Search Results (5,932)

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

Triple-negative breast cancer (TNBC) has historically been challenging to treat due to limited therapeutic options. Since 2018, the treatment landscape has evolved substantially with the approval of precision therapies, including immune checkpoint inhibitors, poly (ADP-ribose) polymerase inhibitors, and antibody–drug conjugates. Despite these advancements, the therapeutic benefit remains limited due to various clinical challenges, largely driven by TNBC heterogeneity and an incomplete understanding of drug–tumor crosstalk mechanisms—both contributing to a restricted pool of eligible patients and variable treatment responses. Concurrently, emerging drugs tested in recent pivotal TNBC trials have demonstrated variable outcomes. Additionally, the associated economic burden has become a pressing global concern, as several approved drugs provide insufficient clinical benefit in relation to high expenditures, often driven by drug pricing. The situation is particularly critical in low- and middle-income countries, where TNBC is highly prevalent, yet access to even chemotherapeutic treatment remains limited. These factors collectively hinder real-world patient outcomes. This review provides a comprehensive analysis of TNBC management, integrating clinical advancements with economic perspectives and raising awareness of underdiscussed topics. The overview presented herein highlights the necessity for a global, interdisciplinary approach and patient centered care in TNBC drug development. Full article

Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., China), the smallest currently available ureteroscope Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard. Full article

Clinical trials in spinal muscular atrophy (SMA) have shown that early treatment improves outcomes, prompting inclusion in newborn screening (NBS) programs worldwide. The province of Quebec launched its SMA NBS program in October 2023, with a rapidly progressive implementation. We describe the program’s first-year experience, focusing on screening yield, birth prevalence, clinical outcomes, and challenges. In the first year, 6 of 67,933 newborns screened positive for SMA, all subsequently confirmed by diagnostic testing. Of these, 4 newborns (67%) had two SMN2 copies and 2 newborns (33%) had four copies. Additionally, one symptomatic compound heterozygote infant presented during this period, indicating a provincial birth prevalence of 1 in 9705 live births (95% CI: 1:20,032–1:4701). Two newborns with two SMN2 copies were symptomatic at initial consultation; one transitioned to palliative care and died at 43 days of life. Surviving newborns initiated treatment at a median age of 30 days (range: 9–103 days), with four receiving onasemnogene abeparvovec and one nusinersen. Motor outcomes at three or six months were stable or improved among treated infants. Overall, the Quebec SMA NBS pilot program successfully identified affected newborns, facilitated early access to therapy, and provided the first provincial estimate of SMA birth prevalence. Improved sample shipping and processing times are needed to maximize the program’s impact, which is expected with full automation. Full article

Access to clean water remains a global challenge, particularly in areas where populations rely on surface water. These water sources must be treated. Coagulation with chemicals causes environmental problems and adverse effects on human health. Natural coagulants obtained from papaya (Carica papaya) waste are presented as an alternative that is safe for human health, non-polluting, and biodegradable. The effectiveness of these natural coagulants is compared to that of aluminum sulfate using jar tests and synthetic and natural surface water, with statistical tools to model treatment processes. All coagulants have competitive results, reaching turbidity remotion levels above 90%. However, in equivalent tested ranges, natural coagulants require lower dosages and perform better with high initial water turbidity due to their polymeric bridging mechanisms and adsorption processes through the action of their functional groups, as detected by FTIR analysis. Additional testing with contaminated water from the Valsequillo dam confirms the use of these coagulants to treat water, with papaya seed coagulant yielding the best results and requiring lower doses, making it a competitive alternative. It can be concluded that papaya-based coagulants obtained from waste can be used as an eco-friendly alternative to aluminum sulfate in physicochemical treatments to purify surface water for human consumption. Full article

Background: Numerous healthcare services have been affected by the COVID-19 pandemic worldwide. Specialized healthcare services were postponed or canceled, potentially compromising regular services for hemato-oncology patients. The current study aimed to analyze the impact of the COVID-19 pandemic on access to hemato-oncology services in Almaty, the largest city in Kazakhstan. Methods: We retrospectively analyzed the socio-demographic characteristics of patients admitted to two large tertiary centers rendering hemato-oncology services, the City Clinical Hospital 7 (H7) and the Kazakh Institute of Oncology and Radiology (KazIOR). All data were retrieved for the period spanning from 1 March 2019 to 28 February 2022. The retrieved variables included age, gender, type of residence, hospitalization rate, treatment outcomes (discharged/deceased), bed days, diagnoses according to International Classification of Diseases (ICD-10) (acute leukemia and hematopoietic depression, lymphoproliferative diseases, and myeloproliferative diseases), and referral sources (ambulance, another hospital, consultative and diagnostic assistance, primary healthcare, self-referral, and referrals from hematologists’ offices). Results: In the 2019–2022 period, 6763 hemato-oncology hospitalizations were registered: 3583 in H7 and 3180 in KazIOR. The mean age at hospitalization was 55.04 (SD = 16.07) for females and 51.2 (SD = 16.7) for males. The proportion of hospitalized urban and rural patients differed significantly: 6191 (92%) and 571 (8,4%), respectively (χ² = 13.8, p = 0.001). In the 2020–2021 period, fewer patients were discharged (n = 2047) compared to 2019–2020 (n = 2387) and 2021–2022 (n = 2081) (χ² = 20.09, p = 0.003). However, the proportion of deaths in the 2020–2021 period (3.5%) was higher than in the 2019–2020 (3.2%) and 2021–2022 periods (2.6%) (χ² = 20.09, p = 0.003). A total of 403 (19%) hospital admissions were carried out by ambulance (emergency cases) in the 2020–2021 period, 368 (14.8%) in 2019–2020, and 394 (18.3%) in 2021–2022 (χ² = 2231, p < 0.001). The number of patients transferred from other hospitals to H7 and KazIOR increased by 12.4% in the 2020–2021 period. Conclusions: Our findings indicate a negative impact of the COVID-19 pandemic on access to hemato-oncology services, leading to increased mortality. Further studies are warranted to explore factors underlying the trends in hospitalizations and mortality of hemato-oncology patients during healthcare crises. Full article

Atherosclerotic cardiovascular disease treatment is being reevaluated, since a residual cardiovascular risk (RCR) persists even in patients who achieve optimal LDL-C values. Underlying causes are metabolic dysfunction, lipoprotein(a), inflammation, and triglyceride-rich lipoproteins and their remnants. Dietary treatment options like time-restricted eating (TRE) are becoming more widely acknowledged for their potential advantages in metabolic health and weight control, as a treatment of atherosclerosis expanding beyond LDL-C medication. Beyond weight loss, TRE (which restricts meals to a window of 6 to 8 h) appears as the most accessible treatment, and has been shown to improve blood pressure, lipid profiles, and glucose regulation through mechanisms like metabolic switching and circadian synchronization. We hypothesize, and will present our arguments, that a key mechanism underlying the cardiovascular and weight-related benefits of TRE is its impact on the circadian regulation of angiopoietin-like protein 4 (ANGPTL4) activity within adipose tissue. Additionally, lipolysis is accelerated by ANGPTL4 activation. TRE, via its actions on ANGPTL4, therefore not only inhibits adipose fatty acid uptake but stimulates their release as well. Additionally, TRE may increase intravascular very low-density lipoprotein (VLDL) catabolism by muscle due to the reduced exposure of lipoprotein lipase (LPL) to competing chylomicrons, known to slow the rate of VLDL catabolism. During the prolonged fasting, VLDL residence time is thus shortened, limiting the exposure to endothelium and hepatic lipases and thus reducing the amount of atherogenic remnant particles. Larger, longer-term randomized controlled studies in a variety of groups are required to further clarify TRE’s function in RCR prevention and therapy. As knowledge of triglyceride lipoprotein (TRL) metabolism expands, a comprehensive strategy for the management of RCR emerges, and a broader spectrum of LPL regulator-based therapeutics is created. Consequently, it is advisable to prioritize further research into the influence of TRE on LPL modulation via ANGPTL4 and ANGPTL8, which provides a natural, accessible, and low-cost alternative. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Introduction: YouTube™ is a widely accessible platform with unfiltered medical information. This study aimed to evaluate the educational value and reliability of YouTube™ videos on Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced epithelial ovarian cancer treatment. Methods: YouTube™ videos were searched using the keywords “ovarian cancer”, “debulking surgery”, “hyperthermic”, and “HIPEC”. Patient Education Materials Assessment Tool for Audiovisual Content (PEMAT A/V) score, DISCERN, Misinformation Scale, and the Global Quality Scale (GQS) were employed to assess the clarity, quality, and reliability of the information presented. Results: Of the 150 YouTube™ videos screened, 71 were suitable for analysis and categorized by target audience (general public vs. healthcare workers). Most (57, 80.2%) were uploaded after the “Ov-HIPEC” trial (18 January 2018), with a trend toward more videos for healthcare workers (p = 0.07). Videos for the general public were shorter (p < 0.001) but received more views (p = 0.06) and likes (p = 0.09), though they were of lower quality. The DISCERN score averaged 50 (IQR: 35–60), with public-targeted videos being less informative (p < 0.001), a trend mirrored by the Misinformation Scale (p < 0.001) and GQS (p < 0.001). The PEMAT A/V scores showed 80% Understandability (IQR: 62–90) and 33% Actionability (IQR: 25–100), with no significant difference between groups (p = 0.15, p = 0.4). Conclusions: While YouTube™ provides useful information for healthcare professionals, it cannot be considered a reliable source for patients seeking information on HIPEC for ovarian cancer. Many videos contribute to misinformation by not properly explaining treatment indications, timing, adverse effects, multimodal approaches, or clinical trial findings. Full article

Objectives: Narratives related to root canal treatment on social media can be problematic. This research examines discourses relating to root canal treatment on the popular platform Instagram. Through this analysis, the way different health discourses relating to endodontics are being communicated to the public and consumers will be explored. Methods: A search was conducted on Instagram to access consumer-focused information related to root canal treatment. Posts were identified, transcribed to capture the audio component in text form, and watched cyclically, with analytical memos being kept on video content. A social semiotic analysis was conducted on posts to capture the multimodal nature of discourse on endodontics. Results: A total of 100 Instagram posts were included in this study. Two overarching themes were used to structure the analysis of posts: (1) presentation of root canal treatment and (2) presentation of expertise. The majority of posts were negative in tone towards root canal treatment. Conclusions: The variety and nature of the misinformation featured in this research present a complex professional challenge for dentistry. The majority of the posts identified and analysed featured sensationalised explanations of dental disease and treatment processes, blended with inaccuracies, many of which were produced by dentists. Conspiracy discourses relating to root canal treatment were also encountered, which questioned the integrity and intentions of the dental profession. Full article

Colorectal liver metastases (CRLM) management remains a complex conundrum in the context of potential curable disease. The combination of systemic therapy and surgery, with overall survival outcomes up to 58% at five years, has become the gold standard. Locoregional therapies have gained evidence in complementing surgery or even substituting it in selected cases. Adequate patient selection is paramount, but prognostic models have certain limitations that prevent their full implementation in clinical practice. A plethora of prognostic factors exists, with variable evidence supporting their definitive role. Thus, CRLM management decisions frequently vary depending on multidisciplinary team experience and hospital access to systemic and locoregional treatments. Definition of resectability has evolved in recent years due to technical developments in surgical and non-surgical approaches. Complexity is added when trying to fully understand the integration between local and systemic treatment. Whereas evidence in the context of resectable disease has been attempted in several phase III trials, definitive conclusions regarding the best approach to potentially resectable disease cannot be drawn. In addition, liver transplantation has gained evidence and is proposed in selected patients, raising a challenge regarding its integration and wider implementation. In this review, current standards in the management of CRLM regarding patient selection, resectability, surgical and non-surgical locoregional strategies, as well as the best systemic approach are covered. Full article

Autologous Chimeric antigen receptor (CAR) T-cell therapies have demonstrated substantial efficacy in patients with relapsed or refractory hematologic malignancies; however, their implementation has been constrained by regulatory barriers. Risk Evaluation and Mitigation Strategies (REMS), mandated by the U.S. Food and Drug Administration (FDA), were initially implemented to mitigate risks associated with cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and other treatment-related toxicities. On 27 June 2025, the FDA removed REMS requirements for all approved B-cell maturation antigen (BCMA) and CD19-directed autologous CAR T-cell therapies, citing that current product labeling sufficiently communicates safety information. Key regulatory changes include the elimination of site certification and tocilizumab stocking requirements, a reduction in the recommended post-infusion proximity period from four weeks to two weeks, increased flexibility regarding monitoring locations, and a shortened driving restriction from eight weeks to two weeks. This review examines the rationale for the REMS requirements for CAR T-cell therapies, synthesizes contemporary safety data from clinical trials and real-world practice, and explores the implications of this regulatory shift for access to care, particularly in rural and underserved populations. The removal of REMS requirements may facilitate broader implementation of CAR T-cell therapies and alleviate logistical and institutional barriers, offering the potential to expand access while preserving patient safety. Full article

As water pollution from dyes, pharmaceuticals, heavy metals, and other emerging contaminants continues to rise at an alarming rate, ensuring access to clean and safe water has become a pressing global challenge. Conventional water treatment methods, though widely used, often fall short in effectively addressing these complex pollutants. In response, researchers have turned to Advanced Functional Membranes (AFMs) as promising alternatives, owing to their customizable structures and enhanced performance. Among the most explored AFMs are those based on metal–organic frameworks (MOFs), carbon nanotubes (CNTs), and electro–catalytic systems, each offering unique advantages such as high permeability, selective pollutant removal, and compatibility with advanced oxidation processes (AOPs). Notably, hybrid systems combining AFMs with electrochemical or photocatalytic technologies have demonstrated remarkable efficiency in laboratory settings. However, translating these successes to real-world applications remains a challenge due to issues related to cost, scalability, and long-term stability. This review explores the recent progress in AFM development, particularly MOF-based, CNT-based, and electro-Fenton (EF)-based membranes, highlighting their material aspects, pollutant filtration mechanisms, benefits, and limitations. It also offers insights into how these next-generation materials can contribute to more sustainable, practical, and economically viable water purification solutions in the near future. Full article

Sex and gender play a critical role in allergic diseases, influencing immune response, clinical phenotypes, treatment strategies, outcomes, and health-related quality of life. Despite mounting evidence across multiple studies examining sex/gender differences in a multitude of allergic diseases, most address isolated conditions, not taking into consideration the vast interplay of hormonal, genetic, immunological, and sociocultural factors and their unique consequences for clinicians and researchers. With this position paper, we aim to assess currently available evidence on the sex- and gender-specific characteristics of the most common allergic diseases, providing an overview of present knowledge and future areas of improvement for clinicians and researchers. This position paper was developed by the Società Italiana di Allergologia, Asma ed Immunologia Clinica (SIAAIC): a panel of experts who conducted a literature review focusing on sex and gender differences across major allergic diseases. A consensus-based approach was employed to assess the immunological, clinical, and therapeutic implications of available evidence, offering a recommendation for researchers and clinicians alike. Data highlights marked differences driven by sex and gender in disease prevalence, immune pathways, clinical phenotype and severity, as well as therapeutic outcomes. Female patients appear to show a higher prevalence of Th2-driven ailments, autoimmune overlap, and allergic drug reactions, whereas males are more likely to experience fatal anaphylaxis and severe mastocytosis. Sex hormones can modulate multiple immune pathways leading to mast cell activation, antibody production, and cytokine expression, thus contributing to divergent disease trajectories. In conclusion, sex and gender are a key determinant in allergic diseases, and their integration in future research is essential to develop a tailored approach to treatment. Efforts should prioritise the identification of sex- and gender-specific biomarkers, therapeutic strategies, and equitable access to healthcare services. A sex- and gender-aware approach could potentially improve outcomes, optimise treatment strategies, and address current gaps in allergy practice. Full article

Obstruction differential diagnosis involves tumors, “acute abdomen”, and chronic pseudo-obstruction (CIPO). Pediatric CIPO cases have different backgrounds than adults’ and impairs development. The cases are rare; diagnosis and treatment are still not well established. Diagnosis is complex; clinical, radiological, molecular, and manometric pathologic data are essential. The performance of broad radiological investigations and manometry is cumbersome in a small intestine. Herein, we present cases of a 14-year-old girl and 11-year-old boy with visceral myopathies (VMs). Presented cases show unique hardship in the analysis of standing and contrast bedside X-ray images—the colon distension alone speaks to Hirschsprung, and the clinicians could not confirm suspected short-segment disease for a long time. VMs are usually diagnosed up to 12 months of life and accompanied by other organ dysfunctions, which are herein absent. The key features here were also the involvement of the small intestine, lack of distant colon contraction, and for the long-lasting case in the boy, loss of haustration. The initial diagnosis relied on clinical data (vomiting, malabsorption, >6-month obstruction, and uncharacteristic biochemical tests), radiology (lack of tumor, enlargement of diameter, and fluid in small and large intestines), and manometry (presence of propagation wave and of anal inhibitory reflex in recto–anal manometry). Examination of intestinal muscle biopsies involved hematoxylin-eosin, trichrome-Masson staining, and immunohistochemistry. The characteristics were fibrosis, small vacuoles, muscle layer thinning, and decreased expression of smooth muscle actin and desmin. The localization of biopsies was chosen after X-ray examination, due to interruption and with various degree changes. The final diagnosis was put forward after the analysis of all accessible data. The diagnosis of VM underlines the importance of interdisciplinary co-work. An earlier intestine muscle biopsy and well-designed molecular panel might fasten the process of diagnosis. Deeper exploration of phenotype–genotype correlation of various VM presentations in the future is crucial for personalized treatment. Full article