Search Results (392)

Background: Living donor liver transplantation (LDLT) poses significant physiological challenges, especially during early postoperative recovery. While the long-term benefits of structured rehabilitation are well documented, data on short-term effects—particularly during the critical early inpatient phase—remain limited. This study aimed to evaluate the short-term impact of a structured exercise program on cardiopulmonary function, respiratory muscle strength, physical performance, oxidative stress markers, and quality of life in LDLT recipients. Methods: Four LDLT recipients (2 males, 2 females; mean age 48.00 ± 18.35 years) underwent a 4-week inpatient rehabilitation protocol. Weeks 1–2 involved conventional care, while weeks 3–4 included structured exercise consisting of early mobilization and inspiratory muscle training. Outcome measures included cardiopulmonary exercise testing (CPET), spirometry, maximal inspiratory and expiratory pressures (PImax, PEmax), 6 min walk distance (6MWD), lower limb muscle strength, Chronic Liver Disease Questionnaire (CLDQ), and serum oxidative stress markers (total antioxidant capacity [TAC] and malondialdehyde [MDA]). Results: All patients demonstrated postoperative declines in VO₂ peak, PImax, PEmax, and TAC. Structured exercise yielded clinically meaningful improvements in respiratory muscle strength, notably in female and younger participants. Two younger patients showed increased 6MWD; however, no patient regained preoperative VO₂ peak. TAC levels decreased following the intervention, and MDA levels remained stable in most cases. Conclusions: A two-week structured exercise program during early postoperative recovery may provide partial benefits in respiratory muscle strength and physical performance but is insufficient to restore full cardiopulmonary function in LDLT recipients. Longer rehabilitation periods may be necessary to achieve preoperative recovery levels. Full article

Epsilon-poly-l-lysine (ε-PL) is a potent antimicrobial agent, but strategies to enhance its biosynthesis remain limited due to insufficient understanding of its physiological regulation. This study explores the interaction between Streptomyces albulus and heterogeneous microbial extracts, with a focus on actinomycete-derived signals. The S. gilvosporeus extract induces the highest ε-PL production (3.4 g/L), exceeding the control by 2.6-fold and outperforming B. cinerea by 1.8-fold. Multi-omics analyses combined with morphological and biochemical profiling reveal that the induced state is characterized by intensified central carbon flux, enhanced lipid turnover, elevated respiratory activity, and cofactor regeneration, alongside suppression of competing secondary pathways. Morphological alterations, including denser mycelial aggregation and compact colony structures, accompany these metabolic shifts. Compared to B. cinerea, S. gilvosporeus elicits more pronounced stress adaptation and metabolic reprogramming in S. albulus. These findings suggest that interspecies interactions can activate intrinsic aggression resistance mechanisms, thereby driving ε-PL biosynthesis through a previously unrecognized physiological route. Full article

Background: Oral antiseptic formulations are widely used as adjuncts in oral hygiene to reduce pathogenic microorganisms and prevent oral diseases. While these agents are effective in controlling biofilm, their broader effects may disrupt the oral microbiota’s balance, potentially contributing to systemic health implications. The complex relationship between antiseptic use, microbial composition, and systemic outcomes remains insufficiently mapped. Objective: This scoping review aimed to explore and map the current evidence regarding the impact of antiseptic formulations on oral microbiota composition and to examine their potential associations with systemic diseases. Methods: A comprehensive literature search was performed using PubMed, Scopus, and Web of Science up to June 2025. Studies were included if they investigated antiseptic formulations commonly used in oral healthcare—such as chlorhexidine, essential oils, and cetylpyridinium chloride—and reported effects on oral microbiota and/or systemic health. Eligible study types included human clinical trials, observational studies, in vitro, and animal studies. Two reviewers independently screened and selected studies, with disagreements resolved by consensus. Data extraction focused on study design, antiseptic agents, microbial outcomes, and systemic implications. A total of 12 studies were included and charted. Results: The included studies demonstrated that oral antiseptics effectively reduce pathogenic microorganisms and improve clinical outcomes in oral diseases such as gingivitis and periodontitis. However, several studies also reported alterations in commensal microbial communities, suggesting a potential for dysbiosis. Some studies indicated possible links between antiseptic-induced microbial changes and systemic conditions, including cardiovascular and respiratory diseases. Conclusions: The evidence highlights a dual effect of antiseptic formulations: while beneficial in controlling oral pathogens, they may disrupt microbial homeostasis with possible systemic consequences. Further research is needed to evaluate long-term effects and develop targeted, microbiota-preserving oral hygiene strategies. Full article

The image represents the post-mortem heart of a 28-year-old female patient, diagnosed in childhood with complete common atrioventricular canal defect. At time of diagnosis, the family refused surgery, as did the patient during her adulthood. Despite being advised against pregnancy, she became pregnant. On presentation to hospital, she was cyanotic, with clubbed fingers, and hemodynamically unstable, in sinus rhythm, with Eisenmenger syndrome and respiratory failure partially responsive to oxygen. During pregnancy, owing to systemic vasodilatation, the right-to-left shunt is increased, with more severe cyanosis and low cardiac output. Echocardiography revealed the complete common atrioventricular canal defect, with a single atrioventricular valve with severe regurgitation, right ventricular hypertrophy, pulmonary artery dilatation, severe pulmonary hypertension and a hypoplastic left ventricle. The gestational age at delivery was 38 weeks. She gave birth to a healthy boy, with an Apgar score of 10. The vaginal delivery was chosen by an interdisciplinary team. The cesarean delivery and the anesthesia were considered too risky compared to vaginal delivery. Three days later, the patient died. The autopsy revealed hepatomegaly, a greatly hypertrophied right ventricle with a purplish clot ascending the dilated pulmonary arteries and a hypoplastic left ventricle with a narrowed chamber. A single valve was observed between the atria and ventricles, making all four heart chambers communicate, also insufficiently developed interventricular septum and its congenital absence in the cranial third. These morphological changes indicate the complete common atrioventricular canal defect, with right ventricular dominance, which is a rare and impressive malformation that requires mandatory treatment in early childhood in order for the condition to be solved. Full article

Background/Objectives: Pulmonary vein isolation (PVI) via cryoballoon ablation (CBA) is a recommended therapeutic strategy for patients with symptomatic paroxysmal and persistent atrial fibrillation (AF) who are refractory to antiarrhythmic drugs. Although PVI has demonstrated efficacy in reducing AF recurrence and improving patients’ quality of life, its impact on respiratory function is not well understood, particularly in patients with comorbid conditions. The aim of the study was to search for functional predictors of the respiratory system in the process of evaluating the efficiency of clinical assessment of CBA in patients with AF. Methods: We conducted a prospective study on 42 patients with symptomatic AF who underwent CBA, assessing their respiratory function through spirometry before and 30 days after the procedure. Exclusion criteria included pre-existing lung disease and cardiac insufficiency. The impact of variables such as body mass index (BMI), coronary artery disease (CAD) and heart failure (HF) on spirometry parameters was analyzed using statistical tests. Results: No significant changes were observed in overall post-PVI spirometry parameters for the full cohort. However, post hoc analyses revealed a significant decline in ΔMEF₇₅ in patients with CAD and BMI ≥ 30 kg/m², whereas ΔFEV₁/FVCex was significantly increased in patients with HF, as well as in patients with ejection fraction (EF) < 50%. Conclusions: CBA for AF does not universally affect respiratory function in the short term, but specific subgroups, including patients with CAD and a higher BMI, may require post-procedure respiratory monitoring. In addition, PVI may improve lung function in patients with HF and reduced EF. Full article

Background and Clinical significance: Single-shot spinal anesthesia for intrapartum Cesarean section has recently been incriminated in carrying a high risk of high neuraxial block (HNB) occurrence in parturients receiving labor epidural analgesia. The so-called volume effect of the epidurally injected solution causes a contraction of the dural sack and unexpected HNB. Case presentation: We present two cases of HNB in parturients receiving epidural analgesia. The first case describes the 36-year-old patient G3P2, who was administered a repeated rescue analgesia single-shot spinal injection with low-dose local anesthetic (levobupivacaine, 3 mg) following non-functional combined spinal–epidural analgesia. The second case describes the 28-year-old parturient G1P0, who experienced HNB after single-shot spinal anesthesia with hyperbaric bupivacaine (7.5 mg) following labor epidural analgesia. Conclusions: Intrathecal administration of local anesthetic for the purpose of spinal analgesia or anesthesia in a parturient with epidural analgesia can cause unexpected HNB and could occur even at low doses of intrathecally administered medications. The interplay of numerous variables and circumstances in the specific case can result in the occurrence of HNB. We assume that in our first case, the volume effect and repeated dural puncture, and in the second case, the low height of the parturient coupled with the volume effect, played significant role in the occurrence of HNB. Full article

Background/Objectives: Cystic fibrosis (CF) is a rare autosomal recessive genetic disease that has a progressive and multisystemic course. The spectrum and frequency of mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) vary both in European countries and in other geographical regions. The aim of our retrospective study was to present the genetic variants identified in a group of 48 CF patients from the Moldova region (Romania), as well as to establish genotype–phenotype correlations. Methods: Genetic testing was initially performed for 38 CFTR mutations, and in heterozygous patients or those in whom no mutation was detected, CFTR gene sequencing (NGS) was performed. Results: The compound heterozygous genotype was identified in 26 (54.16%) of the patients (with one of the alleles being F508del), while 22 (45.83%) patients had the homozygous F508del genotype. The F508del variant was the most frequent (69.79%), followed by G542X (6.25%, 6/96). Several new variants were also identified that had not been reported in other studies from Romania (R1158X, K598*, R347H, c.2589_2599del, R496H, and CFTRdele2). Phenotypic manifestations in patients with CFTR class I, II, III and VII variants (homozygous and compound heterozygous) were more severe compared to those in patients with CFTR class IV, V and VI mutations, with the data obtained being consistent with those in the literature. Respiratory tract involvement was present in 77.08% of the patients, being more frequent in patients with the compound heterozygous genotype compared to the homozygous F508del genotype. Most patients had exocrine pancreatic insufficiency (EPI) (85.41%). Gastrointestinal manifestations included hepatocytolysis (66.66%) and biliary cirrhosis (0.41%). Meconium ileus was detected in 18.75% of patients, all with a compound heterozygous genotype. Conclusions: We compared the results obtained with data from the literature and correlated the detected CFTR variant (genotype) with the phenotypic manifestations, highlighting certain particularities present in some patients. Genetic testing allows for early diagnosis and adapted management, including personalized treatment for each patient. Identification of novel unclassified CFTR variants still remains a challenge for clinicians. NGS-based screening of heterozygous healthy carriers is important for both genetic counseling and prenatal diagnosis. Full article

Background and Objectives: Euthyroid sick syndrome, or non-thyroidal illness syndrome, has been observed in severely ill patients and has been found to be an index of prognosis. It has been detected in patients with severe infectious diseases, e.g., those with severe COVID-19 infection. Prognostic indicators of the outcome of severe COVID-19 disease are important for the prognosis of individual as well as groups of patients. The aim of this study was to identify euthyroid sick syndrome in patients admitted for severe COVID-19 disease and its relationship to disease severity and outcome. Materials and Methods: In a cohort of patients admitted to hospital for severe COVID-19 disease, thyroid function in patients requiring hospitalization was evaluated by measuring TSH, FreeT₃ (FT₃), and FreeT₄ (FT₄) levels. Patients were classified into four groups: a group with uncompromised respiratory function (pO2 > 70 mmHg, without need of oxygen supplementation) (disease severity 1); a group with mild respiratory insufficiency (pO2 50–60 mmHg, in need of oxygen supplementation with nasal cannula) (disease severity 2); a group with severe respiratory insufficiency (pO2 < 50 mmHg, in need of oxygen supplementation with high flow oxygen) (disease severity 3); and a group with severe respiratory insufficiency requiring intubation (pO2 < 60 mmHg on high flow oxygen supplementation) (disease severity 4). Results: In this cohort, euthyroid sick syndrome was diagnosed in 57.1% of the patients. The presence of euthyroid sick syndrome was related to increased disease severity and adverse disease outcome, i.e., death. FT₃ levels were inversely related to CRP levels. Conclusions: Euthyroid sick syndrome may be observed in severe COVID-19 disease and is related to increased disease severity and adverse outcomes. Measurement of thyroid hormones in patients hospitalized for severe COVID-19 infection may aid in the prognosis of the disease. Full article

Background: The long-term impact of SARS-CoV-2 infection on pulmonary function remains insufficiently characterised, particularly among individuals who have experienced mild or asymptomatic disease. This study aimed to assess spirometric changes over a three-year period and evaluate potential associations with demographic and clinical variables. Methods: We retrospectively analysed spirometry data from 103 healthcare workers (HCWs) who underwent pulmonary function tests at three time points: before the pandemic (Time 0), one year post-pandemic (Time 1), and two years post-pandemic (Time 2). Linear regression models were employed to evaluate the impact of various factors, including age, BMI, gender, smoking status, history of SARS-CoV-2 infection, vaccination status prior to infection, and the number of infections, on changes in FVC and FEV₁. Results: A statistically significant decrease in both FVC and FEV₁ were observed at Time 1 and Time 2 compared to baseline (p < 0.05). Smoking habits were significantly associated with a greater decline in both FVC and FEV₁. Multiple infections were associated with larger reductions in FVC at Time 1. No significant associations were found with age, gender, BMI, or vaccination status. Even in the absence of severe symptoms of the disease, healthcare workers exhibited a measurable decline in pulmonary function over time. Smoking and reinfection emerged as relevant factors associated with reduced lung capacity. Conclusions: These findings emphasise the need for ongoing respiratory monitoring in occupational settings and the importance of targeted preventive measures. Full article

Respiratory diseases present significant global health challenges. Recent advances in respiratory sound analysis (RSA) have shown great potential for automated disease diagnosis and patient management. The International Conference on Biomedical and Health Informatics 2017 (ICBHI2017) database stands as one of the most authoritative open-access RSA datasets. This review systematically examines 135 technical publications utilizing the database, and a comprehensive and timely summary of RSA methodologies is offered for researchers and practitioners in this field. Specifically, this review covers signal processing techniques including data resampling, augmentation, normalization, and filtering; feature extraction approaches spanning time-domain, frequency-domain, joint time–frequency analysis, and deep feature representation from pre-trained models; and classification methods for adventitious sound (AS) categorization and pathological state (PS) recognition. Current achievements for AS and PS classification are summarized across studies using official and custom data splits. Despite promising technique advancements, several challenges remain unresolved. These include a severe class imbalance in the dataset, limited exploration of advanced data augmentation techniques and foundation models, a lack of model interpretability, and insufficient generalization studies across clinical settings. Future directions involve multi-modal data fusion, the development of standardized processing workflows, interpretable artificial intelligence, and integration with broader clinical data sources to enhance diagnostic performance and clinical applicability. Full article

Amyotrophic lateral sclerosis (ALS) stands as the leading neurodegenerative disorder affecting the motor system. One of the hallmarks of ALS, especially its bulbar form, is dysarthria, which significantly impairs the quality of life of ALS patients. This review provides a comprehensive overview of the current knowledge on the clinical manifestations, diagnostic differentiation, underlying mechanisms, diagnostic tools, and therapeutic strategies for the treatment of dysarthria in ALS. We update on the most promising digital speech biomarkers of ALS that are critical for early and differential diagnosis. Advances in artificial intelligence and digital speech processing have transformed the analysis of speech patterns, and offer the opportunity to start therapy early to improve vocal function, as speech rate appears to decline significantly before the diagnosis of ALS is confirmed. In addition, we discuss the impact of interventions that can improve vocal function and quality of life for patients, such as compensatory speech techniques, surgical options, improving lung function and respiratory muscle strength, and percutaneous dilated tracheostomy, possibly with adjunctive therapies to treat respiratory insufficiency, and finally assistive devices for alternative communication. Full article

Background: The COVID-19 pandemic has affected countries globally, causing significant respiratory tract symptoms, including shortness of breath, coughing, chest tightness, and wheezing. Vitamin D has been proposed to play a key role, especially in upper respiratory tract infections. Recently, numerous studies and reports associating low serum 25-hydroxyvitamin D levels (s-25-(OH)D) and adverse outcomes in COVID-19 have emerged. We aimed to assess the association between vitamin D status and SARS-CoV-2 positivity among adults in Lebanon. Method: A cross-sectional study was conducted, recruiting 384 participants aged 18–75 years from a university hospital in South Lebanon. Background variables were collected through structured questionnaires. Serum 25(OH)D levels were measured using electrochemiluminescence immunoassay, and SARS-CoV-2 positivity was assessed through PCR testing. Results: The mean s-25(OH)D level was 46.8 nmol/L (SD 28.1), and 30% of the participants had vitamin D deficiency (s-25-(OH)D level <30 nmol/L). SARS-CoV-2 positivity was reported in 28% of participants. However, no significant association was found between s-25(OH)D levels and SARS-CoV-2 positivity. This study had several limitations, including potential selection bias due to recruiting participants from a hospital for PCR testing, the collection of data across different seasons, and the refusal of several eligible individuals to participate. Additionally, the lack of data on participants’ immunization status and assay variability may impact the generalizability and interpretation of the findings. Conclusion: There was a high prevalence of vitamin D insufficiency among adults participating in COVID-19 tests in Lebanon, but it was not associated with SARS-CoV-2 positivity. Full article

Background: Vietnam is experiencing a significant “double burden” of malnutrition, characterized by the persistent challenge of undernutrition, particularly stunting in ethnic minority and mountainous regions, alongside a rising prevalence of overweight and obesity. Understanding dual nutritional status and its related factors in adolescents from these vulnerable areas is crucial for effective intervention. Objective: The current study explored the nutritional status of ethnic minority secondary school students in some mountainous provinces in the northwest of Vietnam and identified some related factors. Methods: We conducted a cross-sectional study over six months (June–December 2023), involving 1847 ethnic minority high school students from Son La and Dien Bien provinces, recruited through convenience sampling in primary healthcare settings. Nutritional status was determined using WHO 2006 Child Growth Standards, specifically height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). A 4-point scale assessed nutritional practices, including food consumption frequency and eating habits. Results: This study identified a stunting (HAZ < −2 SD) prevalence of 16.7% and wasting (BAZ < −2 SD) of 5.6%; overweight/obesity (BAZ > +1 SD) prevalence was 8.2%. Key factors related to stunting were being male, having more siblings, poor/near-poor household economic status, low maternal education level, and frequent occurrences of gastrointestinal and respiratory diseases. A higher risk of overweight/obesity was associated with consuming more than three meals daily, nocturnal snacking, frequent intake of fried foods, insufficient consumption of vegetables and fruits, and inadequate daily physical activity. Conclusions: Our study shows a comprehensive picture of malnutrition among children in ethnic minority areas. Essential nutritional intervention programs, projects, and models are a top priority to reduce the disease burden for children’s bright future and to enhance socio-economic development in the mountainous regions of Vietnam. Full article

Atmospheric air pollution is a major environmental and public health concern, particularly in industrialized regions. The East Kazakhstan Region exhibits high rates of oncological, cardiovascular, and respiratory diseases. However, the specific impact of industrial emissions on morbidity remains insufficiently studied. This study employed correlation and regression analyses using data on pollutant emissions and population morbidity indicators from 2014 to 2023. Correlation and regression methods, along with geoinformation technologies, were applied. A moderate positive correlation was found between industrial emission volumes and the incidence of neoplasms (r = 0.59, R² = 0.35), especially in areas with high concentrations of sulfur dioxide, nitrogen oxides, and particulate matter. The findings confirm the significant influence of polluted air—particularly mixed pollutants—on the increase in cancer-related diseases. The conclusions emphasize the urgent need to implement emission reduction measures, enhance environmental monitoring and disease prevention, and carry out further epidemiological research. Full article

The escalating industrial emissions have dramatically increased airborne particulate matter (PM), particularly submicron particles (PM0.3), creating substantial health risks through respiratory system penetration. Current fiber-based filtration systems predominantly relying on electrostatic adsorption mechanisms suffer from critical limitations, including insufficient efficiency, potential secondary contamination, and performance degradation in humid environments. We develop a flexible silica composite aerogel to overcome these challenges with customizable and exceptional superamphiphobicity. This composite aerogel exhibits high porosity of ~95% and robust compression Young’s modulus that reaches ~220 kPa at 50% strain even after 1000 cycles. These features enable it to maintain a high filtration efficiency of ~98.52% for PM0.3, even after 50 cycles under traditional artificial simulation conditions. Significantly, a competitive filtration efficiency of ~97.9% is still performed in our composite aerogel at high humidity (water mist), high temperatures (50–250 °C), and corrosive solutions or atmospheres environments, revealing potential industrial applications. This work is expected to replace conventional air filtration materials and pave the way for various human protection and industrial production applications. Full article