Search Results (2,193)

Osteochondroses of the foot represent a unique and less frequently discussed topic. This narrative review aims to provide a comprehensive overview of foot osteochondroses, highlighting their definition, pathophysiology, clinical features, diagnosis, and treatment. Historical sources, including early case reports, were included along with the current literature to picture the current knowledge on the subject. Anatomical mapping of pain locations and associated ossification centers was employed as a framework to present the various forms of foot osteochondroses. Multiple types of foot osteochondrosis were identified. The calcaneus, navicular and lesser metatarsal are among the more common involved bones. Most forms share a multifactorial etiology involving mechanical stress, vascular insufficiency, and delayed ossification. The pain is localized and common to all forms. Diagnosis relies on clinical assessment supported by radiographic and sometimes magnetic resonance imaging findings. During the acute phase, joint rest is essential. Despite the potential for spontaneous resolution, some cases can lead to structural deformities or persistent symptoms. Foot osteochondroses, although rare, require careful clinical evaluation due to their impact on pediatric patients. Increased awareness and standardized treatment approaches may improve early recognition and management, potentially reducing long-term sequelae. Full article

Background/Objectives: Isotretinoin is a highly effective therapy for severe acne, but its potential neuropsychiatric adverse reactions (NPsRs) have been controversial. This study evaluated EudraVigilance data from 2005 to 2025 to better understand the frequency, typology, and predictors of such events. Methods: We conducted a retrospective analysis of 33,381 individual case safety reports (ICSRs) related to isotretinoin. Using descriptive statistics, chi-square tests, and logistic regression, we assessed associations between NPsRs and variables such as age, sex, geographic region, and reporter type. Results: A total of 9793 cases (29.3%) involved at least one NPsR. Depression (31%) and suicidal ideation (8.6%) were the most frequently reported symptoms. Adolescents (12–17 years) had the highest proportion of NPsR cases, while male patients and reports submitted by non-healthcare professionals were significantly overrepresented. Reports from non-European Economic Area countries also had slightly increased odds of including NPsRs. All predictors were statistically significant in the logistic regression model, though the explained variance was modest (Nagelkerke R² = 0.065). Conclusions: Neuropsychiatric reactions remain a prominent and persistent signal in isotretinoin pharmacovigilance, particularly among younger patients and non-professional reporters. Although causality cannot be inferred from spontaneous reporting data and confounding factors like acne-related depression cannot be excluded, these findings highlight the clinical value of pre-treatment psychiatric screening, patient-centered education, and proactive mental health monitoring throughout isotretinoin therapy. Full article

Early diagnosis of cystic fibrosis (CF) through newborn screening (NBS) improves clinical outcomes, but in countries like India, delayed diagnosis increases morbidity, mortality, and likely underestimates infant deaths from CF. We performed a retrospective study at a single center in south India from 2017 to 2025 reviewing children diagnosed with CF before one year of age. Patient demographic, clinical, and genetic data were analyzed to characterize early clinical features and identify factors linked to mortality. Of 56 infants diagnosed with CF, 59% survived (median current age 55 months) while 41% died (median age of death 5 months). Key clinical indicators included sibling death with CF-like symptoms, rapid weight loss, and persistent respiratory or nutritional complications. Mortality risk under one year was significantly linked to hypoalbuminemia (OR 9.7), severe malnutrition (OR 4.4), severe anemia (hemoglobin < 7 g/dL) requiring blood transfusions (OR 3.0), and peripheral edema (OR 4.2). A triad of anemia, hypoalbuminemia, and edema was found to strongly predict death (OR 4.2). Integrating clinical checklists of these manifestations into primary healthcare may improve prompt referrals for earlier diagnosis and treatment. Continued education and advocacy for NBS are essential to reduce potentially preventable CF-related deaths in young children. Full article

Urinary incontinence (UI) is a widespread worldwide gynecological pathology with a negative impact on women’s quality of life. We performed a narrative review and present a general, descriptive, and comprehensive perspective about surgical techniques for urinary incontinence in young women. Even though parity and vaginal births represent important risk factors for the occurrence of UI, it is also common among young women who are nulliparous. Lifestyle, obesity, smoking, alcohol consumption, and excessive stretching exercises can contribute to the occurrence of UI. Correct diagnosis and treatment may reduce the negative effects of UI on daily activities. Disease management varies depending on the three types of UI: stress, urge, and mixed. Conservative treatment involves lifestyle changes, pharmacological therapy, and pelvic floor muscle training. If symptoms persist, surgical techniques such as midurethral/suburethral slings, anterior colporrhaphy, and retropubic/laparoscopic colposuspension are necessary. Transvaginal tension-free vaginal tape obturator (TVT-O) is the most common surgical technique for the treatment of UI. Its effectiveness has been proven by reducing symptoms and improving quality of life. Alternative modern treatment methods are vaginal laser therapy, periurethral bulking agents injection, or local injection with autologous platelet-rich plasma. Surgical techniques for the treatment of UI are in continuous development and improvement considering the increased incidence of this pathology and the need of patients to improve symptoms and quality of life. Full article

Background/Objectives: Gender-affirming surgery (GAS) is associated with improved mental health outcomes in transgender and gender-diverse (TGD) individuals. However, TGD populations experience disproportionately high rates of substance use disorders (SUDs), which are established risk factors for surgical complications. Despite this, the relationship between preoperative SUDs and postoperative outcomes following GAS has not been studied. Our objective was to evaluate how specific SUD subtypes, including tobacco, alcohol, and cannabis, impact short- and medium-term postoperative complications following GAS. Methods: A retrospective cohort study was conducted using the TriNetX Research Network, which includes de-identified electronic health records from over 100 million U.S. patients. Adults with documented gender dysphoria who underwent GAS between April 2015 and April 2025 were included. Patients were divided into four groups: no SUD, tobacco use, alcohol use, and cannabis use. Propensity score matching was used to control for demographic variables. Postoperative complications were assessed at 30 days and 6 months. Results: Alcohol use was significantly associated with increased rates of delayed wound healing, wound dehiscence, gastrointestinal symptoms, and postoperative pain at both 30 days and 6 months. Cannabis use was linked to higher rates of wound dehiscence, infections, GI symptoms, and pain. Tobacco use showed the broadest impact, significantly associated with nearly all complications measured except pain at 30 days. These associations persisted at six months. Conclusions: This is the first study to quantify the relationship between substance use and GAS outcomes. Preoperative use of tobacco, alcohol, and cannabis was independently associated with increased postoperative complications. These findings underscore the need for systematic preoperative screening and the development of SUD-specific perioperative care pathways to improve outcomes and advance equity in surgical care for TGD patients. Full article

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of the sociocultural context that perpetuates racially motivated care. This study uses a two-round Delphi process to gather knowledge on the cultural appropriateness and content validity of the adapted Mothers and Babies Online Course, a United States Prevention Service Task Force-recommended intervention for managing mental health symptoms in pregnant and new mothers for Black mothers with preterm birth. The Black feminist theory and cultural adaptation strategies were used to conceptualize the adaptation process. Opinions were solicited from Black mothers and professionals based on predetermined criteria. Eleven participants, comprising eight mothers and three professionals, participated in Round One. Of these, only one professional did not participate in Round Two, totaling 10 participants who participated in Round Two. The participants rated the adapted program—eMB 4 Blackmamas, positively, and four themes emerged, substantiating the importance of culturally responsive mental health. The themes also offered additional feedback related to improving the program delivery. Including diverse stakeholders in mental health research offers unique and balanced insights into designing culturally appropriate programs to promote and protect Black maternal mental health in the NICU. Full article

Background: The therapeutic response in Graves’ Disease (GD) remains largely unpredictable. Patients often experience persistent symptoms that are poorly correlated with thyroid hormone levels, an undefined treatment duration, and the need for long-term or definitive therapies. Based on the nuclear antagonistic properties of L-carnitine (LCT) on thyroid hormone action and the immunomodulatory role of selenium (Se), we aimed to assess the impact of adding a combined LCT and Se supplement to standard methimazole (MMI) therapy on the biochemical profile and quality of life (QoL) of patients with overt GD. Methods: This multicenter prospective randomized trial enrolled 60 consecutive patients with newly diagnosed overt GD. Participants were randomized to receive either standard treatment with MMI alone (Control Group) or MMI plus the combined LCT/Se supplement (Intervention Group). TSH, fT3, fT4, and TSH–receptor antibodies (TRAb) levels were evaluated every two months for up to 24 months or until spontaneous remission or definitive therapy. At each visit, patients completed a symptom questionnaire addressing the frequency of typical thyrotoxic symptoms. Results: No significant differences were observed between groups in the trend or time-to-normalization of TSH, fT3, and fT4 levels. However, the Intervention Group reached TRAb negativity significantly earlier (HR = 2.35 (1.14–4.81), p = 0.016), with a synergistic interaction with MMI therapy. MMI requirements were consistently lower in the Intervention Group, both in average dosage (p = 0.013) and cumulative dose (p = 0.020). The rate of spontaneous remission was significantly higher (OR = 11.22 (3.35–46.11), p < 0.001). Overall symptom burden did not differ significantly between groups; however, the supplement exerted an independent effect in reducing the severity of tremor, irritability, mood lability, heat intolerance, and exertional dyspnea. Conclusions: Our findings suggest the clinical benefits of adding combined LCT and Se supplementation to MMI in the treatment of overt GD, including shorter disease duration, lower cumulative MMI exposure and earlier TRAb normality, that could positively influence TRAb-related prognostic outcomes. Full article

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients. Full article

Background and Clinical Significance: Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) frequently coexist, creating a complex clinical interplay that exacerbates morbidity and mortality. AF can directly precipitate or worsen HFrEF through mechanisms such as tachycardia-induced cardiomyopathy, loss of atrial contribution to ventricular filling, and irregular ventricular response. The use of evidence-based therapies improves clinical outcomes in patients with HFrEF. Case Presentation: We present a clinical case of a 58-year-old man with left bundle branch block (LBBB), tachysystolic AF, and the aforementioned induced HFrEF. The patient’s medical treatment was optimized according to recent guidelines. Subsequent to the improvements in HF treatment, the patient’s echocardiographic data showed a higher left ventricle ejection fraction (LVEF); however, it remained below 35%. Moreover, tachysystolia persisted and was not sufficiently controlled with medications. Therefore, an upgrade of the pacemaker to cardiac resynchronization therapy (CRT) following the destruction of the AV node was performed to control tachysystolic AF and worsening of HF. After the treatment adjustments, the patient’s symptoms regressed, and echocardiography showed improved LVEF up to 41%. Conclusions: This case highlights the successful identification and timely application of intensive heart rate control management and heart failure induced by AF treatment. Full article

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, endocrine, and immunological factors, i.e., complex disorders in interconnected biological and psychological systems. In BMS, patients often suffer from persistent burning sensations without visible lesions, which may be related to altered pain processing, emotional stress, and dysregulation in the brain regions responsible for interoception and perception. Although OLP is primarily characterised by immune-mediated mucosal damage, it often has significant psychological comorbidity, particularly in the erosive form. Common features such as cortisol imbalance, disturbed cytokine patterns, and high levels of anxiety and depression suggest that these conditions may be due to overlapping systemic disorders. It is no longer sufficient to focus only on the visible lesions or symptom relief. Understanding these diseases/disorders through a more comprehensive psychoneuroendocrine immune system (PNEI) opens up new opportunities for early intervention, improved diagnostics, and more personalised therapeutic strategies that go beyond treating symptoms. Ultimately, these diseases/disorders require a more integrated and patient-centred approach, where understanding the whole system is as important as treating its individual parts. Full article

Electrochemical biosensors have emerged as a promising tool for the early detection of diseases in oilseed crops such as rapeseed, soybean, and peanut. These biosensors offer high sensitivity, portability, and cost-effectiveness. Timely diagnosis is critical, as many pathogens exhibit latent infection phases or produce invisible metabolic toxins, leading to substantial yield losses before visible symptoms occur. This review summarises recent advances in the field of nanomaterial-assisted electrochemical sensing for oilseed crop diseases, with a particular focus on sensor mechanisms, interface engineering, and biomolecular recognition strategies. The following innovations are highlighted: nanostructured electrodes, aptamer- and antibody-based probes, and signal amplification techniques. These innovations have enabled the detection of pathogen DNA, enzymes, and toxins at ultra-low concentrations. Notwithstanding these achievements, challenges persist, including signal interference from plant matrices, limitations in device miniaturization, and the absence of standardized detection protocols. Future research should explore the potential of AI-assisted data interpretation, the use of biodegradable sensor materials, and the integration of these technologies with agricultural IoT networks. The aim of this integration is to enable real-time, field-deployable disease surveillance. The integration of laboratory innovations with field applications has been demonstrated to have significant potential in supporting sustainable agriculture and strengthening food security through intelligent crop health monitoring. Full article

Since the start of the COVID-19 pandemic, increasing evidence has shown that SARS-CoV-2 infection can cause long-term symptoms, collectively known as long COVID, and that patients with mild COVID-19 can also be affected by persistent fatigue, cognitive impairment, dyspnea, muscle pain, etc. Recent research has also found multiple organ systems, including the liver, to be significant sites of ongoing injury. This narrative review summarizes current knowledge on organ involvement during and after COVID-19, with particular focus on early and delayed hepatic manifestations and associated risk factors. Pathogenesis appears to be multifactorial, involving direct virus action, the body’s immune-mediated inflammatory response, microvascular damage, drug-induced hepatotoxicity, and, in some cases, reactivation or exacerbation of pre-existing liver conditions. The hepatic clinical manifestations range from asymptomatic elevations of transaminases to cholangiopathy and even fibrosis. These can persist or progress for months after the initial infection with SARS-CoV-2 is resolved, requiring prolonged monitoring and interdisciplinary care, especially in the presence of metabolic disorders, obesity, or hepatitis. Neurological, cardiovascular, and other sequelae are discussed in parallel, with attention paid to common inflammatory and thrombotic pathways. This review concludes that liver dysfunction is of particular interest in long-COVID due to the liver’s central role in metabolism and inflammation. While further research is being conducted into organ-specific and systemic interactions, the available evidence makes a compelling case for extended monitoring and integrated management strategies post infection. Full article

The rising prevalence of pediatric food allergies represents a growing public health concern, with hospitalizations for food-induced anaphylaxis on the rise. Early cutaneous manifestations, particularly in the setting of atopic dermatitis (AD), may indicate sensitization via the skin—a critical route for allergen exposure in early life. Pediatric food allergies can be IgE-mediated, non-IgE-mediated, or mixed, with each type presenting distinct pathophysiological and clinical features. IgE-mediated reactions often involve acute urticaria and angioedema, while non-IgE forms, such as food protein-induced enterocolitis syndrome (FPIES), manifest with delayed gastrointestinal symptoms and limited skin involvement. AD is closely linked with food allergies, both in pathogenesis and symptom exacerbation, with a high prevalence of co-occurrence. Diagnosis primarily relies on clinical evaluation, supported by testing such as skin prick testing, serum IgE, and oral food challenges, though limitations exist in sensitivity and specificity. Management emphasizes allergen avoidance, symptom control, and multidisciplinary care. While many pediatric food allergies resolve with age, others persist or present chronically, necessitating long-term strategies. Coordinated management between allergy and dermatology is key to minimizing complications and supporting better long-term outcomes for affected children. Full article

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes. Full article

Background/Objectives: Burning Mouth Syndrome (BMS) is a chronic orofacial pain disorder characterized by persistent intraoral burning sensations without visible mucosal lesions. Although its biopsychosocial complexity is increasingly recognized, cross-cultural comparison data remain limited. Methods: This cross-sectional study assessed 60 patients with BMS (30 Italian, 30 Romanian) who underwent standardized clinical, psychological, and sleep evaluations. Data collected included sociodemographics, clinical characteristics, diagnostic history, comorbidities, and symptomatology. The assessment tools used included the Numeric Rating Scale (NRS), Short Form of the McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Statistical comparisons were conducted using Mann–Whitney U and Fisher’s exact tests with Bonferroni correction. Results: No significant differences were observed in age, sex, or body mass index. Italian patients had fewer years of education (p = 0.001), higher pain intensity (NRS, p < 0.001), poorer sleep quality (PSQI, ESS, p = 0.001), and more frequent pre-existing sleep disorders (p < 0.001). Romanian patients showed higher levels of anxiety (HAM-A, p < 0.001), longer diagnostic delays (p = 0.002), and more dysesthetic or perceptual symptoms, including tingling and oral dysmorphism (p < 0.05). Stressful events before onset were more common among Romanians (p < 0.001), while Italians more often received a correct diagnosis at first consultation (p = 0.005). Conclusions: This first cross-national comparison of BMS in Western and Eastern Europe shows that cultural, healthcare, and clinician education differences can shape symptom profiles, comorbidities, and diagnostic delays, underscoring the need for personalized, country-specific management strategies. Full article