Search Results (1,926)

Background: skull base chordoma (Ch) and chondrosarcoma (ChSa) are rare neoplasms prone to local relapse. Alongside surgery, proton therapy (PT) is a well-established treatment for them. Given the relatively long patient survival expectancy, post-treatment quality of life (QoL) is crucial. This study prospectively assessed long-term QoL in this collective. Methods: seventy-seven adult patients (median age, 50 years; male n = 31; 40.3%) with skull base Ch/ChSa completed at least two EORTC-QLQ-C30 and BN20 questionnaires during and after PT. Oncological outcomes and therapy-related toxicities were recorded during follow-up. QoL was analyzed, with post-treatment scores compared to each patient’s baseline and correlated to oncological outcomes. Results: median follow-up was 51 months (range, 1–94), with 5-year overall survival (5yOS) and local control (5yLC) rates of 88.8% and 82.8%, respectively. The time to local or distant failure ranged from 8 to 58 (median, 22) months. QoL deteriorated directly at completion of PT and two to three years thereafter, especially in patients with local or distant failure. From the fifth year onward, QoL improved again. Complete resection before PT correlated to better QoL at all time points. Disease progression was associated with overall worse QoL, higher neurological symptoms already before PT, and higher symptom burden one year thereafter. Males reported better QoL before and one year after PT than females. Conclusions: PT achieves excellent OS and LC in patients with skull base Ch/ChSa. QoL declines directly after PT but remains close to reference population values. From the fifth year onward, QoL improves again. Gender, resection status, and disease progression significantly affect QoL in these patients. Full article

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients. Full article

Background: The introduction of the “trace” category in the Xpert MTB/RIF Ultra assay has significantly improved the sensitivity of molecular tuberculosis diagnostics. While it enhances sensitivity, especially in paucibacillary and extrapulmonary cases, its specificity remains debatable, making its interpretation outside select populations a topic of clinical uncertainty. Objectives: This study evaluates the diagnostic and clinical significance of trace-positive results obtained with the Xpert MTB/RIF Ultra assay in the context of a high-incidence TB setting, examining their association with clinical, imaging, and microbiological findings. Methods: A retrospective analysis was conducted on 65 samples with trace-positive Xpert Ultra results, collected over a six-year period from 59 distinct patients in a general hospital in Romania. Correlations were assessed with microscopy, culture, clinical features, imaging, treatment initiation, and prior TB history. A composite reference standard was used for diagnostic accuracy evaluation. Results: Of the 65 trace-positive samples, 29 (44.6%) were culture-positive and 5 (7.7%) were smear-positive. A high proportion of patients, 56 (94.9%), presented with TB-compatible symptoms, and 47 (79.6% of those with imaging) had highly suggestive radiological findings. Based on the composite reference standard, 47 patients (79.7%) were ultimately diagnosed with active TB. Anti-TB treatment was initiated in 44 patients (74.5%). Trace positivity was observed across various specimen types, including sputum, pleural fluid, and cerebrospinal fluid. Conclusions: In high TB burden environments, trace-positive Xpert Ultra results frequently reflect true disease when interpreted within the appropriate clinical and imaging framework. Our findings indicate that, in regions with high tuberculosis incidence such as Romania, trace-positive Xpert Ultra results may contribute meaningfully to clinical decision-making when interpreted alongside clinical and radiological findings, in alignment with current WHO guidance. Full article

Background: Celiac disease (CeD) is a chronic, immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals. While a lifelong gluten-free diet (GFD) remains the cornerstone of treatment, inadequate follow-up can lead to persistent symptoms, nutritional deficiencies, and long-term complications. Aim: This narrative review summarizes best practices in celiac disease follow-up, with emphasis on multidisciplinary, nutritional, clinical, and preventive care strategies to optimize long-term outcomes. Main Findings: High-quality follow-up requires coordinated care involving gastroenterologists, dietitians, primary care providers, and other specialists. Nutritional challenges of the GFD include high cost, limited fortification, suboptimal nutrient content, and increased risk of obesity and metabolic dysfunction. Patients also face psychosocial and behavioral burdens such as anxiety, social isolation, and disordered eating. Evidence-based strategies for follow-up include structured clinical and serologic monitoring, laboratory assessments, bone health evaluation, cancer risk reduction, and preventive care. Novel tools such as gluten immunogenic peptide testing, digital health platforms, and artificial intelligence are emerging as adjuncts to clinical management. Implications: Structured, patient-centered follow-up that integrates medical, nutritional, and psychosocial dimensions is essential to achieving mucosal healing, maintaining long-term health, and improving quality of life in individuals with CeD. Full article

Problematic Internet use is an emerging concern in adolescent mental health and is closely linked to psychological distress and emotional regulation. This cross-sectional study analyzed self-reported data from 1550 adolescents aged 11–19 years in South Tyrol, a linguistically and culturally diverse region in Northern Italy. Problematic Internet use was measured using the validated Generalized Problematic Internet Use Scale 2 (GPIUS-2), along with standardized instruments for depressive symptoms (PHQ-2) and anxiety (SCARED-GAD). Multivariable regression analysis revealed that depression and anxiety symptoms were the strongest independent predictors of higher GPIUS-2 scores. In contrast, demographic factors such as gender, family language, urbanization, migration background, and parental education were not significantly associated with PIU. Modest associations were observed between GPIUS-2 scores and both perceived economic burden and parental use of digital control tools. Perceived family support showed a small protective effect. These findings underscore the central role of emotional vulnerability in adolescent PIU and suggest that interventions should focus on supporting mental health and adaptive coping rather than solely targeting screen time or structural family characteristics. Full article

Human adenoviruses (HAdVs; genus Mastadenovirus, family Adenoviridae) are major etiologic agents of respiratory infections, exerting a disproportionately large impact on children. However, no long-term study to date has spanned pre- and post-pandemic periods in a Korean tertiary setting. Here, we retrospectively analyzed 23,284 nasopharyngeal swabs collected between 2007 and 2024 at a tertiary medical center in South Korea. Most specimens were obtained from inpatients and outpatients presenting with fever or respiratory symptoms for differential viral diagnosis. HAdV was detected using real-time PCR, and positivity rates were compared by year, season, and age group. Overall, 2043 tested positive for HAdV. Annual positivity peaked in 2010, 2013, and 2016, followed by a sharp decline during the coronavirus disease 2019 pandemic, reaching its lowest level in 2024. Positivity was higher in summer and spring than in winter. Children aged 1–5 years had the highest positivity, whereas adults and older adults showed markedly lower rates. The disproportionate burden among children underscores the need for targeted surveillance, school-based infection control, and region-specific preparedness strategies. These findings provide crucial long-term evidence into adenovirus circulation in the post-pandemic era and provides an evidence-based foundation for future public health policy and infection control planning. Full article

Background: Anxiety disorders, including panic disorder, agoraphobia, specific phobias, and generalized anxiety disorder, are among the most frequent psychiatric conditions in primary care. They often present with somatic symptoms such as dyspnea, palpitations, chest or gastrointestinal discomfort, sweating, or flushing. Adaptol^® is a non-benzodiazepine anxiolytic with nootropic properties that modulates the limbic-reticular system, hypothalamic emotional centers, and multiple neurotransmitter systems. This study aimed to assess the association between Adaptol^® use and changes in anxiety symptoms, including somatic manifestations, in routine practice. Methods: A noninterventional observational study was conducted in 100 adults diagnosed with anxiety disorders in primary care. All received Adaptol^® 500 mg as prescribed. Patients had to have mild-to-moderate anxiety (5–14 points according GAD-7) to be enrolled. Exclusion criteria ruled out individuals with concomitant psychiatric or severe somatic conditions and those with use of other medications or any interventions that could affect the symptoms. Anxiety severity and somatic symptom burden were assessed at baseline and after treatment. Results: Adaptol^® treatment was associated with reduction in anxiety and somatic complaints. Improvements were reported in palpitations, chest discomfort, gastrointestinal disturbances, and autonomic symptoms. Greater benefit was observed in male patients, though without significance testing, and in those with severe baseline anxiety, as demonstrated by correlation between GAD-7 scores at baseline and changes after the treatment (r = 0.5). No unexpected adverse events occurred. Conclusions: In this real-world study, Adaptol^® showed anxiolytic efficacy and good tolerability, improving both psychological and somatic manifestations of anxiety disorders. These findings support its use in primary care, especially in severe cases of anxiety. Controlled trials are needed to support these results. Full article

Background/Objectives: The COVID-19 pandemic profoundly disrupted the daily lives of children with neurodevelopmental disorders, particularly Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Lockdowns, therapy interruptions, and reduced access to educational and healthcare services significantly affected developmental progress and family functioning. This pilot study aimed to assess the long-term impact of the pandemic on children with ASD and ADHD in Northern Greece and to explore consequences for their families in the post-pandemic period. Methods: Parents or legal guardians of 72 children (ages 2–17 years) with confirmed diagnoses of ASD (n = 57) or ADHD (n = 15) participated. A structured 25-item questionnaire captured information on developmental, psychological, and social functioning, family well-being, therapy disruption, screen use, and access to online support. Data were collected across urban, semi-urban, and rural areas of Northern Greece over six months. Descriptive and inferential analyses were performed. Results: Most participants were boys (77.8%) and in primary school (73.6%). Common co-occurring conditions included learning difficulties (33.3%), anxiety (8.3%), and epilepsy (6.9%). Nearly half of families (45.8%) reported therapy reductions exceeding 70%, while 29.2% accessed online therapy, often with limited perceived effectiveness. New behavioral symptoms emerged in 45.8% of children, including irritability, anxiety, and emotional instability. Parental psychological distress was reported by 29.2% of caregivers. Screen time increased in over 90% of cases, and 87.5% of parents perceived the pandemic as negatively affecting their child. Financial strain was noted by 37.5% of families. Conclusions: The findings highlight the significant developmental, psychological, and social consequences of the COVID-19 pandemic for children with ASD and ADHD and their families. Service disruptions, unmet therapeutic needs, and increased caregiver burden emphasize the urgency of sustainable, flexible care models. Strengthening telehealth, integrating community-based interventions, and enhancing educational accommodations are essential for resilience in the post-pandemic era. Full article

Background/Objective: The SARS-CoV-2 pandemic, emerging in late 2019, led to a global health crisis, with many patients developing prolonged symptoms after infection known as sequelae of COVID-19. This condition is theorized to be driven by systemic inflammation and immune dysregulation and presents with diverse symptoms from cardiovascular, pulmonary, and neurological systems. This study investigates the prevalence, risk factors, and long-term impacts of sequelae of COVID-19. Method: Using Denmark’s healthcare databases, this population-based cohort study included 1,034,093 individuals over 40 years who tested positive for COVID-19 between 1 March 2020 and 28 February 2022. Participants were divided into two age groups: 40–59 years and 60 years or older. Part A examined the risk of sequelae of COVID-19 diagnoses (ICD-10 code B94.8A) based on the Charlson Comorbidity Index (CCI). Part B assessed two-year outcomes for patients diagnosed with sequelae of COVID-19. Results: Results showed a 0.55% prevalence of sequelae of COVID-19 in both age groups. Higher CCI scores correlated with an increased risk of sequelae of COVID-19. During the two-year follow-up, patients with sequelae of COVID-19 faced significantly elevated risks of thromboembolic events, chronic lung diseases, and infections. Adjusted hazard ratios were notably high: 14.50 (7.54–27.86) and 12.50 (6.95–22.49) for thromboembolic events in adults and older adults, respectively; 33.81 (13.30–85.96) and 9.83 (6.09–15.87) for chronic lung disease; and 8.40 (4.49–15.70) and 15.44 (10.47–22.78) for infections. Conclusions: While the overall prevalence of sequelae of COVID-19 was low among individuals over 40, those with higher comorbidity burdens were at greater risk of severe sequelae and subsequent health complications. These findings underscore the need for clinical monitoring, especially for patients with pre-existing comorbidities, to mitigate long-term health risks associated with COVID-19 sequelae. Full article

Background/Objectives: Machine learning is an extremely important issue, considering the potential to prevent the onset of long-term complications from coronavirus disease or to ensure timely detection and effective treatment. The aim of our study was to develop an algorithm and mathematical model to predict the risk of developing long COVID in children who have had acute SARS-CoV-2 viral infection, taking into account a wide range of demographic, clinical, and laboratory parameters. Methods: We conducted a cross-sectional study involving 305 pediatric patients aged from 1 month to 18 years who had recovered from acute SARS-CoV-2 infection. To perform a detailed analysis of the factors influencing the development of long-term consequences of coronavirus disease in children, two models were created. The first model included basic demographic and clinical characteristics of the acute SARS-CoV-2 infection, as well as serum levels of vitamin D and zinc for all patients from both groups. The second model, in addition to the aforementioned parameters, also incorporated laboratory test results and included only hospitalized patients. Results: Among 265 children, 138 patients (52.0%) developed long COVID, and the remaining 127 (48.0%) fully recovered. We included 36 risk factors of developing long COVID in children (DLCC) in model 1, including non-hospitalized patients, and 58 predictors in model 2, excluding them. These included demographic characteristics of the children, major comorbid conditions, main symptoms and course of acute SARS-CoV-2 infection, and main parameters of complete blood count and coagulation profile. In the first model, which accounted for non-hospitalized patients, multivariate regression analysis identified obesity, a history of allergic disorders, and serum vitamin D deficiency as significant predictors of long COVID development. In the second model, limited to hospitalized patients, significant risk factors for long-term sequelae of acute SARS-CoV-2 infection included fever and the presence of ≥3 symptoms during the acute phase, a history of allergic conditions, thrombocytosis, neutrophilia, and altered prothrombin time, as determined by multivariate regression analysis. To assess the acceptability of the model as a whole, an ANOVA analysis was performed. Based on this method, it can be concluded that the model for predicting the risk of developing long COVID in children is highly acceptable, since the significance level is p < 0.001, and the model itself will perform better than a simple prediction using average values. Conclusions: The results of multivariate regression analysis demonstrated that the presence of a burdened comorbid background—specifically obesity and allergic pathology—fever during the acute phase of the disease or the presence of three or more symptoms, as well as laboratory abnormalities including thrombocytosis, neutrophilia, alterations in prothrombin time (either shortened or prolonged), and reduced serum vitamin D levels, are predictors of long COVID development among pediatric patients. Full article

Background/Objectives: Allergic diseases are highly prevalent worldwide and represent a significant public health burden. Current therapies mainly alleviate symptoms without addressing underlying immune dysfunction, which has increased interest in nutritional bioactive compounds as preventive or modulatory agents. This review summarizes evidence on omega-3 polyunsaturated fatty acids, vitamin D, curcumin, ginger bioactives, quercetin, and epigallocatechin gallate (EGCG) in allergy prevention and management. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science up to July 2025, including preclinical and clinical studies reporting immunological, mechanistic, and clinical outcomes. Results: Omega-3 fatty acids modulate Th2 responses, promote regulatory T cells, and generate specialized pro-resolving mediators, with modest clinical benefits observed in pregnancy and early life. Vitamin D contributes to immune tolerance and epithelial integrity, although supplementation trials remain heterogeneous. Curcumin inhibits NF-κB/MAPK signaling, enhances barrier function, and improves allergic rhinitis and dermatitis despite limited bioavailability. Ginger constituents ([6]-gingerol, [6]-shogaol) modulate Th1/Th2 balance, mast-cell activity, and oxidative stress, with early clinical evidence in rhinitis and asthma. Quercetin stabilizes mast cells, inhibits Lyn/PLCγ pathways, and improves rhinitis symptoms in small randomized trials using bioavailable formulations. EGCG stabilizes mast cells, attenuates FcεRI signaling, and reduces airway inflammation in preclinical models, though clinical data are scarce. Conclusions: Overall, preclinical findings consistently support the immunomodulatory potential of these compounds, while clinical results are promising but heterogeneous. Standardized formulations, long-term trials, and exploration of synergistic effects are required to confirm efficacy and safety, providing future research directions in allergy prevention. Full article

Growing age-related epidemiology, together with an increasing burden of cardiac co-pathology and comorbidities, has progressively subverted the clinical paradigm of Aortic Stenosis (AS) towards a multifaceted scenario. Timely surgical or transcatheter valve replacement is paramount to reduce morbidity and mortality in AS patients provided that the obstruction is hemodynamically important and responsible for the symptoms across a variety of clinical contexts. Despite its recognized role in AS assessment severity, transvalvular gradient (TVG) reflects complex interplay among anatomical, mechanical and fluid-dynamic factors, challenging the ultimate recognition of significant aortic valve obstruction. Careful phenotyping of TVG by assessing its underlying variables may enhance diagnostic work-up, risk stratification and management of AS. Emerging imaging modalities, such as three-dimensional echocardiography, automatic flow and myocardial function assessment, and advanced fluid dynamics analysis are promising for refining multifaceted TVG phenotypes. A deeper understanding of the substrate underlying TVG may add new insight into the trajectory of valve obstruction and its interaction with left ventricular function, thereby supporting the tailoring of TVG-guided clinical strategies of the evolving scenario of AS. Full article

Background/Objectives: Heart Failure (HF) remains a leading cause of hospitalization and mortality worldwide, representing a significant burden on patients and healthcare systems. Despite advances in pharmacological and device-based therapies, readmission rates remain high and traditional monitoring approaches often fail to detect early physiological deterioration. This review examines the clinical utility and implementation challenges of remote hemodynamic monitoring in HF, highlighting its role in improving patient outcomes and guiding precision care. Method: A comprehensive narrative review was conducted using PubMed, Scopus, and Web of Science databases to identify peer-reviewed English-language studies published in the past ten years. Results: Monitoring hemodynamic status is essential for preventing HF readmissions, as elevated filling pressures often precede symptoms. Previous studies suggest that traditional methods may be less effective in detecting early changes, which could contribute to delays in initiating treatment. Remote monitoring offers continuous, individualized assessment and has shown potential to reduce hospitalizations, though its effectiveness varies across populations and settings. Telemonitoring primarily targets patients at higher risk of hospitalization, such as those classified as New York Heart Association(NYHA) class III and individuals with comorbidities that exacerbate HF. Remote hemodynamic monitoring presents notable clinical advantages, although its widespread adoption faces several challenges (i.e., the invasiveness of some monitoring systems; limited patient adherence due to technical complexity or cognitive and physical barriers; difficulties associated with comorbidities; variability in the efficacy of monitoring strategies across populations; difficulties faced by healthcare teams in managing and interpreting large volumes of real-time data; cost-effectiveness issues related to devices and infrastructure costs). Addressing these limitations will be essential to fully understanding the potential of remote monitoring in HF care. Conclusions: Remote hemodynamic monitoring enables early detection of physiological deterioration in HF, allowing timely interventions that reduce hospitalizations and improve outcomes. Emerging evidence suggests that, in contrast to traditional approaches, this method has the potential to support more personalized, data-driven care. Integrating biopsychosocial, gender, and intersectional perspectives further aligns this strategy with precision medicine, enhancing its effectiveness and equity in clinical practice. Despite promising recent advances, further research is essential to broaden the scientific evidence base and to enhance support for clinical decision-making. Full article

Background and Objectives: Lifestyle and dietary behaviors are increasingly recognized as important factors influencing symptom management and quality of life (QoL) in patients with rheumatic diseases. However, evidence remains limited regarding how specific lifestyle patterns interact with sociodemographic and clinical variables to shape patient-reported outcomes. This study aimed to investigate the relationship between diet, lifestyle behaviors, and self-perceived QoL in a cohort of patients with rheumatic conditions. Methods: In this cross-sectional study, 350 adults with rheumatic diseases completed a structured questionnaire covering sociodemographic data, rheumatologic diagnosis and treatment, dietary behaviors, lifestyle factors (physical activity, sleep, smoking, alcohol), and QoL assessments (scales 1–10). Statistical analyses included descriptive measures, Chi-square tests, correlation analyses, logistic regression, and linear regression models to identify predictors of QoL. Results: The majority of participants were female (86.9%) and aged between 26 and 55 years. Urban patients were more likely to attribute a positive influence of diet on QoL, while rural participants reported stronger disease burden. Logistic regression showed that adherence to a special diet significantly increased the odds of reporting good QoL. Linear regression identified sleep quality (β = 0.42), perceived dietary influence (β = 0.29), and physical activity (β = 0.18) as independent predictors of QoL (adjusted R² = 0.47, all p < 0.001). Correlation analyses further revealed that disease burden negatively impacted emotional well-being and sleep, while dietary influence correlated positively with QoL. Conclusions: This study highlights the multidimensional role of diet and lifestyle in shaping QoL in patients with rheumatic diseases. Alongside pharmacological treatment, targeted lifestyle interventions focusing on nutrition, physical activity, and sleep hygiene may substantially improve patient outcomes. Future longitudinal studies are warranted to confirm these associations and explore causal mechanisms. Full article

Background: Long COVID—defined as the persistence of symptoms or the development of new symptoms beyond four weeks after acute SARS-CoV-2 infection—affects an estimated 10–30% of individuals recovering from COVID-19, posing a significant public health burden. Emerging evidence suggests that type I interferons (IFNs) (a critical group of cytokines in the antiviral defense) and hematologic alterations, such as lymphopenia and elevated inflammatory markers, are linked to both the severity of acute COVID-19 and the likelihood of developing long-term symptoms. The aim of this study is to explore the association between type I IFN signatures and long COVID. A second aim is to examine the relationship between laboratory findings during acute infection and long COVID. Methods: The study included 61 patients investigated for the presence of long COVID symptoms 16.5 ±1.5 months after acute infection. Patients were divided into two groups of higher symptom burden of long COVID and those with milder symptoms based on demographic, laboratory, and clinical data as well as type I IFN-inducible gene expression (MX-1, IFIT-1, and IFI-44) measured in peripheral blood by real-time PCR. Data collected during acute infection were recorded. Peripheral blood samples were collected during the acute phase of infection, within the first 48 h of hospital admission. IFN-inducible gene expression was measured prospectively at that time, and RNA was extracted immediately for subsequent analysis. Results: History of intubation emerged as a significant associated factor of severe long COVID, with 75% of intubated patients reporting >8 persistent symptoms approximately 16 months post-infection. Higher white blood cell (WBC) and neutrophil counts but lower eosinophil and monocyte counts in acute infection were found to be associated with a high burden of long COVID symptoms. Interestingly, absolute monocyte count was found to independently correlate with higher long COVID symptom burden. Lactate dehydrogenase (LDH) and serum glutamic-oxaloacetic transaminase (SGOT) also differed significantly between groups, with higher levels correlating with a high burden of long COVID symptoms. Notably, MX-1 transcript levels in peripheral blood at the time of acute infection were reduced in patients with a high burden of long COVID symptoms, suggesting that dysregulated immune responses during the acute phase may contribute to persistent symptoms. Conclusions: These findings suggest the potential association of hematological and immune markers with long COVID severity, as well as the importance of monitoring these parameters to identify at-risk patients for early interventions. Full article