Antimicrobial resistance (AMR) poses a significant global health challenge, and antimicrobial stewardship (AMS) initiatives are acknowledged as vital measures to enhance antibiotic utilization in healthcare facilities. Nevertheless, the effective execution of AMS programs continues to be exceptionally difficult across various healthcare environments. This opinion paper consolidates findings globally to pinpoint the primary obstacles and emerging viewpoints related to the implementation of hospital-based AMS. The analysis indicates that the challenges are complex, encompassing organizational, structural, cultural, educational, and behavioural aspects. Deficiencies in leadership and governance at various institutional tiers create a lack of accountability and commitment, while insufficient human and financial resources—including a shortage of infectious disease specialists, clinical pharmacists, and microbiologists—compromise the sustainability of these programs. Deeply rooted professional hierarchies and power dynamics among healthcare disciplines hinder interprofessional collaboration and diminish the acceptance of stewardship recommendations. Knowledge deficits and a lack of AMS-specific training across all professional categories further limit implementation, as do inadequate diagnostic laboratory capabilities and restricted health information technology. A persistent gap between national policies and local implementation realities leads to guidelines that are poorly suited to institutional contexts, while mandatory strategies may result in unintended outcomes such as regulatory evasion and decreased motivation among healthcare workers. These challenges are intensified in low- and middle-income countries but remain significant even in well-resourced environments. Promising strategies encompass multidisciplinary team approaches, governmentled accountability frameworks, contextualized implementation plans, and expanded roles for healthcare professionals.
Background: Adipose tissue is an active endocrine organ responsible for the production of adipokines. Aim: This study aimed to investigate whether serum levels of four adipokines (leptin, adiponectin, resistin, visfatin) and lipid parameters (cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol) are affected by adjuvant chemotherapy. Methodology: Twenty-five Greek patients who had been operated and received adjuvant chemotherapy with a good response were included. Blood samples were collected at three distinct time points during treatment, in order to mesure the above parameters. Results: Cholesterol, LDL and HDL levels did not show statistically significant differences at the three time points. In contrast, triglycerides were statistically significant higher ( p =0.0030) at the final time point. Serum leptin and resistin levels prior to treatment were significantly higher ( p <0.0001) than those observed during mid- and end-treatment. Comparison between the mid- and end- treatment time points showed a statistically significant difference ( p <0.0001), with higher levels observed at the mid-treatment time point. Serum adiponectin lev-els yielded a significant difference (lower value) between the baseline and the end time points ( p <0.0001), as well as across the other time points. Visfatin levels were significantly higher at the baseline of the treatment compared to both mid- and end-treatment levels (both p <0.0001). Conclusion: Increased levels of adiponectin, together with decreased values of the other three adipokines, are consistent with the results from previous studies, suggesting their potential use as auxiliary parameters. Regarding lipids, only levels of triglycerides provide relevant information. However, due to the absence of a control group and the small sample size (n=25), these findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory.
Background: Spirometric reference equations are essential for accurate interpretation of lung function tests. However, most globally used equations are derived from Western populations and may not reflect the physiological norms of Arab populations. Aim: To systematically evaluate the applicability of internationally adopted spirometric reference equations within Arab populations and to assess the availability of population-specific equations in the Arab world. Methodology: A systematic review was conducted using PubMed, Scopus, Google Scholar, and CORE databases for studies published up to July 2023. Studies were included if they developed, validated, or assessed spirometric reference equations in Arab populations. Out of 57 initially identified studies, 14 met the inclusion criteria. Results: Based on the 14 studies conducted, the majority of studies reported that predicted values for forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) in Arab populations were significantly lower than those predicted by equations derived from Western populations. This discrepancy suggests potential misclassification of respiratory diseases when non-local reference values are applied. Conclusion: The routine application of spirometric reference equations developed in Western populations may lead to inaccurate interpretation of lung function in Arab individuals. There is a clear need for developing standardized, population-specific reference equations that account for the ethnic and anthropometric characteristics of Arab populations to enhance diagnostic accuracy and clinical decision-making.
This review explores the complex relationship between thyroid function and menopause, focusing on physiological interactions, clinical implications, and diagnostic challenges associated with thyroid dysfunction in postmenopausal women. Drawing on recent studies and current understanding, it examines how menopausal hormonal changes influ¬ence thyroid health, increasing the risk of conditions such as hypothyroidism, hyperthyroidism, and subclinical thyroid disorders. Overlapping symptoms, including mood changes, sleep disturbances, weight fluctuations, and reduced libido, complicate diagnosis, as they can be attributed to both menopause and thyroid dysfunction. Hormonal shifts can also impact bone mineral density, cardiovascular health, and metabolism, while prolonged estrogen exposure and surgical menopause are linked to an elevated risk of thyroid cancer. Diagnostic complexity is heightened by age-related changes, comorbidities, and potential interferences in thyroid function tests. Routine thyroid assessment is recommended for women with surgical menopause or other risk factors. Personalized management, including meno¬pausal hormone therapy (MHT), can address overlapping symptoms and mitigate skeletal and cardiovascular risks. A patient-centred approach is crucial, with treatment tailored to individual health profiles. Further research is needed to clarify the interactions between menopause and thyroid function to improve clinical care.
Background: Prescription errors in substitution therapy for addiction treatment, including opioid substitution therapy (OST) with methadone and buprenorphine and pharmacotherapy for alcohol use disorder (AUD) with naltrexone, acamprosate, and disulfiram, pose a critical patient safety issue. These errors are a major contributing factor to adverse drug events (ADEs), poor treatment adherence, discontinuation, and severe outcomes such as fatal overdoses. Additional factors such as miscommunication, inadequate training, and complex medication regimens exacerbate the risk. Aim: This systematic review aims to evaluate the prevalence, causes, and consequences of prescription errors in substitution therapy for addiction treatment. It explores the roles of healthcare professionals, system-level factors and their impact on patient safety, focusing on adherence, treatment outcomes, and ADEs. Methodology: A systematic search was conducted in PubMed, Scopus, and Google Scholar for studies published between January 2000 and July 2025. Studies addressing prescription errors in OST or AUD pharmacotherapy, including generic or therapeutic substitution, were included. Data on error types, prevalence, contributing factors, consequences, and interventions were extracted. Qualitative data underwent thematic analysis, while quantitative data were synthesized descriptively. Results: Prescription error rates in OST varied widely, from 1.7% in older adults to 30.3% in overdose reports, with methadone and buprenorphine implicated most frequently. Common errors included incorrect dosing, dispensing errors, and inadequate monitoring, leading to respiratory depression, overdose, and treatment failure. Key contributing factors were miscommunication, insufficient training, frequent formulary changes, and patient-related factors such as cognitive impairment. Pharmacist-led interventions, digital prescribing systems, and standardized protocols significantly reduced errors. Data on AUD pharmacotherapy errors were sparse, highlighting a critical research gap. Conclusion: Prescription errors in substitution therapy pose significant risks to patient safety, primarily due to systemic and human factors. Enhanced training, standardized protocols, and digital tools are effective mitigation strategies. Further research is needed to quantify errors in AUD pharmacotherapy and develop targeted interventions.
Background: The Bcl-2 protein is a member of the bcl family of proteins, which play a key role in the cell apoptosis process. Its tumorigenic potential has been established long ago in animal experimental models, and was subse¬quently supported by the finding of its overexpression in a variety of human tumours. Bcl-2 has been suggested as a prognostic marker for the neoplastic diseases; new evidence keeps arising providing further support to this finding. Aim: This study investigated the association of Bcl-2 expression with prognostically important clinicopathological fea¬tures in breast carcinoma in the Greek population. Methodology: Immunohistochemical assessment of Bcl-2 was conducted in a case series of 100 surgically resected primary breast carcinomas from November 2022 to July 2023 and the association of Bcl-2 with the grade of histological differentiation and Lymph nodes pN was statistically inves¬tigated. Results: The histological grade profile of the studied samples was: Grade III (24%), Grade II (62%), Grade I (14%). High (score 3+) Bcl-2 expression was found in 65% of cases, moderate (score 2+) expression in 12%, low (score 1+) in 4%, while negative expression was shown in 19% of the samples. A statistically significant inverse association between Bcl-2 expression and the grade of histological differentiation was detected (Phi=-0.850, p=< 0.0001). Bcl-2 expression was also inversely associated with Lymph nodes pN stage (p=0.001). Conclusion: The observed association of immunohistochemical Bcl-2 expression with clinicopathological characteristics which are known prognositc indicators for breast cancer (grade and pN stage) provides confirmatory evidence to the potential important prognostic value of this marker in breast cancer. Future investigations should incorporate Bcl-2 expression in multivariate prediction models to weigh its value in the clinical management of breast cancer.
Background: Breast carcinoma is among the three most common types of cancer worldwide, including lung cancer and colon cancer, regardless of gender. The Bcl-2 oncogene is involved in a number of malignant neoplasms, includ¬ing leukaemia and lymphoma, through the regulation of the cell apoptosis process. Aim: The main purpose of the present study is to investigate the association of Bcl-2 with other molecular parameters of significant prognostic and predictive value for disease and more specifically the ER and PR receptors, along with HER-2 and Ki-67 (MIB-1). Methodology: Immunohistochemical assessment of Bcl-2, ER and PR receptors, HER-2 and Ki-67 was conducted in a case series of 100 surgically resected primary breast carcinomas and the association of Bcl-2 with the other bi¬omarkers was statistically investigated. Results: High (3+) Bcl-2 expression was observed in 65% of cases, moderate (2+) in 12%, low (1+) in 4% and negative expression in 19%. Association of Bcl-2 with ER-PR receptors and HER2 and Ki67 was conducted with Fisher’s exact and Chi square (x2) test of Cramer's V statistics tests were performed where appropriate. Bcl-2 oncogene was positively and highly associated with estrogen ER receptors (Phi=0.760, p=<0.0001); the findings of the association of Bcl-2 oncogene with PR progesterone receptors were similar: a positive association was found between the two specific biomarkers (Phi=0.626, p=<0.0001). Finally, negative association of Bcl-2 with HER2 (Phi=-0.350, p=<0.0001). Conclusion: Considering the association of Bcl-2 expression with the ex¬pression of genes that are related to therapy prediction (ER and PR) it remains to be ascertained whether Bcl-2 could be used as a potential predictive marker. Moreover, the negative association of Bcl-2 with Ki67 and HER2 should be furthermore investigated for its association with disease outcome and response to targeted therapy. Overall, this study suggests that Bcl-2 should be further tested for its incorporation into a multivariate prediction model for breast cancer therapy. In addition, more investigations are required into targeted anti-Bcl-2 therapy may be used to modify re¬sponses to current breast cancer therapy, in order to reduce resistance.
Background: Job satisfaction is a fundamental factor affecting nurse well-being, retention, and healthcare system performance. Aim: This study explores the determinants of job satisfaction among nurses, with particular emphasis on the differences between temporary agency nurses and those in permanent positions in North Rhine-Westphalia, Germany. Methodology: A cross-sectional study was conducted to assess job satisfaction among nurses working under both temporary agency and permanent employment contracts. Data were collected from a sample of 195 nurses using the Job Satisfaction Survey (JSS), a standardized instrument designed to measure multiple domains of job satisfaction. The survey included items related to supervision, salary, promotion opportunities, work relationships, and benefits. Statistical analyses were performed to identify and compare job satisfaction levels between the two employ¬ment groups. Results: Temporary nurses reported consistently higher satisfaction than permanent nurses across most domains of the Job Satisfaction Survey. Supervision was the most positively rated factor (97.9% of temporary vs. 72.2% of permanent nurses), while pay (73.0% vs. 11.1%) and benefits (51.8% vs. 9.3%) also showed large dispari¬ties. Promotion opportunities were rated lowest by both groups (7.1% vs. 3.7%), and satisfaction with co-worker rela¬tionships remained stable across groups (63.1% vs. 63.0%). The most pronounced contrast was observed in overall job satisfaction: 61.7% of temporary nurses reported being satisfied compared with only 5.6% of permanent nurses. Regression analysis confirmed that permanent employment was negatively associated with satisfaction, whereas higher educational attainment predicted higher satisfaction with pay and overall job satisfaction. Conclusion: The findings reveal significant and counterintuitive differences in job satisfaction between temporary and permanent nurses. Contrary to expectations, temporary nurses consistently reported higher satisfaction across most domains of work life. Addressing issues related to compensation, career progression, and job stability is essential to enhance satisfaction and reduce turnover. Healthcare organizations should implement targeted strategies that acknowledge the distinct needs of both employment groups and foster a supportive working environment.
Background: Prescription errors (PE) in psychiatric hospitals can compromise treatment and patient safety. While well studied in general healthcare, evidence from psychiatric settings, particularly in Germany, remains scarce. Aim: This pre-liminary study investigates the prevalence, types, and severity of PE in a German psychiatric hospital over 12 months. Methodology: A prospective observational study was conducted at St. Josef AMEOS Psychiatric Hospital, Oberhausen, Germany (2023–2024). All 6,020 paper-based therapeutic plans were screened. From these, 150 cases of PE were identified for interim analysis. Errors were categorized using adapted EQUIP methodology and classified by severity (minor, major, serious, potentially fatal) and by drug group according to the British National Formulary (BNF). Results: Of the 150 cases, 93.3% were minor, 5.0% were major, and 1.7% were serious; no potentially fatal errors were observed. Writing errors were most common (38%). Errors most frequently involved musculoskeletal medications (BNF 10; 36.7%), followed by gastrointestinal (BNF 1; 18.7%) and CNS/psychotropics (BNF 4; 14.7%). Most errors occurred in inpatient settings and were primarily attributed to residents and consultants. Significant asso¬ciations were found between error type and drug class, and between error type and severity (p<0.05). Conclusion: These interim results suggest that PE in psychiatric hospitals are mostly minor, with somatic medications more often affected than psychotropics. Given the small interim sample (150 of 6,020 plans), findings should be interpreted cau¬tiously and considered hypothesis-generating. Larger, multi-center studies and evaluation of electronic prescribing systems are needed to confirm these patterns and guide interventions.
The biophysical properties of the skin vary significantly across different racial and gender groups, influencing skin health, function, and response to environmental factors. This review explores the impact of race and gender on cutaneous biophysical properties, highlighting differences in skin structure, function, and response to environmental factors. The study synthesizes data from multiple sources to elucidate how genetic, hormonal, and environmental factors contribute to variations in skin properties across different racial and gender groups. Key findings suggest that melanin content, transepidermal water loss (TEWL), sebum production, and skin elasticity exhibit significant variability, impacting dermatological health and cosmetic product development. A comprehensive understanding of these variations can aid in the development of targeted dermatological treatments and skincare products tailored to specific demographic needs.
Hirsutism is observed in 5-10% of women during their reproductive years and is a particularly distressing disorder that affects the quality of life of these women. Many studies have found the role of diet and lifestyle modification to be beneficial in managing non-communicable metabolic diseases; however, there is limited research on their role in hirsutism. Patients with hirsutism, in prevalence, exhibit insulin resistance, hyperinsulinemia, and hyperandrogenism (except for patients with Idiopathic hirsutism), while the majority of them are over-weight and obese. Dietary patterns, such as DASH, ketogenic, and intermittent fasting, have been studied for their positive effect on hirsutism.
Local anesthetics play a crucial role in aesthetic procedures, offering temporary pain relief while preserving recipient’s consciousness. They are widely used in procedures such as laser treatments, injectable therapies, chemical peels, and microneedling. This review explores the mechanisms of action, pharmacokinetics, formulations, and safety considerations of these agents, emphasizing their influence on procedural outcomes and patient comfort. Local anesthetics work by inhibiting sodium ion channels, preventing nerve signal transmission. Their efficacy depends on factors like chemical composition, lipid solubility, pKa, and the tissue environment. Common formulations include creams, gels, patches, and sprays, each tailored to specific applications and procedural needs. Safety concerns, including systemic toxicity and allergic reactions, highlight the importance of appropriate dosing and formulation choice. Recent advancements, such as nanotechnology and enhanced delivery systems, promise to improve anesthetic performance and safety. This review underscores the indispensable role of local anesthetics in modern aesthetic practice.
Permanent makeup (PMU) is a very popular application for the correction of facial imperfections. It can be applied over the face area to correct the characteristics such as the eyebrows, the eyelids and the lips. These applications are the most famous for permanent makeup. The change in shape and colour of eyebrows is most popular in contrast to the eyelids application to create permanent eyeliner shapes, and the lips application to create permanent lipliner and lip shading features. It also has a “medical” role when it is applied for mimicking hair follicles on the scalp area or breast areola reconstruction after mastectomy. These procedures can lead from minor to serious problems in skin condition from the first day of application, even months later. These un-wanted side effects are unpredictable factors that cannot be avoided. On the other hand, the extraordinary rising of the tattoo industry has raised the number of patients who want to “remove” their tattoo. The most common reason is changing their mind or wanting another design to decorate their body. Various ways of tattoo removal have been used for many years with laser removal to gain popularity. Unfortunately, laser tattoo removal has also many unwanted side effects that can lead to serious skin problems.
Expectations are beliefs or assumptions about future events; they allow individuals to be prepared and guide their behaviour when the anticipated situation occurs. Cognitive biases represent judgements about a situation which deviate from norm and rationality. Unrealistic optimism is the tendency for people to believe that a personal future outcome will be more favourable than that suggested by a relevant, objective standard. A growing number of individuals undergo into aesthetic interventions to their body, motivated by interpersonal and/or societal factors. Not all of these individuals are satisfied with the results of the interventions and the unrealistic expectations about the interventions is a contributing factor, alongside with other situational factors. Both clients and aesthetic professionals must be aware of their (unrealistic) expectations regarding aesthetic interventions I order to make the most appropriate decisions.
The biophysical properties of human skin, such as hydration, elasticity, sebum content, and transepidermal water loss (TEWL), are influenced by both age and body location. These factors play a critical role in dermatological health and the efficacy of skincare products. Aging is generally associated with decreased hydration, elasticity, and sebum production, while TEWL increases, indicating a decline in skin barrier function. Additionally, different anatomical locations exhibit distinct biophysical characteristics due to varying densities of sebaceous glands and exposure to environmental factors. For instance, sebaceous gland-rich areas like the forehead show higher sebum content, while the palms exhibit lower hydration levels. This review presents a comprehensive analysis of current research on the effects of age and body location on skin biophysical properties to guide future dermatological studies and skincare product development.
Cellulite is a common dermatologic condition affecting 80-90% of post-pubertal females, particularly on the thighs, buttocks, and hips. It is characterized by dimpling and a "mattress-like" skin appearance, significantly impacting body image and quality of life. More prevalent in Caucasian women, it results from multifactorial causes, including hormonal influences (e.g., estrogen), structural differences in subcutaneous tissues, vascular changes, and low-grade inflammation. Lifestyle and aging further contribute to its severity. Treatments range from topical applications and energy-based devices to minimally invasive procedures, though results are often temporary. Due to its complex etiopathogenesis and structural changes, cellulite remains challenging to treat, necessitating realistic patient expectations and further research for improved and lasting solutions.
Background: A substantial number of thiazolidin-4-one derivatives have been shown to have a variety of pharmaco¬logical characteristics. Aim: The current study seeks to design new acetazolamide products with thiazolidin-4-one moiety and evaluate their inhibitory effect to carbonic anhydrase XII enzyme (protein data bank code: 1JD0) and anti-cancer properties in silico. Four acetazolamide derivatives with a thiazolidin-4-one moiety will be produced using acetazolamide as the starting material. Methodology: The molecular docking studies were determined by utilizing the Molecular Operating Environment (MOE) software version 2015.10. The binding tendencies of docked ligands to the target protein carbonic anhydrase XII were described as root-mean-square deviation (RMSD) and standard score (S score). Results: The process of docking demonstrated that the four test ligands (IIIa, IIIb, IIIc, and IIId) had a higher binding affinity for the objective protein carbonic anhydrase XII than the reference ligand, which is an acetazolamide. Consid¬ering the four compounds, the compound IIIa had the ultimate affinity of binding, and S score of -7.4. Conclusion: The findings imply that the designed acetazolamide compounds, specifically IIIa, have the potential to be carbonic anhydrase inhibitors and anti-cancer medicines that target the carbonic anhydrase XII enzyme.
Cellulite treatments vary in their mechanisms, invasiveness, and durability of outcomes. Non-invasive options, such as topical agents and oral supplements, provide moderate benefits but require prolonged use. Massage and energy-based therapies offer better cosmetic improvements but often require multiple sessions with results that may not be long-lasting. Invasive treatments, like subcision and injectable options, directly address structural issues underlying cellulite. The choice of treatment depends on individual patient needs, cellulite severity, and the desired balance between invasiveness and results. A tailored approach considering the underlying structural and aesthetic concerns often yields the best outcomes.
Aging is the result of tissue energy alteration, therefore when an external energy source is applied, such as radiofrequency (RF), high-intensity focused ultrasound (HIFU), and/or their combination, it results in their renewal and improvement of skin aging. Nowadays, even for the most difficult parts such as the neck and décolleté, these modern non-invasive aesthetic technologies are applied with results from one treatment. The combination protocols will offer maximum results, if they are used under the right conditions.
Background: In Germany, midwifery care has a long-standing tradition and history of providing high-quality services to women, particularly during the critical periods of pregnancy and childbirth. Midwives play a pivotal role, which has evolved to meet the demands of modern maternity care, focusing on prevention, accurate information, comprehensive care during pregnancy, monitoring foetal development, and supporting natural childbirth. Aim: This cohort study examines the data collected from the midwife-led delivery room at the maternity clinic of Hochwald Hospital, with the aim of promoting natural birth-centres around the world. Methodology: The study is based on a retrospective evaluation of data from the maternity clinic at Hochwald Hospital in Bad Nauheim. The data were retrieved from the hospital's electronic patient records Management system to the use of midwife-led delivery rooms. Results: In total during the study period, 748 women were initially admitted to the midwifery led unit/delivery room. Of these, 163 women did not meet the criteria for midwife-led care during labour and were referred for alternative care/ OBGYN led delivery room, escalated to contraindications or complications. Of the remaining 585 women who proceeded to deliver in the midwife-led room, 259 required medical intervention during childbirth. Ultimately, 326 women delivered successfully in the midwife-led delivery room without complications. Conclusion: This cohort study underlines the importance of midwife-led delivery rooms as a vital model of care that promotes and enhances natural childbirth. It also highlights the need for continuous improvement in maternity care services through evidence-based practices and women-centred approach during pregnancy, labour and birth. By strengthening these values, we can manage to improve women's experiences during the perinatal period and contribute to reducing any unnecessary medical interventions.
