Background: Women in perimenopause and menopause often have physical and psychological symptoms, which are frequently overlooked or misattributed. Although treatments like hormone replacement therapy (HRT) exist and management approaches vary, antidepressants are frequently prescribed. Objective: Our aim was to assess symptom burden, healthcare-seeking behavior, and treatment patterns among women, focusing on antidepressant use and HRT consideration. Material and Methods: We conducted a cross-sectional, anonymous questionnaire survey on demographics, symptoms, healthcare-seeking behavior, and treatment. Descriptive statistics summarized findings as proportions. Results: We analyzed 403 respondents; 401 (99.5%) identied as women. Age distribution: 79 (19.6%) under 35, 78 (19.4%) aged 40–45, and 68 (16.9%) aged 45–50. Most, 259 (64.3%), had not sought medical help despite symptoms. Regarding treatment, 101 (25.1%) were prescribed antidepressants, 284 (70.5%) were not, and 32 (7.9%) were offered HRT. Notably, 288 (71.5%) reported HRT was not suggested, and 83 (20.6%) had not consulted a doctor. These findings indicate that many symptomatic women don’t seek care, antidepressants are prescribed more than HRT, and HRT is rarely considered, even for symptoms. Conclusions: Many women with hormonally suggestive symptoms do not seek medical care. In those who do, antidepressants are prescribed more often than HRT, which is rarely considered. This shows a clear gap between symptom presence and medical engagement, highlighting the need for better awareness and improved, guideline-based, personalized care for menopause-related symptoms.
The rapid global aging of the population has heightened the clinical importance of sarcopenia, an interdisciplinary condition characterized by the progressive and widespread decline in skeletal muscle mass, strength, and function. Now formally recognized as a distinct muscle disease, sarcopenia is a key contributor to frailty, physical disability, and increased healthcare use among older adults. While current research encompasses diverse epidemiological and biological perspectives, the integration of multi-system interactions — such as the gut-muscle axis and immune-muscle crosstalk — within clinical assessment remains a vital area of exploration. This review examines the interplay between etiology, molecular pathogenesis, and contemporary diagnostic standards to characterize the syndrome’s complexity. Global prevalence escalates significantly in institutionalized populations or those over age 80. Pathogenesis is rooted in a disruption of protein homeostasis where catabolic pathways, such as the ubiquitin-proteasome system, overwhelm anabolic signaling—a process triggered by mitochondrial dysfunction, chronic low-grade inflammation, and declining sex hormones. Furthermore, the synthesis of diagnostic protocols from international consortia highlights the transition to strength-priority models to better predict the falls, fractures, and cardiovascular events. Despite significant diagnostic progress, more longitudinal research is necessary to refine population-specific cut-off criteria and identify reliable clinical biomarkers. By consolidating current mechanistic evidence and epidemiological trends, this review shows the necessity for the unified diagnostic protocol and calls for continued interdisciplinary research to improve early detection and preserve physical independence in aging societies.
Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by brosis and vasculopathy, commonly leading to microstomia – an abnormally reduced oral aperture that impairs speech, nutrition, and quality of life. Conventional options for managing SSc-related microstomia – for example, stretching exercises, physiotherapy, and various surgical procedures – usually provide only partial or short lived improvement, and results vary widely between patients. Against this background, botulinum toxin (BoNT), a neuromuscular blocker already widely used in neurology and dermatology, has been suggested as an alternative approach to address perioral brosis and increase mouth opening in patients with SSc. This literature review summarizes the current evidence on the effectiveness and safety of BoNT injections for treating microstomia in SSc. We found only a few relevant clinical studies: one small prospective trial, one completed clinical trial (with results not yet available), a case series, and a single case report. These studies suggest that BoNT therapy can lead to short-term improvements in mouth opening and function, with few side effects. However, the data are limited by small sample sizes and a lack of controlled trials. BoNT looks promising as an additional treatment for SSc-related microstomia, but larger studies are needed to conrm its long-term benefts, best dosing, and safety.
Background: Late-onset systemic lupus erythematosus (Lo-SLE) is a rare subgroup of SLE characterized by disease onset at ≥50 years of age and a distinct clinical phenotype. This study aims to evaluate the clinical and laboratory characteristics, comorbidities, and mortality rates of Lo-SLE patients treated at our center. Materials and Methods: This single-center retrospective study included Lo-SLE patients diagnosed with SLE at our center between 2010 and 2025 and whose disease onset age was ≥50 years. The patients’ demographic characteristics, clinical findings, organ involvement, laboratory data, and treatments administered were obtained from medical records. Additionally, comorbidities, mortality rates, and causes of death were analysed. Results: The mean age at SLE diagnosis for the 39 Lo-SLE patients included in the study was 57.8±6.5 years, and 82.1% of the patients were female. The most common clinical findings were hematological abnormalities; renal involvement was detected at a relatively lower frequency. One patient was diagnosed with transverse myelitis. The positivity rates for anti-nuclear antibody (ANA) and anti-dsDNA were 100% and 82.1%, respectively. During a mean follow-up period of 8.2±6.8 years, the most common comorbidity was hypertension (46.2%), and malignancy developed in 4 (10.3%) patients. All patients used hydroxychloroquine during follow-up, while 79.5% of patients received steroids and 59% received at least one immunosuppressive treatment. The mortality rate in the cohort was 35.9%, with the most common causes of death being cardiovascular diseases and infections. Conclusion: Our single-center experience shows that hematological involvement, such as autoimmune hemolytic anemia and immune thrombocytopenia, is more common in Lo-SLE patients, but that a diagnosis can also be made with neurological findings, such as transverse myelitis, in rare cases. It should be kept in mind that malignancies, as well as comorbidities such as hypertension, may be seen in the Lo-SLE group, and cardiovascular diseases and infections are important causes of mortality.
Polypharmacy involving central nervous system (CNS)-active medications is common in patients with chronic pain and may contribute to adverse effects, functional decline, and prescribing cascades. Rehabilitation-based deprescribing addresses pain through non-pharmacological strategies. Herein, we report a case with chronic musculoskeletal pain who was receiving multiple CNS-active medications, including opioids, antidepressants, and antiepileptics. A comprehensive rehabilitation program was performed, and gradual tapering and discontinuation of selected medications were implemented. The patient demonstrated improvements in pain severity and functional performance without withdrawal complications. This case highlights the clinical value of rehabilitation-based deprescribing in chronic pain management.
Sexual health in perimenopausal and postmenopausal women is shaped by complex interactions between hormonal fluctuations, physical changes, and psychosocial factors. Declines in estrogen and other sex hormones contribute to reduced sexual desire and arousal, while urogenital discomfort, fatigue, and mood disturbances further impact sexual well-being. Regular sexual activity is associated with lower symptom burden and improved quality of life in perimenopause. Most perimenopausal women remain fertile and require individualized contraceptive guidance. They are also at heightened risk of sexually transmitted infections, necessitating targeted screening and preventive measures. Proper genital hygiene and attention to vaginal microbiota are essential for maintaining sexual health. Complementary interventions – including aromatherapy, sauna, acupuncture, and vaginal hormonal therapies – may ease menopause-related symptoms and boost sexuality. A holistic, individualized approach is critical to support sexual health and overall well-being during perimenopause.
Polycystic ovary syndrome (PCOS) is a highly heterogeneous endocrine-metabolic disorder with reproductive, metabolic, dermatologic, and psychological manifestations that vary substantially across affected women. This marked phenotypic diversity limits the usefulness of a uniform treatment model and supports a more individualized therapeutic strategy. The present review is based on the hypothesis that management of PCOS is most effective when it is guided by the dominant clinical manifestation or cluster of manifestations, rather than by a generalized syndrome-level approach alone. In this context, treatment priorities may differ depending on whether hyperandrogenism, menstrual dysfunction, insulin resistance and metabolic abnormalities, anovulation, or infertility predominate. This review summarizes current evidence on clinically tailored management strategies in PCOS, integrating lifestyle measures, pharmacological treatment, and reproductive interventions. Particular attention is given to aligning therapy with the prevailing clinical presentation and with the woman’s reproductive intentions, metabolic proŷle, and long-term health risks. Lifestyle modification remains a central component of care, while pharmacological options such as combined oral contraceptives, metformin, letrozole, antiandrogens, and emerging agents including GLP-1 receptor agonists and inositols may have differential relevance across phenotypes. A structured, manifestation-guided, and holistic approach may improve short-term symptom control, enhance reproductive outcomes, and reduce long-term cardiometabolic morbidity.
This study aims to reveal the trends in literature, collaborations, and thematic densities in the field by analyzing scientific publications on "anti-aging" and "nutrition" using bibliometric methodology. The analysis was limited to 431 publications in the Web of Science (WoS) database, and the most prolific authors, countries, institutions, and journals were identified. Additionally, keyword analysis was employed to examine the thematic foci and changes over time in the research field. The study's findings reveal that the anti-aging and nutrition literature exhibits an interdisciplinary structure and that interest in this field has increased in recent years. For future research, it is recommended to increase the diversity of databases, conduct in-depth evaluations supported by content analysis, monitor thematic evolution, and conduct country- or institution-based strategic analyses. These directions will enrich the body of knowledge in the field and guide policymakers and researchers.
Introduction. Community-acquired pneumonia (CAP) is a disease associated with a high risk of complications and mortality, which depends on various risk factors. Smoking is one such factor that contributes to an unfavorable prognosis in various conditions. Objectives. This study aimed to assess the impact of smoking status on the course of CAP and to explore the relationship between smoking, pneumonia severity, and lipid metabolism. A total of 255 patients with CAP were included and divided into two groups: those with moderately severe pneumonia (119 patients) and those with severe pneumonia (136 patients). Among the examined patients, men predominated, and the vast majority were young. The most common complications included pleurisy, myocarditis, and renal dysfunction. Results. The incidence of complications and severe clinical course of CAP was similar in smokers and non-smokers. However, decreased body mass index (BMI) was slightly more common in smokers. Notably, low body mass was twice as frequent among smokers with severe pneumonia compared to non-smokers with severe disease. Systolic and diastolic blood pressure values were significantly lower in smokers. The number of peripheral blood leukocytes was significantly higher in smokers. C-reactive protein (CRP) levels were elevated in both groups. While the average fibrinogen levels did not differ significantly between groups, hyperfibrinogenemia (>10 g/L) was more common in smokers with severe pneumonia. Cholesterol levels were significantly lower in smokers, especially in those with severe CAP. Conclusions. The observed association between smoking and reduced cholesterol levels highlights a potential impact of smoking on lipid metabolism. Smoking cessation may improve lipid profiles and reduce the risk of severe complications in pneumonia and other diseases.
CRYSTAL ARTHRITIS IN THE DIFFERENTIAL DIAGNOSIS OF NECK PAIN: A CASE OF CROWNED DENS SYNDROME
Physical modalities are one of the widely used non-pharmacological approaches in the rehabilitation of older adults. The current article aimed to review commonly used physical modalities (focusing particularly on electrotherapy) in geriatric rehabilitation by describing their mechanisms, clinical applications, as well as geriatric-specific considerations. Modalities are organized into six functional categories: 1. Thermal modalities, 2. Analgesic modalities, 3. Neuromuscular stimulation modalities, 4. Phototherapy and light-based modalities, 5. Electromagnetic and magnetic field therapy, 6. Neuromodulation and brain stimulation techniques. Thermal modalities such as superficial heat and therapeutic ultrasound improve pain and mobility in older adults with musculoskeletal conditions. Analgesic techniques (e.g. transcutaneous electrical nerve stimulation) are effective in reducing chronic pain. Neuromuscular electrical stimulation enhances muscle strength and mobility, particularly in post-stroke and post-surgical recovery. Safety protocols (i.e., adjustments for cognitive impairment, fragile skin, and comorbidities) are of great importance in geriatric applications. Physical modalities, when applied appropriately, provide a safe option for improving quality of life and function older adults. Implementing these interventions into rehabilitation programs can significantly reduce disability and improve patient outcomes.
GOLF AS A MODEL OF 5P (PREDICTIVE, PREVENTIVE, PERSONALIZED, PARTICIPATORY AND PRECISION) CARDIOVASCULAR REHABILITATION IN THE ERA OF ACTIVE AGING
The global trend of delayed childbearing has increased the number of women attempting conception at advanced reproductive ages (≥35 years), a period marked by declining ovarian reserve, compromised oocyte quality, and age-related health challenges such as obesity and osteoporosis. These physiological barriers, compounded by psychosocial factors like stress and diminished intimacy, reduce fertility potential. While conventional treatments like in-vitro fertilization (IVF) are effective, they are costly and primarily address physiological issues. Complementary therapies, including sauna therapy, massage, yoga, acupuncture, and nutritional interventions, offer accessible, low-risk approaches to enhance fertility by targeting both physical and emotional dimensions. This review aims to provide an overview of the mechanisms, efficacy, and applications of these therapies, with a focus on their role in addressing obesity, ovarian aging, and intimacy. The results suggest that these complementary interventions improve hormonal balance, reduce stress, and foster relational vitality, making them valuable adjuncts to reproductive care.
The convergence of biomedical innovation and lifestyle medicine has propelled phototherapy to the forefront of anti-ageing interventions. As interest grows in non-invasive strategies to enhance cellular resilience and systemic health, photobiomodulation, particularly through red and blue light therapies, has demonstrated promising applications in dermatology, ophthalmology, neurology, and cardiovascular care. This article synthesises current evidence on Low-Level Laser Therapy (LLLT) and Light Emitting Diode (LED) therapy, examining their mechanistic foundations, clinical efficacy, and therapeutic precision. Red light has been shown to improve mitochondrial function, collagen production, and vascular dynamics, while blue light offers notable antimicrobial and immunomodulatory effects. The therapeutic impact depends on wavelength, energy dose, and exposure parameters, highlighting the necessity for personalised protocols. Despite challenges in standardisation, phototherapy holds considerable potential as an adjunctive tool in holistic, technology-driven anti-ageing medicine.
Mitochondria, essential for cellular energy production and metabolic homeostasis, undergo progressive dysfunction with aging, contributing to a range of age-related diseases. Key mechanisms underlying mitochondrial deterioration include impaired mitophagy, cardiolipin remodeling, genetic instability, and excessive reactive oxygen species (ROS) accumulation. These dysfunctions are critical in the aging process, affecting brain function, cardiovascular health, metabolic health, fertility, and stem cell maintenance. This article explores the molecular basis of mitochondrial aging and its impact on age-related diseases, highlighting emerging therapeutic strategies from small molecules to mitochondrial transfer techniques that could transform aging research. As mitochondrial-targeted therapies evolve, they offer new hope for mitigating aging-associated decline and improving overall healthspan.
Immune-mediated diseases of the breast represent a minor but important group of conditions that sit at the crossroads of breast pathology and systemic autoimmunity. Because they are relatively rare and unfamiliar to most clinicians, they are frequently misdiagnosed as infection or malignancy often resulting in delayed diagnosis, unnecessary investigations and sometimes avoidable surgery. These disorders may present as isolated breast disease or as part of a broader autoimmune or vasculitic process, further complicating recognition and management. This review aims to bring together the existing literature on immune mediated breast diseases which include idiopathic granulomatous mastitis, lupus mastitis, lymphocytic mastopathy, IgG4 related mastopathy, sarcoidosis associated mastitis and vasculitis related mastitis. Here, we discuss their common clinical manifestations, overlapping imaging features, typical histopathological findings and current management approaches. Emphasis is placed on the need for careful clinicopathologic correlation, exclusion of differential diagnosis like infection and malignancy, and early multidisciplinary involvement. Greater awareness of these uncommon entities can help clinicians avoid diagnostic pitfalls, limit unnecessary surgical intervention, and ensure timely, appropriate immunomodulatory therapy.
Hand and foot involvement is a major determinant of disability in patients with late-onset rheumatoid arthritis (LORA). While inflammatory disease activity has traditionally been regarded as the primary driver of functional impairment, increasing evidence indicates that hand and foot function in older patients is also influenced by additional factors. Age-related physiological changes, sarcopenia, structural joint damage, comorbidities, biomechanical alterations, and psychosocial factors may substantially contribute to functional decline, often independently of measurable inflammation. Elderly patients frequently experience reduced muscle strength, deformities, heightened pain, frailty, and impaired coping capacity, which together exacerbate limitations in daily activities and mobility. Although foot involvement has been less extensively studied than hand dysfunction, it contributes further to gait disturbance, pain, and reduced quality of life. This hypothesis article proposes that functional impairment in LORA is multifactorial rather than being driven solely by disease activity indices. Recognizing multiple determinants may help explain persistent disability despite controlled inflammation, justifying comprehensive functional and geriatric assessment strategies in LORA.
Populations worldwide are aging, with rapid growth in adults aged 65 years and older, particularly those aged 80 years and above. Aging is closely linked to multimorbidity, frailty and polypharmacy, which together create complex clinical profiles that traditional, single-disease models of care and conventional risk scores address poorly. At the same time, digital health infrastructures generate large, heterogeneous datasets (electronic health records, imaging, biosignals, wearable and ambient sensor data, and social determinants) that are well suited to artificial intelligence (AI), which is increasingly explored in geriatric care. We conducted a scoping review to map AI applications in the management of aging-related diseases and outcome prediction. MEDLINE (PubMed), Embase and Scopus were searched for peer-reviewed, English-language empirical studies using AI or machine learning in adults aged ≥60 years, or explicitly focused on older populations, to predict or classify clinically relevant outcomes. Studies limited to younger populations, purely simulated or technical work, and non–full-text reports were excluded. Two reviewers independently screened and extracted data on populations, data sources, model types, targets, performance and validation, followed by narrative synthesis. Most identified applications concerned risk prediction (mortality, hospitalisation, readmission, institutionalisation, frailty progression) using routinely collected clinical data, often enriched with geriatric assessments. Additional use cases included early detection of dementia, frailty and sarcopenia; prediction of treatment response and adverse drug events; remote monitoring and early warning systems; care pathway optimisation; and emerging large language model–based decision support. Across domains, many machine learning models outperformed traditional scores and captured more complex risk patterns, but methodological quality was variable, external validation was infrequent and very old, frail and institutionalised patients were under-represented. Concerns about interpretability, bias, equity, workflow integration and medico-legal responsibility remain prominent. Overall, AI has substantial potential to support more precise, person-centred care for older adults, but realising this promise will require multimorbidity-aware, transparent models, robust evaluation in diverse geriatric populations and governance frameworks that ensure fairness, privacy and meaningful human oversight.
