BACKGROUND:In patients with advanced liver fibrosis, one of the most common complications after the development of clinically significant portal hypertension (CSPH) is the appearance of esophageal varices (EV), which require prophylaxis with nonselective beta-blockers (NSBB) to reduce the risk of bleeding. However, there is no practical, simple tool to predict the development of esophageal varices. The aim of the study was to validate the Fibrosis-4 (FIB-4) Plus score as a predictor of EV in a cohort of patients with advanced liver fibrosis due to hepatitis C virus infection (HCV). METHODS:Retrospective cohort study in patients with advanced liver fibrosis secondary to chronic HCV infection. Endoscopy was considered the gold standard, and the risk of developing EV was estimated using the FIB-4 Plus score in this study. The concordance between both tests was evaluated using Cohen's kappa (k). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated, and a final cut-off point was proposed using the Youden index. RESULTS:The AUC for the diagnosis of EV was good (0.707±0.17; P< 0.001). A value ≥65% on the FIB-4 Plus adequately identifies patients at risk of presenting with an EV of any size, with sensitivity=70.1%, specificity=60.6%, PPV=0.64, and NPV=0.67. When evaluating only the probability of presenting a large EV, sensitivity=82.6%, specificity=50.9%, PPV=0.26, and NPV=0.93 were obtained. CONCLUSIONS:With a cut-off point of ≥65%, FIB-4 Plus is useful for predicting the diagnosis of EV in the population with advanced liver fibrosis due to HCV infection, and it could be feasible to use it as an aid in deciding the early initiation of NSBB.
BACKGROUND:Thumb osteoarthritis (OA) is one of the most common hand disabiliting pathology. To date, many therapies are available, with surgery being the last resort. Given the long post surgical rehabilitation period patients often require a "bridge" therapy, in order to surgery. In lasts years Platelet-Rich Plasma (PRP) has demonstrated interesting anti-inflammatory and anabolic effects when injected intra-articularly, including the trapeziometacarpal thumb joint (TMTJ). However, literature is limited and few standardized methods are available to demonstrate its real effectiveness. The aim of the present study is to evaluate effectiveness of 3 Phase Rhizo Protocol in treatment of Thumb OA. METHODS:In a two year prospective observational study, 42 patients affected by Stage II-III Thumb OA were treated with the 3 Phase Rhizo Protocol. The desired outcomes, such as pain reduction, increased quality of life and improved hand disfunction, were tested using the Visual Analogue (VAS), Quality of life (QoL) and Quick-Dash (QuickDASH) scores at one, three, six and twelve months. RESULTS:At one year was, a mean reduction in all scores was achieved, which ranged from 26.33% to 53.05%. All results improved from the first few months after the injection, with lasting effects up to six months, followed by a slight decrease without ever returning to the initial values. All scores data were statistically significant (P<0.05). CONCLUSIONS:The 3 Phase-Rhizo protocol is a useful method for symptomatic rhizarthrosis, especially in the early stages and refractory to standard treatments, as a bridge between conservative therapy and the surgery.
BACKGROUND:This systematic review compared the characteristics and clinical outcomes between patients with spontaneous coronary artery dissection (SCAD) and those with Takotsubo Syndrome (TS). METHODS:A systematic literature search was performed in PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inspection to February 1st, 2025, then it was updated on February 7th, 2026. The search strategy used the following key words: "Spontaneous Coronary Artery Dissection" OR "Coronary Artery Dissection" OR "SCAD". Additional search was done by adding "Takotsubo Cardiomyopathy," "Takotsubo Cardiomyopathies," or "Takotsubo Syndrome." Data from six studies were analyzed. RESULTS:Patients with SCAD were significantly younger and exhibited lower rates of comorbidities such as dyslipidemia, hypertension, and diabetes than those with TS. Physical stress as a trigger occurred less frequently in patients with SCAD (odds ratio (OR) 0.37, 95% confidence interval (CI): 0.17; 0.83, P=0.0152; I2=91%), who tend to have higher left ventricular ejection fraction value (MD=14.12, 95% CI: 6.71; 21.62, P=0.0002; I2=100%). While there was no significant difference between the groups in terms of in-hospital death or stroke at follow-up, patients with SCAD had significantly lower risk of death at follow-up (OR=0.07, 95% CI: 0.03; 0.21, P<0.0001; I2=0%) than patients with TS. CONCLUSIONS:In conclusion, patients with SCAD were younger with less frequent comorbidities, and exhibited better long-term survival outcome than those with TS.
BACKGROUND:To evaluate the association between circulating osteopontin (OPN) levels and bioelectrical impedance analysis (BIA)-derived body composition measures in adults with systemic lupus erythematosus (SLE), with body fat percentage as the primary outcome and central adiposity and lean-mass surrogates as secondary outcomes. METHODS:Observational cross-sectional study with prospective recruitment of adults with SLE attending a tertiary referral center in Puebla, Mexico. Plasma OPN was quantified by ELISA (Quantikine®, R&D Systems; coefficient of variation 4.1%). Body composition was assessed by BIA (TANITA BC-545F FitScan) under fasting morning conditions. Associations between OPN and continuous body composition measures were examined using Spearman correlations (pairwise complete data). Sensitivity analyses used linear regression with ln(OPN) as the dependent variable, adjusting for age, sex, disease duration, SLEDAI-2K, and current prednisone exposure. RESULTS:Sixty-two patients were included (96.8% women), mean age 51.3±12.8 years; median disease duration 21.5 years (IQR 18.0-25.0). Disease activity was low (median SLEDAI-2K 0 [IQR 0-2]); 46.8% met LLDAS. Median OPN was 16.11 ng/mL (IQR 7.97-54.06). Mean BMI was 29.3±5.6 kg/m2, and 79.5% were overweight/obese. OPN showed no significant association with BMI, body fat percentage, visceral fat rating, muscle mass, or waist circumference. Adjusted regression analyses also remained non-significant. CONCLUSIONS:In this SLE cohort with predominantly low activity, circulating OPN levels were not associated with BIA-derived adiposity, central adiposity, or lean-mass surrogates, suggesting that OPN may reflect lupus-related inflammatory biology rather than body composition phenotypes.
BACKGROUND:The aim of the present registry study was to evaluate the efficacy of a new natural product (Menotrack, Alchem, India) in otherwise healthy post-menopausal women with significant symptoms. The products obtained from Ferula have been used for a long time. Ferula is a genus of about 220 species of flowering plants in the family Apiaceae, native to the Mediterranean region east to central Asia, mostly growing in arid climates. Many plants of this genus, especially F. communis, are referred to as "giant fennel," although they are not fennels. The resin of Ferula species has been used for medicinal purposes. The resin, as a sticky latex, was extracted from the lower stalk or root, with the root resin being the finest-grade. METHODS:The supplementation with a new Ferula extract (Menotrack, Alchem) in post-menopausal (PM) women was based on a daily dosage of 1 capsule (20 mg): the prevention registry was aimed to evaluate whether a rapid improvement of signs/symptoms associated to menopause is possible with the administration of Menotrack. RESULTS:The two management groups resulted comparable. No side effects were observed. At 90 days, safety and tolerability were optimal. No side effects had been recorded. Routine blood tests were within normal values at inclusion and end-study. All main menopausal symptoms were improved more with the supplement (P<0.05). Oxidative stress was high at inclusion in all subjects. At 90 days the decrease in oxidative stress was significantly better in the supplemented subjects (P<0.05). A significantly more important decrease in fat mass (P<0.05) was also observed in women using Menotrack even in a relatively short period of time. CONCLUSIONS:In conclusion, this preliminary, pilot registry on Menotrack in post-menopausal women indicated that this natural product may contribute safely to improve the quality of life of women who go through the MT, a difficult transitional period of their life and in the post-menopausal women with persisting, residual symptoms. A more prolonged study may better indicate the quality of this product and more potential positive effects on long-term problems, including osteoporosis.
Medical decluttering is a pragmatic, ethics-anchored approach to reduce low-value tests, treatments, documentation, and digital noise while preserving safety, dignity, and outcomes that matter to patients and clinicians. It reframes improvement from "doing less" to "doing better," prioritizing value delivered per unit effort and transparent measurement of treatment burden, workload, and harms. We outline why clutter proliferates - decision fatigue, cognitive biases, overdiagnosis, incidental findings, and bureaucratic drift - and how these forces fuel cascades, moral distress, and lost trust. We propose a five-step cycle-Scan, Sort, Select, Safeguard, Sustain-that operationalizes decluttering across patient, team, and system levels through category-first review, explicit thresholds, safety nets, and time-bounded reassessment. Clinical applications include deprescribing with monitored tapers, appropriateness-based testing and screening, pathway redesign to shorten time-to-decision, and courteous refusal scripts paired with contingency plans. Professional practices emphasize agenda setting, message windowing, checklists and dashboards for cognitive offloading, role clarity, digital minimalism, and indication-based telemedicine. Implementation relies on co-designed indicators, governance of order sets and alerts, audit-and-feedback, and rapid learning cycles that balance overuse and underuse while safeguarding equity. By aligning ethics, evidence, and attention, medical decluttering offers a coherent method to reduce cascades, restore focus, and make care simpler, safer, and more humane in internal medicine practice.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by motor neuron degeneration, leading to muscle weakness and respiratory issues. Enteral nutrition is used in ALS patients when they experience severe weight loss, dysphagia, dehydration, or a risk of aspiration pneumonia. Noninvasive ventilation (NIV) is essential for managing respiratory failure in ALS patients, especially during feeding tube placement procedures. This narrative review compares percutaneous endoscopic gastrostomy (PEG), percutaneous radiologic gastrostomy (PRG), and radiologically inserted G-tube (RIG) in ALS patients receiving NIV. Studies were found through electronic database searches of Medline and Embase from 2000 to June 2025, including the Cochrane Central Register of Controlled Trials (CENTRAL), EBSCO Online Research Database, and Scopus. The main outcome was the occurrence of adverse events during and within thirty days after gastrostomy tube placement in NIV. Eleven studies involving NIV during PEG/RIG procedures were included. NIV during PEG, RIG, or PRG placement seems to be safe for ALS patients, with few adverse events reported, though future studies with higher methodological quality are needed. Additionally, the review highlights the benefits of better nutritional support, improved quality of life, interdisciplinary teamwork, increased survival rates, and personalized care.
INTRODUCTION:Acute pain is a common symptom that requires prompt and adequate treatment. Ketoprofen lysine salt (KLS) is a non-steroidal anti-inflammatory drug (NSAID) able to rapidly relieves mild-moderate acute pain in children and adolescents. The present study aimed to perform a meta-analysis of controlled studies on this issue. EVIDENCE ACQUISITION:A scientific literature search selected three controlled trials concerning the KLS use in patients with acute pain. A meta-regression analysis was performed. EVIDENCE SYNTHESIS:The overall trend, modeled through weighted linear regression, confirms a significant time-dependent reduction in pain scores by KLS. The onset of action is quick and analgesic effect is prolonged. CONCLUSIONS:This meta-regression analysis showed that KLS could relieve mild to moderate acute pain promptly and in a prolonged manner over time, as desired by a patient with acute pain.
INTRODUCTION:Hyperoncotic albumin is being discussed as an adjunct to diuretics to facilitate fluid off-loading in critically ill patients with fluid accumulation. However, its effectiveness and clinical benefits remain controversial. This critical appraisal examines the current body of evidence to evaluate both the potential benefits and limitations of albumin co-administration with diuretics and/or renal replacement therapy (RRT) in achieving effective net fluid removal in the intensive care unit (ICU). EVIDENCE ACQUISITION:We performed a systematic literature review of randomized controlled trials (RCTs) and observational studies up to January 2025, adhering to Cochrane Collaboration guidelines. Studies were included if they assessed fluid balance in patients receiving albumin in conjunction with diuretics or RRT for fluid removal. The primary outcome was average daily net fluid balance and secondary outcomes included mortality, ventilator-free days, length of stay, acute kidney injury and change in Sequential Organ Failure Assessment score. EVIDENCE SYNTHESIS:Only four studies involving 196 patients have evaluated net fluid balance in patients receiving albumin as an adjunct to diuretics. Our analysis revealed no significant difference in the average daily net fluid balance between the albumin and control groups (mean difference: -0.22 L/d; 95% CI: -0.88 to 0.43; with high heterogeneity in the reported results. Insufficient data on secondary outcomes was found. No data on the safety-profile in fluid de-resuscitation and on cost-effectiveness are currently available. The methodology of the existing literature is biased, contradictory and of poor overall quality. CONCLUSIONS:This review of albumin co-administration with diuretics and/or RRT in fluid de-resuscitation in the critical ill underscores the limited and often contradictory evidence currently available, despite the frequent use of this practice in clinical settings. Further high-quality research is warranted to determine its efficacy in achieving negative fluid balance and to clarify its impact on clinically relevant patient outcomes.
BACKGROUND:This systematic review evaluated patient characteristics and outcomes of patients presenting with concomitant spontaneous coronary artery dissection (SCAD) and cardiogenic shock (CS) compared with those without CS. METHODS:Data from four studies were analyzed. A comprehensive electronic literature search was performed by two authors using PubMed and Embase databases from inspection to February 1st, 2025. MeSH and broad terms including "Coronary Artery Dissection, Spontaneous" OR "SCAD" OR "Coronary Artery Dissection" were used with and without "Clinical Trials" as a search limit. RESULTS:SCAD patients presenting with CS were less likely to be females (OR=0.64, 95% CI: 0.44; 0.94) and have a history of myocardial infarction (OR=0.71, 95% CI: 0.51; 0.99) but more likely to have heart failure (OR=4.79, 95% CI: 3.30) and renal impairment (OR=2.23, 95% CI: 1.43; 3.50) than those without CS. The presence of CS was associated with longer hospital stay (MD=6.53 days, 95% CI: 5.20; 7.86) and worse in-hospital outcomes including death (OR=39.15, 95% CI: 4.73; 324.25), heart failure (OR=5.32, 95% CI: 2.73; 10.37), and stroke (OR=4.91, 95% CI: 2.44; 9.89). CONCLUSIONS:In conclusion, concomitant CS with SCAD was associated with worse outcomes than in the absence of CS.
INTRODUCTION:This review explores the global integration of Artificial Intelligence (AI) in higher education, examining its impact on teaching, learning, and assessment, while addressing implementation challenges, ethical concerns, and opportunities for sustainable, equitable adoption. EVIDENCE ACQUISITION:A scoping review was conducted following PRISMA guidelines. Peer-reviewed studies published between 2020 and 2024 were identified through Web of Science and SciFinder. Eligible articles were thematically synthesized using the Tranfield, Denyer, and Smart (2003) framework to examine AI integration in teaching, learning, assessment, and related challenges. EVIDENCE SYNTHESIS:Seventy-three studies were analyzed, revealing six major themes: AI for teaching support, learning enhancement, assessment, ethical considerations, implementation challenges, and opportunities. AI has enhanced instructional design, real-time feedback, and personalized learning across diverse disciplines. In assessment, AI facilitates automated grading and adaptive testing but raises concerns about integrity and human oversight. Ethical issues - such as data privacy, algorithmic bias, and academic dishonesty - were recurrent, particularly in under-resourced settings. Challenges include infrastructure deficits, misinformation, low AI literacy, and the absence of governance frameworks. However, AI also presents significant opportunities to improve equity, efficiency, and student engagement when integrated responsibly. CONCLUSIONS:AI is reshaping higher education by enhancing pedagogy and assessment, but its adoption must be balanced with ethical safeguards, educator training, and robust policy frameworks. Institutions must prioritize equitable access, digital infrastructure, and human-centered approaches to ensure AI's responsible and effective use in education.
BACKGROUND:Clinician-patient rapport is linked to safety, satisfaction, and staff wellbeing, yet large-scale, real-time listening across the National Health Service (NHS) is limited. We examined how public discourse reflects rapport experiences in UK healthcare and assessed the utility of an artificial intelligence-assisted qualitative workflow. METHODS:We conducted an observational qualitative study using reflexive thematic analysis of 5011 publicly available post submissions from the Reddit community r/NHS (1st January - 31st December 2024). After cleaning, deduplication, and lexical screening for rapport-related language, a large language model (LLM) supported clustering suggestions and provisional summaries; human researchers led interpretation and theme development. Trustworthiness techniques included analyst triangulation, an audit trail, negative case analysis, and stability checks. Data were non-identifiable and public; research ethics committee review was not required. This study is reported in accordance with the Standards for Reporting Qualitative Research (SRQR). RESULTS:Five overarching themes were identified: 1) access and delays that erode feelings of being heard; 2) first-contact experiences and gatekeeping at reception/telephone interfaces; 3) professionalism and empathy during clinical encounters; 4) emotional reciprocity and staff wellbeing shaping relational tone; and 5) service variation and perceived inequity across settings. Posts more often described administrative/communication breakdowns than clinical competence issues. Positive narratives highlighted brief empathetic acts that buffered system pressures. Cross-cutting, perceived relational communication moderated how operational strain was experienced. Paraphrased, de-identified exemplars underpin each theme. CONCLUSIONS:Public social-media listening can surface scalable signals about clinician-patient rapport across the NHS. An AI-assisted (LLM-supported) qualitative workflow is feasible and enhances, rather than replaces, human interpretation. Findings suggest targeting first-contact communication and access processes, while aligning patient-facing empathy with staff support.
Cardiac rehabilitation (CR) is a cornerstone in the management of patients recovering from myocardial infarction (MI), significantly improving survival, functional capacity, and quality of life. Recent evidence highlights the critical importance of early initiation of rehabilitation, ideally within days to weeks following the acute event. Early cardiac rehabilitation facilitates prompt recovery of cardiovascular function, reduces complications, and enhances patient motivation and adherence to therapeutic regimens. The multidimensional nature of modern CR programs addresses not only physical reconditioning but also psychological, nutritional, and social factors, recognizing the complex interplay affecting patient outcomes. Physical exercise training, tailored to individual risk profiles and functional status, promotes myocardial perfusion, endothelial function, and autonomic balance. Concurrently, psychosocial support targets anxiety, depression, and stress, common sequelae post-MI, which are known to influence prognosis negatively. Nutritional counseling ensures optimal dietary patterns that support cardiovascular health, while smoking cessation and risk factor management are integral components. The multidisciplinary team - comprising cardiologists, physiotherapists, dietitians, psychologists, and nurses - collaborates to develop personalized care plans that maximize patient engagement and long-term adherence. Early, multidimensional cardiac rehabilitation ultimately reduces rehospitalization rates and mortality, improving comprehensive health outcomes. This review underscores the value of initiating rehabilitation promptly after MI and implementing a holistic approach to enhance recovery, prevent recurrent events, and promote sustained lifestyle changes.
BACKGROUND:Achieving optimal skin scarring after surgery is a major concern for patients and physicians worldwide. An innovative form of photobiomodulation, namely Fluorescent Light Energy (FLE), is increasingly used in clinical settings as an adjunct to the Standard of Care (SoC) to treat wounds. In Italy, a post-market observational investigation using data from the Patient and Observer Scar Assessment Scale (POSAS) was conducted to confirm the effectiveness of FLE in managing post-abdominoplasty scars as an adjunct to standard of care (SoC). METHODS:The observational investigation involved the POSAS data of 27 patients treated with FLE treatment, namely LumiHeal. LumiHeal was applied for four weeks during dressing changes following surgery. POSAS questionnaires administered during follow-up visits at three (FU1) and six (FU2) months after surgery were investigated. POSAS scores' percentage decrease and statistically significant P value were calculated. RESULTS:The results showed a significant decrease in the mean values on POSAS Total Scores from FU1 to FU2, and on each sub-scale of the Observer POSAS, as well as on the Patient POSAS on colour, indicative of healthy healing and aesthetically pleasing scar outcomes. In addition, no patient developed complications, including wound dehiscence or infections, or skin lesions due to FLE applications. CONCLUSIONS:Observational POSAS data evaluation reveals to be a valid tool, suggesting that LumiHeal FLE treatment was an effective adjunctive treatment to the SoC on 27 patients in a real-life setting as an Italian clinic for postoperative scar management.
BACKGROUND:Malnutrition is associated with poor outcomes. Exocrine pancreatic insufficiency (EPI) may be an overlooked factor contributing to malnutrition. Early nutritional support improves the prognosis of critically ill patients. The effect of pancreatic enzyme preparations on nutritional status and prognosis in critically ill patients requires further study. METHODS:An exploratory, single-center, randomized controlled trial was conducted in critically ill adult patients. A total of 768 patients admitted to the Department of Critical Care Medicine between November 2021 and August 2022 were screened, and 317 patients who met the inclusion criteria were randomized into the pancreatic enzyme replacement therapy (PERT) group or the non-pancreatic enzyme replacement therapy (NOT PERT) group. Neither group received a specific enteral nutrition formula. The formula was selected according to the patient's condition to provide the required calories and protein. The primary outcome was the change in the cross-sectional area of the rectus femoris muscle (RFCSA). Secondary outcomes included changes in rectus femoris muscle echogenicity, retinol-binding protein, and prealbumin levels; duration of mechanical ventilation; APACHE II scores; and 14-day and 28-day mortality. This trial was registered in ChiCTR under identifier 2100052385. RESULTS:RFCSA decreased over time. PERT combined with enteral nutrition appeared to slow the decline in RFCSA but had no significant effect on rectus femoris muscle echogenicity. PERT had no significant effect on retinol-binding protein, prealbumin, or the duration of mechanical ventilation. No significant differences were observed in APACHE II scores, 14-day mortality, or 28-day mortality. CONCLUSIONS:PERT may serve as an effective adjunct to nutritional support in critically ill patients.
INTRODUCTION:Limitations in mobility caused by pain, injury, or external immobilization can lead to adverse neuroplastic changes affecting the brain, the nervous system, and sensorimotor function. Mental imagery (MI) has been proposed as a non-invasive, low-cost intervention that may help mitigate these negative effects during periods of immobilization following surgery or trauma. This systematic review and meta-analysis aims to analyse the effects of MI applied during post-surgical or post-traumatic immobilization. EVIDENCE ACQUISITION:A systematic literature search was performed in the databases PubMed, CINAHL, Web of Science, Medline, and PEDro. The methodological quality of the included studies was assessed using the PEDro scale, and the risk of bias was evaluated with the Cochrane RoB 2 tool. Only randomized controlled trials were included. EVIDENCE SYNTHESIS:A total of 11 studies met the inclusion criteria. Overall, the studies showed moderate methodological quality and a high risk of bias. The meta-analysis revealed a statistically significant effect on pain reduction in favour of mental imagery, with a Hedges' g of 1.187 (95% CI: 0.492 to 1.882; P=0.001). Additionally, several studies reported improvements in secondary outcomes such as range of motion, muscle strength, mental health, and quality of life. CONCLUSIONS:MI appears to be a beneficial intervention to reduce pain in patients undergoing immobilization after surgery or trauma. Moreover, promising effects have been observed on range of motion, strength, mental health, and quality of life, supporting its inclusion as a complementary strategy in rehabilitation settings.
