Search Results (403)

Background and Objectives: Tumour necrosis factor alpha (TNF-α) inhibitors are widely used for moderate-to-severe psoriasis and are known to induce autoantibody formation in a proportion of treated patients. This study evaluated changes in ANA/ENA and anti-dsDNA antibody levels in psoriasis patients receiving adalimumab therapy during the first 12 months of treatment. Materials and Methods: A retrospective single-centre study was conducted at the Dermatology and Sexually Transmitted Diseases Clinic of Riga 1st Hospital. Adult psoriasis patients treated with adalimumab for at least 12 months were included. ANA/ENA and anti-dsDNA IgG levels were assessed before treatment initiation and after one year of therapy. Statistical analysis was performed using IBM SPSS Statistics version 31, with p < 0.05 considered significant. Results: Seventy-one patients met the inclusion criteria (69%; 49 males, 31%; 22 females), with 41 patients aged ≥45 years and 30 patients aged <45 years. Anti-dsDNA IgG levels increased significantly after therapy in both females (0.9 IU/mL (IQR 9.4) vs. 15.0 (IQR 31.4) IU/mL; p =0.004) and males (0 (IQR 2.9) IU/mL vs. 3.1 (IQR 13.6) IU/mL; p =0.005), with the largest increase observed in patients aged ≥45 years (p < 0.001). ANA/ENA positivity rose from 6% at baseline to 23% after treatment. Patients with elevated autoantibody levels more frequently switched to another biologic agent; however, this association was not statistically significant. Conclusions: Adalimumab therapy was associated with increased anti-dsDNA IgG levels and ANA/ENA positivity after 12 months, confirming previous observations that TNF-α inhibition may be accompanied by treatment-associated autoantibody development. The clinical significance of these serological changes remains uncertain, and further prospective studies, including anti-drug antibody assessment, are needed to clarify their relationship with treatment outcomes and biologic immunogenicity. Full article

Background and Objectives: Apparent non-response to phosphodiesterase type 5 (PDE5) inhibitors is common, but the label conflates inadequate instruction or drug exposure, partial or absent response, treatment discontinuation, and coexisting clinical contributors. This narrative review presents an author-proposed structured reassessment framework, not a new or validated diagnostic classification. Materials and Methods: PubMed/MEDLINE was searched from database inception to 7 August 2026 using a documented, reproducible search strategy, with targeted checks of guideline, regulatory, clinical, observational, and mechanistic sources; selection was purposive, without a registered protocol, quantitative synthesis, or certainty-of-evidence grading. Results: PDE5 inhibitors preserve nitric oxide-cyclic guanosine monophosphate signaling but require sexual stimulation, adequate exposure, and sufficient erectile physiology. In one specialist-referral cohort, 88 of 250 men (35.2%) responded after structured re-education, being 88 of the 115 (76.5%) who accepted it, which should not be generalized. The framework separates trial and exposure adequacy, observed response documented with validated measures where feasible, targeted evaluation of contributing domains, and shared selection of oral optimization or an established non-oral option. Persistent clinically meaningful oral-PDE5-inhibitor non-response is defined by principle rather than by a fixed number of attempts, agents, or mandatory daily tadalafil. Conclusions: Structured reassessment may clarify why an observed response is inadequate and may support preference-sensitive management; whether it does so better than existing guidance has not been tested. Switching agents or daily tadalafil is not a prerequisite and should not delay vacuum therapy, intracavernosal injection, or penile-prosthesis discussion. Full article

γ-Hydroxybutyric acid (GHB), a colorless and odorless central nervous system depressant associated with drug-facilitated sexual assault, demands rapid on-site detection. Polydiacetylene (PDA) colorimetric sensors derived from 10,12-pentacosadiynoic acid (PCDA) conjugates are a promising platform, but the molecular origin of GHB recognition in PCDA–gabazine systems has remained unresolved. Here, we compare a series of structurally related PCDA conjugates to examine how the chemical state of the EDA-derived unit affects the GHB-induced colorimetric response. A side-by-side substituent screen of three PCDA derivatives showed that PCDA–EDA produced the largest colorimetric response (ΔR = 53) within 30 s, the hydrazide analogue gave a moderate response (ΔR = 34), and a simple amide was negligible (ΔR = 12). By contrast, a PCDA–gabazine mat prepared by the same protocol showed only a subtle, barely discernible color shift after several hours and remained predominantly blue even after approximately 24 h, without a visually appreciable blue-to-red transition. This difference suggests that the accessible free primary amine of PCDA–EDA is an important factor contributing to its faster and stronger response. Building on this mechanistic finding, we replaced the previously used PVDF–HFP/PEO matrix with a cellulose/PVDF–HFP formulation processed from DMF and adopted multi-nozzle electrospinning, reducing the fabrication time from approximately 120 to 30 min per sheet, corresponding to a 75% reduction in processing time. The sensor mat showed a clearly distinguishable, dose-dependent visual response across 0.5–3% w/v GHB within 30 s, covering the forensically relevant concentration window. These findings reposition linker architecture as a central design parameter for PDA-based forensic colorimetric sensors. Full article

Pornography use during adolescence is a relevant issue from social, educational, and public health perspectives. As with other behaviours, its correlates may involve complex and nonlinear relationships. This study uses data from the 2023 Spanish Survey on Drug Use in Secondary Education (ESTUDES), a major source for analysing potentially addictive behaviours among adolescents in Spain because of its large sample size (original sample: N = 42,208; complete-case analytical sample: N = 33,543). Pornography use was modelled as a binary outcome using logistic regression, XGBoost, LightGBM, and CatBoost. The models included sociodemographic characteristics, family-related factors, parental control, substance use, selected sexual behaviours, indicators of mental well-being, and addictive Internet use. The four methods showed similar predictive performance. CatBoost achieved the highest AUC and the lowest Brier score and log loss, whereas LightGBM obtained the highest accuracy, specificity, and precision. Logistic regression yielded the highest sensitivity, negative predictive value, balanced accuracy, and F1-score. SHAP analysis identified sex as the most influential predictor, followed by addictive Internet use, cannabis and alcohol use, family conflict, and selected risky sexual behaviours. The findings suggest that pornography use among adolescents forms part of a broader behavioural and psychosocial profile. Whereas sex operated mainly as a strong direct predictor, problematic Internet use showed substantial interactions with age and cannabis and alcohol use. This study demonstrates how explainable machine learning can complement conventional regression by identifying the main correlates, nonlinear patterns, and interactions associated with adolescent pornography use. Full article

The purpose of this review is to highlight the complex influence of antibiotics on human fertility and the need for them not to be underestimated. In creating this review article, data and information from the following international databases were used: PubMed, Scopus and Clarivate Analytics. Only full text articles were used. Antibacterial antibiotics are a group of drugs essential in fighting infections, having multiple mechanisms of action at the level of the bacterial cell; but at the same time they also act on human cells. One of the important actions of antibiotics is on fertility. There are both experimental and clinical data showing the influence of some antibiotics on fertility. There are both positive and negative influences of these drugs on fertility. Some of the most important actions with a positive impact on fertility are: therapy of pelvic infections in women, treatment of endometritis, reduction in post-abortion infections, treatment of infections of the male genital tract—infections that reduce fertility. The most important negative implications of some antibiotics are the direct effects of reducing the production of gametes, decreasing the activity or quality of the gametes, reducing the synthesis of sexual hormones and negative influences on the evolution of pregnancy, including spontaneous abortion in some cases. Other negative influences are produced by the direct action of some antibiotics on the embryo. Some antibiotics such as azithromycin and nitrofurantoin increase the risk of miscarriage. Although only a limited number of antibiotics are known to have an influence on fertility, this influence should not be underestimated in clinical practice. Full article

Background/Objectives: Men who have sex with men (MSM) carry a disproportionate share of the HIV burden in Portugal, yet the psychosocial characteristics of MSM living with HIV remain insufficiently described. This cross-sectional study examined how compulsive sexual behavior, internalized homonegativity, psychological distress, emotion regulation difficulties, and substance use relate to HIV serostatus, independent of sociodemographic characteristics. Methods: A convenience sample of 480 cisgender MSM (66 living with HIV) completed validated self-report measures online. Because the measures departed from normality, group differences were tested with Mann–Whitney U tests, and associations with serostatus were estimated with a parsimonious binary logistic regression, re-estimated with Firth penalization and evaluated with discrimination diagnostics. Results: Participants living with HIV showed small but significant differences on four indicators: higher compulsive sexual behavior and internalized homonegativity and lower scores on one emotion regulation subscale; depression, anxiety, and stress did not differ. In the adjusted model, compulsive sexual behavior, internalized homonegativity, and problematic substance use were associated with higher odds and the emotion regulation subscale with lower odds of living with HIV. In sensitivity analyses, the substance use association depended on how the construct was defined and was specific to chemsex with core drugs. Model discrimination was limited. Conclusions: HIV serostatus was associated with a small set of psychosocial and behavioral correlates rather than sociodemographic characteristics. These group-level associations describe correlates of serostatus, not a clinical profile of men living with HIV; they cannot establish direction and generate hypotheses, for longitudinal and structurally informed research, about stigma and social context. Full article

Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O’Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes. Full article

Background/Objectives: The prevention of sexual HIV-1 acquisition in women and girls in sub-Saharan Africa remains an important public health priority. Expanding the existing biomedical product portfolio to include long-acting vaginal products, such as intravaginal rings (IVRs), is expected to appeal to end users and drive adoption. Methods: We formulated two different triple-combination antiretroviral IVRs, both delivering the acid salt tenofovir (TFV), disoproxil fumarate (TDF), and the free base emtricitabine (FTC), with one delivering elvitegravir (EVG) as the free acid and the other as the sodium salt. The devices were evaluated for pharmacokinetics and local safety in two established preclinical models, sheep and pig-tailed macaques. Results: The IVRs were safe and maintained cervicovaginal fluid (CVF) drug concentrations that were above our efficacy targets derived from prior humanized mouse studies. All three agents were uniformly distributed vaginally, as evidenced by CVF and vaginal tissue measurements. Elevated drug concentrations were observed in macaque vaginal tissue samples collected three days after IVR removal, suggesting a possible forgiveness window. TFV and FTC concentrations in rectal tissue and fluid suggested potential for dual-compartment HIV-1 protection, although the vaginal-to-rectal drug transport mechanism appeared to differ across both species. The humanized mouse vaginal HIV-1 efficacy model was used to empirically compare combination effects when TDF, FTC, and EVG were co-administered, and TDF-EVG was identified as a promising combination to be developed further for IVR delivery in parallel with the triple combination. Full article

Background: Chemsex, or sexualized drug use, exists along a continuum ranging from non-problematic, consensual recreational practice across diverse populations to problematic behaviors linked with clinical vulnerabilities, substance dependence, or compulsive disorders. Within nursing practice, understanding this spectrum is essential to mitigate healthcare-related stigma. Objective: To map and synthesize evidence on stigma and attitudes among nurses regarding chemsex, identifying implications for practice and research. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed across PubMed/MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, and LILACS. Studies involving nurses or healthcare teams focused on stigma, attitudes, or related constructs in chemsex care were included. Data underwent descriptive and thematic synthesis. Results: Six studies met the inclusion criteria, showing substantial heterogeneity. Only one focused exclusively on nurses. Stigma and attitudes were rarely assessed explicitly, emerging instead as underlying factors influencing clinical practice, communication, and patient engagement. Key themes included the necessity for non-judgmental care, significant gaps in knowledge and training, variability in clinical practice, and the impact of organizational barriers. A schematic representation was developed to illustrate the interrelationships between stigma, knowledge, professional attitudes, and structural factors influencing healthcare practice. Conclusions: This review positions stigma as a central mechanism influencing nursing care in chemsex contexts. The findings underscore critical gaps in nursing-specific evidence and emphasize the need for targeted training, validated measurement tools, and integrated care models. Strengthening stigma-informed, patient-centered approaches is essential to improve care delivery and health outcomes for this population. Full article

Sexually transmitted infections (STIs) remain a global health burden. Beyond classical pathogens, dermatophytes are increasingly identified within sexually linked transmission networks. Genital dermatophytosis is a superficial fungal infection of the genital area, primarily caused by anthropophilic and zoophilic dermatophytes. Recently, Trichophyton mentagrophytes genotype VII and Trichophyton indotineae have emerged as clinically significant dermatophytes, increasingly linked to human-to-human and sexually associated transmission within highly interconnected sexual networks. These infections are often marked by inflammatory, persistent, and treatment-refractory presentations, with prominent genital involvement and rising antifungal resistance—particularly to terbinafine—posing growing diagnostic and therapeutic challenges. Doxycycline post-exposure prophylaxis (Doxy-PEP) has recently emerged as a novel preventive strategy for bacterial STIs, involving the administration of 200 mg doxycycline within 24–72 h after activities associated with increased infection exposure, particularly among men who have sex with men (MSM) and transgender women. While effective in reducing infections such as syphilis and chlamydia, its broader implementation raises concerns regarding antimicrobial resistance. Chemsex is an increasingly prevalent behavioural phenomenon, defined as the intentional use of psychoactive substances during sexual activity to enhance or prolong the experience, particularly among MSM. It is associated with multiple adverse effects, including increased STI transmission, substance dependence, drug toxicity, psychological disturbances, and significant challenges in treatment adherence and healthcare engagement. This review aims to provide a comprehensive and clinically oriented overview of emerging trends in STIs, with a particular focus on dermatophyte infections as pathogens with potential sexually associated transmission, alongside evolving prevention strategies and behavioral factors influencing transmission. Full article

This study assessed community process and empowerment in a Primary Healthcare Island Unit in the Azores to support the implementation of Epidemiological Surveillance of Nursing Diagnoses (ESND), focusing on three priority areas: tobacco use, drug dependence, and adolescent decision-making related to sexuality and life planning. Strengthening the visibility of nursing-sensitive phenomena requires integrating nursing diagnoses into epidemiological surveillance systems. A multimethod descriptive study was conducted between September and November 2025, combining document analysis, a community empowerment assessment, and a structured questionnaire. The total population included 328 nurses, with 172 participants (response rate: 52.4%) using a non-probabilistic sampling approach. Data were analyzed using descriptive statistics (frequencies, percentages, means, and standard deviations). Priority nursing foci were identified according to the ICNP^® 2019 classification: tobacco use, drug dependence, and decision-making process related to sexuality and life planning. Results showed that all three dimensions of the MAIEC were weak: community leadership was limited, particularly in knowledge indicators; participation was constrained by unclear organizational structures and insufficient communication; and coping capacity was insufficient due to limited training and experience. Empowerment assessment confirmed structural weaknesses in leadership, organizational support, and resource mobilization. Overall, the community process and empowerment profile indicate that the conditions required to sustain ESND are not yet sufficiently developed. Strengthening leadership, improving communication, and expanding training in ESND and ICNP^® documentation are essential to support nurse-centered surveillance and enhance the visibility of nursing contributions to population health. Full article

This study examined whether family functioning and impulsivity differentiate offense categories or represent shared vulnerability factors among justice-involved adolescents. A cross-sectional survey was conducted in two juvenile correctional facilities and included 159 incarcerated male adolescents aged 13–18 years (mean 16.3 ± 1.1). Participants completed a case report form, the Family Assessment Scale (FAS), and the UPPS Impulsive Behavior Scale. Offenses were classified as property crimes (42%), crimes against persons (31%), sexual offenses (17%), and drug-related crimes (10%). Substance use was highly prevalent (smoking 86.8%; alcohol 61.0%), and 34.6% had experienced repeat incarceration, most frequently in property and drug-related offenses (p < 0.001). Peer influence was the most commonly reported reason for delinquency (44.7%). Family dysfunction was common across the sample, particularly in domains related to parental involvement and behavioral control with some variation across offense categories. In contrast, impulsivity levels were elevated but did not significantly differ between crime categories. These findings support a shared vulnerability perspective, suggesting that dysfunctional family environments and substance-related risk contexts operate across offenses, while impulsivity may represent a general risk rather than an offense-specific determinant. These results highlight the importance of family-centered and developmentally informed interventions in juvenile justice settings. Full article

Adolescent gambling is a growing public health concern as opportunities expand across both physical and digital environments. This study examined gender differences in on-site and online gambling among Finnish adolescents and assessed associations with school engagement, family context, peer activities, and co-occurring risk behaviors. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), collected from Finnish adolescents aged 15–16 in 2024 (boys: n = 1706; girls: n = 1588). Associations with past-12-month gambling were analyzed using Rao–Scott’s chi-square tests, F tests, and multinomial logistic regression, examining gender interactions. Gambling was more common among boys than girls: 7% of boys had gambled on-site only, 3% online only, and 11% both during the past 12 months. Among girls, the corresponding proportions were 0–2%. Skipping school, spending leisure time with friends, risky sexual behavior, and problematic substance use were associated with increased odds of both gambling types, whereas parental control was associated with decreased odds. Problematic social media increased the odds of on-site gambling, while problematic gaming decreased the odds. Several associations with online gambling differed by gender. These findings support multi-level prevention targeting family, school, peer, and behavioral risk factors. Full article

Background: Sexually transmitted infections (STIs) remain a major public health concern among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA). Although routine STI screening is essential for early diagnosis and prevention, uptake among AGYW is often suboptimal and influenced by multiple individual and contextual factors. This study assessed factors associated with STI screening uptake among AGYW enrolled in HIV prevention programs in Namibia. Methods: A secondary analysis of anonymized programmatic data was conducted among AGYW aged 15–24 years who received services through the DREAMS project and REACH PHN activity between 2018 and 2024. Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were performed to identify factors associated with STI screening uptake. Results: A total of 26,689 AGYW were included in the analysis, of whom 97.2% were screened for STIs. STI screening uptake was significantly associated with district of residence, year of enrolment, inconsistent or no condom use, perceived risk of HIV infection, use of family planning, and having had sex under the influence of alcohol or drugs. AGYW who perceived themselves to be at risk of HIV and those using family planning methods had higher odds of STI screening, while those who reported sex under the influence of alcohol or drugs were less likely to be screened. Significant geographic disparities in screening uptake were also observed across districts. Conclusions: STI screening uptake among AGYW enrolled in HIV prevention programs in Namibia was high. While this may reflect the effectiveness of integrated, community-based service delivery models, the results should be interpreted with caution, as they are based on a convenience sample. However, behavioural and geographic disparities persist. Strengthening integrated sexual and reproductive health services, addressing substance-related barriers, and implementing targeted district-level interventions may further improve equitable access to STI screening among AGYW. Full article

Background: The reproductive toxicity of first-line antituberculosis drugs remains poorly understood, particularly when used in combination. Rifampicin, isoniazid, pyrazinamide, and ethambutol are essential in tuberculosis therapy, but their potential influence on female fertility is uncertain. This pilot study evaluated their effects, given alone or in dual, triple, and quadruple combinations, on oxidative stress, endocrine markers, and reproductive outcomes in healthy female rats. Materials and Methods: Ninety-six albino Wistar-type female rats were divided into sixteen groups of six animals each and treated with single, dual, triple, or quadruple regimens of first-line antituberculosis drugs for 28 days. After treatment, two sexually mature males were introduced per group, and therapy continued for seven additional days. Serum malondialdehyde (MDA), total glutathione (tGSH), prolactin, and anti-Mullerian hormone (AMH) levels were measured, and fertility outcomes were evaluated. Results: In single-drug groups, MDA increased and tGSH decreased, but detectable infertility was not recorded. Prolactin remained stable except in the pyrazinamide group, where it declined. Dual-drug regimens increased oxidative imbalance; fertility failure occurred only in pyrazinamide-lacking groups and was accompanied by higher prolactin and lower AMH. Triple and quadruple combinations produced prominent oxidative imbalance. In triple-drug regimens, infertility was lower in pyrazinamide-containing groups than in the pyrazinamide-free group, but this pattern was not maintained in the quadruple regimen. Fertility impairment was not consistently aligned with the degree of oxidative stress and may involve prolactin and AMH alterations. Conclusions: These findings suggest that reproductive impairment under these experimental conditions may involve endocrine alterations and cannot be explained solely by serum oxidative imbalance. Pyrazinamide-associated fertility preservation appeared context-dependent and requires further confirmation in larger mechanistic studies with broader reproductive and endocrine assessment. Full article