Background: With the increasing median age of people with multiple sclerosis (MS), age-related syndromes such as frailty have emerged as new challenges to patient well-being. Prior research on frailty in MS has primarily focused on physical aspects, leaving the relationship between frailty and mental health unexplored. Objective: To investigate the associations between frailty, mental health, and quality of life (QoL) in people with MS. Design: Cross-sectional questionnaire-based study conducted at the Center for MS Care at the University of Kansas Medical Center. Methods: Participants completed validated measures of frailty (Tilburg Frailty Indicator), anxiety and depression (Hospital Anxiety and Depression Scale), QoL (Multiple Sclerosis Quality of Life-54), and disability level (Patient-Determined Disease Steps). Results: A total of 204 patients with MS (median age: 51 (interquartile range = 18) years, 74% women) took part in the study. Overall, 50.5% of respondents were classified as frail. Frail participants were older than their non-frail counterparts ( p = 0.018) and had higher levels of anxiety and depression ( p < 0.001). Frailty status was also associated with lower QoL scores across physical and mental health domains ( p < 0.001). In logistic regression analyses adjusted for age, sex, and disability, higher anxiety scores (odds ratio (OR) = 1.45, 95% confidence interval (CI) (1.28, 1.65), p < 0.001) and depression scores (OR = 1.58, 95% CI (1.365, 1.843), p < 0.001) were associated with greater odds of being frail. Conclusion: This study revealed a strong association between frailty, mental health, and QoL in people with MS. These findings underscore the need for greater attention to both physical and psychological well-being in people with MS. Future research should explore whether integrated care strategies may improve outcomes in this population.
Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease that requires long-term pharmacotherapy and self-management. Disease knowledge and medication adherence are essential for achieving optimal outcomes, but remain under-researched in low-resource settings such as Nepal. Objective:This study aimed to assess the factors associated with disease knowledge and medication adherence among RA patients attending a private rheumatology clinic in Nepal. Design:Cross-sectional study. Methods:A hospital-based cross-sectional study was conducted from March to September 2023 among 428 RA patients who had been on a disease-modifying anti-rheumatic drugs (DMARDs) regimen for at least 3 months prior to the start of the study. Disease knowledge was assessed using the Rheumatoid Arthritis Knowledge Assessment Scale, and medication adherence was measured using the General Medication Adherence Scale. Pearson's χ² test and multivariate logistic regression analyses were employed to examine the associations between levels of the disease knowledge, medication adherence, and related variables, using a 95% confidence interval and a 5% level of significance. Results:A total of 82.2% of RA patients had poor knowledge of the disease, and 62.2% demonstrated low medication adherence. Poor disease knowledge was significantly associated with older age, illiteracy, being a homemaker or unemployed, functional disability, higher disease activity, lower income, and absence of a family history of RA. Low medication adherence was significantly associated with male gender, being a homemaker or unemployed, rural residence, longer disease duration, presence of the comorbidities, obesity, higher disease activity, functional disability, and the use of multiple DMARDs. Conclusion:The findings highlight a critical gap in the disease knowledge and medication adherence among RA patients in Nepal, emphasizing the urgent need for targeted educational and adherence-enhancing interventions. Tailored strategies focusing on older adults, individuals with low literacy, and rural populations are essential to improve health outcomes and support effective RA management in resource-constrained settings.
Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition marked by insulin resistance, decreased insulin production, and persistent low-grade inflammation. The prevalence of T2DM has increased significantly in recent decades; as a result, it is now regarded as one of the fastest-growing public health concerns worldwide. Long-term micro- and macrovascular problems such as nephropathy, retinopathy, neuropathy, and cardiovascular disease can be caused by poor blood glucose control. Therefore, developing reliable diagnostic indicators for early diagnosis and investigating new treatment targets are critical for addressing the increasing prevalence of T2DM. Several novel diagnostic approaches have been created by targeting endogenous proteins, with fetuin-A being one of the most promising targets. Human fetuin-A, also referred to as alpha-2-Heremans Schmid glycoprotein, is a liver-produced glycoprotein that is abundantly secreted into the bloodstream and seems to be involved in insulin resistance, metabolic syndrome, and inflammation. Clinical studies have shown that circulating fetuin-A levels are closely associated with T2DM and its complications, underscoring its potential as both a biomarker and a therapeutic target. This narrative review provides a detailed overview of the evolving role of fetuin-A in the development of T2DM and its associated complications, as well as its future perspectives.
What is this summary about? • This is a summary of a research article published in a medical journal that describes the main results from two studies called TRuE-V1 and TRuE-V2 • These studies looked at the use of ruxolitinib cream to treat vitiligo, a long-term condition where white patches develop on the skin • Ruxolitinib belongs to a group of medicines called Janus kinase (JAK) inhibitors, which have been shown to restore the skin color (also known as skin pigment) of some people with the most common form of vitiligo (non-segmental vitiligo, also known as generalized vitiligo or bilateral vitiligo) What happened in the studies? • Researchers who designed the TRuE-V1 and TRuE-V2 studies wanted to understand if ruxolitinib cream helped to restore the skin color of people with non-segmental vitiligo, compared with an identical cream that did not contain ruxolitinib. This is called a vehicle cream • In the studies, people aged 12 years and older with non-segmental vitiligo were randomly chosen to apply either ruxolitinib cream or vehicle cream to the parts of their body affected by vitiligo twice a day for 6 months. For every one person that used the vehicle cream, two people used the ruxolitinib cream • The main goal of the studies was to find out how many people had a 75% improvement in their facial vitiligo after 6 months ○ This meant that three-quarters of the white patches on the face returned to normal skin color • Other goals included measuring: ○ How many people had a 50% improvement in the vitiligo on their whole body after 6 months ■ This meant that half of the white patches on the whole body returned to normal skin color ○ How many people felt their vitiligo was less noticeable after 6 months • The study also looked at the side effects of ruxolitinib cream and the vehicle cream What do the results mean? • In both the TRuE-V1 and TRuE-V2 studies, people who used ruxolitinib cream for 6 months had greater improvements in their vitiligo compared with those who used the vehicle cream • The most common side effects were acne (red pimples located mainly on the face) and itchy skin where ruxolitinib cream was applied • Results from the studies suggest that ruxolitinib cream helps to restore the color of the skin over time in people with non-segmental vitiligo.
Currently, the diagnosis of Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and Lewy body dementia (DLB) relies on clinical symptoms, with Lewy body (LB) pathology serving as the gold standard. The co-pathology associated with Alzheimer’s disease (AD) contributes to the clinical heterogeneity and rapid progression seen in Lewy body disorders (LBD). The AT(N) classification system may help identify the distinct biochemical, neuro-radiological, and clinical characteristics of both pure LB and PD. Recent advancements in biomarkers have improved the precise identification of pathological α-synuclein (i.e., misfolded and aggregated) in cerebrospinal fluid (CSF) through the seed amplification assay. Consequently, the Neuronal α-synuclein Integrated Staging System (NSD-ISS) has reclassified PD as a neuronal α-synuclein disease, rather than just a clinical syndrome. Although some debate the necessity of a biological definition for clinical diagnosis, biomarker-based systems continue to serve as diagnostic tools for these disorders. This narrative review will explain the definitions of the AT(N) and NSD-ISS systems and provide an updated list of research that supports the proposed biological definitions and staging systems. Additionally, it will discuss how the combination of LB-AD pathology, along with the neuronal concept of the disease, significantly influences the clinical phenotype, progression, and overall prognosis of PD. Finally, this review will overview current advancements in blood-based AD biomarkers that could facilitate faster screening of LBD patients for AD co-pathologies, thereby enhancing the diagnostic sensitivity of LBD-AD and its potential for prognostic, research, and diagnostic applications.
Glatiramer acetate (GA) has been a pivotal therapy for relapsing multiple sclerosis (MS) due to its favorable safety profile. Long-term data spanning decades demonstrate its continued use in diverse patient populations. Adverse events include manageable localized injection site reactions, lipoatrophy or necrosis, and rare cases of liver injury. GA has minimal effects on immune function, and does not increase the risk of opportunistic infections, making it suitable for MS patients at risk for infections or reactivation of latent infections. GA’s immunomodulatory properties may pose a lower infection risk than other disease-modifying treatments. Progressive multifocal leukoencephalopathy risk with GA is low, and screening for latent infection is unnecessary before treatment. Vaccination is important for preventing infections in MS patients. GA does not compromise vaccine efficacy and is compatible with both inactivated and live attenuated vaccines. Special populations that may benefit from the characteristics of GA include older adults and patients with comorbidities and/or polypharmacy. MS patients often have comorbidities, necessitating careful management of potential drug interactions and side effects. Drug interactions with GA are not predicted, and clinical data suggest that the risk is low. GA is not contraindicated during pregnancy and exhibits a reassuring safety profile during breastfeeding, with no increased risk of adverse outcomes identified. Regulatory restrictions on GA use during breastfeeding have been removed. In summary, GA remains a safe and well-established therapy for MS patients, including those in special populations. Its favorable safety profile, compatibility with vaccination, and reassuring outcomes solidify its role in MS treatment.
Background:Optimal use of renin-angiotensin system (RAS) modulators plays a crucial role in improving the outcomes for chronic heart failure (CHF) patients with reduced ejection fraction (rEF). Despite their established benefits, there is limited evidence regarding real-world prescribing patterns, dose optimization, and factors influencing RAS modulator use in this population. Objective:This study aimed to evaluate the patterns of use, dose optimization, and associated factors affecting the administration of RAS modulators among CHF patients with rEF at Public Comprehensive Specialized Hospitals (PCSHs). Design:A hospital-based, multicenter cohort study was conducted from February 1, 2020, to May 31, 2024, at PCSHs among CHF patients with rEF. Methods:A total sample size of 385 patients was determined using a systematic random sampling technique at the Northwest Ethiopian PCSHs during the study period. Data were collected from medical records and interviews using standardized questionnaires. Data analysis was performed using SPSS version 27.0, and binary logistic regression analysis was employed to identify factors associated with the use and optimization of RAS modulators. The study strictly adhered to the most recent guideline recommendations from the American Heart Association (2022) and the European Society of Cardiology (2021). Results:Of 385 patients, 263 (68.3%) were prescribed RAS modulators; however, only 86 (32.7%) of these patients were receiving an optimal dose. Predictors significantly associated with the use of RAS modulators included a duration of CHF with rEF of ⩾3 years (AOR: 1.79, 95% CI: 1.02-3.15), the presence of ischemic heart disease (AOR: 8.23, 95% CI: 4.23-16), hypertension (AOR: 2, 95% CI: 1.09-3.69), diabetes mellitus (AOR: 7.34, 95% CI: 1.48-36.34), chronic kidney disease (AOR: 4.35, 95% CI: 1.32-14.34), and a furosemide dose of ⩾40 mg (AOR: 0.26, 95% CI: 0.013-0.49). Regarding suboptimal RAS modulator dosing, significant predictors identified were age ⩾65 years (AOR: 2.83, 95% CI: 1.46-5.50), a previous history of hospitalization (AOR: 2.05, 95% CI: 1.07-3.95), the use of diuretics (AOR: 5.34, 95% CI: 2.73-10.44), a furosemide dose of ⩾40 mg (AOR: 3.88, 95% CI: 1.89-7.97), and CHF with rEF for ⩾3 years (AOR: 0.31, 95% CI: 0.16-0.63). Conclusions:The majority of CHF patients with rEF received suboptimal doses of RAS modulators, with only one-third receiving optimal therapy. This highlights a critical gap in treatment that must be urgently addressed. Targeted interventions are needed to identify and mitigate modifiable predictors contributing to suboptimal dosing, thereby improving therapeutic outcomes and reducing the burden of CHF with rEF.
Background: Ketamine, an N-methyl-D-aspartate antagonist, has been used for decades as an anesthetic agent, but more recently it has been studied in psychiatric illness. Though ketamine has been investigated for use in the general population, fewer studies have investigated the efficacy and tolerability of this treatment for older (age >60) adults. Objectives: This review sought to compile the randomized controlled trials (RCTs) investigating the evidence for ketamine treatment in older adults with psychiatric disorders. Eligibility criteria: Only RCTs published in English language journals, or with official English language translations, and human studies were included. Sources of evidence: Our team searched PubMed, Cochrane Database, and Ovid with the terms ketamine, depression, suicidal ideation, bipolar disorder, mania, anxiety, schizophrenia, psychotic disorders, dementia, delirium, and post-traumatic stress disorder. Charting methods: Covidence was used to extract and organize included studies. Results: Our review yielded 14 RCTs and 2 post-hoc analyses evaluating ketamine treatment in older patients. Eight of these studies examined ketamine for the treatment of delirium, while the remaining eight examined its use in depression. The studies had significant heterogeneity so direct comparisons of the results were challenging. However, five studies showed no significant impact of ketamine on delirium incidence. Two studies showed a lower incidence of delirium in the ketamine group, but another study showed a higher incidence of delirium with ketamine. Four studies showed improvement in depressive symptoms with ketamine treatment, while the others showed a lack of improvement. Most reported side effects were mild. Conclusion: Several studies have investigated ketamine for depression and delirium in older adults and show mixed results. This review reveals the paucity of current data on ketamine for other psychiatric conditions in older adults. It reaffirms that use of ketamine in older adults with psychiatric illness, including depression and delirium, remains an individual risk versus benefit analysis using shared decision making.
Background: Insulin pump therapy improves glycemic control in children with type 1 diabetes but is associated with technical and dermatological complications that can impact adherence. Research on these adverse effects in pediatric populations is limited. Objectives: This study aimed to evaluate short- and long-term complications of insulin pump therapy in pediatric patients in Saudi Arabia, focusing on technical malfunctions, dermatological issues, and patient satisfaction. Design: A cross-sectional survey-based study conducted in multiple centers in Taif, Saudi Arabia. Methods: Fifty-nine parents of children with type 1 diabetes who used insulin pumps provided data for the study. Participants reported technical issues, skin-related complications, and overall satisfaction. IBM SPSS Statistics version 27.0.1 was used to conduct the statistical analysis. Results: Technical complications were frequent, with 64.4% experiencing tube blockages, 39.0% reporting needle dislodgment, and 39.0% observing air bubbles in the tubing. Dermatological issues included discomfort at the infusion site (54.2%), skin pigmentation (45.8%), and scarring (55.9%), with lipohypertrophy (22.0%) posing a concern for insulin absorption. Longer pump use was significantly associated with increased complications, particularly tube blockages and skin pigmentation. Despite these challenges, 84.7% of participants recommended insulin pumps over multiple daily injections. Conclusion: Technical and dermatological complications were common, increasing with longer pump use. Proper infusion site rotation, infusion set management, and improved patient education are key to reducing adverse effects. To improve safety and efficacy, future studies should concentrate on infusion set change patterns, newer pump technologies, and standardized guidelines.
Background:Antilipidemic therapy adherence to medication among patients with dyslipidemia and type 2 diabetes mellitus (T2DM) remains suboptimal, particularly in developing countries. Poor adherence to lipid-lowering therapy is associated with a significantly higher risk of major adverse cardiovascular outcomes in this population than in the general population. Objectives:This study aimed to assess the level of non-adherence to antilipidemic medications and associated socio-demographic and clinical factors among patients attending comprehensive specialized hospitals (CSHs) in Northwest Ethiopia. Design:This multicenter, prospective, cross-sectional study was conducted at CSHs in Northwest Ethiopia from November 10, 2023 to January 30, 2024. Methods:Data were entered using EpiData version 4.6.0.0 and analyzed using STATA version 17.0. The Adherence in Chronic Diseases Scale was used to assess medication adherence. Multinomial logistic regression analysis was used to identify factors associated with non-adherence, and model fitness was checked before interpretation. Results:The study included 398 patients, yielding a response rate of 98.76%. Of these patients, 290 (72.9%) were classified as non-adherent to their antilipidemic medications. Factors significantly associated with medium and low medication adherence included female sex (adjusted odds ratio (AOR) for medium: 2.94, 95% confidence interval (CI): 1.61-5.38; AOR for low: 3.09, 95% CI: 1.66-5.76), unmarried status (AOR for medium: 2.83, 95% CI: 1.52-5.27; AOR for low: 2.72, 95% CI: 1.43-5.17), current smoking (AOR for medium: 3.25, 95% CI: 1.20-8.82; AOR for low: 6.54, 95% CI: 2.46-17.36), presence of comorbidities (AOR for medium: 3.01, 95% CI: 1.65-5.49; AOR for low: 2.41, 95% CI: 1.29-4.47), and polypharmacy (⩾5 medications) (AOR for medium: 3.00, 95% CI: 1.60-5.63; AOR for low: 4.87, 95% CI: 2.56-9.24). Conclusion:This study revealed a high prevalence of medication non-adherence among patients with T2DM with dyslipidemia in Northwest Ethiopia. Non-adherence was significantly associated with female gender, unmarried status, smoking, comorbid conditions, and polypharmacy. These findings emphasize the need for targeted strategies to improve adherence in high-risk populations to enhance lipid control and lower the likelihood of cardiovascular complications.
Background:Obesity is a significant public health concern linked to various health complications, including periodontitis. This study uniquely integrates multiple obesity indicators (body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)) alongside clinical periodontal parameters and considers sociodemographic factors to provide a comprehensive analysis of the relationship between obesity and periodontitis. Objectives:To determine the association between BMI, WC, and WHR with periodontal clinical parameters, and to explore the role of sociodemographic and behavioral factors. Design:Transversal study. Methods:A total of 1000 adults (579 males and 421 females) with ⩾15 teeth were enrolled using systematic random sampling. Sociodemographic variables (age, sex, marital status, income, education level), behavioral factors (brushing frequency, smoking status), and anthropometric measurements (BMI, BP, WHR) were considered. Clinical periodontal parameters included probing pocket depth (PPD), bleeding on probing, clinical attachment loss (CAL), plaque index, and gingival index. Associations were assessed using multivariate regression models adjusted for age, sex, education, income, and oral hygiene habits. Results:The study population comprised 579 males and 421 females, predominantly aged 19-30 years. BMI classifications were 46.2% normal, 30.5% overweight, and 4.5% obese. Elevated BMI and WC were significantly associated with increased PPD and CAL (p < 0.001*). In univariate analysis, overweight (odds ratio (OR) = 2.28, p < 0.001*) and obesity (OR = 6.46, p < 0.001*) were significantly associated with periodontitis. In multivariate analysis, obesity remained significantly associated with periodontitis (adjusted OR = 3.42, p < 0.01*), as did WC (adjusted OR = 1.84, p < 0.01*). The WHR was associated with periodontitis in univariate but not in multivariate analysis. Conclusion:Obesity, as measured by BMI and central adiposity indicators, is independently positively associated with greater periodontitis severity. The findings highlight the importance of assessing obesity in estimating periodontal risk and structuring targeted interventions that consider both metabolic status and sociodemographic factors to optimize periodontal health benefits.
Background:Cardiovascular disease (CVD) has emerged as the most significant complication and leading cause of death among metabolic-associated fatty liver disease (MAFLD). Objectives:This study aims to investigate the CVD risk among MAFLD subgroups. Design:Data of participants from June 2017 to January 2023 in the Physical Examination Center of the Third Hospital of Hebei Medical University were collected. MAFLD were divided into four subgroups: metabolic healthy lean/normal weight MAFLD (MHL), metabolic healthy overweight/obese MAFLD (MHO), metabolic dysfunctional lean/normal weight MAFLD (MDL), and metabolic dysfunctional overweight/obese MAFLD (MDO). Methods:The risk assessment for atherosclerotic CVD was performed based on the flowchart for primary prevention risk assessment in Chinese adults. Results:The proportions of MHL, MHO, MDL, and MDO were 0.77% (n = 185), 10.05% (n = 2406), 1.29% (n = 310), and 16.86% (n = 4038), respectively. After adjustment for gender, age, smoking history, drinking history, and significant liver fibrosis, the subgroup of MAFLD was still an independent risk factor for high adverse cardiovascular events (HACE). Compared with the MHL, the MDL had the highest risk, followed by MDO (all p < 0.05), and there was no significant difference between MHO and MHL. We performed regression analysis according to age (65 years) and gender (male or female), respectively, and the results were similar to those of the total population. Conclusion:MAFLD is associated with a higher risk of CVD, especially in MDO. Classification of MAFLD based on body mass index and metabolic status helps in risk stratification, which will mitigate or prevent the development of CVD.
Chronic obstructive pulmonary disease (COPD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are highly prevalent conditions that frequently coexist. MASLD, now the leading cause of chronic liver disease globally, affects up to 25% of the population and is increasingly recognized in COPD patients. Shared cardiometabolic risk factors, chronic inflammation, and lipid-mediated injury underpin their pathophysiological link. This review outlines the epidemiology, shared mechanisms, and clinical impact of MASLD in COPD, as well as diagnostic strategies and current management approaches. Recognizing MASLD as a clinically significant comorbidity in COPD may offer new opportunities for risk stratification, integrated care, and targeted therapeutic interventions, underscoring the need for further research into their mechanistic interplay and bidirectional impact.
Background: Myasthenia gravis (MG) is a chronic, fluctuating disease whose unique natural history complicates designing therapeutic trials. The evidence on which many MG management recommendations are based is limited. Objective: To determine the degree of knowledge, agreement, and application of internationally recognized recommendations for managing MG in actual practice. Design: A cross-sectional survey was conducted among Spanish neurologists specializing in MG. Methods: The survey assessed knowledge, agreement, and application of recommendations, along with the degree of agreement with international consensus definitions from the Myasthenia Gravis Foundation of America. Results: Fifty-three neurologists (mean age 45.4 years, 53% men) attended an average of 3.6 patients with MG daily. In 40 out of 61 recommendations, at least 90% of the neurologists were aware of the recommendation. The least known recommendations dealt with juvenile MG and MG in pregnancy. There was no majority agreement in two recommendations (for MG in pregnancy and the use of intravenous immunoglobulin in mild or ocular MG). The implementation of the recommendations was high except for the ones related to plasma exchange, thymectomy, methotrexate, or eculizumab. Conclusion: The recommendations are well-known, agreed upon, and applied. However, the evidence, consensus, and knowledge dissemination need reinforcement regarding aspects such as the management of juvenile MG, MG in pregnancy, or the use of certain treatments.
Background:Liver cirrhosis, characterized by chronic inflammation, is frequently complicated by malnutrition. Nutritional indices, such as the prognostic nutritional index (PNI) and the skeletal muscle index (SMI), calculated as the muscle area quantified via CT scans at the third lumbar vertebra level divided by the square of the patient's height in meters (cm2/m2), are associated with outcomes in inflammatory diseases. Objectives:We aimed to evaluate the diagnostic efficacy of the PNI both independently and in combination with the SMI for identifying malnutrition in cirrhosis and to explore their prognostic implications. Design:A single-center retrospective cohort study of 262 hospitalized cirrhotic patients (2018-2023). Malnutrition was assessed using PNI, PNI-SMI, and Global Leadership Initiative on Malnutrition (GLIM) criteria, respectively. Methods:Nutritional status was defined by PNI (<28.85), PNI-SMI (either reduced PNI or SMI), and GLIM criteria. SMI was quantified via third lumbar vertebra CT scans. Diagnostic performance was evaluated using sensitivity, specificity, and area under the curve (AUC). Cox regression and Kaplan-Meier analyses assessed associations with 1-year mortality. Results:The prevalence of malnutrition, as determined by various criteria, was considerably heterogeneous: 26.72% by the PNI, 56.11% by the PNI-SMI, and 51.14% by the GLIM criteria. Patients classified as malnourished demonstrated inferior clinical parameters and a higher 1-year mortality rate. The PNI-SMI combination exhibited favorable diagnostic performance in detecting malnutrition, with a sensitivity of 75.51%, specificity of 80%, along with an area under the curve of 0.774. Multivariate Cox analysis indicated that all three malnutrition criteria were independently associated with 1-year all-cause mortality, with hazard ratios of 2.56, 4.20, and 7.20, respectively. Conclusion:The PNI, particularly when integrated with the SMI, offers a streamlined yet moderately accurate tool for nutritional and prognostic assessment in decompensated cirrhosis. This combined approach may serve as a practical supplement to GLIM criteria in select clinical contexts, potentially improving outcomes through targeted nutritional interventions.
Background:Type 1 autoimmune pancreatitis (AIP) is more prevalent among males, a significant proportion of whom are known to smoke and consume alcohol, both of which can cause damage to the pancreas. AIP is associated with the new-onset impaired glucose metabolism (NO-IGM). However, it remains unclear whether smoking and alcohol consumption exacerbate this risk. Objectives:The present study aims to clarify the potential impact of smoking and alcohol consumption on the risk of NO-IGM in male patients with type 1 AIP. Design:A retrospective cohort study. Methods:This retrospective cohort study included 305 male patients with type 1 AIP. The participants were categorized into four groups based on smoking and drinking status: neither, smoking-only, drinking-only, and both group. The impact of smoking and heavy drinking on AIP-related IGM was analyzed using multivariate modified Poisson regression. Results:The prevalence of NO-IGM was 40.66% in the study. In the multivariate modified Poisson regression analysis, smoking-only group (relative risk (RR), 2.44; 95% CI, 1.70-3.51) and both smoking and drinking (RR, 2.84; 95% CI, 1.93-4.19) were associated with an increased risk of type 1 AIP-related NO-IGM. Drinking only (estimated RR >1) also appeared to elevate this risk. Conclusion:In male patients with type 1 AIP, smoking and heavy drinking may increase the risk of AIP-related NO-IGM.
Background: Patients with obstructive sleep apnea (OSA) may be at high risk for atrial fibrillation (AF), but data on the benefits of early AF screening in this population, including the prevalence of AF detected through such screening, remain limited. Objectives: This study evaluates the prevalence of AF in OSA patients using three screening methods and aims to identify the most effective approach, as well as the potential benefits of early AF detection in this population. Design: Prospective, single-center, cross-sectional study. Methods: This study assessed AF prevalence using three screening methods: opportunistic screening via pulse taking during a routine visit, systematic screening with a handheld electrocardiogram (EKG), and EKG during polysomnography. The analysis also included the proportion of patients with positive screenings who were indicated for anticoagulation and the prevalence of other non-AF arrhythmias. Results: A total of 201 OSA patients were enrolled, with a mean age of 46 years and a mean CHA 2 DS 2 -VASc score of 1. The prevalence of AF was 1.5%, 2.5%, and 2.0% when detected by pulse taking, handheld EKG, and EKG during polysomnography, respectively, with no statistically significant difference ( p = 0.933). All patients with positive screenings were indicated for oral anticoagulant therapy. The prevalence of other non-AF arrhythmias was higher than in the general population, and detecting arrhythmias during sleep appeared to be more effective than detecting them while awake, particularly for atrial tachycardia. Conclusion: The prevalence of AF in OSA patients ranged from 1.5% to 2.5%, with the highest rate observed in handheld EKG systematic screening, though the difference was not statistically significant. Non-AF arrhythmias were also more common than in the general population, highlighting the need for broader arrhythmia surveillance. Further large-scale studies in higher-risk OSA populations are needed to confirm the benefits of systematic AF screening.
Periodontitis and viral liver infections, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), are chronic inflammatory conditions with a high prevalence worldwide. Recent evidence establishes a possible bidirectional relationship between the two, based on shared immunological, microbial, and inflammatory mechanisms. The objective of this study was to analyze and synthesize the scientific literature on the interactions between viral hepatitis and periodontal health. Through a structured search of the PubMed, Scopus, and Web of Science databases, studies published in the last 20 years that explored the link between viral hepatitis and periodontitis were integrated. The findings from the reviewed studies show consistent, positive associations between HBV and HCV viruses and a higher prevalence and severity of periodontitis. Some studies show increased levels of proinflammatory cytokines (such as IL-6 and TNF-α) and immune dysfunction in participants with both diseases. Additionally, viral markers (such as HBsAg and HCV RNA) have been identified in gingival crevicular fluid, suggesting the presence of oral viral reservoirs. Ultimately, scientific evidence suggests a bidirectional relationship between viral hepatitis and periodontitis, influenced by systemic inflammation, immunological alterations, and microbial dysbiosis. The collected data support the relevance of interdisciplinary management between medical and dental professionals in patients with viral liver conditions.
Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition characterized by the accumulation of fat in the liver. Nutrition, particularly micronutrients, plays a crucial role in the development and progression of NAFLD. Objectives: This study aimed to assess the impact of choline supplementation on oxidative stress, inflammation, and clinical outcomes in patients with NAFLD. Design: A randomized, controlled, single-blinded study. Methods: Eligible NAFLD patients were randomized to; choline group ( n = 39), received conventional management plus phosphatidylcholine (PC) 2400 mg/day for 12 weeks, or c ontrol group ( n = 40), received conventional management for 12 weeks, and 10 healthy volunteers were included. Anthropometric, clinical, and laboratory evaluations were performed at baseline and after treatment. Results: After 12 weeks, choline group showed significant differences versus controls by improvement in controlled attenuation parameter (304 vs 332 dB/m, p < 0.001) and fibrosis score (5.3 vs 6.8 kPa, p < 0.001), reduction in thiobarbituric acid reactive substances levels (1.9 vs 3.8 nmol/mL, p < 0.001), a decline in leptin levels (1.3 vs 2.1 ng/mL, p < 0.001) and liver enzyme (alanine aminotransferase and aspartate aminotransferase), p < 0.001 and 0.004 respectively). Also, the lipid profile improved by a significant decline in triglyceride levels in choline versus controls 133 versus 158, p = 0.048. Conclusion: Choline supplementation in NAFLD patients demonstrated a favorable impact on hepatic steatosis, oxidative stress, inflammatory markers, liver enzyme levels, and lipid profile. These findings suggest that choline may be a promising therapeutic option for NAFLD management. Further large-scale, long-term studies are warranted to investigate the clinical benefits of choline supplementation in NAFLD patients. Trial registration: The study was registered at clinicaltrials.gov and given the ID number: NCT05200156.
Microcurrent (MIC) therapy is a non-invasive, low-intensive electrical modality that remains underutilized despite evidence supporting its therapeutic potential. With applications in chronic pain, wound healing, musculoskeletal injuries, deconditioning, and neuropsychological conditions, MIC offers a pain-free alternative to traditional electrotherapies. This narrative review compiles the current literature on MIC therapy, highlighting its physiological mechanisms, such as promoting cellular repair, modulating inflammation, and reducing pain, without inducing discomfort or muscle fatigue. Though more high-quality evidence is needed, this review examines the current evidence on MIC’s role in managing chronic and complex conditions across diverse healthcare environments and patient populations.
