Original Systematic Reviews Research Articles

Stress to be managed and managing stress in clinical education

We introduced the Journal of Clinical Education in Physical Therapy (JCEPT) in 2019 as an open-access peer-reviewed journal with the twin goals of disseminating educational scholarship related to clinical education and developing physical therapy educational scholars. We were first indexed to the Directory of Open Access Journals (DOAJ) in 2022, and recently passed the scientific quality review for PubMed Central (PMC) indexing. As JCEPT has become more and more established the acceptance rate has declined somewhat, yet our editorial team remains true to the developmental aspect of our mission as we work with authors through multiple iterations of their manuscripts. Over the years, JCEPT abstract views have increased five-fold and indexing will further enhance the visibility and credibility of physical therapy clinical education scholarship. A theme arising from this year’s volume was the focus on issues within the psychosocial domain across the continuum of people involved in clinical education. Student stress during their clinical education experiences including student debt and overall financial stress was explored. Also concerning was the ~66% average rate of inappropriate sexual advances by patients towards physical therapy students and the need to manage related stress and circumstances. Clinical instructors also experience stress as indicated in those with fewer than five years of experience by low compassion satisfaction. The experience may be the opposite for those at the other end of the experience spectrum as those with over 25 years in the field reported low levels of burnout. Directors of Clinical Education also manage stressful scenarios as highlighted by a case report about clinical education adjustments to the challenges of the COVID-19 pandemic as well as a perspective suggesting adopting common clinical education setting terminology to reduce confusion. And for fellows, who are licensed physical therapists managing life beyond school with further training, the impact of life circumstances is suggested by better functional outcomes and more efficient episodes of care for fellows without kids at home. JCEPT publishes scholarly work affecting any aspect of clinical education in physical therapy addressing academic or clinical faculty; entry-level students, residents, or fellows; and curricula or teaching and learning methods. In addition to original research, systematic reviews, and innovative teaching methods, JCEPT publishes clinical education case reports, case reports from residency or fellowship training, excellent critically appraised topics, and the occasional perspective. We look forward to supporting educational scholars and developing the evidence underpinning physical therapy clinical education. Christopher Kevin Wong and Jean FitzpatrickFounding Editors in Chief

Role of neuropeptide Y in development of valproate-induced eating behaviour disorder

Background. Eating behaviour disorder (EBD) induced by valproic acid (VPA) is one of the components of the pathogenesis of a serious complication of therapy with VPA and its salts such as VPA-induced metabolic syndrome (MetS). About 20% of patients receiving VPA have weight gain, which is also a consequence of altered eating behaviour in such patients. Substances such as neuropeptide Y (NPY), leptin, orexin and ghrelin are involved in the regulation of eating behaviour. NPY has received special attention in recent years because it is one of the most potent brain orexigenic peptides and its expression level directly affects the quantity and quality of food intake. NPY overexpression is associated with EBD, food preferences, obesity, and MetS.Objective: to review preclinical and clinical studies of NPY role as a potential sensitive and specific serum biomarker of VPA-EBD, secondary weight gain and VPA-MetS development in children and adults with epilepsy.Material and methods. We analyzed Russian and foreign publications submitted to eLibrary, PubMed/MEDLINE, Scopus, and Google Scholar databases between 2014 and 2024. The full-text articles in Russian and English (original studies, systematic reviews, meta-analyses, Cochrane reviews, and clinical cases) were analyzed. After the selection procedure, 53 out of 1105 publications retrieved by query keywords were included in the analysis.Results. VPA-EDB refers to multifactorial diseases, requiring to take into account the additive contribution of external (food education, eating habits of the patient and family members) and internal (key hormones and neuropeptides regulating appetite and food preferences, the dose and duration of VPA intake, the metabolic rate of VPA) factors while assessing a risk of its development. NPY-associated VPA-EDB affects dietary preferences in favor of high-calorie food and beverages, increases the frequency of meals, the risks of insulin resistance, hyperglycemia as one of the major domains in MetS pathogenesis.Conclusion. VPA-EBD requires timely diagnosis, as it can cause VPA-MetS. NPY is an important biomarker of VPA-EBD, because recent studies have convincingly demonstrated that this neuropeptide is involved in the regulation of eating behavior in patients with epilepsy.

Violence Risk Assessment Tools Used in Forensic and Acute Psychiatry in North America: A Scoping Review

Violence in psychiatric settings presents a significant risk to patients, staff, and society at large. With over 400 risk assessment tools available globally, their applications and the risks they assess vary, allowing for diverse use in different situations. This scoping review investigated the risk management tools utilized in North America’s forensic psychiatry and acute psychiatric units, aiming to identify which ones are mainly used. A comprehensive search was conducted across PubMed, Embase, and PsycINFO databases, following PRISMA Guidelines, covering the literature from their inception date until 2023. Criteria for study inclusion required a focus on risk management tool use in forensic or acute psychiatric settings, originality (original studies, case reports, or systematic reviews), and a North American context. Out of 3059 identified studies, 40 were thoroughly analyzed. Commonly used risk assessment scales include HARM-FV, eHARM-FV, HCR-20, PCL-R, START, BVC, and DASA, with their reliability varying by the clinical context and the assessed population. The review highlights the heterogeneous application of static and dynamic scales across clinical settings, underscoring a need for more precise tools to improve risk assessments in forensic psychiatry, signaling a call for the development and validation of more sophisticated assessment instruments.

Residual Traditional Risk in Non-Traditional Atherosclerotic Diseases.

Individuals with chronic inflammatory and immune disorders are at an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Despite extensive literature exploring the relationship between "non-traditional" atherosclerotic conditions and CV risk, many aspects remain unresolved, including the underlying mechanisms promoting the "non-traditional CV risk", the development of an innovative and comprehensive CV risk assessment tool, and recommendations for tailored interventions. This review aims to evaluate the available evidence on key "non-traditional" CV risk-enhancer conditions, with a focus on assessing and managing CV risk factors. We conducted a comprehensive review of 412 original articles, narrative and systematic reviews, and meta-analyses addressing the CV risk associated with "non-traditional" atherosclerotic conditions. The analysis examined the underlying mechanisms of these relationships and identified strategies for assessing and mitigating elevated risk. A major challenge highlighted is the difficulty in quantifying the contribution of individual risk factors and disease-specific elements to CV risk. While evidence supports the cardiovascular benefits of statins beyond lipid lowering, such as pleiotropic and endothelial effects, current guidelines lack specific recommendations for the use of statins or other therapies targeting non-traditional CV risk factors. Additionally, the absence of validated cardiovascular risk scores that incorporate non-traditional risk factors hinders accurate CV risk evaluation and management. The growing prevalence of "non-traditional CV risk-enhancer conditions" underscores the need for improved awareness of CV risk assessment and management. A thorough understanding of all contributing factors, including disease-specific elements, is crucial for accurate prediction of cardiovascular disease (CVD) risk. This represents an essential foundation for informed decision-making in primary and secondary prevention. We advocate for future research to focus on developing innovative, disease-specific CV risk assessment tools that incorporate non-traditional risk factors, recognizing this as a promising avenue for translational and clinical outcome research.

Attenuation of Endothelial Dysfunction in Diabetes Mellitus: An Integral Characteristic of Anti-Diabetic Medications

Abstract Background: The complications of diabetes mellitus (DM) have incapacitated many patients, especially in poor-income countries. DM is an endocrine disease but its far-reaching complications arise from cardiovascular derangements. The cardiovascular complications usually stem from endothelial dysfunction, which culminates in atherosclerosis. Progressively, atherosclerosis results in microvascular and macrovascular complications. Materials and Methods: Literature searches were carried out in Google, PubMed, and MEDLINE using the following keywords: DM, endothelial dysfunction, biomarkers, anti-diabetic drugs, C-reactive protein (CRP), and intercellular adhesion molecule. Original articles, systematic reviews, and meta-analytic articles were reviewed, and important findings were incorporated into this review. Summary: The review aims to evaluate mechanisms responsible for endothelial dysfunction in diabetes. Endothelial dysfunction may arise from one or a combination of these molecular mechanisms: (i) decreased nitric oxide synthesis, (ii) activation of protein kinase C and reactive oxygen species generation, (iii) activity of advanced glycation endproducts, (iv) activation of tumor necrosis factor-alpha, and (iv) defective insulin signaling and so on. The biomarkers of endothelial dysfunction were also explored and they include CRP, intracellular adhesion molecule-1, vascular cell adhesion molecule-1, microalbuminuria, asymmetric dimethylarginine, Toll-like receptors, and others. The review also evaluated the effectiveness of anti-diabetic medications in modulating the biomarkers of endothelial dysfunction in diabetic patients.

Intestinal Microbiota and Its Influence on Human Health and Autism Spectrum Disorder (ASD)

Introduction: The intestinal microbiota plays a crucial role in human health, influencing digestion, metabolism, immune system development, and even behavior. This review aims to explore the relationship between gut microbiota and Autism Spectrum Disorder (ASD), emphasizing its potential role in the development and manifestation of ASD symptoms through immunological and metabolic pathways. Methods: Data for this review were obtained from PubMed and Science Direct, covering literature from 2011 to 2024. Inclusion criteria focused on original studies, systematic reviews, and meta-analyses discussing gut microbiota composition, dysbiosis, and its relationship with ASD. Articles were selected based on relevance, language (English or Portuguese), and the presence of empirical data. Results: The review identified 36 articles that highlight the diversity and vital functions of the gut microbiota. Dysbiosis, an imbalance in the gut microbiota, is associated with gastrointestinal issues, metabolic disorders, and neuropsychiatric conditions, including ASD. Studies indicate that children with ASD have distinct gut microbiota compositions, with reduced diversity and specific bacterial imbalances. These changes may contribute to ASD symptoms through the gut-brain axis, affecting neurotransmitter production and immune responses. Discussion: Maintaining a balanced gut microbiota is essential for overall health, and modulating the microbiota may offer therapeutic benefits for managing ASD symptoms. The changes in gut microbiota observed in individuals with ASD suggest a potential link between gut health and neuropsychiatric symptoms, highlighting the importance of dietary and probiotic interventions in maintaining gut health. Conclusion: This review underscores the potential of the gut microbiota as a therapeutic target in ASD and the importance of dietary and probiotic interventions in maintaining gut health. Further research is necessary to fully understand these interactions and develop effective microbiota-based treatments, emphasizing the need for personalized approaches in clinical applications.

Molecular Biomarkers in Cutaneous Photodynamic Therapy: A Comprehensive Review.

Photodynamic therapy (PDT) is widely utilized in dermatology for the treatment of various skin conditions. Despite its effectiveness, the exact biomolecular changes underlying therapeutic outcomes remain only partially understood. This review, through a transversal approach, aims to provide an in-depth exploration of molecular biomarkers involved in PDT, evaluate its underlying mechanisms, and examine how these insights can contribute to enhanced treatment protocols and personalized therapy approaches. A narrative review of the literature was conducted, targeting peer-reviewed articles and clinical trials that focus on PDT and its molecular biomarker effects on dermatological conditions. The databases searched included PubMed, Scopus, and Web of Science, and the inclusion criteria encompassed original research articles, systematic reviews, and meta-analyses in English. PDT effectively reduces the expression of critical biomarkers such as p53, Cyclin D1, and Ki-67 in AK and other cancerous lesions, leading to reduced cell proliferation and increased apoptosis. Additionally, PDT promotes extracellular matrix remodeling and stimulates collagen production, which has a rejuvenating effect on the skin and a promising role in the treatment of chronic wounds. PDT represents a powerful and versatile treatment option for various dermatological conditions due to its ability to target cellular pathways involved in proliferation and apoptosis. Further research into optimizing treatment parameters and combining PDT with other targeted therapies may enhance patient outcomes, reduce resistance, and pave the way for more individualized therapeutic approaches in dermatology.

Plantar flexor strength and size decrease following single-leg disuse in uninjured adults: A meta-analysis.

Plantar flexors play a pivotal role in human locomotion and balance. Several original research studies and systematic reviews have characterised the impact of single-leg disuse on plantar flexor strength and size. However, no meta-analysis has quantified the effects of single-leg disuse on changes in plantar flexor strength and size in uninjured adults. To quantify changes in plantar flexor strength and size in response to single-leg disuse. Data were extracted from 19 studies captured in our previous systematic review on studies that employed a unilateral lower limb immobilisation model (cast or brace) and were published up to January 30, 2022. Random-effects meta-analyses were performed on original research studies reporting measures of plantar flexor strength (isometric, isokinetic, or repetition maximum) and size (magnetic resonance imaging or computed tomography) in uninjured adults. Single-leg disuse decreased plantar flexor strength (Hedges gav = -0.71 [95% confidence interval: -0.93, -0.48], p < 0.001, 7-28 days, N = 16 studies, n = 121 participants including ≥13 females, ages 19-29) and plantar flexor size (-0.33 [-0.50, -0.15], p < 0.001, 14-35 days, N = 6, n = 49, 10 females, ages 22-27) across all durations of disuse. Single-leg disuse decreases plantar flexor strength and size in uninjured adults. This work adds to recent meta-analytic findings demonstrating the declines in knee extensors strength and size following single-leg disuse. The paucity of female and participants >30 years old in the single-leg disuse literature examining plantar flexors represents a priority of future work.

Photodynamic therapy – modern views and innovations in dentistry

Photodynamic therapy (PDT) consists of three elements: a photosensitizer, light and oxygen. The photosensitizer has the property of selective accumulation in target tissues without harming healthy cells. This innovative therapeutic method has already been successfully adapted in many areas of medicine, such as dermatology, gynecology, urology and oncology. PDT is also beginning to be introduced in dentistry. The antibacterial and fungicidal properties of the photosensitizer are used to achieve better results in the medical and surgical treatment of patients. Objective. To analyze current scientifi data on the application of photodynamic therapy (PDT) in various fi of dentistry, evaluate its effectiveness, and assess prospects for development. Materials and methods. A review of recent scientifi literature was conducted, including original studies, systematic reviews, and meta-analyses focused on PDT application in dentistry. Data on mechanisms of action, clinical efficacy, and new developments in PDT were analyzed. Results. High effi of PDT was established in the treatment of periodontal diseases, peri-implantitis, endodontic infections, and oral oncological diseases. Advantages of combined application of PDT with other treatment methods were noted. Promising directions for PDT development were identifi including the creation of new photosensitizers and technological innovations in equipment. Conclusions. PDT is a promising treatment method in dentistry, demonstrating high efficacyand safety. Further research is aimed at optimizing treatment protocols, developing personalized approaches, and integrating PDT with other modern technologies.

A Pilot Project to Promote Research Competency in Medical Students Through Journal Clubs: Mixed Methods Study.

Undergraduate medical students often lack hands-on research experience and fundamental scientific research skills, limiting their exposure to the practical aspects of scientific investigation. The Cerrahpasa Neuroscience Society introduced a program to address this deficiency and facilitate student-led research. The primary goal of this initiative was to enhance medical students' research output by enabling them to generate and publish peer-reviewed papers within the framework of this pilot project. The project aimed to provide an accessible, global model for research training through structured journal clubs, mentorship from experienced peers, and resource access. In January 2022, a total of 30 volunteer students from various Turkish medical schools participated in this course-based undergraduate research experience program. Students self-organized into 2 groups according to their preferred study type: original research or systematic review. Two final-year students with prior research experience led the project, developing training modules using selected materials. The project was implemented entirely online, with participants completing training modules before using their newly acquired theoretical knowledge to perform assigned tasks. Based on student feedback, the project timeline was adjusted to allow for greater flexibility in meeting deadlines. Despite these adjustments, participants successfully completed their tasks, applying the theoretical knowledge they had gained to their respective assignments. As of April 2024, the initiative has culminated in 3 published papers and 3 more under peer review. The project has also seen an increase in student interest in further involvement and self-paced learning. This initiative leverages globally accessible resources for research training, effectively fostering research competency among participants. It has successfully demonstrated the potential for undergraduates to contribute to medical research output and paved the way for a self-sustaining, student-led research program. Despite some logistical challenges, the project provided valuable insights for future implementations, showcasing the potential for students to engage in meaningful, publishable research.

Cellular and Molecular Pathophysiology of Gestational Diabetes.

Gestational diabetes (GD) is a metabolic disorder characterized by glucose intolerance during pregnancy, significantly impacting maternal and fetal health. Its global prevalence is approximately 14%, with risk factors including obesity, family history of diabetes, advanced maternal age, and ethnicity, which are linked to cellular and molecular disruptions in glucose regulation and insulin resistance. GD is associated with short- and long-term complications for both the mother and the newborn. For mothers, GD increases the risk of developing type 2 diabetes, cardiovascular diseases, and metabolic syndrome. In the offspring, exposure to GD in utero predisposes them to obesity, glucose intolerance, and metabolic disorders later in life. This review aims to elucidate the complex cellular and molecular mechanisms underlying GD to inform the development of effective therapeutic strategies. A systematic review was conducted using medical subject headings (MeSH) terms related to GD's cellular and molecular pathophysiology. Inclusion criteria encompassed original studies, systematic reviews, and meta-analyses focusing on GD's impact on maternal and fetal health, adhering to PRISMA guidelines. Data extraction captured study characteristics, maternal and fetal outcomes, key findings, and conclusions. GD disrupts insulin signaling pathways, leading to impaired glucose uptake and insulin resistance. Mitochondrial dysfunction reduces ATP production and increases reactive oxygen species, exacerbating oxidative stress. Hormonal influences, chronic inflammation, and dysregulation of the mammalian target of rapamycin (mTOR) pathway further impair insulin signaling. Gut microbiota alterations, gene expression, and epigenetic modifications play significant roles in GD. Ferroptosis and placental dysfunction primarily contribute to intrauterine growth restriction. Conversely, fetal macrosomia arises from maternal hyperglycemia and subsequent fetal hyperinsulinemia, resulting in excessive fetal growth. The chronic inflammatory state and oxidative stress associated with GD exacerbate these complications, creating a hostile intrauterine environment. GD's complex pathophysiology involves multiple disruptions in insulin signaling, mitochondrial function, inflammation, and oxidative stress. Effective management requires early detection, preventive strategies, and international collaboration to standardize care and improve outcomes for mothers and babies.

Age-dependent immune profile in healthy individuals: an original study, systematic review and meta-analysis

BackgroundThe circulatory peripheral immune system is the most convenient approach for determining an individual’s immune status. Due to various reasons, while previous studies have addressed the critical impact of age, most individual studies did not analyze immunosenescence in a systemic manner, which complicates the possibility of building a reference range for age-dependent immune profiles for effective immune monitoring. To address this gap, this study analyzed a group of healthy individuals to establish age-specific reference ranges of the healthy circulatory immune profile, and a systematic review and meta-analysis were conducted to validate the findings and create generalizable immune cell reference ranges.ResultsOur study recruited a total of 363 healthy Taiwanese adults (median age 42 years [IQR 30, 62], age range 21 to 87 years, 43.3% male), including 158 under 40 years old, 127 between 40–64 years old, and 78 over 64 years old. Significant age-related alterations were observed in both adaptive and innate immune cell subsets. CD8 + T cells decreased and CD4/CD8 ratio increased, with notable increases in NK cells. CD4 + T cells were less impacted by aging, while CD8 + T cells significantly lost CD28 and increased CD31 expression with age. A clear reverse trend in naïve and memory subsets of CD4 + and CD8 + T cells was observed. Detailed reference ranges for immune cell subsets in healthy Taiwanese adults were established. A systematic review included 7,425 adults and a meta-analysis of 12 eligible studies confirmed our findings in Taiwan, enhancing generalizability.ConclusionsCombined with previous studies and original data through a systematic review and meta-analysis, we highlighted and quantified significant immune profile differences between older and younger individuals. The sex and age-specific reference ranges for peripheral immune cell subsets can serve as a basis for effective immune monitoring of various aging-related illnesses.

Exploring methodologies and frameworks for best practice transfer at the primary care level

Abstract Background In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings. Methods The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review. Results From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all. Conclusions Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring. Key messages • Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer. • This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.

Erectile dysfunction as a holistic indicator of well-being: a narrative review.

Erectile dysfunction (ED), affecting around 52% of men aged 40-70, is a significant marker of overall health and a potential warning sign of multiple conditions like cardiovascular diseases (CVDs), diabetes, and mental health disorders. Recognizing and addressing ED through a holistic approach involving nutrition, physical activity, sleep, and stress management can improve both erectile and overall health outcomes. To provide a narrative review of the available literature on the relationship between ED and overall health, elaborate on the possible mechanisms explaining this association, and discuss the effects of lifestyle on ED. A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on ED and overall health. Due to shared pathophysiological mechanisms like endothelial dysfunction, ED is a significant indicator of overall health, particularly related to CVD and diabetes mellitus. Multiple studies have shown that ED frequently precedes cardiovascular events and is associated with increased cardiovascular risk, especially in younger men and those with diabetes. It also has a profound, bidirectional relationship with mental health conditions like depression and anxiety, creating a vicious cycle where each exacerbates the other. The four health pillars of nutrition, physical activity, sleep, and stress management play significant roles in erectile function and overall sexual health. ED is not just a condition affecting sexual function but a critical indicator of broader health issues. By adopting an integrative approach that combines nutrition, physical activity, sleep, and stress management, healthcare providers can offer holistic and effective management strategies for this condition.

Osteoarthritis year in review 2024: Biomechanics

ObjectiveWe aimed to systematically review and summarize the literature of the past year on OA and biomechanics, to highlight gaps and challenges, and to present some promising approaches and developments. Methods.A systematic literature search was conducted using Pubmed and the Web of Science Core Collection. We included original articles and systematic reviews on OA and biomechanics in human subjects published between April 2023 and April 2024. Results.Of the 155 studies that met the inclusion criteria, 9 were systematic reviews and 146 were original (mostly cross-sectional) studies that included a total of 6488 patients and 1921 controls with a mean age of 57.5 and 44.7 years, respectively. Promising advances have been made in medical imaging of affected soft tissue structures, the relationship between soft tissue properties and biomechanical changes in OA, new technologies to facilitate easier assessment of ambulatory biomechanics, and personalized physics-based models that also include complex chemical and mechanobiological mechanisms, all of which are relevant to gaining mechanistic insights into the pathophysiology of OA. ConclusionsThere is still an unmet need for larger longitudinal data sets that combine clinical, radiological, and biomechanical outcomes to characterize the biomechanical fingerprint that underlies the trajectory of functional decline and biomechanical phenotypes of OA. In addition, criteria and guidelines for control groups, as well as methods and standards for model verification allowing for comparisons between studies are needed.

Prognostic factors associated with worse outcomes in patients with GBS: A systematic review.

Guillain-Barré syndrome (GBS) is an autoimmune polyradiculoneuropathy with diverse clinical subtypes, characterized by rapidly evolving motor weakness, sensory disturbances and areflexia. The global prevalence of GBS has been steadily increasing, with regional disparities. Mortality rates vary but remain elevated in patients requiring mechanical ventilation. This systematic review aimed to evaluate the predictive risk factors for the severity of the disease and poor shortand long-term outcomes of GBS. The literature search was conducted using the PubMed database by 2 independently working researchers. After a screening process of studies published before November 2023, a total of 109 articles were selected. Original articles, systematic and narrative reviews, meta-analyses, and editorials were selected based on their clinical relevance. The exclusion criteria included patients under 18 years of age, pregnant women and articles in languages other than English and Polish. Long-lasting GBS complications included pain, fatigue and persistent neurological deficits, affecting patients for years after recovery. Identifying the appropriate therapeutic methods, risk factors and prognoses of GBS at an early stage is crucial. Various risk factors for death and poor functional outcomes were found, regarding patient characteristics, the clinical course of GBS, laboratory and neurographic results, as well as treatment methods.

Impact of Corticosteroid Administration on Fetal Doppler Metrics and Neonatal Outcomes: A Comprehensive Review

Abstract Antenatal corticosteroid therapy is a crucial intervention to improve neonatal outcomes in pregnancies at risk of preterm birth. Corticosteroids such as betamethasone and dexamethasone enhance fetal lung maturation and reduce morbidity and mortality. To assess the effects of these drugs, we conducted a systematic review adhering to PRISMA guidelines. Data were located through extensive searches of PubMed, MEDLINE, Cochrane Library, Scopus, and Web of Science, using keywords such as “antenatal corticosteroids,” “fetal Doppler,” and “neonatal outcomes,” and applying filters for human studies published between 2013 and 2024. Studies were selected based on inclusion criteria that prioritized original research articles, systematic reviews, and meta-analyses in English. Screening and eligibility assessments were performed by independent reviewers, with full-text articles. Data extraction involved recording study designs, sample sizes, corticosteroid regimens, Doppler metrics assessed, and neonatal outcomes observed. The extracted data were synthesized qualitatively through narrative methods and quantitatively using meta-analysis where applicable. The review found that corticosteroid administration leads to transient reductions in the resistance and pulsatility indices of key fetal vessels, reflecting improved placental and cerebral perfusion. These Doppler changes correlate with better neonatal outcomes, including reduced respiratory distress syndrome and enhanced neurodevelopmental results. Despite these promising findings, limitations such as small sample sizes and short follow-up periods were noted. Future research should focus on larger, multicenter trials and long-term outcome assessments. Clinicians are advised to incorporate serial Doppler monitoring in high-risk pregnancies to optimize maternal-fetal management and neonatal outcomes.

HARNESSING PHYTOTHERAPY: EXPLORING ALTERNATIVE TREATMENTS FOR MALE INFERTILITY

Purpose: The multifaceted nature of male infertility requires innovative approaches, leading researchers to explore the potential of phytotherapy to improve reproductive health. Phytotherapy offers a promising prospect for individuals seeking alternative treatments for male infertility, harnessing the natural therapeutic properties of plant-based compounds. The aim of this work is to investigate the efficacy and mechanisms of action of phytotherapy as a promising alternative treatment for male infertility. Through a comprehensive review of existing literature and clinical trials, this research aims to elucidate the potential benefits of phytotherapeutic interventions in improving sperm quality, enhancing reproductive parameters and addressing the underlying causes of male infertility. Methodology. We conducted a comprehensive literature search using electronic databases including PubMed, Scopus, Web of Science and Google Scholar. The search was conducted from 1970 to 2024, with no language restrictions. The following keywords and combinations of keywords were used: “phytotherapy”, “male infertility”, “herbal medicine”, “plant extracts”, “natural remedies” and “herbal supplements”. In addition, relevant articles were identified through manual searches of the reference lists of the retrieved trials and review articles. Articles were included if they met the following criteria: (1) original research articles, systematic reviews, meta-analyses and clinical trials investigating the efficacy of phytotherapy in the treatment of male infertility; (2) studies reporting outcomes related to sperm quality, reproductive hormones, semen parameters or fertility outcomes; (3) human studies involving adult men diagnosed with infertility or subfertility; (4) studies published in peer-reviewed journals. Scientific novelty. While conventional treatments for male infertility often focus on hormonal therapies, surgery or assisted reproductive techniques, this manuscript highlights the potential of phytotherapy as an alternative approach. By exploring natural remedies derived from medicinal plants, this manuscript offers new insights into complementary strategies for the treatment of male infertility. The emphasis on alternative treatments reflects a growing interest in holistic and integrative approaches to reproductive medicine. In addition to discussing the broader concept of phytotherapy, this manuscript examines the efficacy of specific phytochemicals in the treatment of male infertility. By focusing on individual compounds and their pharmacological effects, this manuscript advances our understanding of the bioactive constituents responsible for the therapeutic effects of medicinal plants. This targeted approach allows for a more nuanced evaluation of phytotherapeutic interventions and facilitates the identification of potential drug candidates. Conclusions. The use of various medicinal plants with benefits for male reproductive health was discussed, including Tribulus terrestris, Apium graveolens, Withania somnifera, Cornus mas, Fumaria parviflora, Phoenix dactylifera and many others, was discussed. The mechanisms by which these herbal remedies may exert their effects on sperm quality, reproductive hormones and overall fertility were also demonstrated. The role of plants as adjunctive therapies to address underlying conditions associated with male infertility, such as oxidative stress, inflammation and hormonal imbalances, was discussed. Although promising, clinical evidence for the efficacy of herbal treatments for male infertility remains limited, highlighting the need for further well-designed clinical trials and studies. Nevertheless, the integration of medicinal plants into comprehensive fertility care protocols offers a promising avenue for improving male reproductive health outcomes and warrants further exploration.

Epidemiology and Diagnostic Accuracy of Respiratory Pathogens in Pediatric Populations: Insights From Global Studies.

Lower respiratory tract infections (LRTIs) are the most common cause for going to the doctor's at pediatric age. Respiratory infections are still of interest because they are widespread, significantly impact public health by potentially leading to pandemics, drive antimicrobial resistance through antibiotic misuse, more often spread globally due to traveling, and benefit from ongoing advancements in diagnostics and research for better management.This paper's main aim was to offer a systematic review of the literature published over the last 10 years on the etiology of LRTIs. The search strategy was based on reviewing original articles, systematic reviews, position papers, and guidelines published in MEDLINE, EMBASE, Cochrane Library, and PubMed. The review was previously registered with PROSPERO. The final review included 27 articles that met the eligibility criteria (studies identifying the etiology of inferior respiratory infections in children, according to the WHO definition, published in the last 10 years). Statistical analysis was performed using Microsoft Excel Version 2406 (Microsoft Corporation, Redmond, Washington, USA) and SPSS Statistics V.23 (IBM Corp., Armonk, New York, USA). The total number of patients was 2,193,978. Eight articles focused on children younger than five years, and two included children under the age of two.The results revealed that Mycoplasma pneumoniae and respiratory syncytial virus (RSV) are significant respiratory pathogens with seasonal peaks and age-specific prevalence and that nasopharyngeal aspirates (NPAs) are more reliable than throat swabs for confirming infections due to their higher positive predictive value (PPV).The impact of COVID-19 interventions led to reduced infections from RSV, adenovirus, and influenza viruses, but an increase in rhinovirus post-reopening, with high co-infection rates. Co-infections are common, particularly with pathogens like human bocavirus (HBoV) and RSV, underscoring the need for comprehensive diagnostic approaches. The impact of non-pharmaceutical interventions during the COVID-19 pandemic significantly reduced the prevalence of many respiratory pathogens, except for rhinovirus, which increased post-reopening. Understanding these dynamics is crucial for managing respiratory infections, especially in pediatric populations.

O impacto da obesidade nos resultados pós-operatórios de operações abdominais

Introduction: Ankylosing spondylitis or radiographic axial spondylitis is an axial spondyloarthritis with male predominance, whose symptoms include low back pain associated with morning stiffness and may progress to ankylosis. Its inflammatory cause is associated with structural alteration, which may influence clinical presentation, functionality and response to treatment. Objective: To review whether the body composition of patients with ankylosing spondylitis influences inflammatory parameters according to gender. Method: A search was performed in PubMed to identify the available literature. The criteria included the terms “Obesity Paradox”, combined with additional search criteria including the terms “general surgery, abdominal surgery and outcomes” to better define the research. The criteria were restricted to English and Portuguese languages ​​and adult patients. Original articles, systematic reviews and meta-analyses were considered for inclusion. Eligible studies were initially identified by title and abstract. Result: 41 articles were included. Conclusion: Although some groups still require additional studies to prove the real effect of obesity on postoperative results, others already have well-established validity. However, it was demonstrated that obesity contributed to the increase in inflammatory activity parameters in male patients with ankylosing spondylitis.