Search Results (3,328)

Background: Persistent sexual and psychological symptoms after finasteride discontinuation have been reported; however, factors associated with symptom severity remain insufficiently characterized. Methods: This cross-sectional study included 129 adult men with prior finasteride exposure for male pattern hair loss or benign prostatic hyperplasia. Sexual function, depressive symptoms, and anxiety were assessed using the International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Associations between clinical variables (age, treatment duration, cumulative exposure, and indication) and symptom severity were evaluated using univariate and multivariable regression analyses. Results: The median treatment duration was 24 months (IQR: 12.5–36), and the median time from discontinuation to evaluation was 8 months (IQR: 1–17). Erectile function remained stable over time (mean IIEF: 15.2 ± 0.46 at baseline vs. 15.4 ± 0.47 at 6 months). Depressive symptoms decreased from 12.4 ± 0.41 to 9.1 ± 0.41, and anxiety scores from 3.29 ± 0.23 to 2.54 ± 0.20 over the same period, without normalization in most patients. In multivariable analyses, higher cumulative exposure and older age were independently associated with lower IIEF scores and higher PHQ-9 and GAD-7 scores. Conclusions: In this symptomatic cohort, greater cumulative finasteride exposure and older age were associated with more severe sexual and psychological symptoms after treatment discontinuation. These findings highlight the need for prospective studies to better define risk factors and long-term outcomes. Full article

Background: Overweight and obesity are major health problems of the 21st century. As a significant risk factor for numerous noncommunicable diseases, obesity is also strongly associated with the development of abdominal hernias, which significantly impair patients’ quality of life. The review focuses on the pathophysiological mechanisms linking obesity to hernias and the impact of key prehabilitation components. Available research indicates a complex interrelationship between obesity and the development of ventral hernias, driven by pathophysiological mechanisms such as increased intra-abdominal pressure and chronic inflammation, which weakens the collagen matrix of the abdominal wall. Furthermore, both smoking and alcohol consumption significantly increase the risk of abdominal obesity and surgical complications; in turn, physical activity is crucial for reducing visceral fat. Psychological support may reduce pre-operative stress and contribute to improved outcomes. Nutritional intervention and weight loss are other essential components of preoperative management for ventral hernia repair. This review aims to highlight the role of prehabilitation in ventral hernia surgery in obese patients and to propose a structured, evidence-based algorithm (DEPP) for this high-risk population. The algorithm includes: Dietary intervention (D), Elimination of smoking and alcohol consumption (E), Physical activity (P), and Psychological support (P). The algorithm was developed to systematize the clinical approach and determine the steps to be taken in the treatment of patients with obesity and abdominal hernia. Methodology: A literature search was conducted across PubMed, Scopus, and Google Scholar databases for articles published between 2010 and 2026. We included randomized controlled trials, prospective/retrospective cohort studies, systematic reviews, and meta-analyses. Conclusions: Prehabilitation is a multifaceted strategy for optimizing the health of patients with obesity prior to abdominal hernia repair. The proposed prehabilitation algorithm, known as DEPP, is a preliminary approach for managing this group of patients. Full article

Introduction: Neisseria gonorrhoeae, a bacterium responsible for gonorrhea, can spread through oral sex, causing pharyngeal gonorrhea, which is also a leading cause of urethritis in outpatient clinics. This study investigated whether tea tree oil (TTO) alone or in combination with other natural products could serve as an effective alternative to chlorhexidine in preventing the spread of oral gonorrhea. Methods: An in vitro model was developed using T84 epithelial cells as a mucosal layer and Neisseria gonorrhoeae strain MS11. The study assessed the minimal inhibitory concentration (MIC), bacterial adherence, invasion, and transmigration across the mucosal barrier. Berberine (BB), a major and bioactive alkaloid derived from Coptis chinensis, was tested with and without TTO in MIC assays and epithelial cell viability tests. Ceftriaxone was used as a positive control. Results: The MIC values for TTO, BB, and ceftriaxone against the MS11 strain were determined to be 0.2%, 5 μg/mL, and 0.0125 μg/mL, respectively. Notably, the combination of TTO with BB demonstrated a synergistic effect, reducing the MIC to 0.000625% TTO + 1.25 μg/mL BB. This combination provided the strongest protective effect. No cytotoxicity was observed in the epithelial cell viability tests for 0.2% diluted TTO, 5 μg/mL BB, or the combination of 0.000625% TTO + 1.25 μg/mL BB. Conclusions: BB, when combined with TTO, exhibited a synergistic antimicrobial effect against Neisseria gonorrhoeae strain MS11 in the T84 mucosal model. These findings highlight the potential of this combination as a natural alternative to chlorhexidine gluconate for managing oral gonorrhea. Full article

Background/Objectives. Diarrhea-predominant irritable bowel syndrome (IBS-D) significantly affects patients’ quality of life (QoL). However, data on disease severity and its correlation with QoL among Vietnamese patients remain limited. This study aimed to investigate the clinical characteristics, symptom severity, and the relationship between symptom burden and quality of life in patients with IBS-D in Vietnam. Methods. A cross-sectional study was conducted on patients diagnosed with IBS-D based on the Rome IV criteria at an outpatient clinic of a tertiary hospital. Disease severity and QoL were assessed using the IBS Symptom Severity Score (IBS-SSS) and the standardized Vietnamese version of the IBS Quality of Life (IBS-QoL) questionnaire, respectively. Clinical characteristics, comorbidities, and overlap syndromes were also recorded. Results. Among the 123 patients enrolled (mean age 42.6 ± 14.5 years; 55.3% female), the median IBS-SSS score was 175 (interquartile range: 140–225), and the median IBS-QoL score was 72 (interquartile range: 54–85). The prevalence of overlap syndromes was relatively high, with functional dyspepsia accounting for 46.3% and gastroesophageal reflux disease for 8.9%. A moderate inverse correlation was observed between IBS-SSS and IBS-QoL scores (r = −0.494; p < 0.001). Notably, patients with severe IBS (IBS-SSS ≥ 300) had significantly higher rates of smoking (44.4% vs. 13.2%; p = 0.012) and diabetes (22.2% vs. 5.3%; p = 0.047) compared to the non-severe group. Conclusions. IBS-D imposes a substantial symptom burden and significantly reduces the quality of life in Vietnamese patients, particularly among those with severe disease. The high prevalence of overlap syndromes, along with contributing factors like smoking and diabetes, further increase the complexity and severity of the condition. Full article

Background: Fear of falling is common in older adults with type 2 diabetes mellitus (T2DM), particularly in those with balance and mobility impairment. The Falls Efficacy Scale—International (FES-I) is widely used to quantify concern about falling but requires local validation. We aimed to validate the Romanian version of the FES-I in older adults with T2DM. Methods: In this validation study, 124 consecutive outpatients with T2DM aged > 60 years completed the Romanian FES-I at baseline (v1) and at one-month follow-up (v2). Internal consistency was assessed with Cronbach’s alpha and item–total correlations. Test–retest reliability was evaluated using intraclass correlation coefficient (ICC) and the Bland–Altman agreement. Construct validity was examined by correlations with the Fear-of-Falling Questionnaire—Revised (FFQ-R), Berg Balance Scale (BBS), Timed Up and Go (TUG), and single-leg stance (SLS). Discriminative performance was assessed via ROC analyses. Results: Mean FES-I scores were 30.8 ± 11.4 (v1) and 31.1 ± 11.6 (v2). Internal consistency (Cronbach’s alpha 0.945–0.947) and test–retest reliability (ICC 0.972; 95% CI 0.956–0.983) were excellent, with minimal bias. FES-I correlated strongly with FFQ-R (rho = 0.787) and moderately with function (BBS rho = −0.631; TUG rho = 0.547; SLS rho = −0.498; all p < 0.001). Discrimination was good for BBS (AUROC = 0.779) and TUG (AUROC = 0.800). Conclusions: The Romanian FES-I demonstrates excellent reliability and good validity in older adults with T2DM, with low measurement error and clinically interpretable change thresholds. It can be used for fear-of-falling quantification in routine care and research, including longitudinal monitoring and evaluation of interventions in Romanian patients with diabetes. Full article

Background/Objectives: Behçet’s disease (BD) is a systemic vasculitis frequently affecting women of childbearing age. However, the relationship between systemic manifestations and pregnancy loss remains unclear. This study evaluated the association between pregnancy loss history and systemic clinical characteristics in women with BD. Methods: This retrospective cohort study included 114 women with BD followed in a rheumatology outpatient clinic between January 2021 and December 2025. In total, 196 pregnancies were recorded. Women without a pregnancy history were excluded. Pregnancy loss was defined as any spontaneous loss, including biochemical pregnancy, miscarriage, or fetal death, excluding elective terminations. Disease activity was assessed using the Krause score, and univariable logistic regression was performed. Results: Among 97 women with a pregnancy history, 25 (25.8%) had at least one pregnancy loss. Compared with women without pregnancy loss, those with pregnancy loss had longer disease duration and higher Krause scores. Gastrointestinal involvement (OR 6.31, 95% CI 1.87–23.28, p = 0.0035) and ocular involvement (OR 3.93, 95% CI 1.44–10.89, p = 0.0076) were significantly associated with pregnancy loss history. Higher Krause scores were also associated with greater odds of pregnancy loss history. Conclusions: In women with BD, pregnancy loss history was associated with systemic organ involvement and higher disease activity, particularly gastrointestinal and ocular involvement. These findings should be interpreted cautiously in light of the retrospective design and univariable analyses, and they suggest that pregnancy loss history may be associated with greater systemic disease burden. Full article

Background/Objective: A substantial proportion of infected individuals develop persistent symptoms after the acute phase of COVID-19, regardless of initial disease severity. Long COVID (LC) remains a public health challenge characterized by impaired functional exercise capacity (FEC) and quality of life (QoL). We systematically synthesized evidence on the effects of in-person outpatient pulmonary rehabilitation (OPR) with individualized and supervised exercise in adults with LC. Methods: Following PROSPERO (CRD42023389365), this study reviewed randomized controlled trials (RCTs) and observational cohort studies (OCSs) published between November 2019 and January 2026 in MEDLINE/PubMed, Web of Science, PEDro, and EMBASE. Results: Fifteen studies (n = 803) were included. OPR improved FEC (6MWT; MD: 53.72 m, 95% CI 43.69–63.75) and 30″SST (MD: 4.68, 95% CI 3.59–5.77) and reduced exertional dyspnea. RCTs showed benefits in physical (MD: 8.04, 95% CI 3.02–13.05) and mental QoL (MD: 6.60, 95% CI 2.01–11.18) and dyspnea impact, with inconsistent PF findings. Fatigue showed a trend toward improvement but was measured using heterogeneous patient-reported tools in RCTs and OCSs. Conclusions: Supervised PR improves FEC, QoL, and dyspnea in individuals with LC. In patients with fatigue/PEM, systematic assessment and continuous symptom monitoring are essential. High-quality controlled studies are needed to strengthen evidence and clinical guide. Full article

Background: The metamorphopsia questionnaire (MeMoQ) is an established patient-reported outcome measure (PROM) in the context of macular disease. However, its performance has not been proved in those being treated for various macular conditions with intravitreal anti-vascular endothelial growth factor (Anti-VEGF). The objective was to eliminate misfitting items, enhance measurement precision, and ensure optimal response categorisation. Methods: Rasch analysis was performed iteratively on 2286 responses from patients with macular diseases being treated with Anti-VEGF to optimise the MeMoQ. Fit statistics, reliability indices, person and item separation measures, and principal component analysis (PCA) of residuals were assessed to determine the optimal model. This study was conducted in an outpatient clinic specialising in retinal diseases in Hywel Dda University Health Board. Results: Misfitting items were removed in successive iterations, leading to optimised category probability curves and stable fit statistics for the MeMoQ. The resulting model for all responses included two final items, with person separation remaining inadequate reducing from 1.23 to 1.12 and reliability from 0.60 to 0.56. Category probability curves demonstrated good ordering of response variables with Andrich thresholds separated by >1.2 logits. In the subgroups of neovascular age-related macular degeneration and diabetic macular oedema person separation remained below two and reliability remained low. Conclusions: Rasch analysis demonstrated that the MeMoQ was not a valid or reliable PROM in this patient population. Therefore, the MeMoQ may not provide a reliable index of patient’s perception and visual experience when undergoing Anti-VEGF treatment. Full article

Background: Long COVID presents a novel and emerging public health challenge. As the first point of contact, general practitioners (GPs) play a key role in diagnosing and coordinating the care of patients presenting with post-acute sequelae of COVID-19 (PASC), despite a lack of experience. This study aimed to identify the main difficulties encountered by GPs in Franche-Comté, France, in managing adult outpatients with long COVID. Methods: We conducted a cross-sectional survey using an anonymous online questionnaire, which contained 21 questions and was distributed to GPs in Franche-Comté, France. The survey assessed definition, diagnostic and therapeutic challenges in managing long COVID. Results: Among the 410 questionnaires distributed, 90 general practitioners (GPs) responded (response rate: 21.9%). The mean age of participants was 34 ± 10 years, and 64.4% were women (n = 58). Regarding knowledge of long COVID, three participants (3.3%) did not recognize it as a distinct clinical entity, while more than half (58.9%, n = 53) reported insufficient knowledge. The main challenges identified were therapeutic management (76.7%, n = 69) and diagnosis (75.6%, n = 68). Only 4.5% of respondents (n = 4) reported no difficulty in defining post-acute sequelae of SARS-CoV-2 infection (PASC). The most frequently reported diagnostic difficulty was distinguishing long COVID from differential diagnoses (93.3%, n = 83/89), particularly fibromyalgia (94.3%, n = 83/88). Only 37.1% of participants (n = 33/89) reported actively following up patients with PASC. During initial management, the main challenge was the difficulty in objectively assessing patients’ complaints using available diagnostic tools (80.7%, n = 67/83). Additionally, a large majority of GPs reported difficulties in addressing patients’ questions (86.7%, n = 72/83) and managing associated anxiety disorders (75.9%, n = 63/83). Conclusions: These findings highlight the immediate need to enhance GP training in Franche-Comté, France, in dealing with long COVID. Improvements such as harmonizing long COVID definitions, testing diagnoses, and strengthening interdisciplinary coordination are essential to provide coherent and patient-centered care for this disease. Full article

Background: Although the concepts of meteoropathy and meteosensitivity are not included in official classifications, such as the ICD-11 or DSM-5, they are increasingly being studied as potential symptom complexes linking weather variability to health status. The METEO-Q questionnaire, originally developed in Italy, has been adapted in Japan and Turkey, where it has demonstrated satisfactory reliability parameters, although the authors emphasized the need for further verification of the tool’s temporal stability. The present study aimed to adapt METEO-Q to the Polish language and conduct a critical assessment of its factor structure, measurement invariance, and validity in clinical groups. Methods: This cross-sectional study involved 1128 adults: healthy individuals (n = 711), cardiac outpatients (n = 194), and subclinical group with diagnosed mental disorders (n = 223). Data from healthy participants were divided into a training sample (n = 426) for exploratory factor analysis (EFA) and a test sample (n = 285) for confirmatory factor analysis (CFA). Measurement invariance was assessed in the clinical groups. Validity was verified through correlations with a list of 21 symptoms and measures of anxiety and worry about climate change. Results: A two-factor model (meteoropathy and meteosensitivity) was better fitted to the data than a one-factor model, which is consistent with findings from Italian, Japanese, and Turkish studies. However, absolute fit indices in the test sample indicated significant model misfit [CFA: χ² (43) = 210.192, p < 0.001, RMSEA = 0.120, CFI = 0.927], suggesting the presence of local errors in the tool’s structure. The reliability of the subscales was high (α from 0.86 to 0.93). Multi-group analyses suggested metric and scalar invariance. Patients with mental disorders obtained the highest scores, while cardiac outpatients reported a lower level of meteoropathy (M = 6.13) than healthy individuals (M = 7.24). Conclusions: METEO-Q demonstrates a stable two-factor structure and high internal consistency. The obtained RMSEA index (0.12), although indicative of some misfit, is similar to results obtained in other adaptations, such as the Japanese (RMSEA = 0.10) and the Turkish (RMSEA = 0.11), which suggests it is a consistent feature of this tool across different cultural contexts. Accordingly, the instrument is suitable for research purposes; however, its clinical application requires considerable caution and further work to optimize the model. Full article

Background/Objectives: Autoimmune thyroiditis affects physical and cognitive development in children. Therefore, early detection can prevent symptoms that could lead to lifelong changes. Autoimmune thyroiditis can frequently accompany type 1 diabetes (T1DM) and celiac disease (CD). The goal in this study is to evaluate its usability as a screening method by assessing thyroid elasticity in children with negative thyroid autoantibodies and T1DM or CD. Methods: This cross-sectional, case–control, single-center study was conducted with children who had applied to the Pediatrics outpatient clinic of Kayseri City Education and Research Hospital (Turkey). The study included three groups of cases (T1DM, CD and control). The value of the shear wave elastography (SWE) color map was recorded in kPa. Comparisons between two independent groups were conducted using either Student’s t-test or the Mann–Whitney U-test, while categorical variables were analyzed with the Chi-square test. A correlation analysis was conducted to evaluate the relationship between the variables. Results: The study cohort comprised 185 children, of whom 71 had T1DM, 54 had CD, and 60 constituted the healthy control group. The participants ranged in age from 4 to 17.9 years, with a mean age of 11.4 ± 3.8 years. The gender distribution did not differ significantly between the groups. Anti-thyroid peroxidase (TPOAb) levels did not differ significantly between the groups (p = 0.894). Thyroid volume or standard deviation score did not differ significantly between the groups. Corresponding SWE values in the T1DM, CD and control groups were 7.7 (6.0–9.3), 5.9 (5.2–7.9) versus 7.1 (6.0–9.6), respectively (p = 0.002). Correlations were significantly associated between SWE scores and anti-thyroglobulin (TgAb), thyroid volume, mean hemoglobin A1c (HbA1c), and time elapsed from a diagnosis of CD. Conclusions: The SWE scores were observed to be higher in children with T1DM compared to those with CD. Full article

Telemedicine can address access barriers in childhood obesity management by supporting continuity of care and caregiver engagement. This randomized controlled trial compared a telemedicine-based program with guideline-based usual care among 70 children with obesity (aged 5–15 years) and their caregivers, randomized to telemedicine (n = 35) or usual care (n = 35) for 6 months. The telemedicine program included online consultations, digital caregiver education, remote monitoring, and secure messaging via the SUTH application integrated with the hospital information system. The control group received standard outpatient care with routine counseling and printed materials; baseline characteristics were similar between groups. Baseline demographic and clinical characteristics were comparable between groups. After 6 months, both groups showed modest reductions in BMI; however, ANCOVA-adjusted analyses indicated no significant between-group difference in post-intervention BMI. Weight-for-height decreased in both groups, with a slightly greater percentage reduction in the telemedicine group. Caregiver satisfaction and knowledge were significantly higher in the telemedicine group at follow-up (all p < 0.01; knowledge p < 0.001). These findings suggest that telemedicine-based care may contribute to modest improvements in anthropometric outcomes while substantially enhancing caregiver knowledge and healthcare service satisfaction, supporting its role as a scalable adjunct in pediatric obesity management. Full article

Regenerative medicine is becoming more widely integrated with longevity-oriented and preventive care as populations age and chronic degenerative diseases burden healthcare systems. Mesenchymal stem cell (MSC) therapies have progressed from experimental interventions to approved products, yet scalability, safety, cost, and regulatory complexity constrain widespread implementation in medical wellness contexts. The predominant therapeutic effects of MSCs are mediated via paracrine mechanisms, leading to cell-free approaches based on the MSC secretome—a complex mixture of bioactive factors including all types of biomolecules and assemblies thereof, such as exosomes. These acellular products offer compelling advantages: multiple batches from single-donor sources, standardized dosing, reduced allogeneic cell risks, and shorter outpatient-compatible administration. Preclinical and clinical data indicate that secretome-based products exert potent regenerative effects in osteoarthritis, chronic wounds, stroke, traumatic brain injury, and neurodegenerative diseases. This review examines the evolution from cell-based to cell-free regenerative strategies, focusing on human umbilical cord Wharton’s jelly MSC secretome for precision longevity medicine. It compares MSC therapies with secretome- and exosome-based formulations across mechanistic, manufacturing, safety, practical and regulatory dimensions. Regional perspectives highlight Southeast Asia, and especially Thailand, as an emerging regenerative-longevity hub. Finally, it outlines the preventive patient journey integrating cell-free interventions within multi-modal programs aimed at extending healthspan. Full article