Search Results (2,995)

Objectives: The aim was to evaluate associations of hysterectomy and oophorectomy with dementia-related outcomes while distinguishing specific surgical procedures. Methods: PubMed, Embase, and the Cochrane Library were searched from inception and updated through 20 August 2026. Adjusted hazard ratios (HRs), risk ratios (RRs), and odds ratios (ORs) were synthesized on the log scale using generic inverse-variance random-effects models with restricted maximum likelihood. Quantitative pools were restricted to explicitly defined procedures; mild cognitive impairment (MCI) was kept separate from dementia and Alzheimer’s disease (AD). Results: Nine reports involving 2,693,443 participants were included in the systematic review, of which five contributed to at least one procedure-specific meta-analysis. Hysterectomy without documented adnexal surgery was not clearly associated with dementia/AD (4 studies; pooled ratio 0.94, 95% confidence interval [CI] 0.84–1.05; I² = 82.2%). Hysterectomy with bilateral salpingo-oophorectomy/oophorectomy also showed no clear association (2 studies; 1.04, 95% CI 0.67–1.62; I² = 83.6%), nor did bilateral oophorectomy alone (4 studies; 0.99, 95% CI 0.88–1.12; I² = 75.6%). No independently extractable study evaluated hysterectomy with bilateral salpingectomy. Conclusions: Procedure-specific analyses did not demonstrate a clear association with dementia or AD, but substantial heterogeneity, residual confounding, and exposure misclassification limit certainty and preclude causal interpretation. Full article

Dermatology has historically evolved from the observation of visible skin lesions to a complex medical specialty shaped by scientific, institutional, technological, and social transformations. This article aims to analyze the historical trajectory of dermatology through the milestones that transformed practices of care, considering the relationships between skin, subject, environment, and care. This is a historical–reflective study based on a narrative literature review conducted in PubMed/MEDLINE, SciELO, LILACS, and Google Scholar, complemented by primary treatises and institutional documentary sources, covering indexed publications issued between 1950 and 2026 in English, Portuguese and Spanish, addressing the development of dermatological knowledge from ancient civilizations to contemporary practice. The analytical scope was deliberately delimited to the European and Brazilian trajectories, and other traditions are referred to only where they establish contrast. The analysis shows that dermatology was progressively structured through clinical observation, morphological classification, standardized terminology, clinicopathological correlation, hospital-based teaching, scientific societies, specialized journals, and technological innovations such as medical photography, dermoscopy, non-invasive imaging techniques, teledermatology, and artificial intelligence. In Brazil, the specialty developed through the expansion of medical education, specialized services, scientific production, professional certification, continuing education, and public health campaigns. From a systemic perspective, these milestones reveal a shift from a mechanistic view centered on cutaneous disease to a broader understanding of the individual within biological, subjective, social, environmental, technological, and healthcare contexts. This trajectory was, however, neither linear nor uniformly beneficial: stigmatization, unequal access, and dependence on technology accompanied it and persist in certain contexts. Dermatology’s history is therefore not only a history of diseases and techniques, but also of changing ways of observing, interpreting, and caring. Full article

Background: Pediatric thrombosis (PT) is a rare clinical entity manifesting from neonatal life to adolescence with possibly severe clinical complications and increasing prevalence in the last decade. Its pathogenesis has been attributed to a multitude of factors, all of which share stress and inflammation as a common denominator. Although stress-induced inflammation, marked by the upregulation of proinflammatory interleukins, such as IL-1β, creates a prothrombotic environment, its relation with thrombosis remains incompletely defined, especially in the context of PT, which differs substantially from adult thrombosis. Here, we aimed to epigenetically explore the potential link between PT and stress-induced inflammation through a combinatorial approach. Methods: Initially, we bioinformatically identified candidate stress-specific miRNAs in childhood, followed by subsequent experimental assessment in serum samples of PT patients and healthy controls in relation to subjectively perceived stress levels and the functional +3953C/T genetic polymorphism of the IL1B gene, which affects the circulating levels of the proinflammatory and stress-induced interleukin 1beta (IL-1β). Results: The bioinformatic analysis identified miR-34a-5p as the most stress-specific candidate microRNA in childhood, exhibiting the highest gene-target coverage (80.6%) of the developed panel of adversity-related genes, but is also known to regulate IL1B expression. The expression of serum miR-34a-5p was not significantly influenced by subjectively perceived stress; however, its expression was significantly reduced in the presence of the T allele of the functional +3953C/T polymorphism of its target gene, IL1B, associated with increased levels of the stress-induced proinflammatory and simultaneously prothrombotic IL-1β cytokine (FC:0.57; p = 0.024). Conclusions: The observed downregulation of miR-34a-5p in the presence of the IL-1β-increasing T allele possibly indicates a dynamic regulatory relationship, which, alongside its previously established long-term downregulation in PT, renders miR-34a-5p a promising candidate molecule for bridging the biological processes of stress-associated inflammation and thrombosis. In addition, its bioinformatically yielded candidate stress-specific role holds great potential for the non-invasive evaluation of adversity-related stress in childhood. Full article

The need to promote maternal and child health is a concurrent legislative agenda in many developing countries. This is particularly important in South Sudan due to protracted economic fragility. Although previous studies have examined the determinants of antenatal care (ANC) utilization and exclusive breastfeeding (EBF) among refugees and other vulnerable populations, limited empirical evidence has examined the association between ANC visits and EBF in displacement settings. Therefore, this study determined the association between ANC visits and EBF among refugees and host community members in South Sudan. The study was based on cross-sectional secondary data, which were collected in 2023 by the United Nations High Commissioner for Refugees (UNHCR), as part of the Forced Displacement Survey in South Sudan. The data were analyzed with a control function instrumental variable Poisson regression. The results showed that 61.54% of the women breastfed exclusively for six months and 8.14% did not breastfeed. Refugees reported a higher use of skilled ANC providers. The control function instrumental variable Poisson regression results confirmed the endogeneity of ANC visits, given the statistical significance of the control function parameter (p < 0.05). Also, ANC was significantly and positively associated with the number of months of EBF (p < 0.01). The results showed differences in the correlates of ANC visits and EBF duration across residence statuses. The combined analysis revealed a positive association between ANC visits and consultations with doctors and with nurses, while food problems, unchanged household income, urban residence, and some forms of delivery assistance had negative associations among some population groups. In the pooled and refugee results, civil-issued identification had a positive association with ANC visits. Also, income resilience showed different associations with EBF among host community women, and regional differences were observed among refugees. The findings highlight the need to strengthen access to adequate ANC and integrate breastfeeding counselling into maternal healthcare services delivered by skilled healthcare providers while tailoring interventions to the distinct circumstances of refugee and host community populations. Full article

Objectives: This study aimed to evaluate the prevalence of pathological anxiety and to identify clinical, functional, and surgical factors associated with anxiety disorders in adults who underwent hypospadias repair during childhood. Patients and Methods: This cross-sectional analysis included adult males (≥18 years) previously treated surgically for hypospadias in childhood who underwent clinical evaluation and completed validated questionnaires assessing anxiety (State–Trait Anxiety Inventory, STAI-Y1/Y2), depression (Beck Depression Inventory-II), urological function (uroflowmetry and International Prostate Symptom Score), sexual function, and genital perception. Pathological anxiety was defined as STAI-Y1 ≥ 40. Patients with and without anxiety were compared using univariate analyses, and variables reaching statistical significance were entered into a binary logistic regression model to identify clinical variables independently associated with anxiety. Results: A total of 302 patients who underwent hypospadias surgery between 1975 and 2005 were included in this study. Of the 302 traced patients, 113 (37.4%) were contacted successfully, and a total of 36 adult male patients met the inclusion criteria for this study (mean age at assessment 23.6 years). Pathological anxiety was present in 14 patients (38.9%). Compared with non-anxious individuals, anxious patients were younger at assessment (p = 0.012), showed more impaired voiding dynamics, with lower flow index values (p = 0.060), and reported more severe urinary symptoms (p = 0.050). Depressive symptoms were significantly higher in the anxiety group (BDI-II: 9.5 vs. 3.1; p < 0.001) and were independently associated with pathological anxiety on multivariable analysis (OR 1.84, 95% CI 1.16–2.92; p = 0.01). Postoperative complications were more frequent and more severe among anxious patients, although this did not reach statistical significance. Subjective and objective aesthetic outcomes did not differ between groups. Conclusions: This study demonstrates that anxiety in adults treated for hypospadias during childhood is more closely related to functional urinary impairment, surgical complications, and depressive symptoms than to aesthetic outcomes. These findings emphasise the need for long-term, multidisciplinary follow-up incorporating routine mental health assessment. Early psychological screening and targeted supportive interventions may be associated with better functional and psychosocial outcomes, supporting a holistic, integrated model of care for hypospadias patients. Full article

Objective: Given the variability in conization cone volume, specimen fragmentation, and histopathological excisional margin status, even in optimally performed procedures, the study aimed to assess the factors affecting these characteristics. Methods: This cross-sectional study based on retrospectively collected data, included 179 women who underwent large-loop excision of the transformation zone (LLETZ). The impact of age, menopausal status, parity, high-risk human papillomavirus (hr-HPV) status, transformation zone (TZ) type, conization indications, and histopathological characteristics on cone volume, fragmentation, and margin status was assessed. Results: Cone volume was positively associated with increased parity and was significantly larger in women with resection margin involvement and complete lesion excision compared to those with unspecified margins. No significant correlations were found between cone volume and age, menopausal status, hr-HPV status, TZ type, indications for LLETZ, or specimen fragmentation. Specimen fragmentation demonstrated no correlations with parity, menopausal status, LLETZ indications, or hr-HPV status, but it was more prevalent among women aged 31–35 years. Absence of fragmentation was linked to clear resection margins, while fragmentation correlated with margin involvement. Complete excision was more frequent in women with high-grade squamous intraepithelial lesions (HSIL) cytology, although lesions extended to the specimen margin primarily in specimens with biopsy-confirmed HSIL cervical intraepithelial neoplasia (CIN) 3. None of the evaluated factors were independent predictors of complete lesion excision or margin involvement. Conclusions: Cone volume, fragmentation, and margin status are clinically relevant LLETZ outcomes, although no independent predictors were identified after adjustment. Larger prospective multicenter studies are needed to determine how oncologic adequacy can be balanced with preservation of cervical function. Full article

Fathers play a vital role in caring for children with Autism Spectrum Disorder (ASD). Fathers of children with ASD today have moved far beyond the “occasional helper” role. They are deeply involved in daily caregiving routines, supporting their families financially and emotionally. The involvement of the father in raising a child with ASD reduces stress levels for both parents and strengthens family ties. The study explored and described the roles that fathers play in the care of children with ASD. A qualitative, explorative, descriptive, and contextual research design was used to gain a detailed understanding of the role’s fathers play in the care of children with ASD. Non-probability purposive sampling was used to recruit 15 fathers of children with ASD. Data were collected through semi-structured interviews and analysed using Tesch’s eight data analysis steps. The findings revealed that fathers play a variety of roles in the care of their children with ASD. These include participating in meeting the needs of their children with ASD, protecting them from harm, promoting their emotional well-being, and supporting the overall operation of the family. The experiences of fathers in this study also reflect the difficulties of raising a child with ASD, such as financial expenses, safety concerns, and community stigma. It is necessary to create father-inclusive guidelines in maternal and child health services formally to integrate fathers into every aspect of children’s care, switching from a mother-centred approach to a family-centred one. As a result, fathers will routinely participate in the consultation, decision making, and treatment of their children with ASD. Full article

Background: Maternal overweight, obesity, and inappropriate gestational weight gain (GWG) are increasingly recognized as major contributors to adverse pregnancy outcomes worldwide. Elevated pre-pregnancy body mass index (BMI) is associated with gestational diabetes mellitus (GDM), hypertensive disorders, cesarean delivery, fetal overgrowth, and long-term cardiometabolic risks for both mother and child. Regional contemporary data from Bulgaria remain limited. Objective: The objective of this study was to evaluate trends in maternal obesity and gestational weight gain among pregnant women in Southeastern Bulgaria between 2021 and 2025, using a regional cohort from Burgas, and to assess associations with maternal and neonatal outcomes. Methods: This retrospective cohort study included 1176 singleton pregnancies registered for antenatal follow-up at MC Prime Clinic–Dr. Kirovakov Ltd., Burgas, Bulgaria, between January 2021 and December 2025. Women were classified according to World Health Organization BMI categories as underweight, normal weight, overweight, and obese. Gestational weight gain was categorized as below, within, or above Institute of Medicine recommendations. Maternal and neonatal outcomes were analyzed using comparative statistics and multivariable logistic regression. Results: The mean maternal age was 30.8 ± 5.4 years, and the mean pre-pregnancy BMI was 25.1 ± 4.8 kg/m². BMI distribution was: underweight 7.6%, normal weight 49.8%, overweight 27.9%, and obesity 14.7%. Overall, 42.6% of women entered pregnancy overweight or obese. Mean total GWG was 13.2 ± 5.6 kg. Excessive GWG occurred in 39.0% of women, while only 39.6% remained within recommended ranges. Excessive GWG was significantly more common among obese women (52.8%) than among women with normal BMI (34.7%, p < 0.001). Compared with women of normal BMI, obese women had significantly higher rates of gestational diabetes mellitus (16.7% vs. 5.8%), hypertensive disorders (12.9% vs. 4.2%), preeclampsia (8.4% vs. 2.1%), cesarean delivery (47.4% vs. 28.6%), macrosomia (14.5% vs. 6.1%), and preterm birth (10.7% vs. 6.9%) (all p < 0.05). In multivariable analysis, maternal obesity independently predicted GDM (aOR 2.94, 95% CI 1.82–4.73), preeclampsia (aOR 3.18, 95% CI 1.87–5.39), cesarean delivery (aOR 2.11, 95% CI 1.42–3.14), macrosomia (aOR 2.46, 95% CI 1.51–4.01), and preterm birth (aOR 1.67, 95% CI 1.02–2.74). Conclusions: Maternal obesity and excessive gestational weight gain were highly prevalent among pregnant women in Southeastern Bulgaria during 2021–2025 and were strongly associated with adverse maternal and neonatal outcomes. These findings support the need for preconception counseling, individualized antenatal weight management, and targeted regional public health strategies. Full article

Milk-derived extracellular vesicles (EVs) carry proteins and microRNAs that mediate immune communication between mother and offspring, yet which inflammation-related cargo is conserved—and which is species specific—across mammals remains poorly defined. We assembled MetaMilkDB, a provenance-tracked database integrating proteomic, transcriptomic, metabolomic and pathway-level evidence for milk-EVs across four species (Homo sapiens, Bos taurus, Capra hircus, Ovis aries), combining curated studies with in-house EV proteomics (265,009 measurements). Of 4958 EV protein families, 570 (11.5%) formed a conserved core containing five inflammation markers (HP, LTF, MUC1, MUC15, TLR2), four re-detected in our in-house proteomes. This core was an innate scaffold and was not itself enriched for inflammation; instead, inflammation cargo concentrated in the species-specific fraction, overwhelmingly in human milk (45/966 vs. 6/1222 shared; odds ratio 9.9; q = 1.6 × 10⁻¹⁰), forming a secretory-immunoglobulin and complement module absent from ruminant cargo. A parallel layer of inflammation-annotated EV-microRNAs showed heterogeneous conservation across species and converged on TLR/NF-κB-related immune regulation. Milk-EV immunity is organized on two axes—a conserved innate scaffold shared across species and a divergent, largely human adaptive-immune fraction—clarifying which cargo is a candidate cross-species biomarker and which may underlie species-specific immune transfer. Full article

Background/Objectives: Endometrial polyps (EPs) are common benign intrauterine lesions associated with abnormal uterine bleeding, infertility, recurrent implantation failure, and recurrent pregnancy loss. Although traditionally considered hormone-dependent lesions, increasing evidence suggests that chronic endometritis (CE) may contribute to their development and recurrence. This review summarizes current evidence regarding the relationship between CE and EPs, focusing on pathophysiological mechanisms, diagnostic approaches, and clinical implications. Methods: This narrative review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). A literature search was performed using PubMed/MEDLINE, Scopus, and Google Scholar to identify original studies, systematic reviews, meta-analyses, and consensus statements addressing CE, EPs, infertility, endometrial microbiota, and polyp recurrence. Results: Current evidence demonstrates a consistent association between CE and EPs, with approximately half of premenopausal women with EPs showing histological evidence of CE. Chronic inflammation may promote polyp formation through immune activation, inflammatory cytokine signaling, abnormal angiogenesis, extracellular matrix remodeling, dysregulated apoptosis, and alterations in the endometrial microbiome. CE has also been identified as an independent predictor of EP recurrence after hysteroscopic polypectomy and may impair endometrial receptivity. Histopathological examination with CD138 immunohistochemistry remains the diagnostic reference standard. Conclusions: Emerging evidence supports an inflammatory component in the pathogenesis of endometrial polyps and suggests that CE may represent a potentially modifiable risk factor for recurrence and reproductive failure. Incorporating assessment of CE into the evaluation of selected women with recurrent polyps or infertility may improve individualized management. However, prospective studies are needed before routine screening and treatment can be universally recommended. Full article

Background: Intense physical exercise induces oxidative stress and inflammation in adult professional athletes, but data on adolescent elite athletes remain limited. Methods: Twenty-four elite adolescent soccer players were recruited and evaluated three times: pre-season baseline (T0), after one month of pre-season training (T1), and at the end of the first half of the competitive season (T2, approximately 4 months after T0). Saliva samples were collected as non-invasive surrogate indicators reflecting oxidative stress- and endothelial-related signaling. In vitro studies were performed on endothelial cells exposed to H₂O₂ concentrations observed in athletes. Results: Athletes showed a significant increase in salivary oxidative stress markers (NOX2 levels and H₂O₂) at T1 and T2 versus T0. Endothelial impairment was evidenced by reduced salivary NOx concentration and elevated endothelin (ET-1) levels. In vitro, endothelial cells exposed to H₂O₂ (8 μM) showed increased sNOX2-dp and ET-1 levels, reduced eNOS phosphorylation, and impaired tube formation (mesh number and area) compared with untreated cells. NOX2ds-tat treatment reduced cell damage and restored angiogenic capacity. Conclusions: Our findings indicate that adolescent elite athletes experience significant salivary oxidative stress- and endothelial-related alterations, potentially reflecting cardiovascular stress. These results underscore the importance of cardiovascular monitoring and the potential benefits of antioxidant strategies, even in young athletes participating in high-intensity sports. Full article

Background/Objectives: Survival of infants born very preterm or with very low birth weight has improved without a comparable reduction in neurodevelopmental morbidity, and the exposures acting during neonatal intensive care are usually studied in isolation. We aimed to identify which prenatal, perinatal and postnatal factors are independently associated, domain by domain, with neurodevelopment at 24 months’ corrected age (CA) and with the composite outcome of neurodevelopment and survival. Methods: Single-centre prospective cohort of 146 infants (135 assessed at 24 months’ CA and 11 who died between day 8 of life and the assessment) with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g admitted to a level III unit (2018–2022). Neurodevelopment was assessed with the Bayley-III; a score < 85, rather than the conventional <70 being taken as pathological, was used, with the third edition yielding systematically higher scores. Eighty-one candidate exposures were screened; for each domain a primary composite outcome (score < 85 or death) and a secondary survivors-only outcome were analysed by exploratory multivariable logistic regression. Results: Twenty-nine of 164 eligible survivors (17.68%) were lost to follow-up and did not differ appreciably from the analysed cohort (all standardised differences ≤ 0.10). Severe intraventricular haemorrhage was associated with language, sepsis and anaemia requiring transfusion with motor, and male sex and sepsis with socio-emotional development, whereas no covariate was associated with cognition. No nutritional, metabolic or postnatal-growth variable was independently associated with any domain, and no association survived Benjamini–Hochberg control of the false discovery rate (optimism-corrected c-statistics 0.598–0.739). Conclusions: These findings are associations rather than evidence of causality; they are hypothesis-generating and warrant multicentre external validation and longer follow-up. Full article

Background: Diet during pregnancy plays a crucial role in promoting healthy dietary behaviours and positive maternal and child health outcomes. However, evidence regarding the factors associated with healthy dietary behaviours among pregnant women is limited. The SaperePer study aims to assess the dietary behaviours of pregnant women and identify the sociodemographic, lifestyle, and health-related factors that influence their choices. Methods: This cross-sectional analysis included 1254 pregnant women recruited from two Northern Italian centres (Turin and Cuneo). Dietary behaviour was assessed using a questionnaire, which generated a diet-related scores. Associations between these scores and participants’ characteristics were investigated using multivariable regression models. Results: Overall, participants reported relatively favourable dietary habits and a low prevalence of risky behaviours. Higher socioeconomic position was found to be one of the strongest contributing factors to dietary behaviour (medium vs. low β (95% CI) = 1.18 (0.93, 1.42); high vs. low β (95% CI) = 1.57 (1.10, 2.04), both p < 0.001). Higher dietary behaviour scores were positively associated with older maternal age, moderate physical activity, and better perceived physical and psychological health, whereas smoking and alcohol consumption were associated with lower scores. Conclusions: Dietary behaviour during pregnancy appears to be shaped by a complex interplay of socioeconomic, behavioural, and health-related factors rather than by nutritional knowledge alone. These findings highlight the need for tailored interventions that address the social and contextual features of dietary behaviour to encourage healthier habits during pregnancy. Full article

Hepatitis B virus (HBV) infection is a worldwide health concern that infects nearly 254 million people globally and causes more than 1 million deaths annually. The highest prevalence is seen in sub-Saharan Africa and the Western Pacific region. Cirrhosis, liver failure, and hepatocellular carcinoma (HCC) are reported as leading complications of chronic HBV. The route of transmission of this infection is mainly by exposure to infected blood and bodily fluids. Transmission from mother-to-child remains the predominant route in highly endemic areas. Vaccination has significantly reduced HBV seroprevalence and complications. However, incomplete vaccination of newborns continues to be a major obstacle to elimination of the disease. Current prevention strategies include universal vaccination, perinatal prophylaxis with hepatitis B immune globulin, and maternal antiviral therapy in pregnant women with high viral load. The management of chronic hepatitis B virus infection predominantly depends on nucleoside analogs, including entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide, as well as pegylated interferon alfa. These therapies effectively suppress viral replication and reduce the risks of cirrhosis, HCC, and liver-related mortality, but they rarely achieve functional cure characterized by hepatitis B surface antigen loss. The persistence of covalently closed circular DNA (cccDNA) remains a major hindrance in HBV eradication. Therefore, novel therapeutic strategies targeting different stages of the viral life cycle, including capsid assembly modulators, small interfering RNAs, nucleic acid polymers, and cccDNA-directed approaches, are under active investigation. This review summarizes the epidemiology, prevention, current therapies, clinical outcomes, and emerging therapeutic advances in HBV infection, highlighting ongoing efforts toward achieving a functional cure and global HBV elimination. Full article

Although short-term CAT score variability has been associated with COPD exacerbations, evidence supporting its integration into virtual assistant-based monitoring remains limited. The aim of this study was to assess the short-term variability in CAT scores using a virtual management tool in patients with COPD and to examine its relationship with the prediction of exacerbations. A prospective observational single-center study was conducted in patients aged >35 with COPD and an exacerbator phenotype (≥2 outpatient exacerbations or ≥1 hospitalization in the previous year). Follow-up was performed weekly, including the CAT questionnaire, through calls were conducted by the virtual assistant Tucuvi Health Manager^® during a period of one year. A total of 106 patients were included; 64.2% were male, with a mean (SD) age of 66.8 (7.9) years and a median FEV₁(%) of 38.8 (30.1–45.0). The mean follow-up was 25 weeks [IQR 20–35], during which 73 (69%) patients experienced ≥1 exacerbation, accounting for 192 episodes (26% of which required hospitalization). A total of 2550 CAT scores were collected. The mean baseline CAT score was 17.9 (7.6), and scores increased significantly during exacerbations compared with non-exacerbation periods and according to exacerbation severity. Each one-point increase in absolute CAT score was associated with an 11.1% increase in the odds of exacerbation (OR: 1.11; 95% CI: 1.08–1.13), while a weekly variation of ≥2 points (MCID) was associated with more than sixfold higher odds (OR: 6.30; 95% CI: 4.28–9.27). The optimal cut-off for CAT change in the prediction of exacerbation risk was 3 points with a ROC curve of 0.773. Weekly deterioration in CAT scores was associated with increased exacerbation risk in patients with COPD. Short-term increases in CAT may serve as clinically useful warning signals for exacerbation. Full article