically, anthocyanins appear to modulate gut microbial composition, modulate neuroinflammation and alleviate oxidative stress via the Nrf2 pathway, and support synaptic plasticity and neurogenesis. Clinical trials, although limited in number and sample size, have reported modest improvements in mood and verbal memory in typically developing children and adolescents, with some gains in attention and executive function. However, direct trials in children with diagnosed neurodevelopmental or emotional–behavioral conditions remain scarce. There are substantial hurdles to translating these findings. Anthocyanins have poor physicochemical stability and low bioavailability, and routine food processing degrades their activity. Emerging solutions such as green extraction from agricultural by-products, colon-targeted microencapsulation, and zero-waste engineering could address these limitations. Rigorous randomized controlled trials in children with diagnosed neurodevelopmental or emotional–behavioral disorders are essential, as are advances in food engineering. Both are needed to move blueberry-based interventions from the laboratory to application. Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article

The clinical relevance of food-specific IgG antibodies in pediatric gastrointestinal disorders remains controversial. Although current international guidelines discourage their use as standalone diagnostic tools, their significance within a broader immune–gut inflammatory framework has not been sufficiently explored. This study aimed to investigate associations between food-specific IgG reactivity, inflammatory and permeability biomarkers, microbiological findings, and abdominal ultrasound abnormalities in children with chronic gastrointestinal symptoms. Methods: (1) Children presenting chronic gastrointestinal symptoms associated with food-specific IgG polysensitization, elevated inflammatory and permeability biomarkers, and abdominal ultrasound abnormalities (number (n) = 196); (2) a symptomatic gastrointestinal group without the complete multimodal profile (n = 146); and (3) a control group with normal abdominal ultrasound findings and biomarkers within reference ranges (n = 210). All participants underwent food-specific IgG testing using a 216-antigen ELISA panel, abdominal ultrasound examination, and assessment of intestinal inflammatory and permeability biomarkers. Food-specific IgG antibodies were not interpreted as diagnostic markers of food allergy or food intolerance. Comparative analyses, correlation analyses, multivariable logistic regression, and receiver operating characteristic (ROC) analyses were performed. Results: Food-specific IgG polysensitization was significantly more frequent among children presenting the multimodal inflammatory profile compared with symptomatic and control groups (all p < 0.001). Reactivity predominantly involved gluten-containing cereals, dairy proteins, and mixed gluten–dairy patterns. Elevated fecal calprotectin, zonulin, and fecal histamine concentrations were more frequently observed in this subgroup, together with a higher prevalence of ultrasound abnormalities, including bowel wall thickening and mesenteric lymphadenopathy. Correlation analyses demonstrated significant associations between cumulative IgG burden and bowel wall thickness (r = 0.48, p < 0.001), while fecal calprotectin showed the strongest association with ultrasound abnormalities (r = 0.62, p < 0.0001). Multivariable logistic regression identified elevated calprotectin, increased zonulin, IgG polysensitization, and mixed gluten–dairy reactivity as independent predictors of pathological ultrasound findings. The integrated multimodal model demonstrated higher classification performance than isolated biomarkers. Conclusions: Children presenting chronic gastrointestinal symptoms, food-specific IgG polysensitization, inflammatory biomarker abnormalities, and ultrasound changes represented a multimodal clinical subgroup within the study population. These findings support evaluating food-specific IgG reactivity within a broader immune–gut assessment framework rather than as a standalone diagnostic biomarker. The observed associations should be considered exploratory and hypothesis-generating, requiring prospective validation and mechanistic investigation. Full article

Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia and represents a major global public health concern due to its rapidly increasing prevalence. Although current pharmacological therapies effectively achieve glycemic control, their long-term use is limited by adverse effects, high costs, patient compliance issues, and increasing interest in safer, multi-targeted therapeutic strategies. In this context, plant-derived bioactive compounds have gained attention as complementary or alternative approaches to metabolic disease management. Gymnema sylvestre (Retz.) R.Br. ex Sm (GS), traditionally known as “gurmar” (“sugar destroyer”), is one of the most extensively studied medicinal plants with significant antidiabetic potential. This review evaluates the antidiabetic effects of G. sylvestre, focusing on its phytochemical composition, molecular mechanisms, and impact on diabetes-related complications. Major bioactive constituents, including triterpenoid saponins (gymnemic acids), gurmarin-like peptides, flavonoids, and sterols, regulate glucose homeostasis, inhibit intestinal glucose absorption, preserve pancreatic β-cell function, stimulate insulin secretion, modulate lipid metabolism, and suppress inflammatory signaling pathways. Experimental and clinical evidence indicates that G. sylvestre modulates oxidative stress and inflammation associated with complications such as nephropathy, neuropathy, retinopathy, vascular dysfunction, and dyslipidemia. This review adopts a mechanism-oriented framework integrating phytochemical structure–molecular target–metabolic outcome relationships and discusses emerging strategies, including nanotechnology-based delivery systems, molecular docking, and multi-component phytotherapy. Overall, G. sylvestre represents a promising multi-target phytotherapeutic agent, highlighting directions for future mechanistic and clinical research. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication, restricted and repetitive behaviors, and sensory processing abnormalities, including food selectivity. Due to the lack of effective causal therapies, alternative approaches such as dietary interventions are increasingly being explored. This study aimed to assess the impact of dietary factors on the nutritional status of children with ASD. Methods: A total of 103 children (75 with ASD and 28 controls) were included. Nutritional status was assessed using biochemical markers and standardized anthropometric measurements. Associations between nutritional status and dietary factors, particularly elimination diets implemented either on medical indications or in the absence of clinical justification, were analyzed. Results: ASD diagnosis was independently associated with lower height SDS (Standard Deviation Score). Food selectivity was significantly associated with growth patterns: children with food selectivity showed a higher prevalence of short stature compared with the control group (15.2% vs. 0%, p = 0.033). Children following elimination diets had significantly lower BMI SDS compared with those without dietary restrictions (−0.35 [−1.29 to 0.05] vs. −0.22 [−0.78 to 1.14], p = 0.046), although only 11.1% had medical indications for such interventions. Among non-supplemented participants, vitamin D deficiency was significantly more prevalent in the ASD group (84.6% vs. 33.3%, p < 0.001). Conclusions: Elimination diets were the only dietary factor associated with a clinically relevant reduction in BMI SDS in children with ASD. Food selectivity alone was not associated with impaired nutritional status. Most elimination diets were implemented without confirmed medical indications. These findings highlight the importance of evidence-based dietary management and routine vitamin D supplementation in this population. Full article

Per- and polyfluoroalkyl substances (PFAS) are persistent, chemically stable compounds widely used in daily life. Perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexanesulfonic acid (PFHxS), and perfluorooctanesulfonic acid (PFOS) were identified as the most relevant PFAS due to their prevalence and toxicity. This study aimed to investigate the immunotoxic mechanisms of a mixture of these PFAS using an in silico approach. Comparative Toxicogenomic Database (CTD), GeneMANIA, CytoHubba (Cytoscape), ToppGene Suite, and Metascape were used for the analysis. A total of 65 immune-related genes were identified as common to all four PFAS, with IFNG, TNF, IL1B, IL6, TYK2, CD3E, CASP8, VAV1, ARHGAP4, and CARD11 emerging as key hub genes. CTD phenotype analysis indicated immune dysregulation, with decreased humoral and adaptive immune responses in humans and tissue-specific modulation of B- and T-cell activity in mice, while no immune-related phenotypes were observed for PFNA. Network analysis identified functional modules associated with apoptotic and immune signaling, endothelial cell migration and angiogenesis, and shared inflammatory and viral response pathways. Disease enrichment analysis associated PFAS with autoimmune disorders (rheumatoid arthritis, asthma), metabolic conditions, and cardiovascular diseases (experimental diabetes, hypertensive disease). These results highlight PFAS involvement in immune modulation, cytokine signaling, and disease susceptibility. Full article

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD among Japanese male junior high school students. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents (183 fathers and 117 mothers), each reporting on one male junior high school student. Suspected GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Dysfunctional parenting practices were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. Mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups using a t-test. Logistic regression models assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean score of Overreactivity was significantly higher in the suspected GD group than in the non-suspected group, whereas that of Laxness was not. After adjustment, overreactive parenting was significantly associated with suspected GD (adjusted odds ratio: 1.89, 95% CI [1.31, 2.74]). This study showed that overreactive parenting was independently and significantly associated with increased odds of suspected GD. Full article

Background/Objectives: Eating disorders (EDs) are among the most severe psychiatric conditions affecting young people, with increasing prevalence in the post-pandemic period. This study assessed the prevalence of ED risk and dysfunctional eating behaviors among Italian university students, a population poorly characterized with respect to ED risk, and examined associations with key socio-demographic and anthropometric variables. Methods: A cross-sectional online screening study was conducted between August 2023 and February 2026 with 401 Italian university students (306 women and 95 men). Participants completed the validated Italian versions of the Eating Attitudes Test-26 (EAT-26) and the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0), alongside self-reported anthropometric data. Multiple linear regression analyses were performed to identify predictors of ED risk scores. Results: A total of 37.9% of participants had BMI outside the normal range (19.7% underweight; 18.2% overweight or obese). EAT-26 scores exceeded the clinical cut-off in 28.4% of participants (women: 35.6%; men: 5.3%). EDE-Q 6.0 global scores exceeded the clinical cut-off in 21.0% (women: 25.8%; men: 5.3%). Only 45.4% showed no anthropometric or questionnaire-based screening risk indicators (i.e., scores above the clinical cut-off on the EAT-26 or EDE-Q 6.0). BMI was negatively associated with EAT-26 scores in the total sample and in women, while a positive association between BMI and EDE-Q 6.0 scores was observed in men. Conclusions: A substantial proportion of Italian university students, particularly women, presented screening-based indicators of ED risk. The combined use of anthropometric and questionnaire-based screening tools provides a more comprehensive risk assessment than either measure alone, highlighting the need for multidimensional screening programs. Full article