Search Results (10,984)

Cervical cancer remains the main etiology of high morbidity and mortality among women in developing world despite the screening plans. In South Africa, screening policies are low. Attitude, knowledge, and practices (AKP) play a pivotal role in diagnosis, prevention and screening. The review explores AKP towards cervical cancer and screening including global and regional burden, and determinants of screening uptake. Previous empirical studies identifying factors influencing adherence to screening services were identified. Studies from 2020–2025 were searched using PubMed and Google databases. Identified terms and topics were combined using Boolean Operators and PRISMA guidelines. Keywords were “attitudes”, “knowledge”, “practice”, “current cervical cancer screening”, AND “South Africa”, “global”, “regional”, “burden”, “cervical cancer”, “screening uptake determinants ” and “cervical cancer screening”, “factors influencing adherence”, and “cervical cancer screening”, “practices and pap smear tests”, “strengths”, “limitations”, “future research”, AND (“cervical cancer screening”). Key findings: many women know cervical cancer or Pap smears but lack detailed knowledge about risk factors and screening protocols, actual Pap smear uptake is low. Fear of outcome of procedure, pain, or embarrassment are primary barriers, and lack of service access. A multidisciplinary approach involving healthcare providers, government and non-governmental organizations is crucial in addressing gaps in cervical cancer screening. Full article

Background: Severe asthma exacerbations (SAEs) significantly contribute to asthma-related morbidity, mortality, and healthcare burden. Despite therapeutic advances, a subset of patients remains exacerbation-prone. This review aims to summarize current evidence on risk factors, phenotypes, and biomarkers associated with SAEs, and explore personalized strategies for their acute management. Methods: We conducted a comprehensive literature review focusing on clinical, inflammatory, and environmental drivers of SAE. Special attention was given to Type 2 (T2) biomarkers—blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO)—as tools for phenotyping and treatment guidance. Emerging evidence on the use of biologics during exacerbations was also analyzed. Results: SAEs are heterogeneous in etiology and inflammatory profile. Respiratory infections, allergen exposure, obesity, and comorbidities increase exacerbation risk. T2-high SAEs respond well to corticosteroids and biologics, whereas T2-low SAEs show limited treatment benefit. BEC and FeNO reliably predict exacerbation risk and corticosteroid responsiveness. Recent case reports suggest potential roles for anti-IL-5 and anti-thymic stromal lymphopoietin (TSLP) biologics in acute care. Conclusions: Biomarker-guided management of SAEs may enhance therapeutic precision and avoid overtreatment. Integrating phenotypic (observable characteristics) and endotypic (biological markers) assessment into acute care could improve patient outcomes and optimize resource use. Prospective trials are needed to confirm these approaches. Full article

Background/Objectives: This study seeks to evaluate the clinical characteristics of newly diagnosed male breast cancers within the traditionally underserved Bronx population at risk for poorer health outcomes. Methods: We retrospectively searched our database for male patients who presented for mammographic evaluation between 1 January 2016 and 1 October 2024. The primary outcomes were the prevalence of biopsy-proven male breast cancer and its association with gynecomastia and TNM stage at diagnosis. Clinical data, including TNM staging, receptor status, risk factors, and patient demographics, were recorded for patients with biopsy-proven breast cancer based on biopsy results. Two dedicated breast imagers retrospectively evaluated mammograms of these patients to determine by consensus the presence of gynecomastia. Analyses were descriptive in nature. Results: During the study period, 423 screening mammograms and 1775 diagnostic mammograms were performed on male patients. Twenty-six male patients with biopsy-proven breast cancer were identified (two were bilateral and four were multifocal). In total, 69% of our male breast cancer patients (18 out of 26) demonstrated gynecomastia, which was similar across demographic groups, ranging from 63 to 75%. Out of the three patients with Stage 4 disease, two were Black and one was White. Stage 3 or higher disease was seen in 29% of our Black patients, 12% of our White patients, and 0% of our Hispanic patients. Conclusions: Male breast cancer in this Bronx population was frequently associated with gynecomastia and showed notable demographic disparities. Black patients presented with more advanced disease than other demographic groups. These descriptive findings highlight areas of further investigation and may help inform future outreach and early detection efforts in high-risk, underserved communities. This retrospective, single-institution analysis was limited by a small sample size and did not include formal statistical testing; therefore, the findings are descriptive and warrant validation with larger cohorts. Full article

Background/Objectives: Adolescents and young adults (AYAs) with cancer often begin their careers later in life and are at risk of negative work-related outcomes. Research into and tailored support programs for AYAs diagnosed during higher education remain limited. An improved understanding of AYAs’ experiences is essential in guiding the development of age-appropriate support programs. This study explored the impact of cancer and the challenges AYAs face in educational participation and the transition to work. Methods: A qualitative study was conducted with thirteen AYAs diagnosed with cancer during higher education. Participants were interviewed using a semi-structured guide. In collaboration with patient experts as co-researchers, data were analyzed via thematic analysis. Results: Eight analytically derived themes reflected AYA students’ experiences: (1) Meaning and importance of education, (2) Reduced performance, (3) Recovery and expectations, (4) Interruption and delay, (5) Transition to work, (6) Disclosure, (7) Challenges related to the context of students, and (8) Experienced lack of support. The themes were clustered into four overarching thematic categories: Meaningful participation, Impact on performance, Academic progress and career transition, and Challenges in navigation. Conclusions: Our findings provide greater insight into the significance of educational participation for AYAs. AYA students encounter challenges stemming from both diagnosis-related changes in functioning and from contextual factors tied to their roles as students and new starters in the labor market. Navigating the healthcare, education, and social systems is complex and AYAs often lack adequate support when resuming their education or transitioning to work. Tailored support programs in healthcare and educational settings should be developed to help AYAs harness their strong motivation to resume studies, enter the labor market, and achieve their full potential. Full article

Background and Objectives: Sentinel lymph node (LN) biopsy (SLNB) remains to be the standard approach for surgical axillary staging of breast cancer (BC) patients. The aim of this study was to investigate the factors that affect axillary LN involvement in early BC patients. Materials and Methods: Clinically node negative early stage (cT1-2N0) BC patients having undergone breast conserving surgery (BCS) between February 2021 and January 2024 were included. During axillary exploration of all cases, sentinel LNs were excised and reserved for permanent section pathological examination (PS) only. Historical records of patients including clinicopathological features, surgical outcomes as well as pathological results were recorded and analyzed retrospectively. p < 0.05 indicated statistically significant results. Results: The study group consisted of 150 women with cT1-2N0 BC having undergone BCS with a median age of 59 (range: 25–81) years. According to the PS results of the sentinel LNs, the need for reoperation to complete axillary lymph node dissection was present in three (2%) patients. Tumors of the Luminal B subtype were significantly associated with increased sentinel LN positivity (p = 0.014). The risk of sentinel LN metastasis was found to be 5.2 times greater in patients with a Ki-67 ≥ %14 [OR: 5.224 (%95 CI:1.73–15.82, p = 0.003)] and the Ki-67 proliferation index was determined as an independent risk factor. Conclusions: In early-stage BC patients, PS of the excised sentinel LN offers sufficient axillary LN staging. On the other hand, a more careful clinical assessment is necessary for early BC patients harboring tumors with an elevated Ki-67 index and/or tumors of the Luminal B subtype. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) constitutes a leading cause of mortality worldwide. Liver transplantation (LT) and liver resection (LR) represent the main curative-intent treatment modalities for early-stage HCC. LT can offer the advantage of both removing the HCC and alleviating the potential underlying liver disease, yet its application is limited by organ scarcity, waitlist dropout, and eligibility criteria. Hence, LR remains widely used due to greater accessibility but is associated with high recurrence rates. Salvage LT is a treatment option for patients with HCC recurrence post-LR, but up to 40% of patients develop non-transplantable recurrence (NTR), defined as recurrence beyond transplant criteria, which precludes LT and is associated in poor outcomes. Methods: The present review aims to summarize the current state of evidence on the comparison of LT and LR, the management of recurrent HCC, and the risk factors associated with NTR. Results: Clinical and histopathologic factors consistently associated with NTR across studies include larger tumor size, multiple tumors, elevated alpha-fetoprotein levels, underlying liver fibrosis or cirrhosis, microvascular invasion, and satellite nodules—features that reflect aggressive tumor biology and impaired hepatic reserve. Conclusions: Improved preoperative risk stratification and identification of patients at high risk for NTR is essential to inform optimal treatment selection. Full article

Universal newborn hearing screening is essential for early identification of sensorineural hearing loss. Infants born to adolescent mothers may be more vulnerable to abnormal screening outcomes due to biological, socio-economic, and obstetrical risk factors frequently associated with adolescent pregnancy. This study evaluates hearing screening outcomes in newborns of adolescent mothers and examines whether maternal and neonatal vulnerabilities contribute to abnormal (REFER) results. A retrospective observational study was conducted over four years (January 2021–January 2025) at the “Sf. Ap. Andrei” County Emergency Clinical Hospital, Galați, Romania. The study included 187 newborns of adolescent mothers (≤18 years) and 3203 newborns of mothers aged >19 years. All infants underwent transient evoked otoacoustic emission (TEOAE) testing within 48–72 h after birth, according to institutional protocol. PASS/REFER outcomes were recorded, and retesting was performed when indicated. Although otological conditions such as middle ear dysfunction may influence OAE responses, routine otoscopic examination and clinical assessment were performed prior to testing. Automated auditory brainstem response (AABR) testing was not routinely applied due to equipment availability and local screening practices. The final REFER rate was slightly higher in the adolescent group (5.3%) compared with the adult group (4.8%). Maternal age alone was not directly associated with abnormal outcomes; however, maternal anemia, limited prenatal care, rural residence, prematurity, and low birth weight were more frequently observed among cases with persistent REFER results. Infants born to adolescent mothers show a modestly increased likelihood of abnormal hearing screening outcomes, primarily related to cumulative maternal and neonatal vulnerabilities. Strengthening prenatal care and targeted audiological follow-up may improve early detection of sensorineural hearing loss in this population. Full article

Background: Type B Aortic Dissection (TBAD) management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in National Health Services (NHSs). Bridging the gap between Emergency Medicine (EM) and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improve outcomes and reduce mortality. Methods: A cross-sectional survey of EM consultants yielded n = 173 valid responses from n = 33 units across the UK. Subgroup analyses were conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland–Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to a rapid Computed Tomography Angiogram (CTA) was 70% (95% CI: 63.3–76.8%, p < 0.001), while 32% had standard operating procedures (SOPs) for TBAD (95% CI: 25.3–39.1%), and 26% were aware of any decision tool (95% CI: 20.6–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with a reported bias of 23.58% (−38.20% to 85.36%) (p = 0.02). Conclusions: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks. Furthermore, upon recognition of the most prevalent factors, CTA and specialist referral is advocated. Full article

Background: Sleep-disordered breathing (SDB) and intracerebral hemorrhage (ICH) share a bidirectional relationship: SDB may increase ICH risk, while ICH can induce or exacerbate SDB. However, the prevalence and characteristics of post-ICH SDB remain poorly defined. Objective: To estimate the prevalence of SDB among ICH survivors and examine associated clinical factors, including the relative burden of obstructive (OSA) versus central sleep apnea (CSA). Methods: A systematic review and meta-analysis were performed across PubMed, Scopus, CINAHL, and ClinicalTrials.gov. Studies assessing SDB in adults with ICH using American Academy of Sleep Medicine (AASM) category 1–4 diagnostic devices were included. Random-effects models estimated pooled prevalence at varying apnea–hypopnea index (AHI) thresholds, with subgroup analyses by setting, timing, geography, and diagnostic factors. Results: Seventeen studies met inclusion criteria. Pooled SDB prevalence was 85% (95% CI: 80–91%) at AHI > 5, with 49% (95% CI: 42–57%) experiencing moderate SDB (AHI > 15), and 21% (95% CI: 15–27%) experiencing severe SDB (AHI > 30). The prevalence of OSA predominated 73% (95% CI: 64% to 82%),while CSA occurred in 5% (95% CI: 2–9%), corresponding to a pooled RR of 7.44 and OR of 53.08 for OSA versus CSA. Conclusions: SDB—primarily OSA—is highly prevalent following ICH, underscoring the need for early, routine screening and intervention to improve neurological and cardiovascular outcomes. Full article

Alzheimer’s Disease (AD) is a neurodegenerative disorder characterized by cognitive decline and memory loss. Among the genetic risk factors linked to AD, the apolipoprotein E4 (ApoE4) remains the strongest. It is well known that carrying the ApoE4 isoform is associated with advanced AD pathology, blood–brain barrier (BBB) disruption, and changes in lipid metabolism. In this review, we provide an overview of the role of centrally and peripherally produced ApoE in AD. After this introduction, we focus on new findings regarding ApoE4’s effects on AD pathology and BBB function. We then discuss ApoE’s role in lipid metabolism in AD, highlighting examples of lipid changes caused by carrying the ApoE4 isoform. Next, the review explores the implications of ApoE4 isoforms for current treatments—whether they involve anti-amyloid therapy or other pharmacological agents used for AD—emphasizing the importance of personalized medicine approaches for patients with this high-risk allele. This review aims to provide an updated overview of ApoE4’s effects on AD pathology and treatment. By integrating recent discoveries, it underscores the critical need to consider ApoE4 status in both research and clinical settings to enhance therapeutic strategies and outcomes for individuals with AD. Full article

Objective: Additional preoperative risk factors may influence the prognosis of patients diagnosed with HBV. This study aims to compare the effects of cirrhosis patients with HBV with and without risk factors on post-transplant follow-ups and postoperative complications. Materials and Method: The study included patients with HBV who underwent living donor liver transplantation (LDLT) at Demiroğlu Bilim University, Şişli Liver Transplant Center, Istanbul, Türkiye, between 2004 and 2019. The data from 319 patients were retrospectively analyzed. Those without preoperative risk factors were classified as group 1 (n = 214), and those with risk factors were classified as group 2 (n = 105). These patients were compared in terms of complications during their postoperative follow-up. The Student’s t-test, ANOVA test, Mann–Whitney U test, Kruskal–Wallis test, chi-squared test, and Fisher’s exact test were used, and p < 0.05 was considered statistically significant. Results: When group 1 and group 2 were compared in terms of postoperative mortality, infections, bleeding complications, and biliary system complications, no statistically significant difference was found [(8.87% vs. 9.52% p = 0.62), (28.80% vs. 20.24%, p = 0.95), (6.10% vs. 8.70%, p = 0.35), (12.7% vs. 9.60% p = 0.19, respectively)]. Although bleeding complications were numerically found more frequent in patients with obesity, this difference did not reach statistical significance (23.02% vs. 6.10% p = 0.08). Conclusions: Obesity was not significantly associated with postoperative complications and may be influenced by accompanying comorbidities. Full article

Pulmonary embolism (PE) is a potentially life-threatening cardiopulmonary condition that frequently requires hospitalization and is often accompanied by reduced mobility, systemic inflammation, and nutritional impairment. These factors may contribute to the development or worsening of sarcopenia, a condition associated with adverse outcomes in hospitalized patients. However, its clinical relevance in patients with PE has not been sufficiently explored. This longitudinal observational cohort study evaluated the association between sarcopenia and clinical outcomes in patients hospitalized with confirmed PE. Participants were classified according to the presence of sarcopenia based on muscle mass and muscle strength criteria. Symptom severity, functional status, and health-related quality of life were assessed at hospital admission, at discharge, and three months after discharge. A total of 162 patients were included. Patients with sarcopenia exhibited a greater symptom burden, poorer functional status, and worse self-perceived health compared with non-sarcopenic patients. At discharge, sarcopenic patients reported higher levels of dyspnea and fatigue, poorer health-related quality of life, and experienced longer hospital stays. At the three-month follow-up, these patients continued to show significantly worse symptoms, reduced functionality, and lower quality of life. Sarcopenia was therefore associated with a persistently worse clinical and functional profile in patients hospitalized for PE. Early identification of sarcopenia may help identify patients at higher risk of poor recovery and support the implementation of targeted interventions aimed at improving functional outcomes and quality of life. Full article

Background/Objectives: Urinary incontinence (UI) is a prevalent health condition with a negative impact on quality of life (QoL). Exercise therapy (ET), specifically, pelvic floor muscle training (PFMT), is recommended as a first-line conservative treatment for UI during pregnancy, childbirth, and the postpartum period. This study evaluated the effects of ET on the management of postpartum UI. Methods: A systematic search was conducted to identify clinical trials and randomized controlled trials including women over 18 years with postpartum UI. All included studies used ET as the main intervention. Studies were excluded if UI symptoms were attributable to factors outside the urinary tract or if participants had concomitant pathologies. Results: From 298 records screened, four trials were included. Three trials reported statistically significant improvements in UI outcomes, while findings for pelvic floor function and QoL showed greater heterogeneity. One trial found that supervised PFMT was associated with greater improvements in urinary symptoms (BFLUTS), vaginal pressure (18.96 mmHg (SD: 9.08)), and endurance (11.32 s (SD: 3.17)) compared to unsupervised training. Another trial using electromyographic biofeedback with electrical stimulation reported a continence rate exceeding 70% on the 20 min pad test, with improvements in perceived burden (VAS), symptoms (UDI), and QoL (IIQ). A third trial combining PFMT with infrared physiotherapy showed improvements in pelvic floor function (PFIQ-7, PFDI-20), urodynamic parameters, urine loss, and QoL (GQOLI-74). In the remaining trial, within-group improvements were observed, with no statistically significant between-group differences. Conclusions: ET appears to be beneficial for postpartum UI, with a moderate certainty of evidence. While the greatest benefits are observed with supervised PFMT, the diversity of comparators, and the risk of performance bias limit definitive conclusions regarding its superiority. Given the short-term follow-up, it remains unclear whether the results are influenced by the spontaneous recovery trajectory in the postpartum period and if these effects are sustained in the long term. Full article

Background/Objectives: Blood thinners (anticoagulants) remain the first line pharmacotherapy for the management of cardiovascular and thromboembolic disorders. The increased utilization of polypharmacy, likely driven by the greater burden of comorbidities, elevates the risk of potential drug–drug interactions (pDDIs) and creates a significant challenge in anticoagulant management. The aim of the study was to assess the prescribing trend and impact of polypharmacy and pDDIs in patients receiving anticoagulant drug therapy in a public hospital providing secondary care. Methods: A cross-sectional observational study was undertaken between January–June 2023. Data from electronic medical records of prescriptions for anticoagulants were collected, analyzed for prescribing patterns, and checked for pDDIs using Micromedex database 2.0^®. Utilizing binary logistic regression, the relationship between polypharmacy and sociodemographic factors was assessed. Multivariate logistic regression analysis served to uncover determinants linked to pDDIs. Results: Of the total 130 patients, females were predominant (58.46%), with a higher prevalence among those aged 61–90 years. Atrial fibrillation emerged as the main clinical reason and apixaban (51.53%) ranked as the top prescribed anticoagulant in our cohort. Among the 766 pDDIs identified, the majority [401 (52.34%)] were categorized as moderate in severity. Polypharmacy was strongly linked to age (p = 0.001), the Charlson comorbidity index (CCI) (p = 0.040), and comorbidities (p = 0.005) in the binary logistic regression analysis. In the multivariable analysis, the number of medications remain a strong predictor of pDDIs (adjusted OR: 30.514, p = 0.001). Conclusions: Polypharmacy and pDDIs were exhibited in a significant segment of cohort receiving anticoagulant therapy, with strong correlations to age, CCI, comorbidities, and the number of medications. A multidimensional approach involving collaboration among healthcare providers assisted by clinical decision support systems can help optimize the management of polypharmacy, minimize the risks of pDDIs, and ultimately enhance health outcomes. Full article

Background and Objectives: Usual interstitial pneumonia (UIP) is associated with progressive fibrosing interstitial lung diseases (PF-ILD) and poor survival in patients with fibrosing interstitial lung disease (FILD). We aimed to investigate the predictors of PF-ILD and survival in patients with FILD-UIP. Materials and Methods: This retrospective study was conducted at a single, tertiary hospital in China. Patients underwent routine follow-up visits every 3 to 6 months according to standard operating procedures (SOPs). Patients with FILD-UIP were further stratified using the proposed PF-ILD criteria. Results: This retrospective study enrolled 150 patients with FILD-UIP between October 2020 and June 2025, with 117 patients completing follow-up for more than 12 months. FILD-UIP was categorized as idiopathic pulmonary fibrosis (IPF) (n = 67) and non-IPF-UIP (n = 50), which included connective tissue disease-associated UIP (n = 29), hypersensitivity pneumonitis-associated UIP (n = 7), and interstitial pneumonia with autoimmune features-associated UIP (n = 14). During the follow-up period, 32 (47.8%) patients with IPF and 19 (38.0%) non-IPF-UIP experienced PF-ILD. Pulmonary hypertension (PH) and predicted percentage of forced vital capacity (FVC%pred) were dependent risk factors for PF-ILD in patients with FILD-UIP, non-IPF-UIP, and IPF. King’s Brief Interstitial Lung Disease (KBILD) is a dependent risk factor for PF-ILD in patients with FILD-UIP and IPF. PF-ILD is similarly associated with poor survival in patients with FILD-UIP, non-IPF-UIP, and IPF. Conclusions: Baseline disease severity is closely associated with the incidence of PF-ILD, with all forms of FILD-UIP at risk of PF-ILD and showing similar outcomes to IPF-UIP/PF-ILD. Full article