Search Results (757)

Peripartum cardiomyopathy (PPCM) is a distinct condition that presents as heart failure (HF) in a woman who was previously healthy and has no prior cardiovascular issues. It results from idiopathic left ventricular (LV) dysfunction, characterized by a reduced LV ejection fraction below 45%. PPCM is a life-threatening condition with a high mortality rate (MR) that demands urgent treatment. Methods: This narrative review aims to define PPCM and its pathophysiology and conduct a scoping review of the latest data on the management of patients with peripartum cardiomyopathy during pregnancy and the postpartum period. Results: Currently, treatment follows standard HF protocols for reduced ejection fraction, with the possible addition of bromocriptine, and during pregnancy, medications that do not harm the fetus. Conclusions: Early, aggressive therapy is essential for a better prognosis, but managing PPCM can be challenging. Treatment of PPCM patients should be led by a team of highly qualified specialists, known as the Obstetric and Cardiac Care Team, comprising an obstetrician-perinatologist, an anesthesiologist, a cardiologist, and a cardiac intensive care specialist. Baseline left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) are the main prognostic factors. LVEF less than 30%, significant LV dilatation, LVEDD ≥ 6.0 cm, and right ventricular involvement are factors indicative of a poor prognosis. While pregnancy after PPCM is possible, it should be discouraged due to the significant risk of complications and even death. The most common causes of death in patients with PPCM are thromboembolic complications, severe HF, serious ventricular arrhythmias, cardiogenic shock, and sudden cardiac arrest. Full article

Hypertension and chronic kidney disease (CKD) are closely linked conditions and represent common global health problems. Hypertension is a leading risk factor for cardiovascular disease, which is the main cause of mortality in CKD. Endothelial injury underlies the etiopathogenesis of both hypertension and CKD. The endothelial glycocalyx (eGC) is a dynamic, negatively charged, carbohydrate-rich layer that covers the luminal surface of endothelial cells. Its primary physiological function is to protect the endothelium, including the regulation of vascular permeability and homeostasis. Damage to the eGC, known as “shedding”, is an early predictor of endothelial dysfunction and is driven by oxidative stress and low-grade inflammation. In hypertension, loss of eGC integrity—often impaired by a high-salt diet—can reduce the bioavailability of nitric oxide (NO) and increase arterial stiffness. Similarly, in CKD, uremic toxicity, hypertension, and inflammation damage the eGC, resulting in increased permeability, albuminuria, and higher cardiovascular risk. This review summarizes current evidence and underscores the potential of eGC shedding markers, especially syndecan 1 (SDC-1) and hyaluronic acid (HA), as early predictors of vascular risk and disease progression in hypertension and CKD. Full article

Dermatomyositis (DM) is a rare, autoimmune inflammatory myopathy characterized by a heterogeneous clinical course and complex etiopathogenesis. Although classically defined by the coexistence of muscle inflammation and distinctive skin lesions, DM frequently presents as a systemic disease, and, in some patients, cutaneous manifestations may precede muscle involvement or represent the sole clinical feature. The spectrum of skin lesions in DM is broad and includes pathognomonic, characteristic, rare, or atypical manifestations, ranging from classic Gottron’s sign and heliotrope rash to uncommon subtypes such as vesiculobullous dermatomyositis, Wong-type dermatomyositis, or flagellate dermatitis. Particular cutaneous phenotypes often correlate with distinct clinical subtypes, autoantibody profiles, systemic involvement, and prognosis. The diversity of dermatological presentations and their resemblance to other dermatoses may delay accurate diagnosis, especially in amyopathic and hypomyopathic forms of the disease. The aim of this review is to comprehensively discuss the wide spectrum of cutaneous manifestations of dermatomyositis, emphasize less recognized and rare dermatological clinical presentations, and highlight their diagnostic and prognostic significance. However, histopathological examination may support the diagnostic process in challenging cases. Early identification of characteristic skin lesions remains crucial for prompt diagnosis, appropriate screening for systemic complications and malignancy, and optimal management. Close interdisciplinary cooperation among dermatologists, rheumatologists, and other specialists is essential to ensure accurate diagnosis and improve outcomes in patients with dermatomyositis. Full article

Background/Objectives: Although the etiopathogenesis of autism spectrum disorder (ASD) remains incompletely elucidated, current evidence supports a multifactorial model involving genetic and environmental factors that interact to induce a heterogeneous range of symptoms. In recent years, epigenetic mechanisms, particularly DNA methylation, have been recognized as key contributors to ASD pathophysiology. Alterations in mitochondrial DNA (mtDNA) methylation are also emerging as relevant contributors in several human conditions. The mitochondrial D-loop, a non-coding control region essential for mtDNA replication and transcription, is considered a hotspot for epigenetic regulation and its methylation levels have been found altered in various diseases, such as cancer, metabolic disorders, and neurological illness. However, to date, no studies have investigated mtDNA methylation changes in ASD. Methods: We analyzed the average methylation levels of a fragment containing ten CpG sites within the D-loop region and the mtDNA copy number in peripheral blood samples from 49 children with ASD and 50 neurotypically developing (NT) controls using Methylation-Sensitive High-Resolution Melting and quantitative PCR. Results: No significant differences in D-loop methylation levels were observed between ASD and NT children. Similarly, the mtDNA copy number did not differ between the two groups. No significant correlations were found between D-loop methylation or mtDNA copy number and either ASD severity or age. Conclusions: This is the first study investigating mtDNA methylation in ASD. Our results indicate that methylation of the D-loop region and the mtDNA copy number are not altered in ASD children. Further studies including larger cohorts and extended mtDNA regions are warranted to confirm and expand these findings. Full article

Canine atopic dermatitis (CAD) is a chronic, pruritic inflammatory disease that affects up to 15% of the global canine population. Its etiopathogenesis is multifactorial, involving genetic, immunological, environmental, and dietary factors. It is characterized by pruritus, erythema, alopecia, and secondary lesions, predominantly affecting the abdomen, extremities, and ears. This retrospective cross-sectional descriptive study analyzed 735 medical records of dogs diagnosed with CAD treated at the Veterinary Specialty Center (CEVET) in Quito, Ecuador, between January 2018 and July 2025. Demographic, clinical, housing, diet, and cohabitation data were collected and statistically analyzed using χ² for qualitative variables and the Kruskal–Wallis test for quantitative variables, with post hoc analysis as appropriate. Additionally, pruritus severity was assessed using the Pruritus Visual Analog Scale (pVAS). A composite Clinical Severity and Distribution Score (CSDS) was also developed to classify disease severity. A multivariate logistic regression model was performed to identify factors associated with severe CAD. The results showed a predominance of CAD in adult dogs (84.2%) and purebred dogs (74.97%), with a slight majority being males (52.38%). Pruritus was the most frequent initial symptom (80.27%), with most cases presenting moderate-to-severe pruritus (pVAS 7–10). The most affected areas were the abdomen (24.49%) and forelimbs (17.68%). The geographical distribution showed a predominance of urban areas (88.84%) and cold climates (86.39%). Based on the CSDS, 53.2% of cases were classified as severe, 44.4% as moderate, and 2.4% as mild. Multivariate analysis revealed that grass exposure was significantly associated with severe CAD (OR = 1.78; 95% CI: 1.22–2.60; p = 0.003), while urban environment showed a non-significant trend toward increased severity (OR = 1.41; p = 0.071). Significant associations were identified involving sex and body weight, age and affected area, and temporal variations in the severity of pruritus, age group, and distribution of lesions. Among breeds, French Bulldogs, Standard Schnauzers, and Shih Tzus had the highest prevalence of CAD. These findings provide the first systematic epidemiological and clinical characterization of CAD in Ecuador, highlighting the role of environmental factors in disease severity and supporting the use of composite clinical scoring approaches in retrospective studies, thereby contributing to understanding of the disease and serving as a reference for early diagnosis, clinical management, and the development of preventive strategies. Full article

Background: The etiopathogenesis of juvenile systemic lupus erythematosus (JSLE), a complex and complicated illness, is unknown. Genetic, environmental, and dysregulated immune system responses are all thought to contribute to the disease’s etiology. Important immunological molecules that regulate different immune cells and are associated with autoimmune disorders are TNFSF4 and IKZF1. Thus, our purpose was to discover if TNFSF4 and IKZF1 mutations left the Egyptian population genetically predisposed to SLE. Methods: Using real-time polymerase chain reaction (RT-PCR), polymorphism analysis of the TNFSF4 rs1234315 C/T and IKZF1 rs11980379 C/T genes was performed on extracted DNA from JSLE patients and healthy controls. Results: TNFSF4 frequencies (rs1234315 T allele, CT, TT genotypes, dominant and recessive models) were substantially associated with a higher incidence of JSLE (p < 0.05) compared to healthy controls. Conversely, IKZF1 frequencies (rs11980379 T allele, TC, TT genotypes, and dominant model) significantly correlated with a lower incidence of JSLE. Furthermore, the TC + CC rs11980379 genotype was identified as significantly associated with lower kidney biopsy grades and a lower incidence of lupus nephritis. Conclusions: Our findings suggest that TNFSF4 and IKZF1 polymorphisms affect vulnerability to juvenile SLE. Full article

Background and Objectives: Male infertility has emerged as a growing global health concern, contributing to 20–30% of all infertility cases. It is a multifactorial condition, arising from genetic, endocrine, structural, environmental and lifestyle factors. This narrative review synthesizes current evidence on epidemiology, diagnostic advances and therapeutic strategies while highlighting emerging trends and research priorities. Materials and Methods: This review adheres to SANRA guidelines. Literature was sourced from PubMed, Saudi Digital Library, Google Scholar, and PsycINFO using MeSH terms including “Male Infertility,” “Diagnosis,” “Treatment,” and “Epidemiology.” Results: Diagnostic evaluation of male infertility includes clinical assessment, advanced semen analysis, imaging techniques, hormonal assays and molecular testing. Despite significant advances in the evaluation of male infertility, idiopathic causes (30–40%) remain challenging. Management strategies include lifestyle modifications, medical therapies including hormones and drugs, surgical interventions, and assisted reproductive technologies (ARTs). However, outcomes remain suboptimal in idiopathic and severe cases, particularly regarding sperm DNA fragmentation and environmental exposures. Conclusions: Substantial knowledge gaps exist in male infertility, particularly in idiopathic cases, molecular mechanisms of environmental pollutants, and long-term ART offspring outcomes. Future research priorities include: (1) molecular and epigenetic biomarkers for improved diagnosis and prognosis; (2) environmental exposure assessment and mitigation strategies; (3) metabolomics-guided personalized therapies; (4) regenerative medicine approaches including spermatogonial stem cell therapy; and (5) multidisciplinary integrative care models. Addressing these gaps through coordinated research and clinical innovation is essential for improving male reproductive health globally. Full article

Membranous nephropathy is a disease that has been well documented, yet its etiopathogenesis has not been fully clarified and the distinction between its primary and secondary forms has not been completely categorized. The discovery of new antigens and antibodies reveals different percentages of positivity in secondary membranous nephropathy, which is a cause of great confusion and ambiguity not only in diagnosis but also in the choice of a therapeutic approach. The aim of this review is to summarize the literature on newly discovered antigens and antibodies, and to propose a pathogenetic model based on the role of the complement system and its activation pathways. In this model, antigens are categorized based on the type of immunoglobulin deposits and the putative complement pathways that they activate, which can help to differentiate primary from secondary membranous nephropathy. The model also reflects how the deposition of foreign antigens in the basement membrane can activate both the lectin and classical complement pathways, which may explain why positive antibodies are observed in both primary and secondary forms of membranous nephropathy. Full article

Primary Failure of Eruption (PFE) is a disorder characterized by aberrant tooth eruption, in which one or more teeth fail to follow the physiological eruptive pathway and remain partially or completely embedded within the bone or soft tissues. Although the etiopathogenesis of PFE is not yet fully elucidated, several contributing factors have been identified, including genetic alterations, hormonal disturbances, and systemic conditions. An expanding body of evidence points to the centrality of genetic determinants in the etiopathogenesis of PFE, supporting its occurrence in both syndromic contexts and non-syndromic presentations. Non-syndromic forms are closely related to heterozygous variants in the Parathyroid Hormone 1 Receptor (PTH1R) gene, located on chromosome 3p21, which encodes a receptor essential for the regulation of bone and dental growth and development. In most cases, pathogenic variants result in a non-functional receptor. To date, a substantial number 50 PTH1R variants have been documented in individuals exhibiting a phenotype consistent with PFE, underscoring the central involvement of this gene in the disorder’s molecular basis. Advances in understanding the genetic contribution to PFE emphasize the need for early diagnosis, as timely identification of the condition can prevent secondary dental complications and reduce reliance in adulthood on invasive orthodontic or surgical interventions, including extractions, orthognathic surgery, and implant-supported rehabilitation. This review aims to provide a comprehensive analysis of the spectrum of PTH1R variants implicated in PFE, examining genotype–phenotype correlations and their implications for diagnostic strategies and clinical management. Full article

Atopic dermatitis (AD) is a chronic inflammatory dermatosis with a complex etiopathogenesis that, despite extensive research, remains incompletely understood. The disorder affects a substantial proportion of the global population and is associated with a significant clinical burden. In recent years, increasing attention has been directed toward the gut microbiota as a potential modulator of the course of inflammatory diseases, including AD. The aim of this review is to critically examine current evidence regarding the association between gut dysbiosis and the exacerbation of inflammatory processes observed in AD. Available studies suggest that alterations in gut microbiota composition may lead to dysregulation of the gut–skin axis, increased intestinal barrier permeability, and activation of pro-inflammatory mechanisms, thereby contributing to the amplification of AD symptoms. Overall, the analyzed findings suggest that the gut microbiota represents a significant yet underexplored component of AD pathogenesis, and that its modulation may define a novel direction for future therapeutic strategies. Elucidating the mechanisms underlying the gut–skin axis may not only inform the development of preventive approaches targeting gut microbiota regulation but also support a broader view of AD as a systemic disorder in which redox imbalance is critically involved. Full article

Multiple system atrophy (MSA) is a rare, rapidly progressive neurodegenerative disorder characterized by autonomic dysfunction, Parkinsonism, and cerebellar ataxia. While the pathological hallmark of MSA is the accumulation of α-synuclein in oligodendrocytes and formation of glial cytoplasmic inclusions (GCIs), the precise etiopathogenesis, accurate biomarkers, and promising therapeutic targets remain elusive. This review synthesizes current evidence regarding the role of microRNAs (miRNAs) in MSA, focusing on how small non-coding RNAs mediate gene–environment interactions contributing to disease pathogenesis. We explore dysregulated miRNA profiles in MSA, their impact on α-synuclein aggregation, neuroinflammation, demyelinating process, and oligodendrocyte dysfunction, and their potential as biomarkers and therapeutic targets. Understanding the complex interplay between miRNAs, genetic susceptibility, and environmental factors may provide critical insights into MSA pathophysiology and open new avenues for therapeutic intervention. Full article

Autoimmune thyroid diseases (AITDs) represent T cell-mediated, organ-specific autoimmune disorders caused by immune dysregulation, culminating in an immune-mediated attack on thyroid tissue. AITD etiopathogenesis is the result of the interplay between a genetic susceptibility and environmental factors; hypothyroidism and thyrotoxicosis are the respective clinical hallmarks of autoimmune thyroiditis and Graves’disease, the two main forms of AITD. The application of nanomedicine in the context of thyroid disorders ranges from nanodiagnosis and nanotherapy to nanotheranostics. Nanomedicine has been used to develop new sensitive methods for the determination of the TSH, iodine and TSAb. Furthermore, other studies have used nanomedicine to explore new treatments of autoimmune thyroiditis, Graves’disease and also thyroid eye disease. In the future, the application of nanomedicine will be personalized in accordance with individual genetic profiles, thus improving the therapeutic effectiveness and reducing the undesirable side effects with improved patient outcomes. Full article

Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disorder of the central nervous system (CNS) that predominantly affects children and young adults. ADEM typically follows an infectious or, less commonly, immunization-related trigger, and despite decades of clinical observation, its etiopathogenesis remains only partially understood. Clinically, the diagnosis of ADEM continues to pose significant challenges due to the absence of disease-specific biomarkers and its clinical and radiological overlap with other acquired demyelinating syndromes. This narrative review aims to summarize and critically discuss current knowledge on ADEM, with particular emphasis on its etiopathogenesis and clinical characteristics, highlighting the potential implications of recent research for clinical practice and management of this disease. Particular emphasis is placed on post-infectious immune mechanisms, including molecular mimicry, blood–brain barrier (BBB) disruption, loss of immune tolerance, and neuroinflammatory cascades. A wide spectrum of infectious triggers—viral, bacterial, parasitic—as well as post-vaccination, post-transplantation, paraneoplastic, metabolic, and host-related genetic factors are discussed in the context of immune dysregulation leading to CNS demyelination. We also highlight characteristic clinical and neuroimaging features that may aid in differentiating ADEM from other demyelinating syndromes, while acknowledging current diagnostic limitations. The integration of recent advances in ADEM immunopathogenesis with established clinical and radiological insights underscores the complexity of this disorder and highlights the evolving nature of current concepts regarding its diagnosis and clinical heterogeneity. Full article

Dercum’s disease (DD) is a rare condition characterized by intense, asymmetrical, chronic burning pain localized in adipose tissue, often accompanied by subcutaneous fat nodules, leading to a significant reduction in quality of life. It typically affects overweight or obese adults between 35 and 50 years of age, with a marked female predominance. Despite numerous hypotheses proposed over time, the pathophysiology of DD remains poorly understood. Diagnosis is particularly challenging, as it relies solely on clinical evaluation. Given the overlapping features with other conditions, including symptoms, clinical course and inheritance pattern, a differential, accurate, and timely diagnosis is essential for the effective management of DD. Current treatment strategies focus primarily on pain relief, reflecting the still uncomplete understanding of DD etiopathogenesis. This review provides an updated overview of the current knowledge on DD, with particular emphasis on recent advances in pharmacological treatment strategies. Full article

Pediatric obesity has shown a marked upward trend over the past decade, with a particularly significant impact in certain regions, to the extent that it is increasingly regarded as a global epidemic. The factors involved in its development and progression are highly diverse and complex. From genetic predisposition to the influence of epigenetic mechanisms, environmental exposures, nutritional patterns, psychosomatic factors, and endocrinological status, current evidence highlights multiple interacting pathways contributing to excessive weight gain in children. Although numerous studies have explored specific mechanisms and interventions, there remains a need for a comprehensive synthesis that integrates recent pathophysiological insights with practical clinical implications. This narrative review was undertaken to fill this gap by summarizing and analyzing the current literature on the mechanisms underlying pediatric obesity, emphasizing novel findings and evidence-based approaches. In light of recent advances in the field, this narrative review provides a comprehensive overview of the latest pathophysiological principles associated with childhood obesity, with particular emphasis on clinically relevant aspects. The review focuses on potential strategies to mitigate the impact of modifiable risk factors and highlights current trends in clinical research. The included studies were selected to cover the most relevant evidence on genetic, epigenetic, environmental, and psychosomatic determinants of pediatric obesity, providing a synthesis that informs both research and clinical practice. Its aim is to enhance the dissemination of knowledge regarding the underlying mechanisms involved in the development of pediatric obesity. In parallel, the review addresses evidence-based therapeutic approaches that may contribute to limiting the increasing incidence of the condition and its associated complications. Expanding the scope of scientifically grounded interventions may reduce obesity-related morbidity and substantially improve long-term outcomes in pediatric populations. Full article