Search Results (7,768)

Background/Objectives: Oral cavity squamous-cell carcinoma is among the most frequent head and neck neoplasms. Early-stage T1/T2N0 accounts for 40/45% of new diagnoses. Of these, about 30% of cases hide occult metastases in the neck. The management of clinically N0 neck is of paramount importance and is still being debated. Methods: The medical records of patients with a clinical diagnosis of early-stage T1-T2N0 carcinoma of the oral cavity between 2011 and 2021 were retrospectively analysed. The inclusion criteria were complete medical and radiological records, pT1-2 pathology staging, and a minimum follow-up of 24 months. Biographical, management, and survival data were analysed using IBM SPSS Statistics [28.0.1.1]; IBM Corp., Armonk, NY, USA). Results: A total of 121 patients met the inclusion criteria. The tongue was the most affected site, with 52 cases. All patients underwent resection of the primary tumour; for neck management, 47 (38.8%) underwent elective neck dissection, 36 underwent follow-up, and 11 underwent sentinel lymph node biopsy. A total of 59 cases were staged as T1 and 62 as T2; in 97 (80.2%) cases, the neck was confirmed as N0; in 10 (8.3%), N1; in 1 case, N2a; in 8, N2b; in 2, N2c; and in 3, N3b. The mean DOI was 4.8 mm. In a Cox regression, a statistically significant association was shown between overall survival and pN staging (p < 0.05). Kaplan–Meier analysis showed a statistically significant difference between different regimens of management of the neck in terms of overall survival, disease-free survival, and disease-specific survival in favour of elective neck dissection and sentinel lymph node biopsy compared to watchful policy (p < 0.05). Conclusions: Elective neck dissection and sentinel lymph node biopsy proved to be safe and oncologically effective in the treatment of clinically N0 early-stage oral carcinoma. Full article

Background and Objective: Diabetes Mellitus is a long-term, multifaceted metabolic condition that necessitates ongoing medical management. Hypogonadism is a syndrome that is a clinical and/or biochemical indicator of testosterone deficiency. Cross-sectional studies have reported that 20–80.4% of all men with Type 2 diabetes have hypogonadism, and Type 2 diabetes is related to low testosterone. This study presents an analysis of the use of ML and EL classifiers in predicting testosterone deficiency. In our study, we compared optimized traditional ML classifiers and three EL classifiers using grid search and stratified k-fold cross-validation. We used the SMOTE method for the class imbalance problem. Methods: This database contains 3397 patients for the assessment of testosterone deficiency. Among these patients, 1886 patients with Type 2 diabetes were included in the study. In the data preprocessing stage, firstly, outlier/excessive observation analyses were performed with LOF and missing value analyses were performed with random forest. The SMOTE is a method for generating synthetic samples of the minority class. Four basic classifiers, namely MLP, RF, ELM and LR, were used as first-level classifiers. Tree ensemble classifiers, namely ADA, XGBoost and SGB, were used as second-level classifiers. Results: After the SMOTE, while the diagnostic accuracy decreased in all base classifiers except ELM, sensitivity values increased in all classifiers. Similarly, while the specificity values decreased in all classifiers, F1 score increased. The RF classifier gave more successful results on the base-training dataset. The most successful ensemble classifier in the training dataset was the ADA classifier in the original data and in the SMOTE data. In terms of the testing data, XGBoost is the most suitable model for your intended use in evaluating model performance. XGBoost, which exhibits a balanced performance especially when the SMOTE is used, can be preferred to correct class imbalance. Conclusions: The SMOTE is used to correct the class imbalance in the original data. However, as seen in this study, when the SMOTE was applied, the diagnostic accuracy decreased in some models but the sensitivity increased significantly. This shows the positive effects of the SMOTE in terms of better predicting the minority class. Full article

The Empatica EmbracePlus is a recent innovation in medical-grade wristband wearable sensors that enable unobtrusive continuous measurement of pulse rate, electrodermal activity, skin temperature, and various accelerometry-based actigraphy measures using a minimalistic smartwatch design. The advantage of this lightweight wearable is the potential for holistic longitudinal recording and monitoring of physiological processes that index a suite of autonomic functions, as well as to provide ecologically valid insights into human behaviour, health, physical activity, and psychophysiological processes. Given the longitudinal nature of wearable recordings, EmbracePlus data collection is managed by storing raw timeseries in short ‘chunks’ in avro file format organised by universal standard time. This is memory-efficient but requires programming expertise to compile the raw data into continuous file formats that can be processed using standard techniques. Currently, there are no accessible tools available to compile and analyse raw EmbracePlus data over user-defined time periods. To address that, we introduce the LOTUS toolkit, an open-source graphical user interface that allows users to reconstitute and process EmbracePlus datasets over select time intervals. LOTUS is available on GitHub, and currently allows users to compile raw EmbracePlus data into unified timeseries stored in more familiar Excel or Matlab file formats to facilitate signal processing and analysis. Future work will expand the toolkit to process Empatica E4 and other wearable signal data, while also integrating more sophisticated functions for feature extraction and analysis. Full article

Background/Objectives: Malnutrition significantly hinders recovery in patients undergoing convalescent rehabilitation. Proper nutritional management can improve rehabilitation outcomes. This study aimed to develop a novel nutritional screening method (J-Method) specifically in patients undergoing convalescent rehabilitation and compare it with the widely used Mini Nutritional Assessment Short Form (MNA-SF). Methods: We developed the J-Method for convalescent rehabilitation settings and compared its results with that of the MNA-SF. The J-Method comprised six items derived from various nutritional screening methods and obtained solely from medical records, without patient interviews. Data from 148 patients aged > 65 years with cerebrovascular diseases admitted to a convalescent rehabilitation ward (CRW) were collected. Nutritional status was evaluated using the J-Method and MNA-SF, after which the results were compared. Results: It is possible that the J-Method more precisely identified patients as malnourished than did the MNA-SF (J-Method: MNA-SF = 36/148 (24.3%): 111/148 (75.0%)). In detail, 75 (50.4%) were classified as having malnutrition by the MNA-SF but as non-malnutrition by the J-Method; however, no patients were in the opposite scenario. In addition, the results of nutritional screening using the J-Method identified patients in need of nutritional management intervention and suggested that to improve the rehabilitation effect, nutritional management should be initiated in an acute hospital before admission to a CRW. Conclusions: The J-Method may be more effective than the MNA-SF for nutritional screening in convalescent rehabilitation settings, as it provides a more accurate assessment of malnutrition without requiring patient interviews. Full article

Background/Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease typically managed with conservative treatments, such as anti-inflammatory medications and intra-articular hyaluronic acid injections; however, advanced cases may eventually require surgical intervention. Recently, cooled radiofrequency ablation (CRFA) has emerged as a novel treatment option for alleviating KOA-related pain by temporarily disabling pain-transmitting nerves. This study evaluated the short-term effects of CRFA on pain relief and walking ability in KOA patients, with a specific focus on functional improvements in walking capacity. Methods: This study included 58 patients (71 knees) with KOA who underwent CRFA after experiencing inadequate pain control with conservative treatments. The cohort consisted of 28 men and 30 women, with a mean age of 75.2 years (55–90). Under ultrasound guidance, CRFA was performed on the superior lateral geniculate nerve, superior medial geniculate nerve, and inferior medial geniculate nerve, with each targeted nerve ablated. Pre- and post-procedural evaluations (one month after CRFA) included assessments of visual analog scale (VAS) scores for pain at rest and during walking, range of motion (ROM), knee extensor strength, walking speed, and gait stability. Results: Significant improvements in the mean VAS (rest/walking) and mean walking speed (comfortable/maximum) were observed following CRFA. However, no significant changes were noted in ROM, knee extensor strength, or walking stability. Conclusions: These findings suggest that rehabilitation may be essential to further enhance walking stability. Overall, CRFA appears to be a promising short-term treatment option for reducing VAS pain scores and enhancing walking speed in patients with KOA. Full article

Background and Objectives: Recurrent pregnancy loss (RPL) affects numerous couples worldwide and has traditionally been attributed mainly to maternal factors. However, recent evidence highlights significant paternal influences on pregnancy viability and outcomes. This review aims to comprehensively examine male contributions to pregnancy loss, focusing on underlying mechanisms, novel biomarkers, and integrated strategies for improved reproductive success. Materials and Methods: A comprehensive narrative review was conducted by searching databases including PubMed and Embase for the literature published from January 2004 to October 2024. Studies focusing on paternal influences in RPL—encompassing oxidative stress, genetic and epigenetic mechanisms, health conditions, lifestyle factors, environmental exposures, and advancements in sperm proteomics—were included. Inclusion criteria were peer-reviewed articles in English that directly addressed paternal factors in RPL; studies not meeting these criteria were excluded. Results: The review identified that paternal factors such as advanced age, metabolic and cardiovascular health issues, chronic diseases, lifestyle habits (e.g., smoking, alcohol consumption, poor diet), and environmental exposures significantly affect sperm integrity through mechanisms like oxidative stress, DNA fragmentation, and epigenetic alterations. Advanced paternal age and poor health conditions are associated with increased risks of miscarriage and adverse pregnancy outcomes. Novel sperm proteomic biomarkers have been identified, offering potential for enhanced diagnostics and personalized interventions. Integrated approaches involving multidisciplinary assessments, preventive strategies, and genetic counseling are essential for effectively addressing RPL. Conclusions: Integrating paternal factors into clinical evaluations is crucial for effectively addressing recurrent pregnancy loss. Recognizing and modifying paternal risk factors through lifestyle changes, medical interventions, and environmental management can improve pregnancy outcomes. The findings underscore the need for incorporating paternal assessments into standard care and highlight the importance of future research focusing on standardizing diagnostic protocols, expanding studies on paternal contributions, and integrating proteomic biomarkers into clinical practice to facilitate personalized treatment strategies. Full article

Background: Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Methods: Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = “fully disagree” to 5 = “fully agree”; and (ii) individual pain (matched pairs) via numeric analog scale (NAS) from 0 = “no pain” to 10 = “maximum pain”. Patient charts were assessed for pain management (WHO-ladder). Results: In total, 113 patients were enrolled (59.18 [SD: 12.76] years, 46% female, 54% male, 0% diverse), and 42 were matched into female-male pairs. (i) Women and men agreed that men and women should be treated equally despite biological differences (median: 5 [women] vs. 5 [men]; p = 0.789). As a reason for gender-specific aspects, “medication concentration” was reported more frequently by women (p = 0.038) and “no answer” by men (p = 0.014). (ii) Mean value (SD) of pain (NAS) was 4.0 (SD 2.3) for women and 3.3 (SD 2.6) for men (p = 0.215) with a positive correlation between pain management escalation (WHO-ladder) and the pain score (NAS) only in men (r = 0.704, p = 0.001). Women rather reported an influence of adverse drug reactions on treatment contentment than men (p = 0.042). Conclusions: Although patients pleaded for gender-independent equal treatment, gender-specific differences in pain therapy were found. Full article

Background/Objectives: Dermatological complaints are commonly seen in the emergency department (ED) setting and may be attributed to infectious, inflammatory, allergic, hypersensitivity, or traumatic processes, yet few studies have been carried out in Saudi Arabia addressing this topic. This study, therefore, aimed to explore this issue by investigating the most common dermatology-related ED encounters in a large tertiary care center in Riyadh, Saudi Arabia, and estimating the incidence of these encounters. Methods: This was a retrospective cohort study conducted in the ED of King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia. Data included all patients with dermatology-related ED visits during the period of 2022–2023. Demographic information including, for example, age and sex was collected. The International Classification of Diseases, 10th Revision (ICD-10) was used for the classification of diagnoses. Results: A total of 11,443 patients were included in the study, with male patients making up the majority (54.9%). The mean age upon diagnosis was 22.4 ± 23.2 years. More than half of the patients (55.3%) were diagnosed during childhood (<18), while proportions of older ages declined gradually. Average monthly presentations ranged from 400 to 560. Rash and non-specific skin eruptions (16%), cellulitis (13.6%), and urticaria (12.2%) were the most frequent dermatological emergencies. Conclusions: This study examined the dermatological conditions commonly seen in the emergency department. The findings highlighted a range of dermatology diseases that are typically seen in the ED. Addressing these prevalent disorders in the future will enhance ER physicians’ understanding and management of such common dermatological problems. Full article

Autism spectrum disorder (ASD), or autism, is a lifelong neurodevelopmental condition typically detected during early childhood, for which no specific and efficient pharmacological management is currently available. No drugs have been developed specifically for the pharmacological management of autism. Thus, this approach often relies on various conventional psychotropic medications and, depending on the condition, other medications may also be used. Some studies available in the literature indicate that the adjunctive use of corticosteroids can help improve the quality of life of individuals with autism. Therefore, we conducted an integrative review using four databases, which were PubMed, Scopus, Web of Science, and Google Scholar, focusing on clinical trials and animal model studies involving corticosteroids related to autism. We analyzed the effects of treatment on core and associated autism symptoms, as well as adverse effects. Eight studies were selected and analyzed, seven involving humans and one using an animal model. These studies focused on the drugs pregnenolone (3), prednisolone (3), hydrocortisone (1), and betamethasone (1) in trials either alone or in combination with other medications (such as risperidone). We observed that corticosteroids safely and effectively reduced several symptoms, including stereotypical and social behaviors, hyperactivity, and irritability. Furthermore, no serious adverse effects were observed, although all selected studies were of short duration. Thus, corticosteroids are promising options to be included in the pharmacological management of autism, whether or not in combination with other medications, and further studies are needed to evaluate their long-term effectiveness. Full article

Background: Antimicrobial resistance (AMR) has emerged as a significant challenge to public health, posing a considerable threat to effective disease management on a global scale. The increasing incidence of infections caused by resistant bacteria has led to heightened morbidity and mortality rates, particularly among vulnerable populations. Main text: This review analyzes current strategies and health policies adopted in the European Union (EU) and Italy to manage AMR, presenting an in-depth examination of approaches for containment and mitigation. Factors such as excessive prescriptions, self-medication, and the misuse of antibiotics in livestock contribute to the selection and spread of resistant strains. Furthermore, this review provides a detailed overview of resistance mechanisms, including enzymatic inactivation, reduced permeability, efflux pump activity, and target site protection, with specific examples provided. The review underscores the urgent need to develop new antibiotics and implement diagnostic testing to ensure targeted prescriptions and effectively combat resistant infections. Current estimates indicate that AMR-related infections cause over 60,000 deaths annually in Europe and the United States, with projections suggesting a potential rise to 10 million deaths per year by 2050 if current trends are not reversed. The review also examines existing public health policies in Europe and Italy, focusing on national and regional strategies to combat AMR. These include promoting responsible antibiotic use, improving surveillance systems, and encouraging research and development of new therapeutic options. Conclusions: Finally, the review presents short- and long-term perspectives from the authors, suggesting actionable steps for policymakers and healthcare providers. Ultimately, a coordinated and multidisciplinary approach involving healthcare professionals, policymakers, and the public is essential to mitigate the impact of AMR and ensure the effectiveness of antibiotics for future generations. Full article

Endometriosis is a chronic, complex, systemic inflammatory condition that impacts approximately 190 million girls and women worldwide, significantly impacting their quality of life. The effective management of endometriosis requires a multi-disciplinary and holistic approach, one that includes surgical and medical management, such as a laparoscopy and a chronic medical management plan, as well as dietary, nutritional, and lifestyle adjunct interventions, such as pelvic pain physiotherapy and acupuncture. There is growing evidence to support the role of dietary and nutritional interventions in the adjunct management of endometriosis-related pain and gastrointestinal symptoms. However, the implementation of these interventions is often not regulated, as patients with endometriosis often adopt self-management strategies. Diet and nutrition can modulate key players integral to the pathophysiology of endometriosis, such as, but not limited to, inflammation, estrogen, and the microbiome. However, it is unclear as to whether diet plays a role in the prevention or the onset of endometriosis. In this review, we discuss three key players in the pathogenesis of endometriosis—inflammation, estrogen, and the microbiome—and we summarize how diet and nutrition can influence their mechanisms, and consequently, the progression and manifestation of endometriosis. There is a major need for evidence-based, non-invasive adjunct management of this debilitating disease, and diet and nutritional interventions may be suitable. Full article

Objective: In the United Kingdom (UK) and most countries worldwide, midwives are professionally required to undertake an initial perinatal mental health (PMH) risk assessment at every maternity contact. However, studies have found that midwives feel that they are not well-equipped to provide effective care for women with PMH needs. This study explores how the newly qualified midwives (NQMs) are prepared through pre-registration midwifery education and placements to have sufficient confidence in their knowledge, attitude, skills, and habits (KASH) for their post-registration PMH role. Methods: This explanatory sequential mixed methods study collected survey data from two independent groups: NQMs (n = 50), who qualified from 10 UK universities, and senior specialist midwives (SSMs) (n = 32). Descriptive and inferential responses were analysed using SPSS. Statistical differences between the ranged Likert scale responses of the NQMs and SSMs were analysed using the Mann-Whitney U test. The p-value of <0.05 was considered statistically significant. The semi-structured interview phase comprised of NQMs (n = 12) and SSMs (n = 8). The qualitative data were thematically analysed using NVivo. Results: The pre-registration midwifery programme significantly prepared the NQMs to have sufficient confidence in their knowledge of the related PMH role, multidisciplinary team (MDT) role, and available services (p < 0.05) and good attitude towards women with varying PMH conditions (p < 0.0005). The NQMs had sufficient confidence in their skills in using the validated tool for PMH assessment, to build rapport to facilitate disclosure, and recognise deteriorating PMH (p < 0.01). They had regular habits of discussing PMH well-being at booking and made prompt referrals (p < 0.05). The NQMs were not prepared to have sufficient knowledge of PMH medications, perinatal suicide prevention, and the impact of maternal mental health on partners (p < 0.01) including children (p < 0.05); skills in managing PMH emergencies (p < 0.05), and to regularly discuss suicidal thoughts (p < 0.01), issues of self-harm, and debrief women following pregnancy or neonatal losses and traumatic births (p < 0.05). Some aspects were either confirmed or contradicted at the interviews. Conclusions and recommendations: The pre-registration midwifery programme prepares the NQMs to some extent for their post-registration PMH role. Perceived areas for improvement suggest implications for the development of educational, practice, policy, and preceptorship to facilitate the NQMs’ sustainable confidence in their KASH. Full article

Online medical forums have emerged as vital platforms for patients to share their experiences and seek advice, providing a valuable, cost-effective source of feedback for medical service management. This feedback not only measures patient satisfaction and improves health service quality but also offers crucial insights into the effectiveness of medical treatments, pain management strategies, and alternative therapies. This study systematically identifies and categorizes key aspects of patient experiences, emphasizing both positive and negative sentiments expressed in their narratives. We collected a dataset of approximately 15,000 entries from various sections of the widely used medical forum, patient.info. Our innovative approach integrates content analysis with aspect-based sentiment analysis, deep learning techniques, and a large language model (LLM) to analyze these data. Our methodology is designed to uncover a wide range of aspect types reflected in patient feedback. The analysis revealed seven distinct aspect types prevalent in the feedback, demonstrating that deep learning models can effectively predict these aspect types and their corresponding sentiment values. Notably, the LLM with few-shot learning outperformed other models. Our findings enhance the understanding of patient experiences in online forums and underscore the utility of advanced analytical techniques in extracting meaningful insights from unstructured patient feedback, offering valuable implications for healthcare providers and medical service management. Full article

This entry reviews the health condition known as Roemheld syndrome, or gastrocardiac syndrome in modern medicine. A pathology of gastrointestinal origin, the syndrome relies on a gut–brain–heart triad, interconnected by the vagus nerve. Pressure from the intestines pushes the stomach into the diaphragm and activates the vagus nerve, which affects the heart rate and gives the perception of cardiac issues. This distressing sensation, which usually comes after meals or with other digestive problems, causes anxiety or panic. Although events not arising from anatomic abnormalities are relatively harmless, hypersensitivity to these uncomfortable sensations may precipitate psychiatric problems (anxiety or depression) that cause repeated gastrocardiac events through sympathetic activation and the disruption of peristalsis. Treatment is usually symptomatic and may include diet, lifestyle changes, probiotics, or prescriptions that increase gut motility, but this specific set of reproducible symptoms may also be caused by hiatal hernia or side effects from medication/surgery and treated with respect to those mechanical causes. This review highlights details from the most current knowledge of the condition and offers suggestions for clinical management based on the literature. Full article

Background/Objectives: Neovascular age-related macular degeneration (nAMD) is a retinal disorder leading to irreversible central vision loss. The pro-re-nata (PRN) treatment for nAMD involves frequent intravitreal injections of anti-VEGF medications, placing a burden on patients and healthcare systems. Predicting injections needs at each monitoring session could optimize treatment outcomes and reduce unnecessary interventions. Methods: To achieve these aims, machine learning (ML) models were evaluated using different combinations of clinical variables, including retinal thickness and volume, best-corrected visual acuity, and features derived from macular optical coherence tomography (OCT). A “Leave Some Subjects Out” (LSSO) nested cross-validation approach ensured robust evaluation. Moreover, the SHapley Additive exPlanations (SHAP) analysis was employed to quantify the contribution of each feature to model predictions. Results: Results demonstrated that models incorporating both structural and functional features achieved high classification accuracy in predicting injection necessity (AUC = 0.747 ± 0.046, MCC = 0.541 ± 0.073). Moreover, the explainability analysis identified as key predictors both subretinal and intraretinal fluid, alongside central retinal thickness. Conclusions: These findings suggest that session-by-session prediction of injection needs in nAMD patients is feasible, even without processing the entire OCT image. The proposed ML framework has the potential to be integrated into routine clinical workflows, thereby optimizing nAMD therapeutic management. Full article