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Acute pain is a common symptom that requires prompt and adequate treatment. Ketoprofen lysine salt (KLS) is a non-steroidal anti-inflammatory drug (NSAID) able to rapidly relieves mild-moderate acute pain in children and adolescents. The present study aimed to perform a meta-analysis of controlled studies on this issue. A scientific literature search selected three controlled trials concerning the KLS use in patients with acute pain. A meta-regression analysis was performed. The overall trend, modeled through weighted linear regression, confirms a significant time-dependent reduction in pain scores by KLS. The onset of action is quick and analgesic effect is prolonged. This meta-regression analysis showed that KLS could relieve mild to moderate acute pain promptly and in a prolonged manner over time, as desired by a patient with acute pain.

Clinician-patient rapport is linked to safety, satisfaction, and staff wellbeing, yet large-scale, real-time listening across the National Health Service (NHS) is limited. We examined how public discourse reflects rapport experiences in UK healthcare and assessed the utility of an artificial intelligence-assisted qualitative workflow. We conducted an observational qualitative study using reflexive thematic analysis of 5011 publicly available post submissions from the Reddit community r/NHS (1st January - 31st December 2024). After cleaning, deduplication, and lexical screening for rapport-related language, a large language model (LLM) supported clustering suggestions and provisional summaries; human researchers led interpretation and theme development. Trustworthiness techniques included analyst triangulation, an audit trail, negative case analysis, and stability checks. Data were non-identifiable and public; research ethics committee review was not required. This study is reported in accordance with the Standards for Reporting Qualitative Research (SRQR). Five overarching themes were identified: 1) access and delays that erode feelings of being heard; 2) first-contact experiences and gatekeeping at reception/telephone interfaces; 3) professionalism and empathy during clinical encounters; 4) emotional reciprocity and staff wellbeing shaping relational tone; and 5) service variation and perceived inequity across settings. Posts more often described administrative/communication breakdowns than clinical competence issues. Positive narratives highlighted brief empathetic acts that buffered system pressures. Cross-cutting, perceived relational communication moderated how operational strain was experienced. Paraphrased, de-identified exemplars underpin each theme. Public social-media listening can surface scalable signals about clinician-patient rapport across the NHS. An AI-assisted (LLM-supported) qualitative workflow is feasible and enhances, rather than replaces, human interpretation. Findings suggest targeting first-contact communication and access processes, while aligning patient-facing empathy with staff support.

Hyperoncotic albumin is being discussed as an adjunct to diuretics to facilitate fluid off-loading in critically ill patients with fluid accumulation. However, its effectiveness and clinical benefits remain controversial. This critical appraisal examines the current body of evidence to evaluate both the potential benefits and limitations of albumin co-administration with diuretics and/or renal replacement therapy (RRT) in achieving effective net fluid removal in the intensive care unit (ICU). We performed a systematic literature review of randomized controlled trials (RCTs) and observational studies up to January 2025, adhering to Cochrane Collaboration guidelines. Studies were included if they assessed fluid balance in patients receiving albumin in conjunction with diuretics or RRT for fluid removal. The primary outcome was average daily net fluid balance and secondary outcomes included mortality, ventilator-free days, length of stay, acute kidney injury and change in Sequential Organ Failure Assessment score. Only four studies involving 196 patients have evaluated net fluid balance in patients receiving albumin as an adjunct to diuretics. Our analysis revealed no significant difference in the average daily net fluid balance between the albumin and control groups (mean difference: -0.22 L/d; 95% CI: -0.88 to 0.43; with high heterogeneity in the reported results. Insufficient data on secondary outcomes was found. No data on the safety-profile in fluid de-resuscitation and on cost-effectiveness are currently available. The methodology of the existing literature is biased, contradictory and of poor overall quality. This review of albumin co-administration with diuretics and/or RRT in fluid de-resuscitation in the critical ill underscores the limited and often contradictory evidence currently available, despite the frequent use of this practice in clinical settings. Further high-quality research is warranted to determine its efficacy in achieving negative fluid balance and to clarify its impact on clinically relevant patient outcomes.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by motor neuron degeneration, leading to muscle weakness and respiratory issues. Enteral nutrition is used in ALS patients when they experience severe weight loss, dysphagia, dehydration, or a risk of aspiration pneumonia. Noninvasive ventilation (NIV) is essential for managing respiratory failure in ALS patients, especially during feeding tube placement procedures. This narrative review compares percutaneous endoscopic gastrostomy (PEG), percutaneous radiologic gastrostomy (PRG), and radiologically inserted G-tube (RIG) in ALS patients receiving NIV. Studies were found through electronic database searches of Medline and Embase from 2000 to June 2025, including the Cochrane Central Register of Controlled Trials (CENTRAL), EBSCO Online Research Database, and Scopus. The main outcome was the occurrence of adverse events during and within thirty days after gastrostomy tube placement in NIV. Eleven studies involving NIV during PEG/RIG procedures were included. NIV during PEG, RIG, or PRG placement seems to be safe for ALS patients, with few adverse events reported, though future studies with higher methodological quality are needed. Additionally, the review highlights the benefits of better nutritional support, improved quality of life, interdisciplinary teamwork, increased survival rates, and personalized care.

This systematic review evaluated patient characteristics and outcomes of patients presenting with concomitant spontaneous coronary artery dissection (SCAD) and cardiogenic shock (CS) compared with those without CS. Data from four studies were analyzed. A comprehensive electronic literature search was performed by two authors using PubMed and Embase databases from inspection to February 1st, 2025. MeSH and broad terms including "Coronary Artery Dissection, Spontaneous" OR "SCAD" OR "Coronary Artery Dissection" were used with and without "Clinical Trials" as a search limit. SCAD patients presenting with CS were less likely to be females (OR=0.64, 95% CI: 0.44; 0.94) and have a history of myocardial infarction (OR=0.71, 95% CI: 0.51; 0.99) but more likely to have heart failure (OR=4.79, 95% CI: 3.30) and renal impairment (OR=2.23, 95% CI: 1.43; 3.50) than those without CS. The presence of CS was associated with longer hospital stay (MD=6.53 days, 95% CI: 5.20; 7.86) and worse in-hospital outcomes including death (OR=39.15, 95% CI: 4.73; 324.25), heart failure (OR=5.32, 95% CI: 2.73; 10.37), and stroke (OR=4.91, 95% CI: 2.44; 9.89). In conclusion, concomitant CS with SCAD was associated with worse outcomes than in the absence of CS.

Thumb osteoarthritis (OA) is one of the most common hand disabiliting pathology. To date, many therapies are available, with surgery being the last resort. Given the long post surgical rehabilitation period patients often require a "bridge" therapy, in order to surgery. In lasts years Platelet-Rich Plasma (PRP) has demonstrated interesting anti-inflammatory and anabolic effects when injected intra-articularly, including the trapeziometacarpal thumb joint (TMTJ). However, literature is limited and few standardized methods are available to demonstrate its real effectiveness. The aim of the present study is to evaluate effectiveness of 3 Phase Rhizo Protocol in treatment of Thumb OA. In a two year prospective observational study, 42 patients affected by Stage II-III Thumb OA were treated with the 3 Phase Rhizo Protocol. The desired outcomes, such as pain reduction, increased quality of life and improved hand disfunction, were tested using the Visual Analogue (VAS), Quality of life (QoL) and Quick-Dash (QuickDASH) scores at one, three, six and twelve months. At one year was, a mean reduction in all scores was achieved, which ranged from 26.33% to 53.05%. All results improved from the first few months after the injection, with lasting effects up to six months, followed by a slight decrease without ever returning to the initial values. All scores data were statistically significant (P<0.05). The 3 Phase-Rhizo protocol is a useful method for symptomatic rhizarthrosis, especially in the early stages and refractory to standard treatments, as a bridge between conservative therapy and the surgery.

Medical decluttering is a pragmatic, ethics-anchored approach to reduce low-value tests, treatments, documentation, and digital noise while preserving safety, dignity, and outcomes that matter to patients and clinicians. It reframes improvement from "doing less" to "doing better," prioritizing value delivered per unit effort and transparent measurement of treatment burden, workload, and harms. We outline why clutter proliferates - decision fatigue, cognitive biases, overdiagnosis, incidental findings, and bureaucratic drift - and how these forces fuel cascades, moral distress, and lost trust. We propose a five-step cycle-Scan, Sort, Select, Safeguard, Sustain-that operationalizes decluttering across patient, team, and system levels through category-first review, explicit thresholds, safety nets, and time-bounded reassessment. Clinical applications include deprescribing with monitored tapers, appropriateness-based testing and screening, pathway redesign to shorten time-to-decision, and courteous refusal scripts paired with contingency plans. Professional practices emphasize agenda setting, message windowing, checklists and dashboards for cognitive offloading, role clarity, digital minimalism, and indication-based telemedicine. Implementation relies on co-designed indicators, governance of order sets and alerts, audit-and-feedback, and rapid learning cycles that balance overuse and underuse while safeguarding equity. By aligning ethics, evidence, and attention, medical decluttering offers a coherent method to reduce cascades, restore focus, and make care simpler, safer, and more humane in internal medicine practice.

To evaluate the association between circulating osteopontin (OPN) levels and bioelectrical impedance analysis (BIA)-derived body composition measures in adults with systemic lupus erythematosus (SLE), with body fat percentage as the primary outcome and central adiposity and lean-mass surrogates as secondary outcomes. Observational cross-sectional study with prospective recruitment of adults with SLE attending a tertiary referral center in Puebla, Mexico. Plasma OPN was quantified by ELISA (Quantikine&#xae;, R&D Systems; coefficient of variation 4.1%). Body composition was assessed by BIA (TANITA BC-545F FitScan) under fasting morning conditions. Associations between OPN and continuous body composition measures were examined using Spearman correlations (pairwise complete data). Sensitivity analyses used linear regression with ln(OPN) as the dependent variable, adjusting for age, sex, disease duration, SLEDAI-2K, and current prednisone exposure. Sixty-two patients were included (96.8% women), mean age 51.3&#xb1;12.8 years; median disease duration 21.5 years (IQR 18.0-25.0). Disease activity was low (median SLEDAI-2K 0 [IQR 0-2]); 46.8% met LLDAS. Median OPN was 16.11 ng/mL (IQR 7.97-54.06). Mean BMI was 29.3&#xb1;5.6 kg/m2, and 79.5% were overweight/obese. OPN showed no significant association with BMI, body fat percentage, visceral fat rating, muscle mass, or waist circumference. Adjusted regression analyses also remained non-significant. In this SLE cohort with predominantly low activity, circulating OPN levels were not associated with BIA-derived adiposity, central adiposity, or lean-mass surrogates, suggesting that OPN may reflect lupus-related inflammatory biology rather than body composition phenotypes.

This systematic review compared the characteristics and clinical outcomes between patients with spontaneous coronary artery dissection (SCAD) and those with Takotsubo Syndrome (TS). A systematic literature search was performed in PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inspection to February 1st, 2025, then it was updated on February 7th, 2026. The search strategy used the following key words: "Spontaneous Coronary Artery Dissection" OR "Coronary Artery Dissection" OR "SCAD". Additional search was done by adding "Takotsubo Cardiomyopathy," "Takotsubo Cardiomyopathies," or "Takotsubo Syndrome." Data from six studies were analyzed. Patients with SCAD were significantly younger and exhibited lower rates of comorbidities such as dyslipidemia, hypertension, and diabetes than those with TS. Physical stress as a trigger occurred less frequently in patients with SCAD (odds ratio (OR) 0.37, 95% confidence interval (CI): 0.17; 0.83, P=0.0152; I2=91%), who tend to have higher left ventricular ejection fraction value (MD=14.12, 95% CI: 6.71; 21.62, P=0.0002; I2=100%). While there was no significant difference between the groups in terms of in-hospital death or stroke at follow-up, patients with SCAD had significantly lower risk of death at follow-up (OR=0.07, 95% CI: 0.03; 0.21, P<0.0001; I2=0%) than patients with TS. In conclusion, patients with SCAD were younger with less frequent comorbidities, and exhibited better long-term survival outcome than those with TS.

The aim of the present registry study was to evaluate the efficacy of a new natural product (Menotrack, Alchem, India) in otherwise healthy post-menopausal women with significant symptoms. The products obtained from Ferula have been used for a long time. Ferula is a genus of about 220 species of flowering plants in the family Apiaceae, native to the Mediterranean region east to central Asia, mostly growing in arid climates. Many plants of this genus, especially F. communis, are referred to as "giant fennel," although they are not fennels. The resin of Ferula species has been used for medicinal purposes. The resin, as a sticky latex, was extracted from the lower stalk or root, with the root resin being the finest-grade. The supplementation with a new Ferula extract (Menotrack, Alchem) in post-menopausal (PM) women was based on a daily dosage of 1 capsule (20 mg): the prevention registry was aimed to evaluate whether a rapid improvement of signs/symptoms associated to menopause is possible with the administration of Menotrack. The two management groups resulted comparable. No side effects were observed. At 90 days, safety and tolerability were optimal. No side effects had been recorded. Routine blood tests were within normal values at inclusion and end-study. All main menopausal symptoms were improved more with the supplement (P<0.05). Oxidative stress was high at inclusion in all subjects. At 90 days the decrease in oxidative stress was significantly better in the supplemented subjects (P<0.05). A significantly more important decrease in fat mass (P<0.05) was also observed in women using Menotrack even in a relatively short period of time. In conclusion, this preliminary, pilot registry on Menotrack in post-menopausal women indicated that this natural product may contribute safely to improve the quality of life of women who go through the MT, a difficult transitional period of their life and in the post-menopausal women with persisting, residual symptoms. A more prolonged study may better indicate the quality of this product and more potential positive effects on long-term problems, including osteoporosis.

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This review explores the global integration of Artificial Intelligence (AI) in higher education, examining its impact on teaching, learning, and assessment, while addressing implementation challenges, ethical concerns, and opportunities for sustainable, equitable adoption. A scoping review was conducted following PRISMA guidelines. Peer-reviewed studies published between 2020 and 2024 were identified through Web of Science and SciFinder. Eligible articles were thematically synthesized using the Tranfield, Denyer, and Smart (2003) framework to examine AI integration in teaching, learning, assessment, and related challenges. Seventy-three studies were analyzed, revealing six major themes: AI for teaching support, learning enhancement, assessment, ethical considerations, implementation challenges, and opportunities. AI has enhanced instructional design, real-time feedback, and personalized learning across diverse disciplines. In assessment, AI facilitates automated grading and adaptive testing but raises concerns about integrity and human oversight. Ethical issues - such as data privacy, algorithmic bias, and academic dishonesty - were recurrent, particularly in under-resourced settings. Challenges include infrastructure deficits, misinformation, low AI literacy, and the absence of governance frameworks. However, AI also presents significant opportunities to improve equity, efficiency, and student engagement when integrated responsibly. AI is reshaping higher education by enhancing pedagogy and assessment, but its adoption must be balanced with ethical safeguards, educator training, and robust policy frameworks. Institutions must prioritize equitable access, digital infrastructure, and human-centered approaches to ensure AI's responsible and effective use in education.

With the formal designation of obesity as a primary disease process, early detection of its end-organ consequences and the prognostication of long-term risk will become an important aspect of its clinical management. Obesity is increasingly recognized as a treatable risk factor for chronic kidney disease. However, profiling of kidney health and estimation of renal risk remain relatively underemphasized in obesity and nephrology care guidelines. The establishment of clinical protocols that facilitate the detection of early-stage renal impairment in obesity and incorporate profiling of an individual's risk of progression, could help guide strategies to break the causal association between obesity and chronic kidney disease. Currently, checks on kidney health in patients with obesity are prompted due to the presence of obesity complications such as cardiovascular and/or metabolic disease and routine screening relies upon the use of estimated glomerular filtration rate equations. Ample evidence exists to demonstrate that these equations are of limited utility in the setting of excess body weight and intentional weight loss. The present article presents the case that an expanded model of renal risk profiling should be developed for obesity medicine, suggesting feasible means of incorporating important risk factors and biomarker profiling alongside a more targeted assessment of directly measured GFR and renal functional reserve in at risk patients. The development of such a model or variation thereof should be prioritized to guide the targeted deployment of obesity treatments with proven reno-protective effects.

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Achieving optimal skin scarring after surgery is a major concern for patients and physicians worldwide. An innovative form of photobiomodulation, namely Fluorescent Light Energy (FLE), is increasingly used in clinical settings as an adjunct to the Standard of Care (SoC) to treat wounds. In Italy, a post-market observational investigation using data from the Patient and Observer Scar Assessment Scale (POSAS) was conducted to confirm the effectiveness of FLE in managing post-abdominoplasty scars as an adjunct to standard of care (SoC). The observational investigation involved the POSAS data of 27 patients treated with FLE treatment, namely LumiHeal. LumiHeal was applied for four weeks during dressing changes following surgery. POSAS questionnaires administered during follow-up visits at three (FU1) and six (FU2) months after surgery were investigated. POSAS scores' percentage decrease and statistically significant P value were calculated. The results showed a significant decrease in the mean values on POSAS Total Scores from FU1 to FU2, and on each sub-scale of the Observer POSAS, as well as on the Patient POSAS on colour, indicative of healthy healing and aesthetically pleasing scar outcomes. In addition, no patient developed complications, including wound dehiscence or infections, or skin lesions due to FLE applications. Observational POSAS data evaluation reveals to be a valid tool, suggesting that LumiHeal FLE treatment was an effective adjunctive treatment to the SoC on 27 patients in a real-life setting as an Italian clinic for postoperative scar management.

About 20% of adults and between 6% and 13% of children experience mild to moderate anxiety and stress-related symptoms. Benzodiazepines (BZDs) are considered the referring medications for early-stage anxiety and stress-related symptoms management. Nevertheless, BZDs must be managed carefully because their use, especially chronic, could be linked with some adverse effects, and can promote the onset of psychological and physical dependence. They also often show progressive tolerance, necessitating an increase in dosage, and therefore their use should be discouraged. In the clinical management of patients with pathological/dysfunctional anxiety, one of the main issues related to the discontinuation of BZDs treatment is the occurrence of rebound effects and withdrawal syndrome, especially in subjects with certain personality disorders and poly-drug users. The deprescription of BZDs is advisable with the availability of other therapies and interventions, especially in elderly subjects. Therefore, an effective and safe alternative pharmacological tool for mild to moderate anxiety and stress-related symptoms is needed. After the identification of potentially new medications to flank BZDs, it is mandatory to revise and improve good clinical practices even through a consensus process. Taking into consideration all the above-mentioned premises, the present Delphi Consensus Study has explored whether there is agreement about the use of the low-dose multicomponent natural medication Ignatia-Heel in overlapping with BZDs is appropriate for the reduction and potential discontinuation of BZDs intake in patients on chronic BZDs treatment. The Consensus Study also explored the possibility to maintain symptom remission or low disease activity with the long-term use of Ignatia-Heel in patients with pathological/dysfunctional anxiety, after clinical remission achieved with BZDs. For each questionnaire statement, consensus was achieved (being based on the agreement of at least 66.6% of the Consensus Panel and the acceptance of the scientific committee). Ignatia-Heel can be considered a valid opportunity for the treatment of pathological anxiety favoring the deprescription of BZDs in patients under chronic BZDs treatment and the maintenance of a good control of symptomatology, i.e., a good low disease activity.