Search Results (8,788)

Background. Type 2 diabetes mellitus (T2D) and moderate-to-severe obstructive sleep apnea (OSA) commonly coexist and exacerbate poor glycemic control, systemic inflammation, and diminished quality of life (QoL). Although continuous positive airway pressure (CPAP) therapy has demonstrated metabolic and anti-inflammatory benefits, its real-world impact in Bulgarian outpatient settings—where CPAP costs are borne entirely by patients—has not been characterized. Objectives. To evaluate the effects of six months of CPAP therapy on glycemic control (hemoglobin A₁c [HbA₁c]), systemic inflammation (high-sensitivity C-reactive protein [hsCRP]), body mass index (BMI), lipid profile (low-density lipoprotein [LDL]), QoL (Short Form 36 Physical Component Summary [SF-36 PCS] and Mental Component Summary [SF-36 MCS]), and survival among Bulgarian outpatients with T2D and moderate-to-severe OSA. Methods. In this prospective, multicenter cohort study conducted from January 2022 to July 2023, 142 adults with established T2D and OSA (apnea–hypopnea index [AHI] ≥ 15) were enrolled at three outpatient centers in Bulgaria. Fifty-five patients elected to purchase and use home-based CPAP (intervention group), while 87 declined CPAP—either because of cost or personal preference—and continued standard medical care without CPAP (control group). All participants underwent thorough outpatient evaluations at baseline (month 0) and at six months, including measurement of HbA₁c, hsCRP, BMI, fasting lipid profile (LDL), and patient-reported QoL, via the SF-36 Health Survey. Survival was tracked throughout follow-up. Results. After six months, the CPAP group experienced a significant reduction in HbA₁c from a median of 8.2% (IQR 7.5–9.5%) to 7.7% (6.7–8.7%), p < 0.001, whereas the control group’s HbA₁c decreased modestly from a median of 8.6% (IQR 7.9–9.4%) to 8.3% (7.6–9.1%); p < 0.001), with a significant between-group difference at follow-up (p = 0.005). High-sensitivity CRP in the CPAP arm fell from a median of 2.34 mg/L (IQR 1.81–3.41) to 1.45 mg/L (IQR 1.25–2.20), p < 0.001, while remaining unchanged in controls (p = 0.847). BMI in the CPAP group declined significantly from 28.6 kg/m², IQR 26.6–30.6 to 28 kg/m², IQR 25.6–29.2 (p < 0.001), compared to no significant change in controls (median 28.9 kg/m²), p = 0.599. LDL decreased in the CPAP group from a median of 3.60 mmol/L (IQR 3.03–3.89) to 3.22 mmol/L (IQR 2.68–3.48), p < 0.001, with no significant reduction in controls (p = 0.843). Within the CPAP arm, both SF-36 PCS and SF-36 MCS scores improved significantly from baseline (p < 0.001 for each), although between-group differences at six months did not reach statistical significance (PCS: 48 ± 10 vs. 46 ± 9, p = 0.098; MCS: 46, IQR 40–54 vs. 46, IQR 39–53, p = 0.291). All-cause mortality during follow-up included 2 events in the CPAP group and 11 events in the control group (log-rank p = 0.071). Conclusions. In Bulgarian outpatients with T2D and moderate-to-severe OSA, six months of CPAP therapy significantly improved glycemic control, reduced systemic inflammation, lowered BMI and LDL, and enhanced QoL, with a non-significant trend toward reduced mortality. These findings underscore the importance of integrating CPAP into multidisciplinary management despite financial barriers. Full article

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapies. Early and accurate imaging is crucial for diagnosis and management. This review summarizes the current evidence on MRONJ imaging findings across modalities and identifies gaps for future research. Materials and Methods: This narrative review analyzed 32 studies (2010–2024) retrieved from PubMed and EBSCO examining imaging findings and diagnostic patterns of medication-related osteonecrosis of the jaw across different modalities. Two independent reviewers screened all articles, extracted data, and assessed methodological quality. Results: Early-stage MRONJ findings included osteosclerosis, lamina dura thickening, and increased prominence of the inferior alveolar canal, while late-stage findings included periosteal reactions, sequestration, and cortical erosion. CBCT and MRI were most sensitive for early detection and lesion extent. However, substantial variability in imaging protocols limited direct comparisons between studies. Conclusions: This review highlights the variable imaging findings of MRONJ and the need for standardized protocols. Advanced imaging techniques and quantitative indices hold promise for improving early diagnosis, staging, and management. Full article

Background/objectives: Treating pediatric brain tumors remains challenging due to the limitations of conventional therapies, which often damage healthy cells. Ketogenic diets (KDs)—high in fat and low in carbohydrates—have emerged as potential adjunct therapies by limiting glucose availability and offering ketones as an alternative energy source proposed to hinder tumor growth. However, due to limited awareness, there is hesitancy to recommend KDs. Methods: This study assessed oncologists’ knowledge and perceptions in Saudi Arabia regarding KD use in pediatric brain cancer patients. A cross-sectional survey was conducted with 94 oncologists from five major Riyadh healthcare centers, examining their knowledge, safety concerns, feasibility, and perceived efficacy of KDs. Results: Results showed that 67% correctly identified the basic composition of KDs, though 43% were neutral about its safety. Concerns about malnutrition and side effects were common and 53% found adherence to the diet challenging in pediatric patients. While 48.9% believed KDs could improve outcomes when combined with standard therapies, many stressed the importance of tailoring recommendations to individual medical conditions, including patient age, treatment stage, and overall nutritional status. Participants’ responses revealed variability in knowledge and perception levels regarding KDs, with consultants and internationally educated oncologists generally expressing more favorable views compared to fellows, who showed greater hesitancy. Conclusions: This study shows a mixed level of knowledge and perceptions among oncologists, reflecting a lack of consensus about KDs’ safety, feasibility, and potential benefits. These findings suggest the need for further education, clearer guidelines, and interdisciplinary collaboration to support informed decision-making, particularly in the local context. Full article

Osteoarthritis in dogs is commonly managed with non-steroidal anti-inflammatory drugs (NSAIDs), nutraceuticals, and other medications aimed at alleviating pain and inflammation. Although NSAIDs are generally considered the most effective option, their use is contraindicated in certain conditions due to adverse side effects. Consequently, there has been growing interest in alternative or complementary therapies, such as acupuncture, laser therapy, and their combination. Laser acupuncture involves stimulating traditional acupuncture points with low-intensity laser light, producing anti-inflammatory, analgesic, anti-edematous, and bio-stimulatory effects. In this study, 19 dogs with osteoarthritis were assigned to two groups: 10 received laser acupuncture treatment (Group T) using a dual-wavelength system delivering continuous and pulsed, synchronized emissions, while 9 served as controls (Group C). After 30 days, only Group T showed significant improvement (p < 0.01), with reduced pain and improved joint mobility. Significant reductions in LDH and CPK were observed in Group T, along with changes in inflammatory markers (IL-6 and IL-10, though not TNF-α) and a significant increase in biological antioxidant potential. These preliminary findings indicate that laser acupuncture, applied according to a standardized protocol and adapted to the site of disease, may represent a viable non-invasive therapeutic option for canine osteoarthritis, particularly in cases where pharmacological treatment is contraindicated or ineffective. Further large-scale, randomized controlled trials are warranted to confirm these results and establish long-term efficacy. Full article

Background/Objectives: Mental disorders are a growing global concern, with depression being among the most prevalent. Portugal ranks second in antidepressant consumption within the OECD, following a threefold increase between 2000 and 2020. In inland regions such as Beira Interior, reduced healthcare services and distance from major hospitals further complicate access to care. This study analysed 142 patients from Beira Interior undergoing antidepressant therapy to characterise their demographic and clinical profile and to assess associations with adverse effects. Methods: A cross-sectional survey collected demographic data, clinical diagnoses, prescribed antidepressants, concomitant medications, and reported adverse effects. Both descriptive and inferential statistical analyses were performed. Results: Most participants were female (81.0%), with a mean age of 57.8 years. Major depression was the most common diagnosis (76.1%). Selective serotonin reuptake inhibitors (47.4%) and trazodone (27.8%) were the most prescribed agents. Treatment had lasted one to five years in 59.9% of cases. Concomitant use of benzodiazepines (76.8%) and antipsychotics (48.6%) was frequent. Reported adverse effects included anticholinergic symptoms (38.7%) and confusion/agitation (26.8%). Women were more likely to use serotonin modulators, while patients >64 years had higher odds of using tetracyclic/unicyclic antidepressants, serotonin modulators, and multiple antidepressants. These classes were significantly associated with increased adverse effects. Conclusions: The findings reveal important risks related to polypragmasia and adverse reactions, underscoring the need for individualised prescribing, rigorous monitoring, and strict adherence to guidelines. Larger, stratified, and longitudinal studies are needed to clarify causality and optimise treatment outcomes. Full article

Background: This study evaluated the impact of diabetes mellitus (DM) and its treatments on cardiovascular outcomes in prostate cancer (PC) patients aged 66 years and older, with or without androgen deprivation therapy (ADT) exposure. Methods: Using the SEER-Medicare database (2009–2017), two cohorts were created: Cohort 1 included all PC patients enrolled in Medicare Parts A and B; Cohort 2 was a subset of Cohort 1 receiving ADT and enrolled in Medicare Part D. Exposures were DM and DM medications. Outcomes included cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality, analyzed using multivariable Fine-Gray and Cox models. Results: Cohort 1 included 150,647 PC patients (32% with DM, median age 72). DM was associated with higher risk of CVE (subdistribution hazard ratio [sHR] 1.20, 95% CI 1.17–1.22), CVm (sHR 1.35, 1.28–1.43), and all-cause mortality (adjusted HR [aHR] 1.22, 1.19–1.26) (all p < 0.001). Non-Hispanic Blacks (NHBs) and patients from lower socioeconomic (SES) and education areas experienced comparable or worse outcomes. In Cohort 2 (n = 14,938), DM patients on non-metformin therapies had higher all-cause mortality (aHR 1.33, 1.11–1.25; p = 0.002) than those on metformin, particularly in NHB and low education groups. Sensitivity analyses with follow-up limited to two years showed consistent results as overall. Conclusions: Diabetic PC patients, especially NHB, lower SES and lower education subgroups, were associated with worse cardiovascular and all-cause mortality outcomes. Metformin may be associated with better outcomes in these populations, warranting further research on the disparities in PC and diabetes, and cardioprotective effects of DM medications across different subpopulations. Full article

Emerging research has shown that pharmacist-led comprehensive medication management (CMM) can be an effective strategy for controlling hypertension. A synthesis of the evidence on the overall effects of CMM on clinical, quality, and economic outcomes could help inform and contribute to improvements in programming and practice. Presently, such a synthesis is limited in the literature. To address this gap, we conducted a scoping review of CMM effects on these outcomes, organized by 4 domains: therapeutic, humanistic, safety and economic. Using predefined search terms for articles on studies published between 2010 and 2024, we performed a literature search utilizing these terms to search the MEDLINE, Cochrane Library and CINAHL databases. For each of the identified studies, we applied a multi-stage screening process to extract data, chart results, and synthesize findings. The process took into account methodology of study design, patient population involved, CMM implementation, relevance of outcomes to clinical improvement, and factors that were deemed relevant to study selection. In total, 49 experimental, observational, and simulation-based studies were included in the scoping review. The synthesis focused on outcomes most frequently reported and those rigorously evaluated by the studies in the review. They included clinical measures of blood pressure reduction and control, frequency and duration of healthcare visits, and changes in medication therapy regimen and medication adherence. Overall, CMM interventions were found to have significantly favorable effects on systolic blood pressure reduction, hypertension control, and medication changes. Other outcomes, which showed positive effects, included self-reported patient experience and behaviors, emergency department visits, hospitalizations, mortality, and program costs and related savings from implementing a CMM program. Some results, however, were mixed. For example, a number of studies reported outcomes data without significance testing and many generally lacked consistent characterization of their programming and implementation processes. Future research and practice evaluations should include these elements in their documentation. Furthermore, a more consistent approach to implementing CMM in the field may lead to better support of program delivery fidelity, helping to optimize CMM, moving it from demonstrated efficacy to intervention effectiveness in the real world. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

Background: Hyponatremia, defined as a serum sodium concentration below 135 mmol/L, is a common and serious electrolyte disturbance in patients with traumatic brain injury (TBI), and may be treated with vaptans—vasopressin receptor antagonists that promote water excretion. This study evaluates the safety and efficacy of tolvaptan, a vaptan, in correcting hyponatremia in TBI patients compared to a non-trauma cohort. Methods: We conducted a single-center retrospective analysis of 126 adult patients in the intensive care unit who received tolvaptan. The study included 73 TBI patients and 53 non-trauma patients with chronic medical conditions. Serum sodium levels were assessed 48 h after tolvaptan administration and compared between the two groups. Results: At baseline, the mean sodium level was higher in the TBI group compared to the non-trauma group (128.3 ± 4 mmol/L vs. 125.3 ± 5 mmol/L, p = 0.003). Both groups showed a significant increase in sodium levels after 48 h of tolvaptan therapy, and while the post-treatment sodium level was higher in the TBI group, the absolute change was not significantly different between the two groups (132.3 ± 5 mmol/L vs. 130.9 ± 7 mmol/L, p = 0.18). Sodium normalization (135–145 mmol/L) occurred in 48% of TBI patients versus 30% of non-trauma patients (p = 0.045), though this difference was not statistically significant after adjusting for baseline sodium levels. No cases of osmotic demyelination syndrome were observed. Conclusions: Our preliminary analysis suggests that tolvaptan effectively increases sodium levels in both TBI and non-trauma patients with hyponatremia. Further research is needed to fully characterize this response and determine the optimal use of tolvaptan for managing hyponatremia in the TBI population. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with a dismal prognosis; this is in part due to its late diagnosis at advanced stages. For many patients, medical treatment is the only practicable therapy. In recent years, the development of new technologies that investigate genomic biomarkers has improved the concept of precision medicine to treat patients with PDAC. Through endoscopic ultrasound–tissue acquisition (EUS-TA), tissue from pancreatic cancers can be collected; thus, it has the potential to advance personalized treatment by allowing the assessment of genomic alterations. In this review, we explore the role of EUS in genomic profiling and its strengths and pitfalls in obtaining samples for next-generation sequencing (NGS). Full article

Background/Objectives: Information on the economic impact and healthcare resource utilization (HCRU) associated with Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) is lacking. Methods: A retrospective review of medical records identified patients diagnosed with BPDCN between 2009 and 2023. Data on outpatient resource use, reimbursement, frequency and duration of hospitalizations, and transfusion burden were collected from diagnosis to death or last follow-up. Results: A total of 38 patients with a median age of 66 years were included. Conventional intensive chemotherapy (CHT) regimens were initially administered to 58% of patients, while targeted therapies were used in 37% of cases. The ratio of total days hospitalized to the overall follow-up period was 17%, with a total of 182 hospitalizations (average of 5 per patient; mean duration 20 days). The mean total reimbursement was EUR 109,104 per patient, primarily attributed to hospital admissions (EUR 89,158; EUR 18,118 per hospitalization). Hospitalizations before or without any allogeneic hematopoietic stem cell transplant (alloHSCT) accounted for 70% of total admissions, with an average overall cost of EUR 50,285 per patient (EUR 12,427 per hospitalization). AlloHSCT-period hospitalizations occurred in 18 patients, with a mean total reimbursement of EUR 122,497 per patient and EUR 30,464 per hospitalization. Conclusions: The active treatment of BPDCN imposes a high economic burden and extensive HCRU. Comparative pharmacoeconomic studies evaluating the cost-effectiveness of new therapies for BPDCN are needed to identify patient subgroups that may benefit most from these treatments. Full article

Background/Objectives: McCune–Albright syndrome (MAS) is a rare disease characterized by the triad of fibrous dysplasia (FD), café au lait skin macules, and hyperfunctioning endocrinopathies. Although there are many case reports of MAS, few have discussed long-term oral management. We describe the long-term follow-up of an MAS patient over 15 years. Case Presentation: A male patient aged 13 years and 7 months was referred to our department with a chief complaint of difficulty with toothbrushing. He was diagnosed with MAS at 9 years, and bisphosphonate therapy was started. We continued to review the patient periodically and extracted several primary teeth with no adverse effects such as the medication-related osteonecrosis of the jaw (MRONJ). We evaluated the changes in FD using facial photographs, and facial asymmetry worsened over time until the age of 19, when surgery was performed. Although improvement was observed after surgery, there was a tendency for recurrence up to the age of 25 years. Conclusions: Continuous dental support over 15 years has prevented oral disease and minimized the need for surgical procedures such as tooth extractions, which are factors in MRONJ. The worsening of FD on the left side caused facial asymmetry until the age of 25 years; however, the asymmetry may have stabilized with the development of FD on the right side and with age-related changes. It is important for dental professionals to provide MAS patients with appropriate oral health instruction and oral management, taking changes in FD into consideration. Full article

Background: Metastatic pancreatic cancer (mPC) is an aggressive disease with high morbidity and mortality, and long-term survival rates remain poor. New therapeutic options that demonstrate statistically significant improvements in overall survival (OS) and progression-free survival (PFS) are still being sought. Although many first-line (FL) treatment studies exist in the literature, there are almost no prospective studies on second-line (SL) therapy. Methods: The aim of this clinical study was to retrospectively analyze the medical history of 251 patients diagnosed with mPC, treated first-line (FL) with GEM-NAB between February 2017 and January 2025. After disease progression, 109 patients received SL treatment. We also present a multivariate analysis based on routinely collected data (demographic, clinical, and laboratory parameters) evaluating their impact on OS and PFS. Results: The median age was 66 years (range 37–84 years). The median PFS was 2.33 months (95% CI 1.69–2.97). Specifically, the mPFS was 4.1 months (95% CI 1.31–6.90) for FOLFIRINOX; 2.8 months (95% CI 2.30–3.30) for FOLFIRI; 2.37 months (95% CI 1.66–3.08) for NALIRI; 1.47 months (95% CI 1.18–1.75) for FOLFOX 6; and 0.93 months (95% CI 0.00–2.64) for GEM-cisplatin. The median OS was 5.03 months (95% CI 3.75–6.31). Seven patients achieved a partial response (overall response rate 6%). The most frequent adverse events (AEs) included anemia, fatigue, peripheral neuropathy, neutropenia, and thrombocytopenia. Conclusions: As a result, SL treatments were compared, and some statistically significant difference was found between them in PFS time for chemotherapy FOLFIRINOX and GEM + cisplatin. The most frequent AEs occurred during treatment with FOLFIRINOX chemotherapy. Full article

Background: Breast cancer is frequently diagnosed in older women. However, the impact of surgery on survival is not well studied and prognosis for women ≥ 80 years of age is progressively depending on comorbidities. Methods: Medical records of consecutive women aged ≥ 80 years diagnosed with primary breast cancer treated with upfront surgery at two Breast Centers from 2011 to 2021 were retrospectively analyzed. Results: A total of 553 consecutive women with a median age of 83 years and a median tumor diameter of 21 mm were analyzed (574 lesions). Clinical Stages II or III were found in 263/574 (46%) and 101/574 cases (18%), respectively. Axillary staging was completely omitted for 94/542 invasive lesions (17%), and this increased over time from 2% to 33% (p < 0.001). Adjuvant hormone therapy and radiotherapy were omitted in 134/490 (27%) and in 122/420 patients (29%), respectively, while only 26/195 (13%) of patients with a clear clinical indication received adjuvant chemotherapy. At a median follow-up of 61 months (6–147) the 5- and 10-years overall survival (OS) were 64% and 21%, while breast cancer-specific survival (BCSS) at 5 and 10 years were 94% and 78%, respectively. Adjuvant therapies were not associated with a significant improvement in BCSS, while worse OS was associated with older age or more comorbidities as measured by the Charlson Comorbidity Index (CCI) (p < 0.001 and p = 0.012, respectively). Conclusions: Breast surgery, when possible, has a primary role even for women > 80 years of age, and it is associated with a reasonable BCSS. De-escalation of adjuvant therapies should be considered in this setting because survival is largely determined by age and co-morbidities. Full article

Background: The increasing demand for care in hospital settings, often at a high intensity, requires organizing work according to 24 h shifts. Nevertheless, shift work (SW), especially at night, alters the circadian rhythm, negatively affecting the psychophysical health of nurses, compromising their quality of life, and jeopardizing patient safety. Shift-work-related diseases (SWDs) can arise from these disruptions. Methods: This systematic review aims to evaluate the effects of several types of medical, psychotherapeutic, and educational interventions and strategies on shift-work-related diseases (SWDs). The databases PubMed, Embase, Web of Science, and Cochrane were searched using the MESH terms “shift work” and “nurses” from January 2015 to March 2025. A total of 43 articles were included in the final analysis. Results: Quantitative findings from the studies showed, for example, improvements in sleep quality scores ranging from 15% to 40% with optimized shift planning, reductions in fatigue scores by 20–35% through strategic napping, and moderate effect sizes for light therapy interventions. Physical activity and relaxation techniques were associated with a 10–25% improvement in subjective well-being indices, while meal timing interventions led to reductions in gastrointestinal symptom prevalence by up to 18%. The selected articles were discussed by dividing them according to the type of intervention applied to shift nurses, namely improvement of shift planning, light and temperature modulation, introduction of napping, supplementation, meal management, psychotherapy, sleep education, physical activity, relaxation techniques and yoga, music therapy, and aromatherapy. This categorization was performed to highlight the range of strategies tested and their relative quantitative impact. Conclusions: There is evidence that SWDs can be mitigated through targeted interventions and strategies. The limitations of the studies examined include small sample sizes, extreme heterogeneity of follow-up, the few numbers of randomized controlled trials, and the prevalence of female or Intensive Care Unit nurses in study samples. Further research should focus on large-scale randomized controlled trials, multicenter longitudinal studies, and the evaluation of the most promising interventions—particularly light therapy, optimized shift scheduling, and structured napping protocols—to assess their long-term efficacy and generalizability. Full article