Search Results (1,203)

The goal of this study was to identify factors associated with pain sensitivity, procedural discomfort, and referral for surgical hysteroscopy, aiming to improve office hysteroscopy success rates. This was an observational prospective cross-sectional study that analyzed data from women who underwent outpatient hysteroscopy between October 2022 and October 2023. Epidemiological, clinical, and procedural data were collected from medical records. Pain levels were assessed using a visual analog scale (VAS), categorized as acceptable (0–6) or severe (7–10). Statistical analyses were performed to explore associations between patient characteristics and pain levels, with p-values < 0.05 considered significant. This study evaluated 1662 women. The mean age was 54.0 (±12.4) years, and 59.1% were postmenopausal. Nulliparity, menopause, lower body mass index (BMI), and fewer vaginal deliveries were associated with higher pain levels (p < 0.05). Cervical stenosis significantly increased procedural pain: 20.8% and 27.6% of patients with stenosis resolved during the procedure, respectively, reported severe pain. In the multivariate logistic regression analysis, protective factors against severe pain included having ≥2 vaginal deliveries (OR 0.53, 95% CI 0.39–0.72), patent internal (OR 0.53, 95% CI 0.38–0.75) and external cervical orifices (OR 0.47, 95% CI 0.30–0.72), presence of myomas (OR 0.53, 95% CI 0.34–0.83), and biopsy performance (OR 0.55, 95% CI 0.41–0.74). Severe pain, uterine lesions, and stenosis were the main reasons for surgical referral. Lower BMI, nulliparity, menopause, and cervical stenosis were significant predictors of increased pain during outpatient hysteroscopy. These findings may help identify patients at higher risk for procedural discomfort and support strategies to improve success of office hysteroscopy. Full article

Background/Objectives: Glioblastomas are a part of adult-type diffuse gliomas, the most common and most aggressive primary brain tumors in adults (glioblastoma, IDH-wildtype). The identification of the genetic factors associated with glioblastoma could be an important contribution to the diagnosis and early prevention of this disease. We compiled data from the global literature and analyzed clinically relevant variants implicated in glioblastoma risk. Methods: PubMed, Web of Science, and Scopus were used as databases. Associations between the SNPs and glioblastoma risk were calculated as a measure of pooled odds ratios (ORs) and 95% confidence intervals. Pearson’s analysis was used for epidemiological correlation (only p-values less than 0.05 were statistically significant), and data were obtained from the World Health Organization platform and the 1000 Genomes Project. Statistical analysis was performed using Review Manager (RevMan) 5.4 and BioEstat 5.0. Results: CCDC26 rs891835 G/T, G/G, and G/T-G/G genotypes were analyzed and determined to increase glioblastoma risk (G/T OR = 1.96, 95% CI: 1.38–2.77, p = 0.0002, I² = 0%; G/G OR = 1.33, 95% CI: 0.46–3.85, p = 0.60, I² = 0%; G/T − G/G OR = 1.96, 95% CI: 1.39–2.76, p = 0.0001, I² = 0%). Epidemiological correlation also demonstrated that the higher the frequency of the CCDC26 rs891835 variant, the higher the incidence of that variant in the European population. Conclusions: CCDC26 rs891835 may serve as a predictive biomarker for glioblastoma, IDH-wildtype risk and may influence higher glioblastoma incidence rates in the European population. Full article

Objectives: Connective tissue diseases (CTDs) include a diverse group of systemic autoimmune conditions, among which interstitial lung disease (ILD) is acknowledged as a major determinant of prognosis. High-resolution computed tomography (HRCT) is the gold standard for ILD assessment. The distribution of HRCT patterns across CTDs remain incompletely defined. The objective of this systematic review is to synthesize available evidence regarding the prevalence of specific radiological patterns within CTD-ILDs and to assess whether specific patterns occur at different frequencies among individual CTDs. Methods: The inclusion criteria encompassed original human studies published in English between 2015 and 2024, involving adult participants (≥18 years) with CTD-ILDs assessed primarily by HRCT and designed as retrospective, prospective, or cross-sectional trials with extractable data. We systematically searched PubMed, Scopus, and Web of Science (January 2025). Risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS) for cohort and case–control studies, and the JBI Critical Appraisal Checklist for cross-sectional studies. Data were extracted and categorized by HRCT pattern for each CTD, and then summarized descriptively and statistically. Results: We analyzed 23 studies published between 2015 and 2024, which included 2020 patients with CTD-ILDs. The analysis revealed non-specific interstitial pneumonia (NSIP) as the most prevalent pattern overall (36.5%), followed by definite usual interstitial pneumonia (UIP) (24.8%), organizing pneumonia (OP) (9.8%) and lymphoid interstitial pneumonia (LIP) (1.25%). HRCT distribution varied by CTD: NSIP predominated in systemic sclerosis, idiopathic inflammatory myopathies, and mixed connective tissue disease; UIP was most frequent in rheumatoid arthritis; LIP was more common in Sjögren’s syndrome. While global differences were statistically significant, pairwise comparisons often lacked significance, likely due to sample size constraints. Discussion: Limitations include varying risk of bias across study designs, heterogeneity in HRCT reporting, small sample sizes, and inconsistent follow-up, which may reduce precision and generalizability. In addition to the quantitative synthesis, this review offers a detailed description of each radiologic pattern mentioned above, illustrated by representative examples to support the recognition in clinical settings. Furthermore, it includes a brief overview of the major CTDs associated with ILD, summarizing their epidemiological data, risk factors for ILD and clinical presentation and diagnostic recommendations. Conclusions: NSIP emerged as the most common HRCT pattern across CTD-ILDs, with UIP predominating in RA. Although inter-disease differences were observed, statistical significance was limited, likely reflecting sample size constraints. These findings emphasize the diagnostic and prognostic relevance of HRCT pattern recognition and highlight the need for larger, standardized studies. Full article

Background: Ecuador presents a unique epidemiological laboratory for studying arboviral dynamics due to its diverse ecological zones and exposure to climatic variability. Methods: We conducted a comprehensive 36-year analysis (1988–2024) of dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) using national surveillance data from Ecuador’s Ministry of Public Health. Statistical analyses included time series decomposition, change-point detection, correlation analysis, and climate association studies. Results: Ecuador reported 387,543 arboviral cases, with dengue comprising 91.3% (353,782 cases). Dengue exhibited endemic–epidemic cycles with major peaks during El Niño events (1994: 10,247 cases; 2000: 22,937 cases; 2015: 42,483 cases; 2024: 23,156 cases through week 26). CHIKV emerged explosively in 2015 (29,124 cases, incidence 181.10 per 100,000), followed by ZIKV in 2016 (2947 cases). Both showed rapid decline post-epidemic. Severe dengue cases paradoxically decreased from 2–4% of total cases in early 2000s to <0.1% post-2016, suggesting immunological modulation. Cross-correlation analysis revealed significant associations between climatic indices and epidemic timing ($r=0.67$, $p<0.001$), particularly for the El Niño-Southern Oscillation. Conclusions: Arboviral diseases in Ecuador function as an integrated epidemiological system with evidence of viral interactions, cross-protective immunity, and strong climate forcing. These findings emphasize the need for integrated surveillance and adaptive control strategies. Full article

Ionizing radiation can damage DNA, leading to mutations, and is a risk factor for cancer. Based on the assumption that all radiation exposure poses a risk in linear proportion to its dose, ionizing radiation is considered a non-threshold carcinogen. However, most epidemiological studies have had insufficient statistical power to detect excess cancer risks from low-dose radiation exposure. Therefore, research is needed to identify radiation signatures that distinguish radiation-induced cancers from spontaneously developed cancers. In rodent cancer models, interstitial chromosomal deletions of specific tumor-suppressor gene loci are characteristically found in cancers from irradiated animals. In humans, a high frequency of small deletions and chromosome rearrangements, such as large deletions, inversions, and translocations, has also been reported in second cancers that develop in patients who received radiotherapy and in thyroid cancers diagnosed in residents after the Chornobyl accident. These genomic alterations are likely to be generated as a consequence of the processing of radiation-induced DNA double-strand breaks. Particularly, chromosome rearrangements that occur at loci directly linked to tumor formation after ionizing-radiation exposure are potentially useful as biomarkers and as therapeutic targets for radiation-induced cancer. Here we provide an overview of the radiation-induced mutational signatures observed in animal and human cancers. Full article

Wild animals often serve as reservoirs for vector-borne zoonoses, which are on the rise worldwide but have not yet been sufficiently researched. Vector-borne zoonoses, such as those caused by Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato, and Dirofilaria immitis, are a growing public health concern due to their increasing incidence and broad host range. The aim of this study was to determine the prevalence and risk factors for vector-borne bacterial (borreliosis, anaplasmosis, ehrlichiosis) and parasitic (dirofilariasis) pathogens and to detect some of these pathogens in the red fox (Vulpes vulpes) population in Croatia. A total of 179 blood samples from foxes from nine districts were analysed. The SNAP ^® 4Dx ^® Plus rapid test was used to detect circulating D. immitis antigen and antibodies against B. burgdorferi, A. phagocytophilum/Anaplasma platys, and Ehrlichia canis/Ehrlichia ewingii. Circulating D. immitis antigen was detected in 6.70% of the samples (95% CI: 3.20–10.19%), while antibodies against A. phagocytophilum/A. platys were found in 10.06% (95% CI: 5.8–14.25%). Only one sample was positive for B. burgdorferi, while no antibodies were detected for E. canis/E. ewingii. Spatial analysis revealed statistically significant differences in prevalence by geographical region (district) and age, while no significant correlations were found. In the standard PCR analysis, DNA of D. immitis was not detected in any of the eight positive and eight negative SNAP ^® 4Dx ^® Plus samples. D. repens, A. reconditum, or co-infections were also not detected by PCR. Of the nine samples that tested positive for A. phagocytophilum/A. platys antibodies, four were confirmed to be positive for A. phagocytophilum by nested and semi-nested PCR targeting the 16S rRNA and GroEL genes. Phylogenetic analysis revealed similarities with various European strains, including zoonotic strains. This study is the first molecular detection of A. phagocytophilum from blood samples of red foxes in Croatia. The results show that red foxes are not free from infections such as anaplasmosis and dirofilariasis, emphasising their possible role in the maintenance and transmission of these pathogens in certain regions of Croatia. These results underline the need for further research to better understand the epidemiological importance of red foxes in the spread of vector-borne diseases. Full article

Human toxocariasis is a neglected tropical disease with a potentially major impact on public health. Our aim was to assess the seroprevalence and risk factors associated with Toxocara seroprevalence in blood donors from Romania. Serum samples were obtained from 1347 Romanian blood donors and serologically tested for anti-Toxocara antibodies. An epidemiological questionnaire was used to determine the risk factors associated with Toxocara infection. The overall prevalence of Toxocara antibodies was 29.6%, with a significant age-associated increase (p < 0.001). A higher rate was observed in individuals from rural areas compared to urban areas (p = 0.002) and in males compared to females (p = 0.001). In univariate statistical analysis, seropositivity was significantly associated with household ownership (p < 0.001), contact with soil (p < 0.001), owning dogs (p < 0.001), cats (p = 0.003), and consumption of undercooked poultry (p = 0.002). In a stepwise multivariate logistic regression model, only a lower level of education, age, male gender, consumption of undercooked or raw poultry, and contact with soil were associated with higher Toxocara seroprevalence. Our findings suggest a significant prevalence of Toxocara infection in this region. The identified risk factors highlight the necessity of health education programs that focus on public awareness and promote preventive behaviors, especially among at-risk populations. Full article

Malaria is a parasitic disease caused by Plasmodium protozoa, which is a serious public health issue in Madagascar, an island country located off the coast of Africa in the Indian Ocean. Despite significant efforts to prevent the spread of communicable diseases, the country’s epidemiological situation is worrying and has been deteriorating in recent years, mostly due to poverty and limited access to healthcare. The aim of the present study was to assess the prevalence rates of malaria in northern Madagascar, as exemplified by the Mampikony District, between 2023 and 2024, as well as to assess the effectiveness of the methods used for malaria diagnosis. Material and methods. The study was conducted on a sample of 782 local residents who reported to healthcare centres in Mampikony between 2023 and 2024. The methods used to establish the diagnosis of malaria included rapid diagnostic tests (mRDTs) and molecular assays (RT-PCRs). Results. The 2023 study conducted on a sample of 484 patients demonstrated malaria prevalence of 4.5% (by mRDTs) and 8.2% (by RT-PCR), while the 2024 study carried out on a sample of 298 patients demonstrated malaria prevalence of 8.4% (by mRDTs) and 12.4% (by RT-PCR). The analysis of demographic variables showed that malaria was more prevalent in women and in adults; however, the differences between individual study groups were not statistically significant. In this study, positive malaria cases were predominantly caused by P. falciparum, but we also found cases caused by P. vivax as well as mixed infections. Conclusions. The study results support the need to apply more sensitive diagnostic tools for malaria diagnosis, e.g., RT-PCR. Also, our findings indicate the necessity to reassess and update the strategies for the treatment of malaria in the region due to a growing asymptomatic malaria carriage. To control the spread of malaria in Madagascar, it is essential to apply a wide range of interventions. Full article

Cryptosporidium is a protozoan parasite and a major cause of diarrhea, especially in children and immunocompromised individuals. Despite evidence of its presence in Thailand, comprehensive national data remain limited. This systematic review and meta-analysis aimed to estimate the prevalence of Cryptosporidium infection in Thailand and assess its association with diarrhea, especially among vulnerable populations, to support targeted public health strategies. This systematic review followed the PRISMA guidelines and was registered with PROSPERO (CRD420251015538). A systematic search was conducted in PubMed, Embase, Scopus, Journals@Ovid, Nursing & Allied Health Premium, Google Scholar, and the Thai-Journal Citation Index (TCI) to identify studies on Cryptosporidium infections in humans in Thailand. Quality assessment was independently performed using Joanna Briggs Institute tools. Pooled prevalence and odds ratios (ORs) were estimated using random-effects meta-analyses. Heterogeneity was explored via meta-regression and subgroup analyses, and publication bias was assessed using funnel plots and Egger’s test. A total of 38 studies with 24,759 participants were included, mostly conducted in Central Thailand. The pooled prevalence of Cryptosporidium infections was 4.70% (95% CI: 2.68–8.13%), with the highest prevalence observed in Northern Thailand (11.14%) and among HIV-infected individuals (16.33%). Significant predictors of higher prevalence included region, age group, participant type, and diarrheal status. Infection was associated with a non-significant two-fold increased odds of diarrhea (p: 0.39; OR: 2.00; 95% CI: 0.67–5.99), but significantly higher odds of diarrhea among patients with Cryptosporidium infections were seen in the Central region (OR: 3.71; 95% CI: 1.17–11.8). HIV-seropositive individuals had a significantly higher risk of infection (p: 0.006; OR: 8.15; 95% CI: 1.82–36.50). This systematic review and meta-analysis estimated a pooled prevalence of Cryptosporidium infections in Thailand of 4.70%, with the highest rates in Northern Thailand (11.14%) and among HIV-infected individuals (16.33%). Although infection was associated with a two-fold increase in the risk of diarrhea, the association was not statistically significant. Notably, HIV-seropositive individuals had an eight-fold higher risk compared to HIV-seronegative individuals. Future research should expand surveillance in under-represented regions to better understand the epidemiological burden and guide public health interventions. Full article

Background/Objectives: Impacted teeth are characterized by having more than three-quarters of root development completed, however failing to erupt or demonstrate imminent eruption, as evidenced both by clinical and radiographic evaluation. Canine impaction is an entity of clinical significance considering its potential to affect both oral function and facial aesthetics. If not appropriately managed, this condition may adversely impact functional occlusion and structural smile integrity. The purpose of the study was to investigate the prevalence of impacted and transmigrant canines in a Greek orthodontic cohort and identify potential sex-based differences. Methods: A total of 2594 panoramic radiographs and clinical records of consecutive patients in the mixed and permanent dentition stages, treated at the Department of Orthodontics of the Aristotle University of Thessaloniki, Greece, were retrospectively retrieved and analyzed to detect the presence of impacted and transmigrant canines. Patients lacking complete clinical records or panoramic radiograph, undergoing or had undergone orthodontic treatment, or presenting conditions affecting normal permanent dentition development, including pathological conditions, cleft lip and palate or hereditary disorders, were excluded. Results: At least one impacted canine was detected in 109 patients (67% females, 33% males), with a median age of 15 years (IQR: 13–18), documenting a 4.2% prevalence (6.97% females, 2.32% males). The frequency of maxillary canine impaction was 3.97%, while in the mandible a frequency of 0.46% was reported. The frequency of bilateral canine impaction was 1%, with it being present in 25.7% of patients with canine impaction. The prevalence of transmigrant canines was 0.11%, with detection solely in the mandible. A statistically significant sex difference was detected solely in the prevalence of impaction. Conclusions: Considering the implications of canine impaction, the epidemiological investigation of this entity may facilitate an early diagnosis and treatment. Full article

Background: Endometrioid ovarian carcinoma is a subtype of epithelial ovarian carcinoma and is the second most common type of malignant ovarian neoplasm. Studies investigating delayed treatment of ovarian cancer have identified significant impacts on overall survival rates. This study utilizes the Surveillance, Epidemiology, and End Results (SEER) database to identify cases of endometrioid ovarian carcinomas and factors associated with delays in time to treatment (TTT) greater than one month. Methods: The SEER database was queried to identify females with biopsy-confirmed cases of ovarian endometrioid carcinoma from 2010 to 2015. Chi-square tests, two-sided Fisher’s exact tests, and multivariable binary logistic regressions were completed using SPSS version 29.0.2. Statistical significance was confirmed when p < 0.05. Results: A total of 11,235 relevant patients were identified within the SEER database. A majority were Non-Hispanic White (69.2%), aged 50–59 (30.1%), had an annual income of $75,000+ (58.9%), resided in urban communities (90.0%), and were diagnosed with AJCC stage 1 disease (62.0%). When investigating treatment, 94.9% of patients received treatment within 1 month of diagnosis, while 5.1% experienced a delay of over 1 month before starting treatment. Multivariable binary logistic regression analysis demonstrated that American Indian and Alaksa Native (AIAN) patients independently experienced a +376% increased likelihood of treatment delays exceeding 1 month (aOR 4.76; 95% CI 1.32–17.08; p = 0.017). Patients diagnosed at AJCC stage III (aOR 1.88; 95% CI: 1.22–2.91; p = 0.004) or stage IV (aOR: 4.50; 95% CI: 2.75–7.38; p < 0.001) additionally had +88% and +350% higher odds of treatment delays greater than 1 month, respectively. Conclusions: AIAN patients and those presenting with later stage disease for endometrioid ovarian carcinoma face significantly longer TTT, indicating disparities in timely care. Our findings demonstrate an urgent need for targeted interventions to address systemic barriers contributing to delayed treatment in these populations. Full article

Background/Objectives: The os supranaviculare (OSSN), also known as os talonaviculare dorsale, astragalo-scaphoid ossicle, or Pirie’s bone, is a small extra bone that was first described in 1921 by A.H. Pirie and is located at the top front part of the navicular bone or talonavicular joint. The knowledge regarding the epidemiology of the OSSN is scarcely established, as its prevalence remains unknown and varies significantly among multiple studies. This meta-analysis aims to clarify and systematically summarize all available data on the characteristics and prevalence of the OSSN. Methods: Four major databases (PubMed/Medline, Embase, ScienceDirect, Scopus) were thoroughly searched for studies reporting original data regarding the OSSN up until May 2025. The protocol of this study was pre-registered on PROSPERO (ID: CRD42025638111) and adhered to PRISMA guidelines. To evaluate the between-study heterogeneity, the 95% prediction intervals (95%PI) were calculated; I² statistic and Chi² test were also used. The AQUA-tool was used to assess the quality of included studies. Results: In total, 13 studies (18,745 feet) qualified for inclusion in the quantitative analysis. The pooled prevalence estimate (PPE) of the OSSN in the general population was found to be 0.88% (95%CI: 0.62–1.24%). The PPE of the OSSN was higher in males (0.87%, 95%CI: 0.58–1.32%) than in females (0.48%, 95%CI: 0.14–1.64%). The os supranaviculare was similarly prevalent in both European (1.04%, 95%CI: 0.55–1.96%) and Asian (0.87%, 95%CI: 0.66–1.13%) populations. Conclusions: the os supranaviculare is a very rare anatomical variation that is present in less than one in a hundred feet. Moreover, although usually asymptomatic, it can occasionally be associated with dorsal foot pain or navicular stress fractures. Accurate differentiation from avulsion fractures is essential to avoid unnecessary invasive treatment. Full article

Background and Objectives: This retrospective single-center study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of syphilis cases diagnosed at our hospital between 2005 and 2024, with a focus on the performance of serological tests used for diagnosis. The study also sought to characterize changing epidemiological trends of syphilis over this 20-year period. Materials and Methods: Data from 671 patients with confirmed syphilis diagnoses were retrospectively analyzed. Demographic information, transmission routes, co-infection status, and serological test results—including Rapid Plasma Reagin (RPR) and Indirect Hemagglutination Assay (IHA)—were evaluated. Statistical analyses were performed using chi-square and Fisher-based tests, with Bonferroni correction applied for multiple comparisons Results: Of the 671 cases, 74.6% were male and 25.4% female, with the highest incidence in the 22–41 age group. The number of diagnosed cases increased approximately 6-fold after 2016 compared to the preceding years. Unprotected sexual contact was the most common transmission route. HIV co-infection was present in 32.6% of cases, predominantly in males. Significant differences in RPR and IHA titers were observed across clinical stages of syphilis, with notably higher titers in late latent and neurosyphilis cases. Conclusions: The 6-fold increase in syphilis diagnoses since 2016, alongside a high rate of HIV co-infection, underscores the need for targeted prevention and screening programs for high-risk populations. Serological testing remains essential for diagnosis and disease monitoring. Full article

The objective of this study was to estimate the seroprevalence of Ehrlichia canis in clinically suspect dogs in the Laguna Region of Coahuila, Mexico, and to analyse its association with several clinical, haematological, and social variables. The present study focuses on the veterinary care provided to a total of 249 dogs during the period from August 2023 to November 2024. The implementation of an immunochromatographic test was undertaken for the purpose of antibody detection. The observed seroprevalence was 63.9% (n = 156). Firstly, statistically significant associations were identified with clinical haemorrhagic signs (77.33%; OR = 5.03; p < 0.001), anaemia (81.25%; OR = 4.17; p < 0.001), and thrombocytopenia (96.26%; OR = 43.24; p < 0.001). Secondly, rural dogs exhibited a higher prevalence (70.54%) compared to urban dogs (54.17%), which was found to be statistically significant (p < 0.01). Multivariate analysis and logistic regression identified thrombocytopenia as the most robust predictor. The findings emphasise the substantial circulation of Ehrlichia canis in the region, thereby reinforcing the clinical significance of haemorrhagic manifestations and haematological parameters as diagnostic tools in low-resource settings. The implementation of epidemiological surveillance, vector control, and community education programmes is recommended in order to reduce the impact of this disease on animal and public health. Full article

Background/Objectives: Epstein–Barr virus (EBV) detection patterns in lymphoproliferative disorders (LPDs) show significant geographical variation worldwide. Regional epidemiological data are essential for understanding viral distribution patterns and developing appropriate clinical surveillance strategies. This study aimed to determine EBV detection frequency in LPDs using available molecular and immunohistochemical methods in Western Mexico. Methods: We conducted a cross-sectional study of 200 formalin-fixed paraffin-embedded tissue samples from patients diagnosed with LPDs (2015–2019) at Hospital Civil de Guadalajara. EBV detection combined with real-time PCR targeting the BNTp143 gene and immunohistochemistry for LMP-1 protein. Cases were classified following current WHO criteria. Statistical analysis included multivariate logistic regression, diagnostic concordance assessment, and age-stratified analysis. Results: EBV detection frequency reached 35.5% overall, with marked differences between neoplastic (53.9%) and reactive LPDs (24.2%) (OR: 3.515; 95% CI: 1.859–6.645, p < 0.001). Hodgkin lymphoma showed the highest detection rate (80.6%), significantly exceeding non-Hodgkin lymphoma (39.3%) (OR: 6.43; 95% CI: 2.08–19.41, p = 0.001). Age-stratified analysis revealed predominant adult involvement (49.1% vs. 22.0% in young adults, p = 0.025). We identified three epidemiological categories based on detection probability patterns. Conclusions: This study represents the first comprehensive molecular and immunohistochemical characterization of Epstein–Barr virus in lymphoproliferative disorders from Western Mexico, establishing distinct epidemiological patterns that align with Latin American regional characteristics. The validated methodology provides a reproducible framework for multi-center studies, while the epidemiological data serve as an essential baseline for future longitudinal research and resource optimization in similar healthcare settings. Full article