Search Results (1,414)

Children living with chronic diseases represent a great challenge for the health care system, their families, and communities. These young patients face continuous medical needs that affect not only their health but also their daily routines, emotional well-being, and family dynamics. In response, clinical practice is increasingly integrating psychosocial indicators alongside traditional medical parameters. Consequently, there is a growing consensus that the evaluation of pediatric chronic diseases should address not only clinical dimensions but also the disease’s impact on socialization, emotional health, and daily functioning. This narrative review explores the role of psychosocial variables in the management of pediatric chronic illnesses, including the experiences of parents and siblings, with a focus on effective strategies to improve everyday life. The integration of quality of life and well-being within a multidimensional care model could be instrumental in both symptom management and psychosocial support. Recognizing that children with chronic conditions are at increased risk for long-term adverse outcomes, it is critical to develop interventions that go beyond clinical care, encompassing education, coping reinforcement, and family-centered approaches. Full article

The rapid advancement of artificial intelligence is transforming agriculture by enabling data-driven plant disease monitoring and decision support. Soil-borne mosaic wheat virus (SBWMV) is a soil-transmitted virus disease that poses a serious threat to wheat production across multiple ecological zones. Due to the regional variability in environmental conditions and symptom expressions, accurately evaluating the severity of wheat soil-borne mosaic (WSBM) infections remains a persistent challenge. To address this, the problem is formulated as large-scale group decision-making process (LSGDM), where each planting plot is treated as an independent virtual decision maker, providing its own severity assessments. This modeling approach reflects the spatial heterogeneity of the disease and enables a structured mechanism to reconcile divergent evaluations. First, for each site, field observation of infection symptoms are recorded and represented using intuitionistic fuzzy numbers (IFNs) to capture uncertainty in detection. Second, a Bayesian graph convolutional networks model (Bayesian-GCN) is used to construct a spatial trust propagation mechanism, inferring missing trust values and preserving regional dependencies. Third, an enhanced spectral clustering method is employed to group plots with similar symptoms and assessment behaviors. Fourth, a feedback mechanism is introduced to iteratively adjust plot-level evaluations based on a set of defined agricultural decision indicators sets using a multi-granulation rough set (ADISs-MGRS). Once consensus is reached, final rankings of candidate plots are generated from indicators, providing an interpretable and evidence-based foundation for targeted prevention strategies. By using the WSBM dataset collected in 2017–2018 from Walla Walla Valley, Oregon/Washington State border, the United States of America, and performing data augmentation for validation, along with comparative experiments and sensitivity analysis, this study demonstrates that the AI-driven LSGDM model integrating enhanced spectral clustering and ADISs-MGRS feedback mechanisms outperforms traditional models in terms of consensus efficiency and decision robustness. This provides valuable support for multi-party decision making in complex agricultural contexts. Full article

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article

Climate change is profoundly impacting human health in South Africa, aggravating existing health challenges and creating new threats, particularly in vulnerable populations. This scoping review aims to comprehensively map existing evidence of climate change and diverse human health impacts to assist in the equipping of health systems to address evolving challenges of climate change. The scoping review will inform the development of evidence-based policy, improve public health preparedness, and ensure that adaptation strategies are effectively tailored to South Africa’s socio-economic and environmental conditions. This scoping review protocol will be conducted using the Joanna Briggs Institute (JBI) methodology, following five steps: (1) defining the research question, (2) search strategy, (3) setting inclusion criteria, (4) extracting data, (5) assessing, summarizing, and presenting findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) tool will be used. A comprehensive peer-reviewed literature search, including PubMed, Scopus, ScienceDirect, and Google Scholar, will be conducted by two independent reviewers. The review will be conducted over eight weeks, focusing on English studies published between 2015 and 2025, and conducted within South Africa. A two-stage screening process will determine article eligibility. Disagreements will be resolved through consensus and consultation of a third reviewer. The results of this review will be presented as tables, including a narrative synthesis of the findings. Full article

Background/Objectives: Histological follow-up still lacks consensus in the long-term management of adult patients with celiac disease (CD) adhering to a gluten-free diet (GFD). Despite clinical and serological improvement, a significant proportion of patients continue to have persistent villous atrophy. We aimed to synthesize current evidence regarding histological outcomes after GFD treatment in adult CD, focusing on mucosal healing rates, assessment methods, and remission criteria. Methods: We conducted a literature search with extraction and analysis of published cohort studies that included adult patients with CD on GFD with follow-up biopsy data. Extracted parameters included demographic details, baseline histology, GFD duration and adherence, serologic status, and histologic recovery rates with corresponding remission criteria. Results: Data from 46 studies comprising 15,530 patients were analyzed. The overall mean age was 41 years, and 73.3% were female. Mean histologic remission across cohorts was 58.8%, with considerable interstudy variation. Remission criteria also varied widely, ranging from strict Marsh 0 control histology to more inclusive definitions that considered Marsh 1 or even non-atrophic mucosa (Marsh < 3) as indicative of recovery, while some studies relied on quantitative villous height-to-crypt depth ratio thresholds, substantially influencing reported remission rates. Longer GFD duration and rigorous diet adherence assessment using validated questionnaires and accurate laboratory tools were associated with higher remission rates. Conclusions: Histologic remission in GFD-treated adult patients with CD is highly variable and strongly influenced by remission definitions and adherence assessment methods. Standardized reporting using validated metrics for histologic outcome and dietary compliance is essential for harmonizing follow-up strategies in adult CD. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article

This narrative review explores the intricate relationship between the plasminogen activator system (PAS), comprising urokinase-type plasminogen activator (uPA) and tissue-type plasminogen activator (tPA), and a range of neuropsychiatric disorders, including depression and anxiety. By synthesizing existing preclinical and clinical evidence, we clarify the roles of uPA and tPA in the pathogenesis and potential treatments of these conditions. This narrative review emphasizes their involvement in modulating neuronal plasticity, synaptic remodeling, and neurotransmitter systems, which are pivotal in maintaining brain function and behavior. Additionally, this review highlights key mechanisms by which these activators influence the neurobiological processes underlying mood and cognitive dysfunction. Critical analysis identifies areas of consensus, such as the role of plasminogen activators in neuroinflammation and stress responses, while also addressing gaps and controversies in the literature. The findings underscore the therapeutic potential of targeting the uPA/tPA system for innovative interventions. By offering a nuanced understanding of their contributions to mood disorders, this review aims to inspire future research toward developing novel, mechanism-based treatment strategies that harness the PAS’ capacity to restore neural homeostasis and improve patient outcomes. Full article

Background: The integration of artificial intelligence (AI) into cervical cancer diagnostics has shown promising advancements in recent years. AI technologies, particularly in the analysis of cytological images, offer potential improvements in diagnostic accuracy and screening efficiency. However, challenges regarding model generalizability, explainability, and operational integration into clinical workflows persist, impeding widespread adoption. Aim: This narrative review aims to critically evaluate the current state of AI in cervical cancer diagnostic cytology, identifying trends, key developments, and areas requiring further research. It also explores the potential for AI to improve diagnostic processes, alongside examining international guidelines and consensus on its adoption. Methods: A narrative review was conducted through a comprehensive search of PubMed and Scopus databases. Thirty studies published between 2020 and 2025 were selected based on their relevance. Results: The literature review reveals a growing interest in the application of AI for cervical cancer diagnostics, particularly in the automated interpretation. However, large-scale clinical adoption remains limited. Most studies are experimental or application-based in controlled settings. Consensus efforts and specific recommendations for this domain are still limited and not specific. Key barriers include limited model generalizability, lack of explainability, challenges in integration into clinical workflows, and regulatory and infrastructural constraints. Conclusions: A sustainable and meaningful integration of AI in cervical cancer diagnostics requires a unified framework that addresses both technical challenges and operational needs, supported by context-specific strategies and broader consensus-building efforts. Full article

Technology-based strategies for the prevention and management of suicidal behavior are widely referenced for identifying vulnerable groups and for supporting clinical reasoning, decision-making, and appropriate referrals. In this study, we estimated the interface and content validity evidence of an interactive mobile application developed for managing suicidal behavior. This methodological study employed psychometric parameters to evaluate the content and interface of the mobile application, following five action phases: analysis, design, development, implementation, and evaluation. A total of 27 healthcare professionals participated, selected by convenience sampling, all working within the Psychosocial Care Network across different regions of Brazil. Data were collected using an electronic form, the Delphi technique for evaluation rounds, and a Likert scale to achieve consensus. The validity analysis was based on a Content Validity Index (CVI) equal to or greater than 0.80. The results showed that GerenciaVida, a technology developed for healthcare workers—regardless of their level of care or professional category—can be used to screen for suicide risk in the general population and indicate preventive alternatives. The app demonstrated satisfactory indicators of content validity (0.974) and interface validity (0.963), reflecting clarity (0.925), objectivity (1.00), adequacy (0.925), coherence (0.962), accuracy (0.962), and clinical relevance (1.00). The development path of this mobile application provided scientific, technological, and operational support, establishing it as an innovative care tool. It consolidates valid evidence that supports the identification, risk classification, and prevention of suicidal behavior in various healthcare contexts. Full article

High-density lipoprotein (HDL) and small dense low-density lipoprotein (sdLDL) represent two critical yet contrasting components in lipid metabolism and cardiovascular risk modulation. While HDL has traditionally been viewed as cardioprotective due to its role in reverse cholesterol transport and anti-inflammatory effects, emerging evidence emphasizes that HDL functionality—rather than concentration alone—is pivotal in atheroprotection. Conversely, sdLDL particles are increasingly recognized as highly atherogenic due to their enhanced arterial penetration, oxidative susceptibility, and prolonged plasma residence time. This review critically examined the physiological roles, pathological implications, and therapeutic interventions targeting HDL function and sdLDL burden. Lifestyle modifications, pharmacologic agents including statins, fibrates, PCSK9 inhibitors, and novel therapies such as icosapent ethyl were discussed in the context of their effects on HDL quality and sdLDL reduction. Additionally, current clinical guidelines were analyzed, highlighting a paradigm shift away from targeting HDL-C levels toward apoB-driven risk reduction. Although HDL-targeted therapies remain under investigation, the consensus supports focusing on lowering apoB-containing lipoproteins while leveraging lifestyle strategies to improve HDL functionality. In the setting of heart failure, particularly with preserved ejection fraction (HFpEF), alterations in HDL composition and elevated sdLDL levels have been linked to endothelial dysfunction and systemic inflammation, further underscoring their relevance beyond atherosclerosis. A comprehensive understanding of HDL and sdLDL dynamics is essential for optimizing cardiovascular prevention strategies. Full article

Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways. Methods: A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant studies, clinical guidelines, and expert consensus documents related to difficult airway management. The focus was placed on both pre-intubation assessment tools and intervention strategies used in various clinical contexts. Results: Airway difficulty is best anticipated through a combination of history, physical examination, and validated tools such as the Mallampati score. Several algorithms, including those from the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS), provide structured approaches that emphasize preoxygenation, preparedness for failed intubation, and the use of adjuncts such as video laryngoscopy, supraglottic airway devices, and awake intubation techniques. Crisis algorithms such as the Vortex approach help simplify decision-making during emergencies. It is important to have adjuncts available in cases of anticipated difficult airways, such as fiberoptic intubation, while surgical airway access is an important component of a stepwise airway management algorithm when critical scenarios are encountered. Conclusions: Effective difficult airway management requires anticipation, a structured plan, familiarity with advanced airway tools, and adherence to validated algorithms. Training in crisis resource management and multidisciplinary rehearsal of airway scenarios are essential to improving outcomes. Full article

Consensus protocols for a multi-agent networked system consist of strategies that align the states of all agents that share information according to a given network topology, despite challenges such as communication limitations, time-varying networks, and communication delays. The special orthogonal group $SO\left(n\right)$ plays a key role in applications from rigid body attitude synchronization to machine learning on Lie groups, particularly in fields like physics-informed learning and geometric deep learning. In this paper, N-agent consensus protocols are proposed on the Lie group $SO\left(4\right)$ and the corresponding tangent bundle $TSO\left(4\right)$, in which the state spaces are $SO{\left(4\right)}^N$ and $TSO{\left(4\right)}^N$, respectively. In particular, when using communication topologies such as a ring graph for which the local stability of non-consensus equilibria is retained in the closed loop, a consensus protocol that leverages a reshaping strategy is proposed to destabilize non-consensus equilibria and produce consensus with almost global stability on $SO{\left(4\right)}^N$ or $TSO{\left(4\right)}^N$. Lyapunov-based stability guarantees are obtained, and simulations are conducted to illustrate the advantages of these proposed consensus protocols. Full article

In the United States, the Clozapine Risk Evaluation and Mitigation Strategy (REMS) program was implemented to ensure safe prescription and monitoring; however, its administrative complexity has often resulted in unintended barriers to access. Clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), yet its use continues to be constrained by outdated regulatory frameworks, cultural inertia, and clinical hesitancy. This perspective article revisits the pharmacokinetic foundations of clozapine, re-examines its association with fatal outcomes, and critiques the persistence of obsolete monitoring systems such as the U.S. REMS program. Drawing on recent consensus publications endorsed by over 120 international clozapine experts, this article outlines the proposed changes to the U.S. prescription information and contextualizes them within broader global practices. This article argues that many barriers to clozapine use stem not from evidence, but from regulatory conservatism and the perpetuation of clinical myths. The dismantling of the REMS program in early 2025 represents a pivotal moment, yet further reforms are urgently needed to align regulatory guidance with contemporary science. Ultimately, this article is a call to rediscover the clinical value of clozapine and to translate decades of knowledge into regulatory and clinical action. Full article

Background: Developing countries face significant challenges in accessing high-quality pharmaceutical products due to resource constraints, limited regulatory capacity, and market dynamics that often prioritize cost over quality. This review addresses the critical gap in regulatory frameworks that fail to ensure pharmaceutical quality equity between developed and developing nations. Objective: This comprehensive review examines a novel dual-pathway regulatory framework that leverages stringent regulatory authority (SRA) approvals, artificial intelligence-based evaluation systems, and harmonized pricing mechanisms to ensure pharmaceutical quality equity across global markets. Methods: A comprehensive systematic analysis of current regulatory challenges, proposed solutions, and implementation strategies was conducted through an extensive literature review (202 sources, 2019–2025), expert consultation on regulatory science, AI implementation in healthcare, and pharmaceutical policy development. The methodology included an analysis of regulatory precedents, an economic impact assessment, and a feasibility evaluation based on existing technological implementations. Results: The proposed framework addresses key regulatory capacity gaps through two complementary pathways: Pathway 1 enables same-batch distribution from SRA-approved products with pricing parity mechanisms. At the same time, Pathway 2 provides independent evaluation using AI-enhanced systems for differentiated products. Key components include indigenous AI development, which requires systematic implementation over 4–6 years across three distinct stages, outsourced auditing frameworks that reduce costs by 40–50%, and quality-first principles that categorically reject cost-based quality compromises. Implementation analysis demonstrates a potential for achieving a 90–95% quality standardization, accompanied by a 200–300% increase in regulatory evaluation capability. Conclusions: This framework has the potential to significantly improve pharmaceutical quality and access in developing countries while maintaining rigorous safety and efficacy standards through innovative regulatory approaches. The evidence demonstrates substantial public health benefits with projected improvements in population access (85–95% coverage), treatment success rates (90–95% efficacy), and economic benefits (USD 15–30 billion in system efficiencies), providing a compelling case for implementation that aligns with global scientific consensus and Sustainable Development Goal 3.8. Full article

Background/Objectives: Auditory capacity plays a fundamental role in human emotional development from prenatal stages and persists as the last sensory modality to fade during terminal phases. In palliative sedation, uncertainty about preserved hearing—despite potential unconsciousness—underscores the need to evaluate current care recommendations for this critical sensory dimension. This review examines European guidelines to (i) assess auditory care integration in palliative sedation protocols and (ii) propose humanization strategies for sensory-preserving end-of-life care. Methods: Narrative review of evidence from the European Palliative Sedation Repository and the European Association for Palliative Care (EAPC). Results: Three key findings emerged: (i) lack of explicit protocols for auditory care despite acknowledging environmental sound management (e.g., music, family communication); (ii) limited consensus exists regarding hearing preservation during unconsciousness. Conclusions: Although auditory perception during palliative sedation remains scientifically uncertain, the precautionary principle warrants integrating auditory care into palliative sedation through (i) family education on potential hearing preservation; (ii) therapeutic sound protocols; and (iii) staff training in sensory-inclusive practices. This approach addresses current gaps in the guidelines while enhancing patient dignity and family support during end-of-life care. Further research should clarify auditory perception thresholds during sedation. Full article