BACKGROUND:An increased incidence of auto-inflammatory diseases, such as celiac disease (CD), has been reported following coronavirus disease 2019 (COVID-19) pandemic. The aim of this systematic review and meta-analysis was to assess whether COVID-19 is associated with CD risk. METHODS:We searched MEDLINE (PubMed), Cochrane Library and Clinicaltrial.gov databases up to October 30, 2025, for studies evaluating the incidence of CD following COVID-19 infection (PROSPERO ID: CRD420251174742). We performed qualitative and quantitative syntheses of retrospective studies to evaluate the role of COVID-19 infection in CD incidence. RESULTS:A total of 4 studies were used in the qualitative and quantitative analysis. The studies were conducted between 2023 and 2024 and included 3,465,996 exposed and 7,044,493 non-exposed COVID-19 people. The results from the pooled synthesis showed no significant difference in CD incidence among exposed and non-exposed people with COVID-19 (risk ratio [RR] 1.25, 95% confidence interval [CI; 0.94, 1.66], P=0.12, I2=87%). Similarly, no difference was observed in CD incidence between COVID-19 and non-COVID-19 patients after performing a leave-one-out sensitivity analysis (RR 1.10 95% CI [1.00, 1.22], P=0.06, I2=0%). CONCLUSIONS:These findings suggest that COVID-19 infection does not appear to increase the risk of developing CD.
BACKGROUND:This study aimed to demonstrate the superiority of diclofenac sodium 75 mg/thiocolchicoside 4 mg/4 mL fixed-dose combination (FDC) for intramuscular (IM) injection vs. diclofenac 75 mg alone or placebo in relieving pain in patients suffering from low back pain (LBP). METHODS:Adult patients with acute moderate-severe LBP, i.e., with ≥50 mm at Visual Analogic Scale (VAS) assessment and stable muscle contracture, were randomized to receive diclofenac/thiocolchicoside FDC (N.=68), diclofenac monotherapy (N.=68) or placebo (N.=69), all given IM once-daily in two consecutive days. The primary endpoint was the sum of pain intensity difference from pre-dose to Day 3 in VAS for pain - SPID(0-3). Pain was also measured twice daily up to Day 7. RESULTS:Mean SPID(0-3) was significantly higher with test FDC (116.2 mm) versus diclofenac (94.8 mm) and placebo (62.6 mm). The superiority of FDC over control groups was maintained up to Day 7 - SPID(0-7). Muscle contracture (expressed as Schober's index) decreased more markedly in the test group compared to controls. The results of the 24-item Roland-Morris disability questionnaire confirmed the superiority of FDC over diclofenac and placebo on physical functions. Rescue treatment (oral diclofenac) was used in fewer patients in the FDC group than in control groups. Treatment-related adverse events were reported in fewer patients in the FDC and diclofenac groups (5.9%) compared to the placebo group (16.2%). CONCLUSIONS:IM diclofenac + thiocolchicoside FDC was significantly more effective than diclofenac and placebo in the relief of pain and improvement of mobility in patients with acute moderate-severe LBP, and was well tolerated.
BACKGROUND:Transcatheter aortic valve implantation (TAVI) has become the preferred therapeutic option for patients with severe aortic stenosis (SAS) at high or intermediate surgical risk. Despite its minimally invasive nature, TAVI is frequently associated with post-procedural complications, among which acute kidney injury (AKI) represents a major clinical concern. Early identification of patients at increased risk for AKI remains a critical unmet need. METHODS:This retrospective, observational, single-center study enrolled consecutive patients with severe aortic stenosis who underwent TAVI between December 2022 and December 2023. The primary endpoint was to identify independent predictors of acute kidney injury (AKI) within 48 hours after TAVI. Secondary endpoint was to identify independent predictors of hospitalization for heart failure (HHF) during follow-up. Predictive modeling was conducted using the eXtreme Gradient Boosting (XGBoost) algorithm, with interpretability enhanced via SHapley Additive exPlanations (SHAP). RESULTS:A total of 116 patients were included (mean age 76±6.5 years; 57% male). Comorbidities were common, including heart failure (41%), coronary artery disease (32%), atrial fibrillation (41%), diabetes mellitus (29%), and chronic kidney disease (34%). Median EuroSCORE II was 2.1 (IQR 1.5-3.9). Median ferritin was 99.5 ng/mL (IQR 40-129), mean hemoglobin 12.3±1.7 g/dL and mean eGFR was 69.9±24.9 mL/min/1.73 m2. After TAVI procedure, AKI occurred in 9% of patients within 48 h. According to the SHAP analysis, ferritin and TSAT emerged as the two most influential features in AKI prediction. The machine learning model achieved high sensitivity (96%) and an F1-score of 0.98, suggesting strong clinical utility for early risk stratification. CONCLUSIONS:In patients undergoing TAVI, iron deficiency, as reflected by low ferritin and TSAT levels, emerged as independent predictors of early post-procedural AKI.
BACKGROUND:Recombinant human prourokinase (rhPro-UK) has been investigated as an alternative thrombolytic agent to alteplase for acute ischemic stroke (AIS). While alteplase remains the standard of care, uncertainties persist regarding whether rhPro-UK provides similar efficacy and safety outcomes. This systematic review and meta-analysis aimed to compare intravenous rhPro-UK with alteplase in patients with AIS. METHODS:A systematic literature search was conducted in PubMed, Embase, and Cochrane Central up to January 2025. Randomized controlled trials (RCTs) comparing intravenous rhPro-UK with alteplase were included. Outcomes of interest were functional recovery (modified Rankin Scale [mRS] 0-1 and 0-2 at 90 days), early neurological improvement (National Institutes of Health Stroke Scale [NIHSS] reduction within 24 hours), intracranial hemorrhage, all-cause mortality, and recurrent stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool. RESULTS:Three RCTs involving 2295 patients were included (1209 treated with rhPro-UK; 1148 with alteplase). No statistically significant differences were observed between groups for intracranial hemorrhage (OR 1.04; 95% CI: 0.73-1.48), mRS 0-1 at 90 days (OR 0.91; 95% CI: 0.77-1.08), mRS 0-2 at 90 days (OR 0.95; 95% CI: 0.79-1.14), early NIHSS improvement (OR 0.94; 95% CI: 0.79-1.11), all-cause mortality (OR 1.16; 95% CI: 0.66-2.03), or recurrent stroke (OR 0.72; 95% CI: 0.31-1.66). CONCLUSIONS:Intravenous rhPro-UK demonstrated comparable efficacy and safety to alteplase in AIS, supporting its role as a potential alternative thrombolytic, particularly in regions with limited access to alteplase.
BACKGROUND:This systematic review aims to evaluate the efficacy, safety, and tolerability of oral tapentadol in the management of cancer-related pain in adults. It updates the 2015 Cochrane review on the same topic by including newer trials up to March 2024. METHODS:A systematic search of Medline (via PubMed), the Cochrane Central Register of Controlled Trials, and references from the previous review was conducted. Randomized controlled trials comparing oral tapentadol with placebo or other opioids (e.g., morphine, oxycodone, tramadol/paracetamol) in adults with chronic cancer pain were included. The main outcomes assessed were pain reduction, need and dose of rescue medication, adverse events, treatment discontinuation, and patient-reported global impression of change. Risk of bias was evaluated using the Cochrane tool. Meta-analyses were performed using a random-effects model. RESULTS:Five randomized controlled trials comprising 1152 patients were included. Across all outcomes evaluated, there was no significant difference between tapentadol and comparator opioids. Pain reduction was comparable (MD=-0.06; 95% CI: [-0.44, 0.31]), as were adverse effects (RR=0.98; 95% CI: [0.90, 1.08]), need for rescue medication (RR=1.07; 95% CI: [0.93, 1.22]), and dropout rates (RR=1.10; 95% CI: [0.87, 1.40]). All outcomes were rated as inconclusive due to overlapping confidence intervals with the null effect. The overall risk of bias was high in three studies and unclear in two. CONCLUSIONS:Tapentadol demonstrated similar efficacy and safety compared to other opioids for cancer-related pain, with no evidence of superiority. Given the limited number and methodological quality of studies, further high-quality trials are needed to establish more robust conclusions.
BACKGROUND:Recurrent laryngeal nerve (RLN) dysfunction represents one of the most feared complications of thyroid surgery, with significant impacts on patients' quality of life due to the potential paralysis of the vocal cords. Although nerve transection is rare, functional loss - non-structural and invisible to the human eye - is the primary cause of this complication. Intraoperative nerve monitoring (IONM), introduced more than 50 years ago and significantly improved over the past decade, represents a crucial tool for preventing this outcome. METHODS:This retrospective observational study involves patients undergoing total or partial thyroidectomy at a specialized center in Italy from 2023 to the present and aims to compare the predictive effectiveness of vagus nerve (VN) stimulation versus RLN stimulation, evaluating three techniques (C-IONM, I-IONM, and No-IONM). All patients were monitored using a NIM system (NIM Avalanche SI2), with pre- and postoperative laryngoscopic evaluation. RESULTS:Among 378 patients undergoing thyroid surgery, no significant differences in baseline demographics were observed among groups. The absence of intraoperative neuromonitoring was associated with a significantly higher risk of permanent vocal cord paralysis compared with I-IONM (OR 4.84, P=0.012). C-IONM showed no cases of permanent paralysis and was associated with significantly shorter operative time and reduced length of hospital stay compared with both intermittent monitoring and no monitoring. CONCLUSIONS:I-IONM significantly improves neurological safety in thyroid surgery. C-IONM provides the most favorable overall profile, combining comparable safety with improved operative efficiency and postoperative recovery, and represents a promising strategy for further optimization of surgical outcomes.
This critical narrative review examines the widespread belief that exceptional longevity can be achieved through simple behavioral "recipes," frequently promoted in media and commercial discourse. Drawing on research in demography, epidemiology, gerontology, and genetics, the article reassesses commonly cited determinants of extreme longevity, including nutrition, physical activity, social environment, psychological resilience, and genetic factors. Emphasis is placed on the analytical value of studying populations characterized by unusually high survival at advanced ages, commonly referred to as "longevity Blue Zones." Whereas studies of individual centenarians provide only limited evidence linking specific behaviors to survival beyond age 100, population-level observation of validated longevity regions offers a complementary and especially informative framework. Analyses of these populations help identify long-term configurations of social, environmental, and behavioral conditions associated with exceptional survival. Recurrent features include lifelong moderate physical activity embedded in daily routines, relatively stable and frugal dietary patterns, dense family and community networks, and culturally embedded mechanisms of stress regulation and meaning. Although none of these factors alone determines extreme longevity, their sustained interaction across the life course appears to increase the probability of surviving to very advanced ages. The review underscores the importance of distinguishing determinants of healthy ageing from those of exceptional survival. Rather than proposing prescriptive formulas, the study of longevity populations provides a population-based observational model for identifying favorable life-course conditions that support extreme longevity. Such insights are valuable for promoting healthier ageing trajectories while acknowledging the multifactorial and probabilistic nature of survival to extreme ages.
Systemic arterial hypertension remains the leading modifiable risk factor for cardiovascular mortality, yet the optimal blood pressure target remains a subject of intense global debate. While recent American guidelines advocate for a lower diagnostic threshold (≥130/80 mmHg), European and Asian guidelines largely maintain a conservative threshold (≥140/90 mmHg). This narrative review addresses the central clinical question: "Is lower always better?" We synthesize evidence from landmark trials, including SPRINT and STEP, which demonstrate that intensive systolic blood pressure control (<120-130 mmHg) significantly reduces cardiovascular events and mortality, particularly in high-risk phenotypes such as resistant hypertension. However, this benefit is not without cost. We discuss the physiological "J-curve," the increased risk of adverse events such as hypotension and acute kidney injury, and emerging concerns regarding the long-term durability of stroke prevention observed in the ESPRIT trial. Furthermore, the dominant narrative of "intensification" is challenged by the recent STOP-Trial, which validated a framework for safe de-prescribing in low-risk hypertensive patients using home-based monitoring. Crucially, the divergent findings of the CREOLE and TOPSPIN trials reveal that therapeutic efficacy varies profoundly by ethnicity and geography, rendering a "one-size-fits-all" approach obsolete. We conclude that while intensive control is a life-saving opportunity for high-risk cohorts, it is not a universal mandate. The future of hypertension management lies in the transition from a single numerical target toward precision medicine - utilizing pharmacogenomics and population-specific strategies to maximize protection while minimizing harm, mandating development of "population-based guidelines" aiming for personalized blood pressure targets.
Medical journalism is undergoing rapid renewal in a digital environment that accelerates discovery, conversation, and scrutiny across borders. Its purpose extends beyond transmitting facts, aiming to transform evidence into comprehension and comprehension into responsible action for individuals, institutions, and policy. Journalists curate credibility by verifying claims, contextualizing uncertainty, and translating complex study designs, while clinicians expand their societal role by communicating clearly beyond clinical settings. Collaboration between these communities strengthens public understanding and aligns scientific accuracy with narrative clarity, particularly when stakes are high. Ethical foundations remain central: accuracy, independence, transparency, respect for privacy, and avoidance of harm guide reporting choices that shape trust. Interpreting evidence requires attention to design quality, bias, effect size, and clinical relevance, presenting findings in plain language without sensational framing. Healthcare institutions and research centers must also act as reliable anchors within this ecosystem, providing transparent, verifiable data and methodological clarity to support responsible communication. The infodemic challenges all participants, as misinformation spreads quickly through emotionally charged content and algorithmic amplification that reward novelty over truth. Restoring trust calls for humility, timely corrections, consistent messages, and investment in media literacy for citizens and professionals. Artificial intelligence (AI) introduces powerful capabilities for discovery, summarization, personalization, and verification, yet also new risks such as hidden bias and synthetic content. A responsible medical media ecosystem demands shared literacy, collaborative practice, and ethical stewardship today. In this regard, medical communication must increasingly be regarded as a public good, sustained by the joint responsibility of journalists, clinicians, healthcare institutions, and citizens.
INTRODUCTION:Severely calcified carotid artery stenosis (CCS) limits the effectiveness and safety of conventional carotid artery stenting (CAS); this systematic review and meta-analysis evaluated the efficacy and safety of intravascular lithotripsy-assisted CAS (IVL+CAS) in CCS. EVIDENCE ACQUISITION:PubMed, Embase, MEDLINE, Scopus, and ScienceDirect were systematically searched from inception to December 2024. Eligible studies included adult patients with CCS treated with IVL+CAS and reporting at least one predefined outcome. Primary endpoints were technical success, residual stenosis <30%, and stent restenosis. Secondary endpoints included stroke, transient ischemic attack (TIA), myocardial infarction (MI), and all-cause mortality. Single-proportion meta-analyses were performed using random-effects models. Heterogeneity was assessed with the I2 statistic, and Baujat and leave-one-out sensitivity analyses were conducted when heterogeneity exceeded 35%. EVIDENCE SYNTHESIS:Three observational studies comprising 96 patients were included. The pooled technical success rate was 99% (95% CI: 0.96-1.00; I2=0%). Residual stenosis <30% was achieved in 91% of cases (95% CI: 0.71-1.00; I2=77%). Stent restenosis occurred in 3% (95% CI: 0.00-0.07; I2=0%). The pooled incidence of TIA was 6% (95% CI: 0.01-0.11; I2=0%), and combined stroke/TIA was 4% (95% CI: 0.00-0.10; I2=45%). MI occurred in 2% (95% CI: 0.00-0.05; I2=0%), and all-cause mortality was 2% (95% CI: 0.00-0.05; I2=0%). Sensitivity analysis confirmed the robustness of the primary efficacy outcomes. CONCLUSIONS:IVL+CAS demonstrates high procedural success, low restenosis, and favorable short-term safety in patients with CCS, supporting its role as a viable endovascular option in complex calcified carotid disease.
BACKGROUND:The aim of this pilot registry study was to evaluate the effects of the supplement Robuvit® (French oak wood extract) in otherwise healthy subjects with sarcopenia. Robuvit® is used in several conditions including convalescence, fatigue, vigor loss, hepatic failure and liver inflammatory conditions. Subjects (30 male subjects and an equivalent control group) were evaluated for a period of 3 months. Standard management (SM) was compared to SM+Robuvit® (3 cp/day; 300 mg/day). METHODS:Sixty male subjects (age 70-80 years) with loss of muscular mass and strength were included; 30 subjects used Robuvit® 300 mg/day and 30 served as controls. Both groups were comparable at baseline. RESULTS:The tolerability was very good. After 3 months, body fat percentage decreased significantly in the supplement group compared to controls (P<0.05). Hand strength, measured using hand grip dynamometry, was significantly increased in the supplemented subjects compared to controls (P<0.05). Muscular vascularization, assessed using laser Doppler flowmetry, improved significantly in the supplemented group compared to controls (P<0.05). The subjective perception of vigor significantly increased in the subjects using Robuvit® compared to controls (P<0.05). After 3 months, plasma oxidative stress was significantly decreased with the supplement compared to controls (P<0.05). The urinary excretion of 3-methylhistidine (3MEH) significantly decreased (P<0.05) in the Robuvit® group compared to controls, suggesting a reduced level of muscle breakdown. CONCLUSIONS:In conclusion, this pilot registry study suggests that 'primary' (idiopathic) sarcopenia can be reduced in otherwise healthy subjects with supplementation of Robuvit®. Robuvit® increased hand strength, muscular vascularization, subjective vigor and reduced plasma oxidative stress and urinary excretion of 3-methylhistidine a marker of muscle loss after 3 months.
Since its release, ChatGPT, which is a novel artificial intelligence (AI) tool, has become a global phenomenon with its utilization in various fields of life. In particular, ChatGPT has many potential uses in the medical field, and its evidence base is expanding momentously. We thus aimed at synthesizing the evidence on medical applications of ChatGPT. After searching several databases, 4351 articles were initially retrieved, eventually yielding that we retrieved 42 systematic reviews or meta-analyses. The main fields of applications were medical education, medical research, and actual use in clinical practice. Additional areas addressed in the literature focused on ethics issues, using ChatGPT as assistance in medical writing and research, as well as ChatGPT's demonstrated medical knowledge. While these reviews demonstrated the potential transformative role of ChatGPT in the medical field, there were also common areas of concern expressed in the articles. A frequently noted concern was inaccuracy, as well as the risk of hallucination. Other key limitations were limited validity, reliability, and privacy issues. In conclusion, the totality of evidence suggests that ChatGPT can be a valuable tool in the medical field, with favorable applications ranging from generation to dissemination and application of clinical knowledge. However, further refinements are required to ensure that its output can be directly applied to medical activities while protecting patient safety and rights.
BACKGROUND:Tobacco use remains a major global health issue, causing over seven million deaths annually. In Italy, nearly one-quarter of the population are current smokers, with increasing use of electronic and heated tobacco products, particularly among adolescents. The expanding availability of high-nicotine vaping devices highlights the need to better understand smoking behaviors in young people. This study aimed to assess the prevalence and determinants of smoking habits in a high school in northern Italy. METHODS:An anonymized online survey was administered to all students of a high school in Pavia between March and October 2025, collecting information on demographics, smoking behaviors, product use, age and context of initiation, and parental smoking. RESULTS:A total of 1179 valid questionnaires were analyzed. Overall, 41.2% of students had used at least one tobacco or nicotine product, with e-cigarette use exceeding traditional cigarette smoking. The mean age at first use was about 14 years. Most adolescents initiated smoking in social settings. Parental smoking was strongly associated with adolescent use of cigarettes (OR=1.69), e-cigarettes (OR=1.68), and cannabis (OR=1.43). Price increases and reduced peer smoking were the most frequently reported motivators for cessation. CONCLUSIONS:Adolescent nicotine use in this cohort was markedly higher than national and international estimates, with earlier initiation and narrowing gender differences compared with past data. Parental and peer influences remain key determinants. Early, school-based and family-oriented strategies are essential to reduce experimentation and promote long-term cessation.
INTRODUCTION:The effect of chronic kidney disease (CKD) on outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) remains uncertain. We evaluated the impact of CKD on the efficacy and safety of EVT in patients with AIS. EVIDENCE ACQUISITION:PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 2024 for studies comparing EVT outcomes in AIS patients with and without CKD. Primary outcomes included functional independence at 3 months (modified Rankin Scale [mRS] 0-2), mRS shift at 3 months, in-hospital mortality, and 3-month mortality. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3), National Institutes of Health Stroke Scale (NIHSS) score at 24 hours, time to recanalization, and intracranial hemorrhage. Risk of bias was assessed using the ROBINS-I tool. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. EVIDENCE SYNTHESIS:Seven studies including 27,572 patients were analyzed. Compared with non-CKD patients, those with CKD had a lower likelihood of achieving functional independence at 3 months (RR=0.70, 95% CI 0.60-0.82) and higher 3-month mortality (RR=2.12, 95% CI: 1.88-2.39). In-hospital mortality was also increased in the CKD group. No significant differences were observed in successful reperfusion, NIHSS score at 24 hours, time to recanalization, or intracranial hemorrhage. CONCLUSIONS:Chronic kidney disease is associated with poorer functional outcomes and increased mortality in AIS patients treated with EVT, despite similar procedural efficacy and safety.
INTRODUCTION:Post-stroke patients with nasogastric tubes are at higher risk of aspiration pneumonia. In such cases, prokinetics have been linked with improved gastric emptying and reduced reflux, even though their effectiveness is controversial. This research aims to assess the application of prokinetics for the prevention of post-stroke pneumonia. EVIDENCE ACQUISITION:We searched the databases Cochrane, PubMed, Embase, Web of Science and Scopus for RCTs up to November 2024. The outcome of interest was incidence pneumonia, and we assessed bias using RoB 2 and ROBINS-1. EVIDENCE SYNTHESIS:Overall, 326 articles were screened and 3 RCTs, comprising 600 patients, were included. There were 291 patients in the intervention group and 309 in the control group. Risk ratio for pneumonia was 0.80 (95% CI: 0.50-1.27, P>0.05), which showed no significant reduction. High heterogeneity was observed (I2=87%, P<0.001). Thirty- and 90-day mortality was not significantly different (RR=0.93, 95% CI: 0.75-1.17, P=0.349, I2=5%). Functional independence (mRS) was marginally better in some cases but not of clinical significance, with high heterogeneity (I2=82.2%). Neurological improvement (NIHSS) had variable results, with no overall benefit that reached statistical significance (pooled effect size = -0.05, 95% CI: -0.62-0.51, P=0.057, I2=72.4%). The variation observed limits the confidence in these findings. CONCLUSIONS:Prokinetics have no relationship with pneumonia in patients with nasogastric tubes according to the existing evidence. More trials are needed since there are no established guidelines.
BACKGROUND:Chronic lymphedema of the upper limb is a frequent and disabling consequence of breast cancer surgery. It is associated with swelling and reduced quality of life. While manual lymphatic drainage is a standard treatment, additional physical modalities have shown potential to enhance therapeutic outcomes. This study aimed to evaluate the effects of short-wave diathermy combined with manual lymphatic drainage on limb circumferential measurements and quality of life in women with chronic lymphedema following breast cancer surgery. METHODS:This single-arm, pre-post, retrospective observational study included twenty female patients treated between January 2023 and January 2025. All participants received nine sessions of short-wave diathermy over four weeks, followed by manual lymphatic drainage, with concurrent compression therapy as per routine care. Limb circumference was measured at nine anatomical sites before and after treatment. Quality of life was assessed using the Italian version of the Lymphedema Quality of Life Questionnaire. Statistical analysis was performed using paired t-tests. RESULTS:Significant reductions in limb circumference were observed at seven of the nine measurement sites (P<0.05), particularly in the mid and proximal forearm and upper arm. The mean baseline overall score on the Lymphedema Quality of Life Questionnaire was 7.8, indicating moderate to severe impact. No adverse events were reported during the treatment period. CONCLUSIONS:Short-wave diathermy combined with manual lymphatic drainage appears to be a safe and effective adjunctive treatment for chronic upper limb lymphedema in breast cancer survivors. These findings support its integration into multidisciplinary rehabilitation programs.
