Search Results (2,494)

Background/Objectives: Classified as a hypertensive disorder of pregnancy, preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The abnormal trophoblast invasion that leads to a failed transformation of the uterine spiral arteries during placentation remains the most probable cause for preeclampsia. It is known that adiponectin acts on the placenta, playing a regulatory role in placentation processes. Therefore, the aim of this systematic review is to compile scientific evidence to evaluate the role of adiponectin as a biomarker for preeclampsia. Methods: The protocol for this systematic review was registered on the PROSPERO database (ID CRD42024542403) and follows the PRISMA 2020 guidelines. Overall, twenty-nine studies were selected from the PubMed and Scopus databases, including case–control, prospective and retrospective cohort, cross-sectional, and bidirectional Mendelian randomization studies. Results: From the articles analyzed, nine studies indicated an increase in adiponectin levels in preeclampsia, eleven reported a decrease, eight detected no significant changes, and in two studies, it was not possible to determine the glycoprotein levels. Analysis of the evidence quality revealed that moderate and low evidence levels predominate, with stronger evidence for decreased adiponectin levels. Conclusions: Promoting the advancement of scientific research is crucial, particularly exploring the association between adiponectin and other biomarkers. This approach could facilitate the development of screening and diagnostic methods, enabling the implementation of specific preventive and therapeutic strategies. Full article

Background: Depression has been identified as an important determinant of outcomes in hip and knee arthroplasty, but its impact on total ankle arthroplasty (TAA) remains unclear. Given the growing use of TAA as a treatment for end-stage ankle arthritis, understanding psychosocial risk factors is critical for optimizing surgical outcomes. This study aims to assess the effect of preoperative depression on clinical and functional outcomes following total ankle arthroplasty. Methods: A systematic review was conducted in accordance with PRISMA guidelines and prospectively registered with the Open Science Framework. PubMed, Cochrane Library, and CINAHL were searched through August 2025 for studies reporting outcomes of TAA stratified by depression status. Eligible designs included randomized trials, cohort studies and case series. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Given heterogeneity in study designs, depression definitions, and outcome measures, findings were synthesized narratively and summarized using a revised effect-direction plot. Results: Six unique studies involving approximately 9000 patients met inclusion criteria. Five studies were rated as good quality on the Newcastle–Ottawa Scale, while one study was judged to be of moderate quality. Four studies assessing pain outcomes consistently demonstrated worse postoperative pain or less improvement in patients with depression. Three of five studies assessing functional or disability outcomes reported reduced improvement, while two studies found no independent association. Two studies evaluating complications showed higher risks of adverse events, including prolonged hospital stay, non-home discharge, osteophytosis, and implant subsidence, among depressed patients. Revised effect-direction synthesis confirmed a consistent trend toward poorer outcomes across pain, function, and complication domains. Conclusions: Depression is associated with worse pain and higher complication rates following TAA, while its influence on functional recovery was not demonstrated uniformly. These findings support the importance of routine preoperative screening and targeted management of depression. Further prospective, multicenter studies and interventional trials are needed to clarify causality and optimize perioperative care. Full article

Background: Cardiac arrests can occur both in and out of hospital settings. Over the years, several protocols have been developed to standardize the behavior of healthcare professionals called upon to deal with these emergencies. Advanced Cardiac Life Support (ACLS) algorithms enable healthcare professionals to effectively manage cardiac arrest and achieve better patient outcomes, particularly at the time of discharge. Methods: We conducted a narrative review. Three databases (PubMed, Embase, Cochrane) were searched for relevant articles. The articles were screened and analyzed in accordance with the PRISMA guidelines. Results: A total of 1252 articles were initially identified. After screening, 11 papers were included in the review. From the selected studies, it has emerged that ACLS training had several positive effects, including an overall decrease in mortality rates. Adherence to ACLS protocols throughout an event is associated with increased Return of Spontaneous Circulation (ROSC) in the setting of In-Hospital Cardiac Arrest (IHCA). Advanced Life Support (ALS) response interval in out-of-hospital cardiac arrest was associated with decreased survival and a favorable neurological outcome. ALS response ≤ 10 min was associated with improved survival and favorable neurological outcomes. Conclusions: This review underscores the importance of adherence to ALS/ACLS guidelines in the resuscitation of patients who suffer in-hospital and out-of-hospital cardiac arrest. Full article

Background/Objectives: Early detection of undiagnosed prediabetes (PD) and type 2 diabetes (T2D) could prevent or delay the onset of diabetes and its complications. The dental setting has been suggested as a location for expanding diabetes screening in primary care. This study aimed to investigate behavioural factors that influence an oral healthcare professional’s (OHP) participation in diabetes screening and their decision to refer individuals at a high risk of diabetes for medical follow-up and confirmatory diagnosis. These factors provide targets for future interventions to encourage screening implementation and increase referral guideline compliance. Methods: This qualitative study utilised OHPs who had participated in a diabetes screening trial in Victoria, Australia. Qualitative, semi-structured interviews were conducted by telephone or videoconferencing and transcribed and analysed thematically. The themes identified were deductively mapped onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Results: In total, eight interviews were conducted (seven dentists and one oral health therapist). Five COM-B domains were identified: reflective motivation, automatic motivation, social opportunity, physical opportunity, and psychological capability. Nine TDF domains were associated with issues related to knowledge, the environmental context and resources, memory, attention and decision processes, skills, social influences, beliefs about consequences, emotion, beliefs about capability, and social influence. Conclusions: This is the first study to investigate the factors influencing an OHP’s participation and decision making in diabetes screening and referral processes in the dental setting. The results demonstrate that OHPs need more education and training to screen for diabetes in dental clinics. This study represents the first step in developing interventions to target these factors and improve the effectiveness of diabetes screening in the dental setting. Full article

Nepal is currently facing critical water quality challenges due to urbanization, water management and governance issues, as well as natural disasters. This has resulted in the presence of harmful contaminants (e.g., pathogens, nitrates, arsenic) across multiple water sources, subsequently leading to waterborne disease risks (e.g., cholera and typhoid). In response to these environmental and public health concerns, we conducted a scoping review to assess microbial and chemical contaminants in drinking and irrigation water in Nepal, as well as their potential impacts on public health. Following the JBI Manual for Evidence Synthesis and the PRISMA-SCR guidelines, we systematically searched for peer-reviewed literature on Nepal’s water quality in seven databases. Of 3666 unique records screened using predefined inclusion criteria, 140 met our criteria. The studies encompassed a variety of methodological designs, with the majority focusing on water sources in the Bagmati province. Bacteria and arsenic emerged as the most prevalent contaminants. Additionally, diseases such as arsenicosis and typhoid remain widespread and may be linked to contaminated water sources. The review identified key gaps in Nepal’s water quality management, including limited geographic research coverage, inconsistent testing protocols, weak regulatory enforcement, and a lack of integration of water quality with public health planning. Our findings underscore the urgent need for effective surveillance systems and a robust regulatory framework to promptly respond to water contamination events in Nepal. Full article

Surgical site infections (SSIs) remain a significant complication in spine surgery, especially in instrumented procedures with long operative times. Although guidelines recommend cefazolin as the first-line agent due to its efficacy against Staphylococcus aureus, predictable pharmacokinetics, and safety, its real-world practice is highly variable, with inappropriate and prolonged regimens reported across Europe. Vancomycin is often used as the first choice of therapy empirically and without screening, exposing patients to risks such as delayed infusion, nephrotoxicity, and the emergence of vancomycin-resistant enterococci (VRE).This review assesses the present function of vancomycin in relation to cefazolin for spinal prophylaxis and examines wider trends in the misuse of surgical antibiotic prophylaxis, which were identified through PubMed and Scopus searches. Evidence from randomized and prospective studies consistently supports cefazolin as the preferred prophylactic agent in clean spinal surgery. Observational data suggest that adjunctive or topical vancomycin may reduce infection rates in selected high-risk or revision cases, though the results are inconsistent and frequently limited by retrospective designs and heterogeneous outcome reporting. Importantly, the most rigorous randomized controlled trial found no benefit of intrawound vancomycin over the placebo. A small number of available investigations in vancomycin use with major design limitations have resulted in no significant VRE emergency. Unexpectedly, widespread use of vancomycin was followed by a notable transition toward Gram-negative and opportunistic organisms. In summary, vancomycin may only be considered in patients with documented MRSA colonization, β-lactam allergy, or selected revision procedures, but its widespread empirical use as a first-choice therapy is not supported. Full article

Background and Objectives: Sensorineural hearing loss (SNHL) is influenced by various causes, including thyroid diseases. For example, hypothyroidism and thyroid autoimmunity can damage the inner ear through hormonal, immune, and vascular mechanisms. Vestibular disorders like Ménière’s disease (MD) and benign paroxysmal positional vertigo (BPPV) also show possible associations with thyroid dysfunction. Materials and Methods: A review following PRISMA guidelines searched PubMed, Scopus, and Google Scholar for studies linking thyroid disorders with inner ear dysfunction. Results: Out of 985 screened records, 30 studies met inclusion criteria, involving various thyroid disorders, primarily hypothyroidism and autoimmune thyroiditis. Scientific evidence supports a correlation between hypothyroidism and hearing impairment. However, some studies also suggest a link between hyperthyroidism and inner ear disorders, particularly focusing on the role of autoimmunity in this context. Concerning vestibular dysfunction, the available studies are less abundant and support a significant association between thyroid disease and Meniere’s disease. Conclusions: There is a clear correlation between hypothyroidism and auditory function. A substantial body of literature also supports an association with vestibular disorders, although some discrepancies remain. Further research is needed to elucidate the underlying pathophysiological mechanisms (e.g., autoimmune, vascular, metabolic) involved with this correlation. Full article

Air quality is a vital factor for safeguarding public and environmental health. Particulate matter (i.e., PM2.5 and PM10) and nitrogen dioxide are among the most harmful air pollutants leading to severe health risks such as respiratory and cardiovascular diseases, while also affecting the environment negatively by contributing to the formation of acid rains and ground level ozone. The European Union has introduced new thresholds on those pollutants to be met by the year 2030, taking into consideration the guidelines set by the World Health Organization, aiming for a healthier environment for humans and living species. Cyprus is an island that is vulnerable to those pollutants mostly due to its geographic location, facilitating shipping activities and dust transport from Sahara Desert, and the methods used to produce electricity which primarily rely on petroleum products. Furthermore, the country suffers from heavy traffic conditions, making it susceptible to high levels of nitrogen dioxide. Thus, the projection of air pollutants according to different scenarios based on regulations and policies of the European Union are necessary towards clean air and better practices. The Screening for High Emission Reduction Potential on Air (SHERPA) is a tool developed by the European Commission which allows the simulation of emission reduction scenarios and their effect on the following key pollutants: NO, NO₂, O₃, PM2.5, PM10. This study aims to assess the potential of the SHERPA simulation tool to support air quality related decision and policy planning in Cyprus to ensure that the country will remain within the thresholds that will be applicable in 2030. Full article

Objective: Metabolic syndrome (MetS) represents a growing and significant public health burden worldwide. The evidence regarding whether skipping breakfast affects the development of MetS and its components remains inconsistent and uncertain. This study aimed to synthesize the best available evidence regarding the association between skipping breakfast and the risk of MetS and its components. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. We systematically searched the PubMed, Embase, Cochrane Library, and Web of Science databases from inception until May 2025. Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed the risk of bias. This review included cross-sectional and cohort studies on the association between breakfast skipping and the risk of MetS and its components. Results: Nine studies were included after quality evaluation by NOS. Pooled results from the meta-analysis revealed that skipping breakfast was significantly associated with an increased risk of MetS (OR: 1.10, 95% CI: 1.04–1.17) and its components—namely abdominal obesity (OR = 1.17, 95% CI 1.01–1.34), hypertension (OR: 1.21, 95% CI: 1.10–1.32), hyperlipidemia (OR: 1.13, 95% CI: 1.04–1.23), and hyperglycemia (OR = 1.26, 95% CI: 1.16–1.37). Conclusions: The meta-analysis demonstrated that skipping breakfast was significantly associated with an increased risk of MetS and its key components—abdominal obesity, hypertension, hyperlipidemia, and hyperglycemia. These findings highlight regular breakfast consumption as a potential modifiable factor for preventing and managing MetS and related cardiometabolic diseases. Full article

Background: Cervical intraepithelial neoplasia grade 2 (CIN2) represents a controversial lesion in cervical cancer prevention. Traditionally included in the aggregate CIN2+ endpoint for reasons of diagnostic stability and statistical power, isolated CIN2 has unique biological characteristics: greater interobserver variability, a high probability of spontaneous regression and a lower risk of progression compared to CIN3. Objectives: To critically describe the epidemiology, natural history and management strategies of CIN2, integrating data from clinical and population-based studies and comparing the recommendations of the main international guidelines. Methods: A narrative review was conducted using a search of PubMed and Scopus (1990–January 2025). Prospective and retrospective studies on isolated CIN2, screening and vaccination trials with CIN2+ endpoints, biomarker research, and consensus documents (ASCCP, ESGO, GISCi, Ministry of Health, WHO) were included. Results: Clinical studies have shown a high probability of CIN2 regression (50–70% within two years, >70% in those <25 years), compared to a 10–15% risk of progression, especially in the presence of persistent HPV16. Screening trials and vaccine evaluations with CIN2+ endpoints have documented the efficacy of the HPV test and a dramatic reduction in lesions in vaccinated cohorts, which was also confirmed for isolated CIN2. The most recent guidelines have progressively adopted a risk-based approach, which allows for active surveillance in young women or those seeking to conceive, while the WHO maintains a screen-and-treat model in resource-limited countries. Conclusions: CIN2 is not a lesion to be treated automatically, but rather a paradigmatic model for personalized management. Integrating epidemiological and clinical data, supported by biomarkers, allows for reducing overtreatment without compromising oncological safety. Full article

Background/Objectives: Migrant youth often experience multiple, intersecting systems of oppression (e.g., racism, poverty, and discrimination) that may contribute to disparities in pediatric pain prevalence, severity, and management. However, pain in migrant youth remains poorly understood. This rapid scoping review will examine the nature and extent of the existing literature on pain among migrant youth. Methods: This protocol has been preregistered on the Open Science Framework. The review will follow guidelines for conducting and reporting rapid and scoping reviews, and will be guided by PCC (population, concept, context) and PROGRESS-Plus methodological frameworks. Electronic searches will be conducted in MEDLINE, CINAHL, and Scopus for primary research studies published since 2015 that describe and examine pain among migrant youth (age < 18 years). Two reviewers will independently screen titles, abstracts, and full texts, with disagreements resolved by consensus or a third reviewer. Data charting will be piloted on 5–10 studies, then independently conducted by two reviewers. Extracted data will include study characteristics (authors, year, purpose, methodology); participant sociodemographic information (e.g., racial and/or ethnic identity, age, sex, gender identity, sexual orientation, socioeconomic position); migration status; countries of origin and destination; definition and characteristics of pain; and measures of systemic factors (e.g., racism). Results: Findings will be synthesized descriptively and interpreted within sociocultural and geopolitical contexts to better understand pain among migrant youth. Conclusions: This review will aim to provide critical insights into the intersections between migration and pediatric pain, offering guidance for future research, clinical practice, and policy to improve pain management and outcomes for migrant youth. Full article

Background/Objectives: Hearing loss is a disorder that develops because of being exposed to high noise levels affecting the quality of life among affected individuals. A review of the literature was conducted to explore the prevalence of hearing loss and its associated factors among workers in the metal industry. Methods: The literature search was conducted on ScienceDirect, Google Scholar, Pub Med, ResearchGate and African Journals Online databases to identify articles according to the Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines. The studies published in scientific journals between January 2014 and December 2024 describing hearing loss and its associated factors among workers in the metal industry were considered for inclusion in the review. The articles were screened by the author. The Critical Appraisal Skills Programme (CASP) quality assessment tool with modified checklist questions was used to evaluate the quality of studies. Results: Following the literature search and using the relevant inclusion criteria, a total of 127 articles were identified, and 8 articles with a total of 2605 participants were included in the review. The sample sizes ranged from 93 to 606. The participants’ age ranged from 19 to 65 years. A review of studies showed varying prevalence of hearing loss ranging from 13.8% to 59%. Furthermore, the studies have found working experience, advanced age, cigarette smoking, tinnitus, working in areas of high noise levels and not using hearing protective devices to be associated with a risk of developing hearing loss. Conclusions: The review found that workers in the metal industry are at risk of developing hearing loss and, therefore, implementation of control measures to prevent the occurrence of hearing loss is necessary. Full article

Background/Objectives: Transforming growth factor-beta (TGF-β) is a multifunctional cytokine involved in immune regulation, extracellular matrix turnover, and tissue repair. Its role in periodontitis remains controversial due to conflicting human studies. This systematic review addressed the PICO-based question: in adults with periodontitis (population), how does the expression and regulation of TGF-β isoforms (intervention/exposure) compare with healthy or post-treatment states (comparator) regarding clinical outcomes (outcomes)? Methods: A systematic search of PubMed and Scopus was conducted on 1 July 2025 for human studies published in English between 2010 and 2025. Eligible studies investigated TGF-β expression, function, or genetic regulation in periodontal tissues or biological fluids. Screening and quality appraisal were performed according to PRISMA guidelines, using design-specific risk-of-bias tools. The review protocol was prospectively registered in PROSPERO (CRD420251138456). Results: Fifteen studies met inclusion criteria. TGF-β1 was the most frequently analyzed isoform and was consistently elevated in diseased gingival tissue and gingival crevicular fluid, correlating with probing depth and attachment loss. Several studies reported post-treatment reductions in TGF-β, supporting its value as a dynamic biomarker. Additional findings linked TGF-β signaling to immune modulation, fibrosis, bone turnover, and systemic comorbidities. Evidence for TGF-β2 and TGF-β3 was limited but suggested isoform-specific roles in epithelial–mesenchymal signaling and scar-free repair. Conclusions: Current evidence supports TGF-β, particularly TGF-β1, as a central mediator of periodontal inflammation and repair, with promise as both a biomarker and therapeutic target. Standardized, isoform-specific, and longitudinal studies are needed to clarify its diagnostic and translational utility. Full article

Background: attention-deficit/hyperactivity disorder (ADHD) and Alzheimer’s disease (AD) are distinct neurological conditions that may share genetic and molecular underpinnings. ADHD, a neurodevelopmental disorder, affects approximately 5% of children and 3% of adults globally, while AD, a neurodegenerative disorder, is the leading cause of dementia in older adults. Emerging evidence suggests potential overlapping contributors, including pathways related to synaptic plasticity, neuroinflammation, and oxidative stress. Methods: this systematic review investigated potential genetic predispositions linking Attention-Deficit/Hyperactivity Disorder (ADHD) and Alzheimer’s Disease (AD). Following PRISMA guidelines, a search was conducted in Web of Science, Embase, PsycINFO, and PubMed using keywords related to ADHD, AD, and genetic factors. Studies included were original human studies utilizing genetic analyses and ADHD polygenic risk scores (PRS), with AD confirmed using established diagnostic criteria. Exclusion criteria comprised non-original studies, animal research, and articles not addressing genetic links between ADHD and AD. Screening was conducted with Rayyan software, assessing relevance based on titles, abstracts, and full texts. Results:. The search identified 1450 records, of which 1092 were screened after duplicates were removed. Following exclusions, two studies met inclusion criteria. One study analyzed ADHD-PRS in 212 cognitively unimpaired older adults using amyloid-beta (Aβ) PET imaging and tau biomarkers. The findings revealed that ADHD-PRS was associated with progressive cognitive decline, increased tau pathology, and frontoparietal atrophy in Aβ-positive individuals, suggesting that ADHD genetic liability may exacerbate AD pathology. Another study assessed ADHD-PRS in a cohort of 10,645 Swedish twins, examining its association with 16 somatic conditions. The results showed modest risk increases for cardiometabolic, autoimmune, and neurological conditions, with mediation effects through BMI, education, tobacco use, and alcohol misuse, but no direct link between ADHD-PRS and dementia. Discussion and conclusion: this review highlights preliminary but conflicting evidence for a genetic intersection between ADHD and AD. One study suggests that ADHD genetic liability may exacerbate AD-related pathology in Aβ-positive individuals, whereas another large registry-based study finds no direct link to dementia, with associations largely mediated by lifestyle factors. The potential ADHD–AD relationship is likely complex and context-dependent, influenced by biomarker status and environmental confounders. Longitudinal studies integrating genetics, biomarkers, and detailed lifestyle data are needed to clarify this relationship. Full article

Breast cancer detection remains a significant challenge, with traditional mammography presenting barriers such as discomfort, radiation exposure, high false-positive rates, and financial burden. Moreover, younger women frequently fall outside routine mammographic screening guidelines, leaving critical gaps in early detection. Objectives: This study investigates the potential of quantitative transmission breast acoustic computed tomography scanner imaging (QT3D) as an innovative, non-invasive imaging modality for characterizing and evaluating breast masses. Methods: A comparative analysis between QT3D imaging and magnetic resonance imaging (MRI) was conducted in a cohort of patients with biopsy-proven benign or malignant breast lesions, comparing key metrics in quantifying breast masses for the purposes of breast mass characterization. Results: The findings in this study highlight its capability in identifying relatively small tumors, multiple lesions, satellite lesions, intraductal extensions, and calcifications, in addition to offering valuable diagnostic insights. Conclusions: This work is a first step toward studies essential for confirming its clinical feasibility, establishing its role in breast cancer tumor characterization, and potentially improving patient outcomes. Full article