Search Results (2,113)

Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017. Full article

Background/Objectives: Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence in women. Obturator-route MUS procedures reduce retropubic morbidity, but rare concealed hemorrhagic complications can be severe and rapidly progressive. This report describes a complex case of life-threatening hemorrhage, upper urinary tract extravasation, and delayed infection involving a persistent pelvic collection after obturator-route MUS. Methods: We reviewed the clinical course, imaging findings, interventions, and follow-up of a 77-year-old woman who developed severe complications after outpatient obturator-route MUS. A descriptive narrative summary of published hemorrhagic complications after TOT or TVT-O procedures was also performed. Result: On postoperative day 1, the patient presented with left lower abdominal pain, dizziness, vomiting, tachycardia, and severe anemia. Contrast-enhanced computed tomography showed active bleeding from the left obturator artery, an 11.5 cm pelvic hematoma with bladder displacement, and upper urinary tract contrast extravasation at the left renal pelvis and ureteropelvic junction. Emergency transcatheter arterial embolization and left percutaneous nephrostomy were performed, followed by delayed antegrade double-J ureteral stenting. Four months later, she developed E. coli urosepsis with a persistent 7.9 cm paravesical collection. Persistent symptoms despite initial antibiotic therapy required broad-spectrum antibiotics and percutaneous catheter drainage. The drainage fluid was serous, and S. hominis isolated from the drainage culture was interpreted as a contaminant; therefore, the collection was managed as a clinically suspected infection involving a persistent pelvic collection rather than as a microbiologically confirmed infected hematoma. Conclusions: After obturator-route MUS, severe abdominal or pelvic pain, dizziness, tachycardia, hypotension, or abrupt hemoglobin decline should prompt contrast-enhanced CT to evaluate for concealed pelvic arterial bleeding and associated urinary tract extravasation. Early multidisciplinary coordination and follow-up of persistent pelvic collections may be important in complex cases. Full article

Background: Pregnancy following liver and kidney transplantation is rare. The presence of a rare genetic disorder and advanced chronic kidney disease (CKD) further complicates clinical management, for which evidence-based guidelines are limited. Case presentation: A 29-year-old woman with Alagille syndrome underwent combined liver and kidney transplantation in early childhood. She had stage 4 CKD, and her baseline creatinine was around 250 umol/L. Her pregnancy was unplanned and diagnosed at 19+1 weeks of gestation. After the diagnosis of pregnancy, immunosuppressive therapy was promptly adjusted, and potentially teratogenic medications were discontinued. At 21+1 weeks’ gestation, creatinine and urea levels rose despite multidisciplinary management, and she started renal replacement therapy. Despite ongoing multidisciplinary care, the pregnancy was complicated by placental abruption at 24+5 weeks, requiring a preterm cesarean section. A live-born female infant weighing 590 g was delivered. Discussion: The coexistence of CKD, long-term immunosuppression, and high obstetric risk requires early multidisciplinary assessment and individualized management. Currently, standardized protocols for monitoring and treatment are lacking in this rare population, making clinical decision-making particularly challenging, especially regarding CKD progression. Conclusion: Pregnancy in women with combined liver and kidney transplantation and advanced CKD carries a high risk of severe renal and obstetric complications. Preconception counseling and early referral to multidisciplinary teams may help improve management in similar rare clinical scenarios. Full article

Sexual objectification is the treatment of a person as a body or a collection of body parts that are valued primarily for their sexual appeal. The main purpose of this study was to determine the relevance of sexual objectification to women’s health and well-being across the life cycle, from middle adolescence to old age. Additionally, the relevance of age and education to sexual objectification and its association with traditional gender role attitudes was examined. This study was cross-sectional and the sample consisted of 6112 Spanish women between the ages of 16 and 85, who were assessed using seven questionnaires and scales. The results show that lower age and lower number of children were associated with greater importance of sexual and physical attractiveness and with a more sexualized image, although there were no differences between adolescent and emerging adult women. Greater importance placed on sexual and physical attractiveness, as well as total sexual objectification, was associated with greater mental distress, lower psychological well-being, lower life satisfaction, and lower self-esteem at every life stage. Greater importance placed on sexual and physical attractiveness was associated with more traditional gender role attitudes among all age groups, except for older women. We conclude that sexual objectification is a threat to women’s mental health and well-being. Full article

Leukocyte telomere length (LTL) has been proposed as a molecular marker of biological aging reflecting cumulative cellular stress and replicative senescence. Multimorbidity represents a major challenge in aging populations and reflects the progressive accumulation of chronic diseases. However, the relationship between LTL and multimorbidity burden remains incompletely understood. We investigated the association between LTL and multimorbidity burden, assessed using Cumulative Illness Rating Scale (CIRS) indices, in a cohort of older nursing home residents. Sex-stratified analyses were performed to explore potential biological heterogeneity. In multivariate analyses, shorter LTL was significantly associated with higher multimorbidity burden among women, particularly when considering severity- and comorbidity-weighted CIRS indices [False discovery rate-adjusted q-values (qFDR < 0.01)], whereas no significant associations were observed in men. Adjustment for functional status partially attenuated but did not eliminate these associations. Organ-specific analyses indicated that these associations in women were primarily driven by cardiovascular, respiratory, gastrointestinal, and genitourinary domains, systems commonly characterized by chronic inflammatory and oxidative stress processes that may promote telomere attrition. Overall, these findings support a sex-specific relationship between telomere dynamics and clinically relevant multimorbidity patterns in very old adults. LTL may reflect biologically meaningful aspects of disease severity and systemic stress regulation rather than merely the accumulation of diagnoses. Full article

Background/Objectives: The prevalence of women who exclusively pump (EP) their breast milk to feed their infants is increasing; however, this group is underrepresented in research. This study aimed to examine maternal and infant characteristics and the experiences of EP women. Methods: An online survey explored the experiences and characteristics of EP women with <24-month-old infants. Quantitative data included demographics and maternal and infant characteristics; qualitative data included perspectives on how support for EP women can be improved. Results: The survey of 195 EP women revealed that while most had intended to exclusively breastfeed (50%) or breastfeed and pump (26%) their milk for an average of 12 months, the average time of EP cessation was 6 months postpartum. Compared with the general population, EP women had higher rates of pregnancy complications (p < 0.001) and lactation/breastfeeding challenges (p < 0.001). Themes developed from the qualitative data relating to how health professionals/support people could better assist EP women were: ‘Respect for the EP Journey’, ‘EP Information and Logistical Needs’ and ‘Mental and Physical Load’. Conclusions: Most EP women had originally intended to breastfeed but utilised EP because of latching issues, breast refusal and/or neonatal unit admission. They face unique challenges associated with EP, yet current professional acceptance and support are lacking. Targeted education for health professionals on EP is needed so that they can better support women with tailored, evidence-based guidelines aimed at extending lactation and improving maternal well-being. Full article

Background and Objectives: The prognostic value of frailty and infarct-related coronary artery occlusion (IRCAO) in very old patients with acute coronary syndrome (ACS) remains insufficiently studied. This study aimed to identify risk factors for 30-day mortality in patients aged ≥75 years with myocardial infarction, depending on the presence of IRCAO and frailty. Materials and Methods: A total of 360 patients (median age 80 [77; 84] years, 61.7% women) with ACS or acute myocardial infarction (AMI) were enrolled. Frailty was screened using the “Age is Not a Barrier” questionnaire in 228 patients. IRCAO was defined as TIMI 0–1 flow, absence of developed collateral circulation, and concordance between electrocardiogram changes and the affected coronary artery. The primary endpoint was all-cause mortality at 30 days. Kaplan–Meier survival analysis, Cox regression, and propensity score matching (PSM) were used. Results: Frailty was present in 21.9% (50/228) of screened patients and was associated with significantly lower 30-day survival (88.0% vs. 97.2%, log-rank p = 0.015). Frailty increased the risk of death by 4.5-fold (HR = 4.474; 95% CI: 1.365–14.663; p = 0.013). IRCAO was detected in 20.0% (72/360) and was a significant predictor in the overall cohort (HR = 1.792; 95% CI: 1.031–3.112; p = 0.038), but its significance disappeared in the frailty-screened subgroup. Age remained an independent predictor only in the overall cohort. The unadjusted association between percutaneous coronary intervention and higher mortality (HR = 2.37) was explained by confounding by indication; after PSM, no difference in mortality persisted (p = 1.000). Conclusions: Frailty is a powerful independent predictor of 30-day mortality in very old patients with AMI, outweighing chronological age and IRCAO. The prognostic value of IRCAO is mediated by frailty. The apparent harmful effect of percutaneous coronary intervention is explained by symptom severity rather than the procedure itself. Routine frailty assessment should be integrated into risk stratification for elderly ACS patients. Full article

Background: Osteoporosis is a major skeletal disorder, particularly affecting postmenopausal women. Young ovariectomized rat models are commonly used to investigate estrogen deficiency-related skeletal changes, although they do not fully reproduce osteoporosis in a mature postmenopausal skeleton. Established pharmacological therapies remain the cornerstone of osteoporosis management, while nutritional factors continue to be investigated for their potential supportive role in bone metabolism. Menaquinone-7 (MK-7), a form of vitamin K2, has been investigated for potential skeletal effects through vitamin k-dependent mechanisms, particularly osteocalcin carboxylation. The aim of this study was to evaluate the dose-dependent effects of MK-7 on bone turnover markers, femoral mechanical resistance, qualitative histological findings, and hepatic safety in a young ovariectomized rat model. Methods: Forty female Wistar rats that were 8 weeks old, and thus still undergoing skeletal maturation, were assigned to four groups: sham-operated controls, ovariectomized controls, ovariectomized rats treated with low-dose MK-7, and ovariectomized rats treated with high-dose MK-7. Treatment was administered every 48 h for 12 weeks. At study completion, 35 rats survived; standardized analysis included eight animals per group. Plasma bone turnover markers (BTMs) and alanine aminotransferase were measured, femoral strength was assessed by the three-point bending test, and bone and liver histology was analyzed. Results: Biomechanical testing showed that high-dose MK-7 was associated with greater femoral mechanical resistance compared with untreated ovariectomized rats, while qualitative histology suggested differences in cortical architecture among groups. Biochemically, MK-7 treatment reduced undercarboxylated osteocalcin, suggesting vitamin K-dependent target engagement, whereas conventional turnover markers showed discordant findings. Overall, hepatic architecture was preserved, although mild hepatocellular apoptosis was observed. Conclusions: In this young OVX rat model, high-dose MK-7 was associated with improved femoral mechanical resistance compared with untreated OVX controls. However, because ovariectomy was performed during skeletal maturation, these findings should be interpreted as preliminary and cannot be directly extrapolated to established postmenopausal osteoporosis in a mature skeleton, and further studies are needed to clarify its activity pathways and safety profile. Full article

Background/Objectives: Physiological and psychological health could be altered in modern societies due to stressful environments and activities. A multimodal training based on nutrition, physical activity, breathing and hugging was proposed for improving physiological parameters in a group of women compared to a control group. Methods: 33 women (41 ± 15 years old) were enrolled, divided in two groups, and assessed before and after 6 weeks. Heart rate parameters, superficial adipose tissue (SAT), and trunk rotational range of motion (ROM) were measured. Stroop test and Forward Digit Span Task (FDST) were administered, in order to assess cognitive functions. Results: The trained group showed a significant improvement in the very low-frequency domain of heart rate variability (p = 0.002), a reduction in the high-frequency domain (p = 0.003), an improvement in the number of women with a physiological SAT (p = 0.014), and an improvement in memory (p = 0.005). In the control group, only improvements in the performances of memory (p = 0.029) and attention (p = 0.004) at Stroop test were observed. Conclusions: Changes in cardiac parameters and physiological level of adipose tissue showed significant variations following the multimodal training. For attention and memory, the improvements were observed also in the control group and could be related to a learning effect of the tests. Full article

Uterine fibroids are among the most common benign tumors affecting women, with a prevalence reaching up to 50–60% in those over 40 years of age, although often underestimated due to asymptomatic cases. Radiofrequency ablation (RFA) represents a minimally invasive alternative to surgery for selected patients. We report the case of a 41-year-old woman with symptomatic uterine fibroids (FIGO type 4, size of 5 cm) treated with transvaginal RFA. One month post- treatment, the fibroid showed partial volume reduction. Two months after the procedure, the patient presented with foul-smelling discharge and heavy bleeding. Ultrasound confirmed complete fibroid migration into the cervical canal. Vaginal removal was performed without complications. Fibroid expulsion after RFA is a rare event that may represent either a complication or a therapeutic outcome. A balanced interpretation and appropriate clinical management are required. Further studies are needed to clarify its clinical significance. Full article

Integrated care programs (ICPs) are associated with positive patient experiences, but provider experiences remain understudied. We examined burnout in healthcare providers working in an ICP that facilitates hospital-to-home care transitions for patients. We conducted a mixed-methods evaluation comprising a cross-sectional survey of burnout and provider experience using the Maslach Burnout Inventory, open-ended questions, and semi-structured interviews. Twenty-eight participants completed the surveys (31% response rate). Respondents were 75% female, and, on average, were 42 ± 10 years old, had spent 19 ± 11 months as providers in the ICP and had cared for a median of 170 (IQR = 245) patients. Twenty staff, who were 38 ± 8 years old on average and 95% women, were interviewed. Emotional exhaustion was low (average total score = 14 ± 7 out of 42), depersonalization was moderate (9 ± 6 out of 42), and personal achievement was high (40 ± 5 out of 48), corresponding to low-to-moderate burnout. Respondents cited teamwork as the leading protective factor against emotional exhaustion and positive impact on patients as the leading factor underlying high personal achievement. Perceived under-appreciation was the leading factor for depersonalization, likely moderated by team support and rapport. Burnout was low to moderate in our sample of ICP healthcare providers, who cited several important contextual factors requiring further study. Full article

Mpox is a rare but potentially serious vaccine-preventable disease. The 2022 United States outbreak disproportionately impacted gay, bisexual, and other men who have sex with men, people living with HIV, and people of transgender experience. Early vaccination efforts revealed substantial racial and geographic inequities, with lower uptake among Black and Hispanic cisgender men, transgender women, and residents of rural areas. To address these challenges, Fairview’s Minnesota Immunization Networking Initiative (MINI), a 20-year-old mobile health collaborative, partnered with state and local public health agencies and community-based organizations to expand mpox vaccine access. With support from governmental outbreak response funding and stockpiled vaccine, mobile clinics were deployed in trusted community settings, including Pride events and recurring community sites. Targeted outreach, education, and coordination with local providers supported stigma reduction and second-dose series completion. Program data were collected from October 2022 through December 2024. MINI hosted 125 community-based mpox vaccination events, administered 2259 doses to individuals from 220 cities across the United States, including 195 cities in the Midwest. Pride events were key entry points for first-dose vaccination, particularly in rural areas; urban non-Pride clinics played a complementary role in facilitating second-dose completion. Program-level vaccination-to-case ratios were highest among populations experiencing disproportionate mpox burden, including Black, Hispanic, and American Indian/Alaska Native male participants, suggesting alignment of preventive resources with community need. MINI’s mobile, partnership-driven approach demonstrates the value of pairing large-scale community events with recurring clinics to address barriers to both vaccine access and series completion. These findings underscore the importance of flexible, community-centered infrastructure in advancing health equity and strengthening outbreak preparedness. Full article

Background: The 2025–2030 Dietary Guidelines for Americans recommend that 6–12-month-old infants receive 11 mg iron/day. The contribution of iron-rich foods in meeting guidelines is unclear. Objectives: The aims were to: (1) determine the contribution of iron-fortified cereal, infant formula and heme-iron sources to infants’ total dietary iron intake; (2) examine differences in iron adequacy by milk-feeding type; and (3) identify feeding patterns associated with meeting daily iron requirements through dietary sources. Methods: Mothers of infants were recruited from a pediatric clinic and 24 h feeding recalls were conducted to estimate infants’ iron intake. Infants’ milk-feeding types were: breastmilk only (BF), mixed (MF), or infant formula only (FF). Main outcomes were: meeting/not meeting daily iron requirement (11 mg) overall and by milk-feeding type; contribution of iron-fortified infant cereal, formula and meat to daily iron intake. Descriptive statistics, bivariate chi-square tests, and multivariate logistic regression analyses were conducted. Results: Most participants identified as African American or Hispanic (76%) and were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (84%). Thirty-nine percent consumed < 11 mg iron/day from dietary sources. By milk-feeding type, inadequate iron intake was significantly higher among the BF (72%) and MF (74%) groups vs. the FF group (24%, p < 0.05). Iron-fortified cereals were consumed by 46% of infants and provided a median iron intake of 6.75 mg. Among the FF group, infant formula provided 63% of the daily iron requirement. Conclusions: Inadequate dietary iron intake is common. Iron-fortified cereal is an important dietary iron source. Future research is warranted to understand the relations among infants’ daily iron intake, iron sources (heme vs. non-heme), and iron status. Full article

Background and Objective: Sex differences in the treatment of people with Parkinson’s disease (PwP) with a device-aided therapy (DAT) have been poorly investigated. Our aim was to analyze sex differences in the management and response to a DAT in PwP in daily clinical practice (DCP). Patients and Methods: Data collected in the DATs-PD GETM Spanish Registry until 30 October 2025 were used. This is a descriptive, observational, prospective, and multicenter clinical registry with progressive inclusion of PwP treated with a DAT in DCP conditions in more than 40 centers from Spain. Sex differences in the DAT received and changes in quality of life (QoL), motor symptoms (MS), non-motor symptoms (NMS), and autonomy for activities of daily living (AADL) after 6 months of treatment were analyzed. Results: A total of 618 PD patients (66.9 ± 9.5 years old; 57.6% men) were treated with a DAT. A significant difference was observed in the DAT type according to sex (p = 0.006), with 73.1% of PwP who were treated with deep brain stimulation being men. At the time of DAT indication, women were older, received a higher levodopa equivalent daily dose, and had a worse health-related QoL and AADL. OFF time decreased, whereas MS and NMS burden and health-related QoL improved at 6 months follow-up in both groups (men and women). AADL improved only in men during the OFF state. Conclusion: Sex differences were detected in the use of DATs in PwP. Improvement in OFF time, MS, NMS, and QoL was detected in both groups. Full article

Background and Clinical Significance: The management of large benign ovarian cysts in women of reproductive age requires balancing minimally invasive surgery with oncologic safety and preservation of ovarian function. Laparoscopic cystectomy for large cysts is technically challenging and carries an increased risk of intraoperative rupture and spillage; Case Presentation: We describe a novel hybrid laparoscopic–extracorporeal technique in which controlled cyst decompression is performed using a balloon-tipped trocar through a suprapubic port under direct laparoscopic visualization. The ovary is then carefully mobilized and exteriorized through the same incision, allowing extracorporeal cystectomy and ovarian reconstruction before returning the adnexa to the abdominal cavity. This approach was applied in a series of six patients with large benign-appearing ovarian cysts, including one 42-year-old patient with an 18 cm multilocular mature cystic teratoma. There were no intraoperative or postoperative complications, no conversions to laparotomy, and all patients were discharged on postoperative day 1. Follow-up at six weeks and subsequent imaging at nine months demonstrated preserved ovarian architecture, normal menstrual function, and high patient satisfaction; Conclusions: The hybrid laparoscopic–extracorporeal approach appears feasible and may offer a safe surgical option in carefully selected patients, allowing fertility preservation while minimizing the risk of spillage. Further studies are needed to evaluate reproducibility, oncologic safety, and long-term reproductive outcomes. Full article