Search Results (999)

Background: Dementia is a condition that affects the components of cognitive functions that are responsible for processing thought. There is no cure, but both pharmacological and non-pharmacological treatment helps to slow its progression. Presently, there is an increasing interest in non-pharmacological treatment, including cognitive stimulation, which aims to improve the person’s preserved abilities in order to slow down the progression of the disease while maintaining the current state for as long as possible. The aim of this systematic review is to analyse the effects of cognitive stimulation in older people with dementia. Methods: This systematic review was conducted in the Pubmed, OTSeeker, ScienceDirect, Dialnet, and Scopus databases. The inclusion criteria were controlled trials, randomised and non-randomised clinical trials, and pilot studies that applied cognitive stimulation to older people with dementia or compared this therapy with another type of non-pharmacological intervention. Results: Twenty-one studies were included in the review. Most of the articles showed that the intervention group achieved better cognitive performance than the control group after completing the cognitive stimulation intervention. Four of the studies assessed caregivers and, in two of the them, improvements in the caregiver’s relationship with the person with dementia were achieved and the caregivers also improved their health-related quality of life. Conclusions: According to the results, cognitive stimulation does influence older adults with dementia, especially on cognitive functions. The results also indicate that cognitive stimulation can be beneficial for the caregivers because this therapy has positive effects on their quality of life as related to both their health and their relationship with the person with the disease. However, more research is needed, especially regarding the quality of life of patients with the disease. Full article

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children’s dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4–14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = −0.48, 95% CI: −0.72 to −0.25, p < 0.001). Heart rate was also significantly reduced (SMD = −0.42, 95% CI: −0.68 to −0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach. Full article

Background: Early hematoma expansion is a major determinant of poor outcomes after spontaneous intracerebral hemorrhage (ICH). Identifying reliable predictors of hematoma expansion may facilitate risk stratification and timely interventions. This study aimed to evaluate clinical, laboratory, and radiological factors associated with early hematoma expansion within 24 h. Methods: We retrospectively analyzed consecutive patients with spontaneous ICH admitted to a tertiary hospital in Korea between 2009 and 2021. Inclusion criteria were aged ≥ 18 years, primary spontaneous ICH, baseline non-contrast CT (NCCT), and follow-up CT within 24 h. Clinical, laboratory, and medication histories were collected, and NCCT/CT angiography (CTA) imaging markers (spot sign, blend sign, hypodensity, swirl sign, black hole sign, island sign, mean hematoma density) were evaluated. Early hematoma expansion was defined as an absolute volume increase ≥6 cm³ or a relative increase ≥33% on follow-up CT. Multivariate logistic regression identified independent predictors. Results: Among 899 screened patients, 581 met inclusion criteria (mean age 61.6 years; 59.7% male). Seventy-eight patients (13.4%) experienced early hematoma expansion. Independent predictors included CTA spot sign (adjusted OR 9.001, 95% CI 4.414–18.354), blend sign (OR 3.054, 95% CI 1.349–6.910), mean hematoma density <60 HU (OR 2.432, 95% CI 1.271–4.655), male sex (OR 2.902, 95% CI 1.419–5.935), and statin use (OR 2.990, 95% CI 1.149–7.782). Prior antiplatelet therapy was associated with a reduced risk of hematoma expansion (OR 0.118, 95% CI 0.014–0.981). Conclusions: Early hematoma expansion occurred in 13.4% of patients and was predicted by a combination of CTA and NCCT markers, as well as clinical and pharmacological factors. Spot sign remained the strongest predictor, while NCCT features such as blend sign and low hematoma density also provided practical prognostic value. These findings underscore the multifactorial pathophysiology of ICH expansion and highlight the importance of integrating imaging, clinical, and therapeutic variables into prediction models to improve early risk stratification and guide targeted interventions. Full article

Quercetin, a key flavonoid in Anoectochilus roxburghii (Wall.) Lindl., plays an important role in determining the pharmacological value of this medicinal herb. However, traditional methods for quercetin quantification are destructive and time-consuming, limiting their application in real-time quality monitoring. This study investigates the hyperspectral response characteristics of quercetin using near-infrared hyperspectral imaging and establishes a feature-based model to explore its detectability in A. roxburghii leaves. We scanned standard quercetin solutions of known concentration under the same imaging conditions as the leaves to produce a dilution series. Feature-selection methods used included the successive projections algorithm (SPA), Pearson correlation, and competitive adaptive reweighted sampling (CARS). A 1D convolutional neural network (1D-CNN) trained on SPA-selected wavelengths yielded the best prediction performance. These key wavelengths—particularly the 923 nm band—showed strong theoretical and statistical relevance to quercetin’s molecular absorption. When applied to plant leaf spectra, the standard-trained model produced continuous predicted quercetin values that effectively distinguished cultivars with varying flavonoid contents. PCA visualization and ROC-based classification confirmed spectral transferability and potential for functional evaluation. This study demonstrates a non-destructive, spatially resolved, and biochemically interpretable strategy for identifying bioactive markers in plant tissues, offering a methodological basis for future hyperspectral inversion studies and intelligent quality assessment in herbal medicine. Full article

Background/Objectives: Traumatic brain injury (TBI) is a major global cause of death and disability, with long-term cognitive, behavioral, and functional consequences. Despite its high burden, management is complicated by heterogeneous presentations and limited evidence. This review summarizes recent advances in monitoring, therapeutic strategies, neuroprotection, and rehabilitation, while highlighting future directions toward individualized and globalized care. Methods: This paper is a narrative review of clinical trials, systematic reviews, and observational studies, focusing on invasive and non-invasive monitoring, pharmacologic and non-pharmacologic interventions, neuroprotective agents, stem cell therapy, and advanced rehabilitation modalities. Results/Findings: Our review focuses on emerging monitoring techniques, including brain tissue oxygenation, cerebral microdialysis, and multimodal strategies, that provide detailed insights but lack standardized application. Interventions such as anti-inflammatory agents, hypothermia, hyperosmolar therapies, and metabolic suppression show mixed efficacy, with few therapies supported by high-level evidence. Novel agents like erythropoietin and progesterone demonstrate neuroprotective potential in preclinical models but remain inconclusive in clinical trials. Stem cell therapies and extracellular vesicle approaches are promising in early studies. Rehabilitation is expanding with virtual reality, robotics, and neurostimulation to promote neuroplasticity. Personalized medicine approaches incorporating biomarkers and machine learning may refine prognostication and guide therapy. Global inequities persist, particularly in low-resource settings. Conclusions: TBI care is shifting toward individualized, multimodal, and technology-driven strategies. While emerging therapies show promise, high-quality randomized trials and global implementation strategies are needed to improve outcomes and reduce disparities. Full article

Background: hearing loss represents, today, one of the most significant health problems affecting the world’s population. This clinical condition, particularly manifest in adulthood, can arise or be aggravated by both the presence of specific pathologies and by taking multiple classes of drugs at the same time. Methods: to understand this relationship, the present non-interventional observational study aimed to investigate the relationship between worsening hearing abilities in 1651 patients aged between 18 and 99 years. In particular, the thorough history of patients allowed us to evaluate the pathological profiles, pharmacological profiles, and therapeutic regimens adopted. This allowed us to evaluate its association with self-reported hearing loss, assessed through the administration of the HHIE-S-It questionnaire. Furthermore, given the presence of multimorbidity, the possible correlation between self-reported hearing loss and the specific classes of drugs, categorized using the Anatomical Therapeutic Classification (ATC) system, was evaluated. Results: the results highlighted how patients taking drugs, both in mono- and polytherapy regimens, had higher hearing deficits than patients not taking drugs. Furthermore, an apparent dose–response effect, in which the risk of moderate to severe impairment progressively increased with the number of drugs taken, was also observed. Different classes of drugs, particularly those used for the treatment of diseases of the cardiovascular system, as well as drugs for acid-related disorders, were significantly linked to an increased risk of perceived hearing impairment. On the contrary, agents belonging to the antidiabetic category have proven to be drugs capable of offering a potential protective effect. Conclusion: this study highlighted how both the number of drugs taken and some specific categories of drugs can contribute to perceived hearing impairment. While this evidence highlights the importance of integrating audiological evaluation into the management of patients in polypharmacy, the cross-sectional nature of the design precludes the inference of causality. This evidence still favors safer and more personalized therapeutic strategies. Full article

Background/Objectives: Pain is a common issue among patients undergoing hemodialysis (HD), and palliative care (PC) aims to improve their quality of life. This study investigates the incidence, nature, and treatment of pain in chronic HD patients in Hungary, along with factors influencing pain intensity and the benefits of PC. Methods: This study used a cross-sectional design involving 159 patients with chronic end-stage kidney disease (ESKD) receiving HD at the National Dialysis Center in Pécs, Hungary. Pain was assessed using a “PQRST” questionnaire, and statistical analyses were performed on clinical and laboratory data to identify potential pain triggers. We also reviewed the latest literature on PC for patients with ESKD undergoing HD. Results: Approximately 57% of patients reported pain, with 88% indicating moderate-to-severe pain levels. While 64% used regular pain medication, only 29% experienced complete pain relief. Non-pharmacological methods, along with adjuvant agents and strong notably different based on parathyroid opioids, were underutilized. Pain intensity was hormone (PTH) and C-reactive protein (CRP) levels. Key factors affecting pain included body mass index (BMI), hypertension (HT), diabetes mellitus (DM), and PTH levels. Research shows that PC is rarely used for patients on HD in many countries, despite being effective in managing symptoms. Conclusions: PC, along with pain assessment and multidisciplinary management, reduces the symptomatic burden for patients with ESKD. Effective management of mild pain should be handled by a nephrologist experienced in PC, while severe, therapy-resistant pain should be managed by PC specialists. Therefore, implementing PC is essential in the treatment of these patients. Full article

Background: Increasing numbers of young people with severe neurological impairment are suffering from gastrointestinal symptoms, which may result in nutritional failure and ultimately death. Gastrointestinal dystonia is a recently described clinical diagnosis amongst patients with severe neurological impairment, and no systematic review of existing evidence currently exists. Aim: To conduct a systematic review of existing evidence for the management of gastrointestinal dystonia in children and young people with severe neurological impairment and palliative care needs. Method: A systematic review assessing pharmacological and non-pharmacological treatments was undertaken using standard Cochrane methodology. We searched Cochrane CENTRAL, MEDLINE, EMBASE, and PsycInfo. All databases were searched from inception, and no language restrictions were used. Results: 1580 references were identified. After abstract screening, 56 references were reviewed at full text, and a case report and case series were identified for inclusion. Low-quality, indirect evidence exists for the management of gastrointestinal dystonia, including symptom management, hydration and nutrition decisions, and end-of-life care. Conclusions: There is a paucity of existing evidence directly relating to gastrointestinal dystonia, but low-quality indirect evidence from studies of children with severe neurological impairment and gastrointestinal symptoms exist, which may begin to inform clinical practice. Full article

Background/Objectives: This study evaluated a novel rehabilitation tool that combines prismatic adaptation (PA) and cognitive training through serious games (SGs) in patients with mild cognitive impairment (MCI) due to prodromal Alzheimer’s dementia or consequent to Parkinson’s disease. While non-pharmacological interventions have been shown to improve cognition or delay dementia onset, their underlying neurobiological mechanisms, such as brain plasticity, remain unclear. Leveraging studies suggesting neuromodulatory effects of PA, we investigated whether the combined PA+SGs treatment could influence plasticity-related mechanisms, assessed through brain-derived neurotrophic factor (BDNF) serum levels, compared to cognitive training with only SGs and standard cognitive rehabilitation (SCR). Methods: Twenty three MCI patients were randomized into three intervention groups: PA+SGs (experimental group), SG-only (control group), and SCR (control group), completing ten treatment sessions. Patients underwent neuropsychological assessments and blood sampling pre- and post-treatment. Results: At baseline, demographic, clinical, and biological characteristics were comparable across groups. Post-treatment, though differences from control groups were not statistically significant, the PA+SGs group showed significant within-group improvements in memory, with trend-level changes also in executive function and visuospatial abilities, which, however, did not reach the significance threshold. Notably, only the PA+SGs group exhibited increased BDNF levels, which positively correlated with memory and language performance. Conclusions: Our findings suggest that combining PA with cognitive training may enhance cognitive functioning in MCI patients, yielding results comparable to SCR. Furthermore, PA appears to enhance neuroplasticity mechanisms that may support the behavioral improvements observed in cognitive training. Future research should validate these findings and further explore the relationship between cognitive impairment and its rehabilitation, while also considering the underlying neurobiological mechanisms. Full article

Background: Spinal Muscular Atrophy type 1 (SMA type 1) is a genetic neuromuscular disease that typically presents before 6 months of age and is characterized by profound hypotonia, progressive muscle weakness, and early involvement of respiratory and bulbar musculature. Swallowing impairment (dysphagia) is a hallmark of SMA type 1 and significantly contributes to morbidity. Despite the documented benefits of disease-modifying therapies (DMTs) in terms of enhanced survival and motor outcomes, their impact on swallowing remains understudied. Aim: This study aims to longitudinally characterize swallowing function in children with SMA type 1 treated with DMTs, while contextualizing these findings in relation to the patients’ current motor abilities and cognitive performance. Materials and Methods: A single-center, longitudinal, observational study was conducted at IRCCS Besta, Milan, Italy, from 2021 to 2025. Swallowing function was evaluated using four validated scales (MAS, OrSAT, FILS, and p-FOIS), while motor and cognitive functions were assessed using CHOP-INTEND and age-appropriate cognitive tests (DQ/IQ). Patients were stratified by baseline swallowing status, pharmacological therapy, and age at DMT administration. Non-parametric statistical tests were applied. Results: No statistically significant changes in swallowing function were observed over one year in the overall cohort or its subgroups, despite significant improvements in motor function. MAS/e, FILS, and p-FOIS showed moderate associations with CHOP-INTEND and DQ/IQ scores. Conclusions: Swallowing function in children with SMA type 1 remained largely stable, while motor function significantly improved over one year, regardless of baseline swallowing status, DMT type, and age at administration. These findings underscore the need for standardized, longitudinal assessments of swallowing, motor, and cognitive functions in the management of SMA type 1. Full article

Background: Musculoskeletal (MSK) pain is a frequent but under-addressed concern during pregnancy. In Bangladesh, challenges such as limited antenatal care (ANC) access and heavy maternal workloads make this issue particularly urgent for maternal health. This study aimed to determine the prevalence and predictors of MSK pain among pregnant women attending government ANC clinics in Bangladesh. Methods: A facility-based cross-sectional study was conducted among 300 pregnant women recruited from two government hospitals in Dhaka Division. Data were collected using structured interviewer-administered questionnaires covering patient characteristics, pain-related characteristics, and pregnancy-related characteristics. Pain was measured using the Numeric Pain Rating Scale (NPRS; mild <4, moderate 4–7, severe >7), and body mass index (BMI) was calculated based on self-reported height and weight. Descriptive statistics, chi-square tests, and multivariable logistic regression were employed to identify factors independently associated with MSK pain. Results: Overall, 67% of women reported MSK pain, most frequently in the lower back and lower abdomen. Women in later trimesters had about twice the odds of experiencing pain, while those with obesity had nearly six times higher odds compared to women with normal body mass index (BMI). Conclusions: MSK pain is common among pregnant women in Bangladesh and shows associations with later gestational stages and obesity. These findings suggest that integrating routine screening and non-pharmacological management into ANC may help support maternal health and reduce preventable complications in resource-limited settings. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is associated with impaired functional capacity, persistent fatigue, and poor health-related quality of life despite advances in pharmacological therapy. Exercise training has been proposed as a non-pharmacological intervention, but its efficacy and safety remain incompletely defined. This systematic review aimed to evaluate the effects of exercise training on functional aerobic capacity and quality of life in adults with SLE. Methods: A comprehensive search of PubMed, EMBASE, Cochrane Library, and PEDro was conducted to identify randomized controlled trials published up to October 2022, in accordance with the PRISMA guidelines. Results: Twelve randomized controlled trials involving 619 participants were included. Exercise interventions were heterogeneous and comprised aerobics, resistance, combined programs, vibration training, home-based protocols, and counseling strategies, with durations ranging from 6 weeks to 12 months. Supervised aerobic and combined interventions consistently improved functional aerobic capacity, while quality of life benefits were reported across several domains, particularly physical health, vitality, and fatigue. Additional positive effects were observed on fatigue, depression, pain, sleep, insulin sensitivity, and self-care ability, without evidence of increased disease activity. Conclusions: Structured exercise is safe and can meaningfully enhance functional capacity and quality of life in patients with SLE, supporting its incorporation into multidisciplinary clinical management. Full article

Background: Polycystic ovarian syndrome (PCOS) is one of the most prevalent reproductive, endocrine, and metabolic disorders inflicting women of childbearing age. Dietary interventions have gained interest as non-pharmacological approach to control obesity and metabolic disturbances. However, the effects of intermittent fasting (IF) on metabolic and hormonal profiles of PCOS patients is debatable. Objectives: We performed this systematic review and meta-analysis to explore IF’s effect on PCOS women’s metabolic and hormonal profile (PROSPERO: CRD42024511520). Eligible studies included IF interventions in women with PCOS, with metabolic and hormonal profiles being reported. Methods: A systematic literature search using three databases, including PubMed, SCOPUS, and Web of Science, was conducted. The systematic review was performed following PRISMA guidelines. Results: A total of four studies were included (N = 4). IF is not associated with significant change in BMI (MD = −0.200, 95% CI [−0.807, 0.407], p = 0.518). The analysis revealed that IF had no statistically significant impact on FBG (MD = −0.569, 95% CI [−9.955, 8.818], p = 0.906), HOMA-IR (MD = −0.862, 95% CI [−1.737, 0.014], p = 0.054), and FINS (MD = −2.749, 95% CI [−6.441, 0.943], p = 0.145). No significant change in TG (MD = −3.120, 95% CI [−9.624, 3.385], p = 0.347), total cholesterol (MD = −0.918, 95% CI [−2.960, 1.124], p = 0.378), and LDL levels (MD = −0.433, 95% CI [−1.224, 0.359], p = 0.284) between IF and pre-fasting or non-intervention diet groups. However, the explanation is limited by the small number of studies, duration of fasting regimes, and/or variations in fasting strategies. Sex hormone data were collected but were insufficient for a pooled analysis. Conclusions: Overall, our study suggests that IF is not an effective intervention to enhance BMI, glycaemic control, and lipid metabolism in PCOS patients. Nevertheless, the current conclusion is inconclusive and preliminary, as additional well-designed studies are required to support this conclusion. Full article

Background: Psychotropic medications are frequently prescribed to elderly patients in emergency settings, yet their potential to induce electrocardiographic (ECG) abnormalities, particularly QTc interval prolongation, raises safety concerns. Older adults may be especially vulnerable due to polypharmacy, age-related cardiac changes, and comorbidities. Methods: We conducted a retrospective observational study on patients aged ≥65 years who underwent psychiatric evaluation in the Emergency Department (ED) of a tertiary hospital between 2015 and 2023. Data was extracted on demographics, psychiatric symptoms, psychotropic drug use, and ECG findings. The primary outcome was the prevalence of major ECG abnormalities (QTc or QRS prolongation), and secondary analyses explored associations with drug class and hospitalization. Results: Seventy-seven patients were included (62.3% female, median age 74 years). Overall, 22.1% exhibited ECG abnormalities, with QTc prolongation in 16.9% and QRS widening in 5.2%. ECG alterations were more common among patients receiving psychotropic drugs (30.7% vs. 13.2%; p = 0.046). Multivariate analysis confirmed psychotropic therapy as an independent predictor of ECG abnormalities (OR 2.84; 95% CI: 1.01–7.98; p = 0.049). No significant sex-related differences were observed. Conclusions: ECG abnormalities are common in elderly patients undergoing psychiatric assessment in the ED and seem associated with psychotropic medication use. However, non-pharmacological factors also contribute significantly to risk. Integrated multidisciplinary evaluation is essential to ensure both psychiatric and cardiovascular safety in this fragile population. Full article