Search Results (29,565)

Myocarditis is a condition marked by inflammation of the heart muscle, which can lead to serious outcomes such as sudden cardiac death (SCD) and life-threatening arrhythmias. While myocarditis can affect any population, athletes, especially those engaged in high-intensity training, are at increased risk due to factors such as reduced immunity and increased exposure to pathogens. This review examines the clinical presentation, current guidelines, diagnostic challenges, and the significance of cardiac magnetic resonance imaging (CMR) in detecting myocardial inflammation and scarring. Current guidelines recommend a period of exercise restriction followed by thorough reassessment before athletes can return-to-play (RTP). However, there are several knowledge gaps, including the implications of persistent late gadolinium enhancement (LGE) on CMR and the optimal duration of exercise restriction. Additionally, the psychological impact of myocarditis on athletes highlights the importance of incorporating mental health support in the recovery process. A shared decision-making approach should be encouraged in RTP, considering the athlete’s overall health, personal preferences, and the potential risks of resuming competitive sports. We have proposed an algorithm for RTP in athletes following myocarditis, incorporating CMR. Future research is warranted to refine RTP protocols and improve risk stratification, particularly through longitudinal studies that examine recovery and outcomes in athletes. Full article

Background: Periodontal disease is an inflammatory, chronic, and multifactorial disease. The objective of this study is to analyze the association between periodontal disease and some disorders such as papillomas (benign lesions), lichen planus (a chronic immune-mediated disorder), leukoplakia (potentially malignant lesions), and oral cancer (malignant lesions). Methods: For this study, 42 patients were recruited whose supragingival and subgingival plaque was qualitatively analyzed using a phase-contrast microscope, which allowed for the detection of compatible bacterial flora (immobile and composed mainly of cocci) indicative of periodontal health and incompatible bacterial flora (mobile and composed mainly of spirochetes) indicative of periodontal pathology. Patients with incompatible bacterial flora were then subjected to a laser-assisted periodontal treatment with irrigation with hydrogen peroxide within the periodontal pockets (a non-surgical laser-assisted periodontal protocol which is referred to as dye-free photodynamic therapy). Results: Based on the 42 patients recruited, there was no association between oral cavity lesions and periodontal pathogenic bacteria. Four of them were found to have incompatible bacterial flora. Indeed, it was found that almost all the patients had been previously instructed in the proper techniques of home oral hygiene, and more than half of them reported that they carried out periodic check-ups by a dental hygienist. Of the four patients with signs and symptoms of periodontitis, two stated a willingness to undergo the non-surgical laser-assisted periodontal protocol and showed improvements in periodontal indices such as CAL, PPD, and BoP. Conclusions: hygienists and dentists are determining factors in the prevention of periodontal disease and for the maintenance of good oral health. Full article

Sucralose stands as the most common non-nutritive sweetener; however, its metabolic effects have sparked significant controversy over the years. We aim to examine the effects of sucralose daily intake on glycemia, subjective appetite, and gut microbiota (GM) changes in subjects with overweight or obesity. In this randomized, crossover, and controlled trial, 23 participants with a body mass index between 25 kg/m² and 39.9 kg/m² will be assigned to one of two interventions to receive either sucralose (2 mg/kg/day equivalent to 40% of the acceptable daily intake) or glucose (control) for 4 weeks, each phase separated by a 4-week washout period. The glycemic response will be determined during a meal tolerance test, subjective appetite will be evaluated using a visual analog scale, and GM changes will be analyzed by next-generation sequencing of the bacterial rRNA 16S gene from fecal samples. All measures will be performed before and after intervention periods. We hypothesize that sucralose supplementation induces changes in glycemic response, subjective appetite, and gut microbiota in overweight and obese participants. This protocol was approved by the Ethics Committee of the UJAT (No. 0721) and was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12621001531808). Full article

Background/Objectives: The COVID-19 pandemic has posed significant challenges, particularly for individuals residing in psychiatric facilities. This study aims to investigate the impact of COVID-19 on psychiatric patients, focusing on factors such as their vaccination status, comorbidities, medication regimens, and biomarkers like C-reactive protein (CRP) and ferritin. Methods: This retrospective study analyzed 100 patients with confirmed SARS-CoV-2 infections admitted to the private psychiatric clinic “Asclepius of Upper Volos” from March 2020 to March 2023. The data collected included sociodemographic characteristics, vaccination status, symptom severity, medication regimens, and levels of CRP and ferritin. Statistical analyses using IBM SPSS Statistics version 29 included Pearson’s chi-square tests, Student’s t-tests, and a survival time analysis via the log-rank test to assess associations between clinical characteristics and outcomes. Results: Among the participants, 64% were female and 74% received two doses of the COVID-19 vaccine. The majority experienced mild symptoms, with a survival rate of 74%. Statistically significant findings include a higher survival rate among vaccinated individuals (98.6%) versus unvaccinated individuals (1.4%, p < 0.001). Comorbidities like chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure were associated with severe symptoms and higher mortality rates. Higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to the 416.9 (SD = 215.9) seen in non-survivors (p < 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) than in non-survivors (3.46, SD = 2.92), with a p-value of 0.002. Conclusions: The findings underscore the importance of tailored health protocols and continued support for this vulnerable population. Enhanced strategies for managing comorbidities and utilizing biomarkers can aid in better predicting and improving psychiatric patient outcomes. Full article

Opioids are commonly used to reduce pain after surgery; however, there are severe side effects and complications associated with opioid use, with addiction being of particular concern. Recent practice has shifted to reduce opioid consumption in surgery, although a specific protocol for rhinoplasty is still in progress. This paper aims to expand on the protocol previously established by the senior author based on updated evidence and details. This was accomplished by first high-lighting and summarizing analgesic agents with known opioid-reducing effects in the surgical field, with a particular focus on rhinoplasty, then compiling these analgesic options into a recommended protocol based on the most effective timing of administration (preoperative, intraoperative, postoperative). The senior author’s previous article on the subject was referenced to compile a list of analgesic agents of importance. Each analgesic agent was then searched in PubMed in conjunction with “rhinoplasty” or “opioid sparing” to find relevant primary sources and systematic reviews. The preferred analgesic agents included, as follows: preoperative, 1000 mg oral acetaminophen, 200 mg of oral celecoxib twice daily for 5 days, and 1200 mg oral gabapentin; intraoperative, 0.75 μg/kg of intravenous dexmedetomidine and 1–2 mg/kg injected lidocaine with additional 2–4 mg/kg per hour or 1.5 cc total bupivacaine nerve block injected along the infraorbital area bilaterally and in the subnasal region; and postoperatively, 5 mg oral acetaminophen and 400 mg of oral celecoxib. When choosing specific analgesic agents, considerations include potential side effects, contraindications, and the drug-specific mode of administration. Full article

Objectives: Esophageal high-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders, but it may be poorly tolerated and unsuccessful. We sought to evaluate a protocol for sedation and endoscopy-assisted (SEA) HRM in patients who previously failed standard HRM and assess patient perspectives towards it. Methods: Adult patients who previously failed HRM were prospectively enrolled. Under propofol sedation, an upper endoscopy was performed during which the HRM catheter was advanced under endoscopic visualization. If the catheter did not reach the stomach on its own, the endoscope itself or a snare was used to help it traverse the esophagogastric junction (EGJ). Results: Thirty patients participated (mean age 67.8, 70% female). The technical success of SEA-HRM was 100%. Twenty-two (73.3%) were diagnosed with a motility disorder including thirteen (43.3%) with achalasia. Eighteen (60%) had previously failed HRM due to discomfort/intolerance, while twelve (40%) failed due to catheter coiling in the esophagus. Subjects in the coiling group were more likely to need endoscopic assistance to traverse the EGJ (91.7% vs. 27.7%, p = 0.001) and have a motility disorder (100.0% vs. 55.6%, p = 0.010), including achalasia (75.0% vs. 22.2%, p = 0.004), compared to the discomfort/intolerance group. All patients preferred SEA-HRM and rated it higher than standard HRM (9.5 ± 1.3 vs. 1.9 ± 2.1, p = <0.001, on a scale of 1–10). Conclusions: SEA-HRM is a highly successful and well-tolerated option in patients who previously failed standard HRM. This should be the recommended approach in cases of failed HRM rather than secondary tests of esophageal motility. Full article

Background and Objectives: Developmental and epileptic encephalopathy refers to a group of conditions where patients experience abnormal development due to various causes as well as frequent epileptiform discharges that ultimately contribute, in an independent and additive fashion, to cognitive and linguistic impairments. The language and cognition outcome of these patients in adulthood has been understudied. This paper aims to present a scoping review of linguistic abilities in adults with developmental and epileptic encephalopathy to determine the extent to which language outcomes in adulthood and their relation to cognitive outcomes have been studied. Design: Two online databases were searched and the methodological framework by Arksey & O’Malley (2005) was adopted. Results: Out of the 27 selected studies, only 13 exclusively examined adults, 15 were group studies, 5 were case studies and 7 were case series. A total of 9 out of the 15 group studies provided individual results for adults. Twenty-two studies included a follow-up examination. Twenty-three studies addressed the relationship between language and cognition. The selected studies indicate the presence of language impairments, which are nevertheless differentially manifested in the syndromes under investigation, whereas individual variability is also reported. Aspects of cognition seem to correlate with linguistic abilities. Conclusions: In sum, despite variability in linguistic abilities, language deficits constitute a significant aspect of the clinical profile of many adults with developmental and epileptic encephalopathy, a finding that should be taken into account for the treatment protocols of these individuals. Full article

Objectives: This study analyzed the effect of different positions on pelvic floor muscle (PFM) function in women with and without stress urinary incontinence (SUI). Methods: This study included women with (n = 17, research group) and without (n = 25, control group) SUI. Using abdominal ultrasound, PFM function (maximum contraction and endurance) was measured in four different positions: lying, sitting, standing and squatting. The level of difficulty perceived by the participants was recorded. Results: In both groups, the best contraction was observed in the standing position and the weakest in the lying position. Women with SUI showed a lower ability to perform PFM contraction. A significant difference was found between the groups in the sitting and standing positions, and it was smaller in the research group. In the research group, the contraction displacement during sitting was 2.68 (1.67) mm versus 4.51 (2.62) mm in the control. The displacement during standing was 6.92 (3.50) mm versus 9.18 (5.05) mm, respectively (p < 0.05). In the research group, 52.9% reported the sitting position as the most difficult compared with only 12% in the control group. Conclusions: Women with SUI have lower PFM function while standing or sitting, but not while lying, than those without SUI. Variations in PFM function across different positions exist. A new protocol for PFM examination should be written with the standing position included. Full article

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma. Full article

The economic cost of repairing corrosion-affected reinforced concrete structures (RCSs) means that reliable and accurate assessment and early detection methods must be sought after. Conventional techniques, such as visual inspections, or measuring either cover layer resistivity or the corrosion potential, are methods that require accessibility and involve personnel having to travel to take in situ measurements. Monitoring by embedded sensors is a much more efficient approach that allows early detection by remote sensing. This work presents the implementation of a new measurement protocol regarding the existing monitoring system called INESSCOM (Integrated Sensor Network for Smart Corrosion Monitoring). Along with the corrosion intensity measurement in embedded sensors, it also proposes monitoring the double layer capacity of the sensors’ responses. It aims to determine, along with the rebars’ corrosion rate, the triggering agent of the corrosion process. This study was carried out using three reinforced concrete scaled columns that were exposed to different environments. The results demonstrate with this new protocol that the remote INESSCOM monitoring system can establish the corrosion rate and identify the precursor agent of corrosion (carbonation or chlorides), even when the recorded corrosion rates are similar. Full article

This study aimed to compare two female field hockey teams of different competitive levels by analyzing kinematic variables in repeated sprint ability (RSA) tests and the force-velocity profile (FVP). Twenty-five female hockey players representing the elite and subelite levels from the same club volunteered to participate. The RSA protocol included six 30 m maximal sprints with a 30 s recovery. Kinematic variables, such as sprint time, step frequency, and step length, were analyzed for each sprint. Additionally, players performed counter-movement jumps (CMJs) and CMJs with 50% body weight (CMJ50s) to calculate the FV50 using the Bosco Index. The elite players showed better (≈2%; p < 0.05) fatigue indexes in sprint time (0–30 m and 0–10 m sections), step length (0–10 m, 10–20 m, and 20–30 m sections), and step frequency (20–30 m section) during the RSA test, as well as greater values (>10%; p < 0.05) in the CMJ50 and FV50 tests. In addition, these RSA (sprint time, step frequency, and step length) and jumping (CMJ, CMJ50, and FV50) variables showed a moderate, significant, or very significant relationship with each other. Therefore, it seems that both strength and speed capacities can be used either in conjunction or as a complementary approach to enhance the overall RSA performance. Full article

Background: Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. Aim: To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. Methods: This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Results: Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. Conclusion: The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population. Full article

Pediatric patients with polyuria polydipsia syndrome (PPS) represent a diagnostic challenge for clinicians because of the technical difficulties in performing the gold standard water deprivation test (WDT). Copeptin, a stable biomarker representing the C-terminal portion of the polypeptide chain of the antidiuretic hormone, is a reliable diagnostic tool. To assess the diagnostic accuracy of baseline copeptin dosing, arginine/hypertonic saline copeptin stimulation tests, and WDT. This study aimed to establish the diagnostic utility of copeptin in pediatric patients by distinguishing between central diabetes insipidus, nephrogenic diabetes insipidus, and primary polydipsia. Comparative and non-comparative primary studies published between January 2018 and August 2024 focusing on children were searched and included in PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, and Google Scholar. The QUADAS-2 tool was used to assess the risk of bias and applicability. Meta-analyses used fixed effects models because of low heterogeneity and the HSROC model. Eleven studies were included with an overall low bias and no significant applicability concerns. The mean pooled sensitivity = 0.98 (95% CI: 0.936–1.025), pooled specificity = 0.947 (95% CI: 0.920–0.973), and AUC = 0.972 (95% CI: 0.952–0.992), indicating excellent diagnostic accuracy. Stimulation methods for copeptin dosing represent an effective and less invasive diagnostic test for children with PPS, and future development of standard copeptin testing protocols is needed. Full article

Background/Objective: This study investigated the differences in acute fatigue following resistance training performed with low versus high loads in the bench press (BP). Methods: Trained males (n = 5, 21.2 ± 2.77 years; 81.86 ± 6.67 kg; 177 ± 7.52 cm) undertook three protocols with 50%RM and three with 85%RM with volume equalized between protocols: muscular failure protocols (TF, RTP1 and 2), half-maximum repetition protocols (RTP3 and 4), and cluster set protocols (RTP5 and 6). Mechanical performance, lactate, and perceptual responses were analyzed during protocols and at post 0, 24, and 48 h using frequentist (p < 0.05) and Bayesian approaches. Results: Moderate to large (ES ≥ 0.3) and trivial to moderate (ES < 0.3) effects were observed at 0 and 24 h post-session, respectively, across all protocols. TF protocols, particularly RTP1, showed the greatest impairments when compared to the other RTP (ES ≥ 0.3). The Bayesian analysis supported the frequentist results, showing strong-decisive evidence for our data under the model that included protocols as predictors for mechanical, metabolic, and perceptual variables during protocols. Inter-individual variability in responses was observed in the neuromuscular tests, potentially related to the strength level and perceptual responses. Conclusions: In summary, TF generates greater fatigue, while reducing set volume to half of maximum repetitions or including intra-set rest that helps to mitigate fatigue symptoms. Full article

This study explores the association of respiratory muscle strength with aerobic endurance kinetics among athletes, with a specific focus on maximal oxygen consumption (VO₂max). Previous research has elucidated the complex interactions between respiratory and skeletal muscles during exercise, highlighting the critical role of efficient respiration in maximizing athletic performance. The interplay between active skeletal muscles and respiratory muscles, especially the influence of respiratory muscle fatigue on exercise capacity, is well-documented. High-intensity exercise has been shown to activate the respiratory muscle metaboreflex, which can restrict blood flow to working muscles, thereby impacting the energy required for respiration. A total of 41 athletes, drawn from the disciplines of biathlon, judo, and cross-country, participated in this study. Respiratory function tests (RFTs) were administered to assess various respiratory parameters, including changes in chest circumference. Additionally, maximal oxygen consumption (VO₂max) and heart rate were measured during a treadmill test. To explore the associations between VO2max and ventilatory parameters—namely, ventilation (VE), oxygen consumption (VO₂), carbon dioxide production (VCO₂)—as well as respiratory metrics, linear regression analysis was employed. Based on the standardized regression coefficients (β), it was found that maximum expiratory pressure (MEP) (mean ± SD: 130.95 ± 42.82) and inspiratory diaphragmatic circumference values were significantly associated with VE, VO₂, and VCO₂. Conversely, the other predictor variables did not exhibit a significant effect on VE (mean ± SD: 134.80 ± 36.69), VO₂ (mean ± SD: 3877.52 ± 868.47 mL), and VCO₂ (mean ± SD: 4301.27 ± 1001.07 mL). Similarly, measurements of chest circumference (mean ± SD: 91.40 ± 10.72 cm), MEP, and diaphragmatic circumference during inspiration (mean ± SD: 95.20 ± 10.21 cm) were significantly associated with VO₂max (mean ± SD: 58.52 ± 10.74 mL/kg/min), while the remaining predictor variables did not demonstrate a significant effect on VO₂max. Additionally, a multiple linear regression analysis was conducted to examine the combined effects of respiratory muscle strength and ventilatory factors on VO₂max. The model, which included interaction terms, explained 89.9% of the variance in VO₂max (R² = 0.899, adjusted R² = 0.859). Significant interactions were found between MIP and VE (B = −0.084, p = 0.006), as well as MEP and VE (B = 0.072, p = 0.012). These findings suggest that respiratory muscle strength plays a more substantial role in determining VO₂max in individuals with higher ventilatory efficiency, highlighting the importance of both respiratory strength and breathing efficiency in aerobic performance. Our findings underscore the importance of considering respiratory muscle strength in assessing and enhancing athletes’ aerobic performance. Integrating objective measurements such as maximal inspiratory and expiratory pressure assessments into routine performance evaluations allows coaches and sports scientists to monitor changes in respiratory function over time and adjust training protocols accordingly. Full article