Medicina, Volume 61, Issue 2 (February 2025) – 94 articles

Background and Objectives: Age-related macular degeneration (AMD) remains a leading cause of legal blindness. Anti-Vascular Endothelial Growth Factor (VEGF) agents are the first-line treatment for neovascular AMD (nAMD). The choroid plays a key role in AMD and is affected by the anti-VEGF treatment. Faricimab, a bispecific antibody additionally targeting angiopoietin 2 (Ang2), was recently approved for nAMD treatment. This study investigates the effect of Faricimab on choroidal flow signal. Materials and Methods: Optical coherence tomography angiography images of 29 nAMD eyes were examined retrospectively. Patients had received treatment with other anti-VEGF agents before Faricimab application. The flow signal in the choroid was measured before, after one and after a series of ≥2 Faricimab injections. Results: The flow signal decreased significantly (p = 0.026) at the choriocapillaris (CC) level after ≥2 injections. The flow signal did not show a significant change in Haller’s layer but increased slightly in Sattler’s layer (p = 0.034). Conclusions: In conclusion, our results show that the flow signal, especially at the CC level, changed during treatment. Despite the known influence of anti-VEGF treatment on the choroid, auxiliary inhibition of Ang2 might enhance this effect. Due to the retrospective nature, moderate sample size and non-treatment, naïve patients, care must be taken while interpreting our observations. Prospective studies with larger sample sizes and treatment-naïve patients will be needed. Full article

Background and Objectives: One of the most widely used reversible contraceptive techniques among women of reproductive age worldwide is oral contraceptives (OCPs). Despite their widespread use, OCPs are associated with increased risks of stroke, yet the extent of awareness of these risks among women remains insufficiently explored. This study aims to evaluate the level of awareness among women resident in Saudi Arabia regarding the potential risk of stroke linked to the use of OCPs. Materials and Methods: A cross-sectional descriptive study was conducted targeting women of reproductive age (18–49 years). Data was collected through an online self-administrated questionnaire distributed via social media platforms, encompassing sociodemographic characteristics, OCP usage patterns, and awareness of stroke risks, perceived side effects of OCPs, symptoms of stroke, and methods to reduce stroke incidence. Statistical analysis was performed using SPSS version 23, with descriptive statistics for categorical data and chi-square tests to assess associations. Results: A total of 516 women participated in the study. Of these, 148, or over a quarter (28.7%), of the participants reported using oral contraceptive pills; 86, or more than half (58%), who use OCPs are not sure what type of OCPs they use; 60, or over half of the participants (40.5%), have been using for less than a year. Over two thirds of the participants (350, 67.8%) are not aware that using OCP increases the risk of stroke. The most recognized side effect of OCPs use was weight gain (38.2%), while awareness of stroke as a side effect was significantly lower (24.6%). Additionally, 62.8% of respondents identified selecting the appropriate type of contraceptive as the best way to prevent stroke while taking OCPs. Conclusions: this study highlights the need for increased awareness and education about the potential risk of cerebral thrombosis associated with OCP use among Saudi women. Addressing this knowledge gap through targeted educational initiatives could help mitigate the risks and improve overall public health outcomes. Full article

Background and Objectives: Sepsis triggers a complex immune response, disrupting the balance between pro- and anti-inflammatory signals and causing widespread immune cell apoptosis. Interleukin 7 (IL-7) is emerging as one of the most promising immunoadjuvants to boost host immunity during the immunosuppressive phase of the disorder. This study aimed to investigate the dynamics of endogenous plasma levels of IL-7 during sepsis and septic shock, correlating its levels with lymphopenia and various lymphocyte subtypes, including CD4+ and CD8+ T cells, B cells, and natural killer T cells (NKT), in both survivors and non-survivors. Materials and Methods: This prospective observational study included 87 critically ill patients. We categorized the patients into four subgroups based on their diagnosis (sepsis or septic shock) and survival status (survivors and non-survivors). The parameters were monitored on day 1 (when sepsis was diagnosed according to the Sepsis-3 Consensus) and again on day 5. Eighty-two healthy volunteers were included as a control group to establish the cut-off values for IL-7. Results: Statistical analysis revealed a significant difference in median values between days 1 and 5 for lymphocytes (p = 0.01) and NKT cells (p = 0.01), observed only in sepsis survivors. In the group of sepsis survivors, we observed a negative correlation between IL-7 levels and NKT cells but only on day 1. Additionally, we identified negative correlations between Th cells (CD4+) and Tc cells (CD8+) on both day 1 and day 5. In the group of sepsis non-survivors, we observed a positive correlation between IL-7 and B cells (CD19+) but only on day 1. We also identified a negative correlation between Th cells (CD4+) and Tc cells (CD8+) on day 1. In the group of septic shock survivors, we did not observe any correlation between IL-7 levels and other parameters studied on day 1 or day 5. We identified a negative correlation between Th cells (CD4+) and Tc cells (CD8+) on both day 1 and day 5, a negative correlation between Th cells (CD4+) and NKT cells on both day 1 and day 5, and a positive correlation between Th cells (CD4+) and B cells (CD19+) on day 1. In the group of septic shock non-survivors, we did not observe any correlation between IL-7 and other parameters studied. Conclusions: Determining the IL-7 plasmatic value every five days did not demonstrate the necessary sensitivity and specificity as a biomarker to accurately assess each patient’s immune balance. Endogenous IL-7 levels appear inadequate to overcome the immunosuppressive environment induced by sepsis. Full article

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving care strategies. The primary aim of this study was to determine the prevalence of depressive symptoms in older patients undergoing geriatric rehabilitation and to assess their specific impact on their functional abilities. Materials and Methods: A retrospective study was conducted at the Lucerne Cantonal Hospital in Wolhusen, Switzerland, spanning from 2015 to 2020 and including 1159 individuals aged 65 years and older. The presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS) Short Form, while functional abilities were evaluated using the Functional Independence Measure (FIM) and the Tinetti test. Data analysis was performed using TIBCO Statistica 13.3, with statistical significance set at p < 0.05. Results: Of the participants, 22.9% (N = 266) exhibited depressive symptoms, with no notable differences between genders. Although all patients showed functional improvements, the duration of rehabilitation was prolonged by two days (p = 0.012, d = 0.34) in those with depressive symptoms. Alarmingly, 76% of participants were classified as at risk of falling based on the Tinetti score. However, no significant correlation was found between the GDS and Tinetti scores at admission (p = 0.835, r = 0.211) or discharge (p = 0.336, r = 0.184). The results from the non-parametric Wilcoxon matched-pairs test provide compelling evidence of significant changes in FIM scores when comparing admission scores to those at discharge across all FIM categories. Conclusions: Depressive symptoms are particularly common in geriatric rehabilitation patients, leading to prolonged recovery time and increased healthcare costs. While depressive symptoms showed no correlation with mobility impairments, improvements in functional status were directly associated with reduced GDS scores. Considering mental health during admission and planning is critical in optimizing rehabilitation outcomes. Full article

Background and Objectives: Actinomycosis is a rare chronic contagion caused by Actinomyces spp. known for its ability to mimic malignant processes across various anatomical locations. Its clinical presentation can often resemble malignancies, Mycobacterium tuberculosis infections, nocardiosis, fungal infections, or other granulomatous diseases. This case series presents three patients diagnosed with Actinomyces spp., highlighting the diagnostic challenges and diverse clinical manifestations of the disease. Materials and Methods: We reviewed the clinical course, diagnostic procedures, and treatment outcomes of three patients with confirmed Actinomyces spp. The first case involved a 51-year-old male with a history of rhabdomyosarcoma in remission who presented with dysphagia. Magnetic resonance imaging identified an irregularly enhancing mass in the tonsil, and subsequent tonsillectomy confirmed Actinomyces spp. The second patient, an 80-year-old female, presented with dysphagia and a sublingual mass initially suspected to be diffuse large B-cell non-Hodgkin lymphoma; however, a histopathological analysis confirmed Actinomyces spp. The third case involved a 72-year-old male with abdominal pain and an ulcerated gastric lesion, where subtotal gastrectomy and histopathological examination confirmed the diagnosis of Actinomyces spp. Results: These three cases highlight the ability of Actinomyces spp. to closely mimic malignant lesions, which significantly complicates the diagnostic process. Although personalized interventions were required for each patient, diagnoses were ultimately confirmed through histopathology. Despite these challenges, timely recognition and appropriate treatment were achieved, underscoring the need to consider Actinomyces spp. in the differential diagnosis of similar presentations. Conclusions:Actinomyces spp. remains a diagnostic challenge due to its ability to mimic a variety of malignant and contagion conditions. This case series emphasizes the need for a thorough histopathological examination and a high index of suspicion when encountering lesions with atypical presentations. Given the potential for misdiagnosis, awareness and consideration of Actinomyces spp. are crucial in the differential diagnosis of chronic contagion and mass lesions. Further studies are warranted to refine diagnostic and therapeutic approaches. Full article

Background and Objectives: Obesity is a significant risk factor for cardiovascular disease. Physical exercise has been established as an effective intervention for reducing cardiovascular mortality. This systematic review aimed to investigate the effects of various exercise modalities on cardiovascular risk factors in men with obesity. Materials and Methods: This review included randomized controlled trials (RCTs) published between 2005 and November 2023. Studies were eligible if they assessed the impact of exercise interventions on blood pressure (BP), lipid profiles, and glucose/insulin regulation in males aged 18 years or older with a body mass index (BMI) of 25 kg/m² or greater. The quality of included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results: A total of 25 RCTs were included in the analysis, with PEDro scores ranging from 3 to 7. High-intensity interval training (HIIT) was associated with significant reductions in BP, with an average decrease of 12.5 mmHg. However, the magnitude of BP reduction varied across studies, likely due to differences in training protocols and study quality. Resistance training (RT) was associated with modest improvements in glycemic control, with some studies reporting a reduction in fasting blood glucose levels by 5–10%. Combined exercise (CT) programs, which included both aerobic and resistance training, as well as aerobic exercise alone, were shown to improve lipid profiles, with some studies showing reductions in total cholesterol levels ranging from 10–15%. However, the findings were inconsistent, highlighting the need for further research to better understand the potential benefits and optimal exercise regimens. Conclusions: This systematic review supports the potential of exercise training in reducing cardiovascular risk factors in men with obesity, though the effectiveness varies depends on the type of exercise. Combined exercise programs have shown promise for lipid profiles, but further research is needed to confirm these effects. HIIT has been linked to BP reductions in some studies, although the results are inconsistent and depend on protocols and study quality. The limitations in study quality may impact the reliability of these findings. Full article

Nicotinamide (NAM), the amide form of vitamin B3, is a precursor to essential cofactors nicotinamide adenine dinucleotide (NAD⁺) and NADPH. NAD⁺ is integral to numerous cellular processes, including metabolism regulation, ATP production, mitochondrial respiration, reactive oxygen species (ROS) management, DNA repair, cellular senescence, and aging. NAM supplementation has demonstrated efficacy in restoring cellular energy, repairing DNA damage, and inhibiting inflammation by suppressing pro-inflammatory cytokines release. Due to its natural presence in a variety of foods and its excellent safety profile—even at high doses of up to 3 g/day—NAM is extensively used in the chemoprevention of non-melanoma skin cancers and the treatment of dermatological conditions such as blistering diseases, atopic dermatitis, rosacea, and acne vulgaris. Recently, its anti-aging properties have elevated NAM’s prominence in skincare formulations. Beyond DNA repair and energy replenishment, NAM significantly impacts oxidative stress reduction, cell cycle regulation, and apoptosis modulation. Despite these multifaceted benefits, the comprehensive molecular mechanisms underlying NAM’s actions remain not fully elucidated. This review consolidates recent research to shed light on these mechanisms, emphasizing the critical role of NAM in cellular health and its therapeutic potential. By enhancing our understanding, this work underscores the importance of continued exploration into NAM’s applications, aiming to inform future clinical practices and skincare innovations. Full article

Background and Objectives: We aimed to evaluate the current uterotonic administration practices among anesthesiologists and obstetricians and gynecologists (OBGYNs) during cesarean section (CS), focusing on variations in approaches for low- and high-risk postpartum hemorrhage (PPH) cases. The objective was to identify key differences and provide evidence that could contribute to the development of standardized national protocols for uterotonic usage. Materials and Methods: A snapshot online survey was employed between October 2021 and January 2022 and distributed to anesthesiologists and OBGYNs from university-affiliated, government, and private hospitals across Turkey, consisting of 23 questions addressing demographic data, institutional PPH rates, first-line uterotonic choices, administration methods, and dose adjustments for low- and high-risk PPH cases. Specific questions also targeted uterotonic usage in the presence of comorbidities such as pre-eclampsia and cardiac disease. Results: There were 204 responses (54% anesthesiologists and 46% OBGYNs) out of 220, yielding a response rate of 92.7%. Oxytocin was the most common first-line uterotonic for CS with low-risk PPH (99.1% of the anesthesiologists and 96.8% of the OBGYNs). In total, 60% of the anesthesiologists favored an intravenous (IV) bolus followed by infusion, while 56.4% of the OBGYNs preferred IV infusion alone (p < 0.001). For CS with high-risk PPH, approximately half of the participants reported increases in oxytocin dose, while 26.4% of the anesthesiologists and 20.2% of the OBGYNs opted for combined oxytocin and carbetocin use. During intrapartum CS, 69.1% of anesthesiologists and 77.7% of OBGYNs reported no change in dose. However, 11.8% of the anesthesiologists indicated combining oxytocin and carbetocin (p < 0.05). In managing pre-eclampsia and cardiac disease, the anesthesiologists were likely to reduce uterotonic doses (15.5%) and avoid methylergonovine (35.5%) compared to the OBGYNs, who reduced doses less frequently (4.3%), but 79.8% of the OBGYNs avoided methylergonovine (p < 0.001). Conclusions: There was considerable variability in uterotonic administration practices between the anesthesiologists and OBGYNs. Full article

Background and Objectives: This study analyzes the effects of proprioceptive training on the physical fitness and soccer-specific technical skills of young professional soccer players. Materials and Methods: Twenty-eight male professional soccer players from the Türkiye Football Federation’s Third League, aged 20.46 ± 1.60 years (average), participated voluntarily. Body composition was assessed with the Inbody270 bioelectrical impedance analyzer, while agility and maximal VO₂ cardiorespiratory fitness were measured using the ChronoJump smartspeed mat. Soccer-specific technical skill assessments were also conducted. Data were analyzed using SPSS 22, with paired sample t-tests for comparisons, Cohen’s d test for effect size, and repeated measures two-way ANOVA for interaction effects (group × time). Eta squared (η²) values were reported for effect size. A 95% confidence level and p = 0.05 were used. Results: Proprioceptive training significantly improved body fat percentage (p < 0.05; η² = 0.006) and soccer-specific technical skills, including free juggling (p < 0.05; η² = 0.302), alternating foot juggling (p < 0.05; η² = 0.271), right foot juggling (p < 0.05; η² = 0.250), and shooting performance (p < 0.05; η² = 0.513). Conclusions: A 12-week proprioceptive training program, when incorporated into soccer practice, significantly enhances soccer-specific technical skills and reduces body fat percentage. Full article

Background and Objectives: Oral cancer remains a critical global health concern, with oral squamous cell carcinoma (OSCC) being the most prevalent form. Oral potentially malignant disorders (OPMDs), such as oral leukoplakia (OLK), oral lichen planus (OLP), and actinic cheilitis (AC), often precede OSCC. Identifying reliable biomarkers is vital for assessing malignant transformation risk. The present study aimed to evaluate the immunohistochemical expression of differentiated embryonic chondrocyte 1 (DEC1), a marker of dysplasia severity, and cluster of differentiation 44 (CD44), which is associated with cancer progression, in OPMD and OSCC tissues. Materials and Methods: A retrospective analysis was conducted on 145 biopsy specimens from January 2015 to January 2023, comprising normal mucosa (NM), OLK, OLP, AC, and OSCC. DEC1 and CD44 expression levels were assessed using immunohistochemical staining. Positivity scores were determined based on staining intensity and extent, with statistical analyses performed using SPSS software (SPSS Inc., Chicago, IL, USA, version 29.0 for Windows). Results: It was found that CD44 expression significantly increased across OPMD and OSCC compared to NM (p < 0.001). Conversely, DEC1 expression was consistent across lesion types and dysplasia levels. CD44 expression was the highest in AC and OSCC, underscoring its potential role as a progression marker. Conclusions: The results indicate that CD44 is a more sensitive marker for assessing dysplastic severity and malignant transformation, while DEC1 may serve as a complementary marker for early-stage evaluation. Further research involving larger cohorts is needed to confirm these findings. Full article

Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected. Full article

Background: This study reported a case of zone VII multiple neglected extensor tendons reconstruction with a palmaris longus tendon autograft in a 15-year-old boy 3 months after the initial trauma. Case presentations: Preoperative examinations revealed complete damage of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), and partial injury of the extensor pollicis brevis (EPB). The extensor tendons were reconstructed with a palmaris longus tendon autograft combined with graft tunnel reconstruction within the scar at the level of the damaged retinaculum. After the surgical treatment, short immobilization and early rehabilitation were applied, providing passive sliding of the reconstructed tendon supplemented with actively mediated extension. Results: Despite the neglectful nature of the injury, surgical treatment and early postoperative rehabilitation resulted in an excellent functional outcome. At the follow-up visit, 6 months postoperative, the patient presented a full range of motion of the radiocarpal joint and thumb without any limitations on hand function. Conclusions: (1) Palmaris longus tendon autograft is a viable option for the treatment of multiple zone VII extensor tendon damage. (2) The combination of early passive motion and actively mediated extension provides tendon gliding and results in good functional outcomes for a hand with zone VII extensor tendon injury. (3) Ultrasound examination can evaluate early results and detect complications, mainly tendon/graft adhesions, after extensor tendon reconstruction surgery. Full article

Background and Objectives: The aim of this study was to determine the effect of immersive virtual reality used as a short-term multifaceted activity with a focus on motor and cognitive function in patients with Parkinson’s Disease. The sub-objective focused on quality of life in the study group of patients. Materials and Methods: Nineteen patients (64.2 ± 12.8 years) were included in this study. Inclusion criteria for this study: adult patients in Hoehn and Yahr’s stage 1–3, cooperative, with stable health status, independent and mobile. IVR therapy was performed twice a week for 20 min for one month. Input and output measurements were taken within 14 days of starting or ending therapy. The 10 Meter Walk test was used to examine and assess both comfortable and fast walking, and the Timed Up and Go (TUG) + s dual task was applied to quickly assess the highest possible level of functional mobility. The Berg Balance Scale test (BBS) was used to assess balance with a 14-item balance scale containing specific movement tasks. The standardized Parkinson’s Disease Questionnaire (PDQ-39) was used to assess quality of life. Data were processed in the PAST program using a nonparametric paired Wilcoxon test. The significance level was set at α = 0.05. The value of the r score was used to evaluate the effect size. Results: A significant reduction in the time in the fast walk 10MWT (p = 0.006; r = 0.63) and TUG (p < 0.001; r = 0.80) parameter were found after therapy. Significant improvement in the BBS score was found after applied therapy (p = 0.016; r = 0.55). In the PDQ-39 questionnaire, significant improvements were found in the study group after therapy in the domains of mobility (p = 0.027; r = 0.51) and emotional well-being (p = 0.011; r = 0.58). Conclusions: The results of this study indicate a positive effect of virtual reality therapy on balance and gait, which is also good in terms of reducing the risk of falls in the study group. Therapy also promoted quality of life in the study group. Full article

Background and Objectives: The pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) remains incompletely understood. However, recent studies highlight the interactions between muscle, liver, and adipose tissue. This study aimed to explore the relationships between clinical indicators of MASLD and sarcopenia, cardiorespiratory fitness, fatigue, and mood. Materials and Methods: The study involved 60 participants, including 28 healthy controls and 32 with MASLD, categorized into two disease subgroups: 15 with MASL and 17 with metabolic dysfunction-associated steatohepatitis (MASH). Participants completed an incremental speed shuttle walk test to evaluate cardiorespiratory fitness, a hand-held dynamometer assessment for appendicular muscle strength, and the timed up and go test for physical performance. Physical activity level, fatigue, quality of life, and emotional state were assessed using questionnaires. The test results were compared between groups and with disease characteristics. Results: MASL and MASH groups showed reduced cardiorespiratory fitness (p < 0.001). The knee extensors were significantly weaker in both MASL and MASH groups (p < 0.001 and p = 0.001, respectively). The MASH group reported higher levels of depression and negative health perception (p = 0.006 and p = 0.03, respectively). Muscle strength in patients with MASLD showed a significant negative association with depression (OR = −0.384, 95% CI: −3.10 to −0.74, p = 0.003), intrahepatic triglyceride content (OR = −0.287, 95% CI: −1.31 to −0.11, p = 0.023), and LDL (OR = −0.286, 95% CI: −0.02 to −0.33, p = 0.03). In contrast, a positive association was observed between VO₂ and muscle strength (OR = 0.531, 95% CI 1.27 to 3.47, p < 0.001). Conclusions: This study suggests that muscle strength is linked to key metabolic parameters, such as hepatic fat, LDL levels, and aerobic capacity, that may contribute to the development and progression of MASLD. Interventions aimed at preserving or enhancing muscle strength in MASLD patients may be essential for preventing liver damage and improving metabolic health. Full article

Background and Objectives: Kinematic and kinetic data from gait analysis are commonly used for clinical decision making in cerebral palsy (CP). However, these data may not fully capture the underlying causes of movement pathologies or effectively monitor post-treatment changes. Joint reaction forces (JRFs), estimated through simulation-based methods, provide valuable insights into the functional state of musculoskeletal components. Despite their importance, comprehensive evaluations of lower limb JRFs in CP are limited, and comparisons with typically developing (TD) individuals remain underexplored. This study aimed to provide a detailed comparison of lower limb JRFs between children with CP exhibiting mild crouch gait and age-matched TD children during self-selected walking speeds. Materials and Methods: Open-access gait datasets from eight children with CP and eight TD children were analyzed. A full-body musculoskeletal model was scaled to individual anthropometric data in OpenSim. Joint angles and moments were obtained using inverse kinematics and inverse dynamics, respectively. Ankle, knee, and hip JRFs were calculated using OpenSim’s Joint Reaction tool. Root-mean-square differences and Pearson correlation coefficients quantified the differences between CP and TD JRFs. Results: The anterior–posterior and vertical components of the hip JRFs in CP were lower than in TD children. CP knee JRFs exceeded TD values across all anatomical axes. For the ankle, the anterior–posterior JRF was lower in CP, whereas the vertical component was higher compared to TD. Conclusions: Children with CP experience distinct lower limb JRF patterns compared to TD children. While some findings align with previous studies, discrepancies in other components highlight the influence of model and patient-specific characteristics. These results emphasize the need for standardization in reporting patient data and systematic evaluations to improve the interpretation and applicability of JRF analyses in CP research and treatment planning. Full article

Background and Objectives: Angioedema is a non-pitting edema of the submucosal layer which can be acquired or inherited and usually presents with hives. Intestinal angioedema is rare and can mimic other acute gastrointestinal disorders. It is typically associated with a lack or dysfunction of C1-inhibitor, with a small number of cases having normal C1-inhibitor function. We present a rare case of chronic recurrent intestinal angioedema in a patient with normal C1-inhibitor function who did not respond to icatibant therapy. Case presentation: A 56-year-old woman presented with 3 days of abdominal pain, nausea, vomiting, and diarrhea. She denied a history of allergies and reported a 30-year history of similar episodes requiring hospitalization. Initial evaluation demonstrated normal C4 and C1 esterase inhibitor function with negative gastrointestinal bacterial and viral panel. A CT of the abdomen and pelvis demonstrated acute diffuse bowel thickening and prominent mesenteric lymph nodes. MRI demonstrated inflammation of the small and large bowel. EGD and colonoscopy findings were normal. She was diagnosed with intestinal angioedema and started on icatibant without significant improvement. Her symptoms resolved after 3 days of supportive therapy and resolution of inflammation was noted on imaging. She was discharged home with allergy and immunology follow-up. Conclusions: Intestinal angioedema is under-recognized and presentation can overlap with other pathologies of the GI tract. Extensive work up is needed during the first episode of an attack and complement levels should be checked in all patients. Appropriate classification is important as it dictates therapy. However, ambiguous cases like ours sometimes cannot be classified into any specific category. Full article

Background and Objectives: Acute exacerbation of idiopathic pulmonary fibrosis (IPF-AE) often results in severe respiratory distress requiring treatment in the intensive care unit and has a high mortality rate. Identifying prognostic markers and assessing disease severity are crucial for clinicians to gain detailed insights. The mean platelet volume-to-platelet count ratio (MPR) is an inflammatory marker commonly used in malignancies. This study aimed to evaluate MPR and other factors affecting mortality in patients with IPF-AE who were monitored in the intensive care unit (ICU). Materials and Methods: This retrospective study was conducted on patients monitored in the ICU for IPF-AE between 2017 and 2023. Demographic characteristics, vital signs, laboratory and imaging findings, and administered treatments were reviewed. MPR was calculated by dividing the mean platelet volume by the platelet count. The primary endpoint was defined as 1-month in-hospital mortality. Results: A total of 59 patients monitored in the ICU for IPF-AE were included in the study. The mean age of the patients was 62.75 years, and 81.4% of the participants were male. During the 30-day follow-up period, 62.7% of the patients died. The need for invasive mechanical ventilation (IMV) was significantly associated with increased mortality (p < 0.001). The optimal cutoff value for MPR was determined to be 0.033, with a sensitivity of 83.7% and specificity of 63.64%, indicating its predictive value for mortality (AUC: 0.764; 95% CI: 0.635–0.864; p < 0.001). Conclusions: In this study, the need for IMV emerged as a critical parameter in predicting mortality in patients with IPF-AE. Additionally, the use of the MPR as a prognostic biomarker may offer a novel approach in the management of IPF patients. These findings could contribute to the development of strategies aimed at early intervention in IPF patients. Further studies with larger sample sizes are needed to validate these results. This study has demonstrated that MPR is a significant prognostic biomarker for predicting mortality in patients with IPF-AE who are managed in the intensive care unit. The potential use of MPR as a biomarker in clinical decision-making may provide new approaches to the management of IPF patients. Additionally, the need for IMV in IPF-AE emerges as a critical parameter for predicting mortality. These findings may contribute to the development of early intervention strategies for IPF patients. Further studies with larger cohorts are needed to validate these results. Full article

Saliva has emerged as a powerful diagnostic tool due to its non-invasive collection, straightforward storage, and ability to mirror systemic health. This narrative review explores the diagnostic potential of salivary biomarkers in detecting systemic diseases, supported by examples such as salivary proteomics’ role in monitoring endocrine disorders, cancer, and viral infections. Advances in technologies like microfluidics, biosensors, and next-generation sequencing have enhanced the sensitivity and specificity of salivary diagnostics, making it a viable alternative to blood-based diagnostics. The review also evaluates challenges such as the need for standardized collection protocols, variability in salivary composition, and the integration of these technologies into clinical workflows. The findings emphasize the transformative potential of saliva in personalized medicine, especially for early disease detection and real-time health monitoring. Practical applications include its use in mass screenings and public health crises, highlighting saliva as a cornerstone for future advancements in non-invasive diagnostics. Full article

Early detection of breast cancer plays a crucial role in reducing the number of cases diagnosed at advanced stages, thereby lowering the high healthcare costs required to achieve disease-free survival and helping to prevent avoidable premature deaths. However, women living in rural and low-income areas face multiple obstacles that limit their access to conventional screening methods, such as mammography, which has been widely proven effective, particularly in high-income countries. The main barriers include a lack of healthcare infrastructure, long distances to medical facilities, high costs associated with large-scale screening programs, and shortages of specialized personnel. In this context, emerging technologies offer innovative solutions with the potential to mitigate these challenges. The development of strategies supported by artificial intelligence and the use of portable devices capable of overcoming geographical and sociocultural barriers represent valuable complementary tools for strengthening community-driven screening programs and expanding the reach of large-scale initiatives. However, to date, no comprehensive analysis has been conducted on the availability of evidence assessing the outcomes of breast cancer screening programs in vulnerable and underserved communities. This manuscript outlines the benefits of emerging portable technologies powered by artificial intelligence for detecting significant breast lesions in low-resource rural areas, where traditional screening methods are often difficult to implement. It also highlights gaps in the current knowledge, drawing on the available evidence. A search using PubMed yielded 7629 articles on breast cancer screening, of which only 59 (0.77%) addressed resource-limited settings and rural populations. Further filtering identified 29 original studies (0.38%) with specific epidemiological designs involving humans as the unit of analysis. The findings revealed significant disparities in evidence availability: nine studies originated from high-income countries, while fewer than half were from low-income or lower middle-income countries. Only two studies were conducted in Latin America, specifically in Peru and Argentina. This limited evidence poses challenges for generalizing and replicating recommendations for unexplored settings. Full article

Background and Objectives: The use of anabolic–androgenic steroids (AASs) by competitive and recreational athletes has been studied and well documented. There are numerous studies showing its effects on personality traits and risky behaviors like aggression. The relationship between AAS use, aggression, and narcissism is complex and intricate. We examined this relationship in male bodybuilders who use AASs. Materials and Methods: A total of 319 healthy subjects aged 18–44 years (33.4 ± 9.4) who have been regularly training at bodybuilding for at least 3 years participated voluntarily in the study and completed a demographic data inventory, the Five-Factor Narcissism Inventory Short Form (FFNI-SF), and the Buss–Perry Aggression Scale anonymously. Demographic data were given as percentages, comparisons of aggression and narcissism scores according to AAS use were performed by using an independent sample t test, and effects of narcissism and aggression levels on AAS use was assessed by using logistic regression analysis. All analyses were performed by using SPSS Statistics 22.0. Results: Results showed that AAS users had significantly higher scores on the overall FFNI-SF Scale (p < 0.001) and all sub-dimensions of narcissism (p < 0.001) and on the overall Buss–Perry Aggression Scale (p < 0.001) and all sub-dimensions of aggression (p < 0.001). It was also shown that there were significant and positive correlations between the FFNI-SF overall score (p < 0.001) and both the vulnerable narcissism and grandiose narcissism sub-dimensions (p < 0.001) and the scores of the Buss–Perry Aggression Scale (p < 0.001), physical aggression (p < 0.001), anger (p < 0.001), hostility (p < 0.001), and verbal aggression (p < 0.001) sub-dimensions. Conclusions: These results show a strong relation between AAS use, narcissism, and aggression in bodybuilders. However, it is not clear whether AAS use leads to aggression and narcissism or whether narcissistic and/or aggressive people tend to use AASs. Furthermore, including a lot of potential third variables shows that it does not have to be either one or the other way around. There is a need to conduct future studies to determine this causality. Full article

Background and Objectives: The management of HIV patients presenting with fever in the Emergency Department (ED) remains a challenging clinical scenario. Accurate risk stratification and prognostic indicators are crucial for timely intervention and improved patient outcomes. Procalcitonin (PCT) has emerged as a promising biomarker for assessing the severity and prognosis of various infectious diseases. The study aimed to evaluate the prognostic value of procalcitonin (PCT) in HIV patients admitted to the Emergency Department for clinical suspicion of infection and assess its association with in-hospital mortality. Methods: A retrospective analysis was conducted on febrile HIV-positive patients admitted to the Emergency Department. Clinical data were collected from 2018 to 2022. Patients were categorized based on PCT levels (>0.5 ng/dl), clinical findings, comorbidities, and viro-immunological status. Results: We investigated data from 289 HIV-positive patients (74% male). The median age of the sample was 54 years [IQR: 42–62], 100 (35%) patients presented detectable viremia, and the median value of CD4+ T lymphocytes was 358 [IQR: 104–531]. Elevated PCT levels (≥0.5 ng/dL) were detected in 69 (23.8%) patients. A significant association was observed between elevated PCT and increased mortality risk (p < 0.05). The mortality rate among patients with detectable HIV viremia was higher compared to those with undetectable viremia (p = 0.02). Moreover, deceased patients had statistically lower CD4+ values compared to survivors (61 [IQR: 14–186] vs. 370 [IQR: 136–548], p < 0.001). Conclusions: In febrile HIV patients admitted to the Emergency Department, elevated procalcitonin levels, low CD4+, and detectable viremia are associated with an increased risk of in-hospital mortality. Full article

Background and Objectives: Acute pancreatitis (AP) is an inflammatory disease where there is autodigestion of the pancreas by prematurely activated enzymes which may lead to a systemic inflammatory response. The aim of our study was to investigate the levels of circulating serum leukotriene B4 (LTB4), lipoxin A4 (LXA4), and resolvin D1 (RvD1) in pancreatitis due to gallstones in the etiologic investigation of AP. Materials and Methods: A total of 147 patients with AP (n: 49), AC (n: 49), and combined AP + AC (n: 49) will be included in the study. Healthy volunteers (n: 49) will be included as the control group. Results: RvD1 levels were significantly lower in patient groups compared to controls, while LXA4 levels were lower in patients with combined AP + AC (145.24 ng/L) compared to both controls (312.36 ng/L) and other patient groups. LTB4 levels were elevated in all patient groups compared to controls (335.56 ng/L vs. 65.56 ng/L) and were highest in combined AP + AC. Significant correlations were identified: RvD1 showed a negative correlation with LTB4 (r =−0.676; p < 0.001) and a positive correlation with LXA4 (r = 0.563, p < 0.001). ROC analysis demonstrated high diagnostic accuracy, with LXA4 and LTB4 achieving perfect differentiation (AUC: 1.0) between control and combined AP + AC cases. Conclusions: Our study showed that serum RvD1 and LXA4 levels have powerful anti-inflammatory properties in accordance with the literature. LTB4 may represent new, effective indicators to predict the severity of AP and the presence of necrosis in patients with AP. Despite its low sensitivity and specificity, RvD1 could be used as a complementary marker to the current scoring systems for the initial assessment of AP prognosis. These findings provide a new mechanistic understanding of how RvD1 attenuates inflammation to facilitate resolution, which could help develop novel therapeutic strategies for diseases caused by unresolved inflammation. It is easily obtainable and can provide additional prognostic information to clinicians. Full article

Background/Objectives: Sepsis-associated acute kidney injury caused by lipopolysaccharide (LPS) is related to hypoxia, amplification of the inflammatory response, oxidative stress, mitochondrial dysfunction, and apoptosis. This study aims to explore the protective effects of a radiofrequency electromagnetic field (RF-EMF) and a pulsed magnetic field (PMF) on acute kidney injury in rats. Materials and methods: Forty female Wistar albino rats were randomly divided into five groups (each containing eight rats): control, LPS, RF-EMF, PMF, and RF-EMF + PMF groups. Six hours after LPS application, blood and tissues were removed for histopathological, immunohistochemical, biochemical, and genetic analysis. Results: Histopathological findings, caspase-3, inducible nitric oxide synthase and tumor necrosis factor-alpha immunoexpressions, total oxidant status and oxidative stress index levels, and interleukin-6, hypoxia-inducible factor alpha, Bcl-2-associated X protein, and caspase 9 gene expression in kidney tissue and blood urine nitrogen and creatinine levels in blood were increased, whereas endothelial nitric oxide synthase and B-cell lymphoma 2 gene expression were decreased in the LPS groups. Both RF-EMF and PMF reversed all these findings and recovered renal tissues. Conclusions: Noninvasive, nontoxic, low-cost PMF and RF-EMF, both single and combined, have been demonstrated to have renoprotective anti-inflammatory, antioxidant, and antiapoptotic effects. Full article

Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) was described in December 2019 for the first time, and it was responsible for a global pandemic. An alarming number of patients with coronavirus disease 2019 (COVID-19) also developed acute kidney injury (AKI), especially those who required extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS). The aim of our retrospective observational study was to assess the prognostic significance of AKI in these patients. This study observed, in COVID-19 patients admitted to an intensive care unit (ICU), AKI stages and the need for renal replacement therapy (RRT), assessing the risk factors and outcomes. Moreover, we evaluated the mortality rate of patients treated by ECMO. Materials and Methods: Between November 2020 and December 2022, among 396 patients admitted to our intensive care unit (ICU) diagnosed with SARS-CoV-2 infection, we selected patients with severe ARDS requiring veno-venous (vv) ECMO support and AKI. Results: The 30-day mortality after ECMO positioning was 85.7%. A Cox regression revealed a significant advantage for RRT with a high cut-off (HCO) hemofilter both for ICU mortality (HR 0.17 [95% CI: 0.031–0.935], p = 0.035) and 15 day-mortality after the start of vv-ECMO (HR 0.13 [95%CI: 0.024–0.741], p= 0.021), whereas the early onset of vasoplegic shock after ECMO implantation indicated a higher risk of death (HR 11.55 [95% CI: 1.117–119.567], p = 0.04) during the ICU stay. Conclusions: COVID-19 induces a high risk of AKI and RRT. In our cohort, hypertension, pre-existing renal disease, and mechanical ventilation represented independent risk factors for AKI. Patients requiring ECMO support had a high mortality rate. The early implementation of RRT reduced the risk of death during the ICU stay. Full article

Background and Objective: to test a model aimed at delving into the psychological processes that lead to hopelessness in Spanish nurses two years after a stressful work situation. The model proposed starts with the anxiety experienced at the beginning of the COVID-19 pandemic and includes cognitive fusion and emotional exhaustion, evaluated six months after the end of the confinement, as possible contributing factors to development of hopelessness. Design: prospective study with three data collection periods, May to June 2020 (period 1), January to April 2021 (period 2), April to July 2022 (period 3). Materials and Methods: The sample (n = 131 Spanish nurses) was selected by non-probabilistic convenience sampling. The inclusion criteria were as follows: being female, over 18 years of age, and working as a nurse in direct contact with COVID-19 patients. Results: The model proposed was statistically significant (B = 0.34, SE = 0.07, t = 5.15, p < 0.001, 95% CI = [0.21, 0.47]), contributing to the explanation of 28% of the variance of hopelessness, finding that the direct anxiety–hopelessness effect was equally significant (B = 0.19, SE = 0.08, t = 2.46, p = 0.014, 95% CI = [0.04, 0.34]). An effect of anxiety on cognitive fusion and on emotional exhaustion was observed. In turn, cognitive fusion had a significant effect on emotional exhaustion but not on hopelessness. Finally, emotional exhaustion had a significant effect on hopelessness. In this final model, years of experience had a significant effect (p = 0.004) on hopelessness. Conclusions: Cognitive fusion and emotional exhaustion are shown to be relevant psychological processes upon which to intervene to contribute to the improvement of the mental health of nurses regarding the COVID-19 pandemic. Full article

Background and Objectives: The aims of this study were to assess the impact of smoking on cervical histopathology in women with high-risk HPV types 16 and 18 (the most common types) utilizing comprehensive clinical data and to conduct a risk analysis based on smoking pack-years. Materials and Methods: Between 2022 and 2024, 1048 high-risk HPV-positive women aged 25 to 65 years were categorized into two groups: smokers and non-smokers. Data acquired from a histopathological examination of samples collected during a colposcopic evaluation of these women were compared individually regarding clinical and demographic factors, specifically age, gravida, parity, and alcohol consumption. Subsequently, the impact of prolonged and excessive smoking on histopathological cellular changes was assessed in women with the same characteristics. A case–control study was performed on 312 smokers and 312 non-smokers following mutual matching. Results: The women were matched one-to-one regarding gravida, parity, and alcohol consumption. Subsequently, they were paired within a ±2-year age range. The mean age of the smoker group was 47.1 ± 8.8, while that of the non-smoker group was 47.2 ± 8.5 (p: 0.904). In all cases of high-risk HPV positivity, the rate of normal cervical cytological results was 14% in women who smoked and 29% in women who did not smoke. The LGSIL, HGSIL, ASC-H, and AGC-NOS rates were elevated in the smoker group, and a statistically significant difference was observed between the two groups in terms of abnormal cervical cytological results (p < 0.001). After a colposcopic biopsy, the smoker group exhibited higher rates of HGSILs, LGSILs, AGC-NOS, and CIS pathological lesions (28% vs. 23%), whereas the non-smoker group exhibited higher rates of chronic cervicitis (23% vs. 16%). However, no statistically significant difference was found between the two groups (p: 0.092). In a comparison of endocervical curettage (ECC) samples, it was observed that the HGSIL, CIS, and AGC-FN rates in the smoker group were almost the same as those in the non-smoker group. However, the LGSIL histopathology results (32% vs. 18%) were higher, and the rate of negativity with no pathology was higher in the non-smoker group (72% vs. 59%). A statistically significant difference in ECC histopathology was noted between the two groups (p < 0.001). An ROC analysis conducted between smoking pack-years and the colposcopic and endocervical curettage biopsy results revealed that the cutoff value for the colposcopic abnormal histopathological results increased, with 40% sensitivity and 76% specificity above 20 pack-years (AUC: 0.592 and p: 0.025). Additionally, the abnormal histopathology rates for endocervical curettage exhibited 81% sensitivity and 32% specificity above 13 pack-years (AUC: 0.586 and p: 0.008). The rate of abnormalities in the colposcopic biopsy results was 2.19 times higher for individuals with over 20 pack-years, and the rate of abnormalities in the ECC results was 2.08 times higher for those with over 13 pack-years; additionally, statistically significant results were obtained (p-values of 0.027 and 0.008, respectively). Conclusions: The most important cause of neoplastic changes in the cervix uteri is high-risk HPV infection, with evidence indicating that prolonged excessive smoking significantly exacerbates the persistence and progression of HPV infection, thereby influencing neoplastic changes in the cervix uteri. It is crucial for women to cease smoking in order to eradicate HPV infection from the body. Full article

Background and Objectives: Diabetes mellitus is a prevalent chronic disease caused by inadequate insulin secretion or ineffective insulin response, leading to complications such as retinopathy, nephropathy, heart attacks, and strokes. Recently, “diabetes distress (DD)” has emerged as a concept, highlighting the significant emotional burden of managing diabetes, which can impact disease outcomes. Thus, this study evaluates the impact of virtual clinics on diabetes distress and glycemic measures in individuals with diabetes mellitus. Materials and Methods: A cross-sectional study was conducted between May and August 2024 at the Endocrine and Diabetes Center in Alahsa, Saudi Arabia, targeting persons aged 18 and older with diabetes who had engaged in-person clinics, virtual clinics, or both between 2019 and 2024. Data were collected through structured phone interviews, supplemented by laboratory results from clinical records. The survey included demographic details, diabetes information, and the Diabetes Distress Scale. Statistical analyses, including descriptive statistics, were performed to explore the relationships between diabetes distress, clinic visit type, and glycemic control, with Mann–Whitney and Chi-Squared tests used to compare variables between two groups. Results: Of the 108 participants, 55.6% were male, with a mean age of 38.5 years. Type 2 diabetes was reported in 51.9% of individuals, while 48.1% had type 1. High emotional burden (44.4%) and regimen-related distress (28.7%) were prevalent, particularly among individuals with suboptimal glycemic control. While virtual visits were not significantly correlated with lower distress levels, individuals with suboptimal glycemic control exhibited significantly higher diabetes distress across various domains, including emotional and regimen-related distress (p < 0.05). Laboratory analysis showed a median HbA1c of 8.2%, with poor control associated with greater distress. Conclusions: Diabetic individuals with suboptimal glycemic control report higher diabetes distress levels, underscoring the need for integrated psychological support in DM care. Although virtual clinic visits did not significantly reduce distress, they provide a feasible option for individual follow-up. Full article

Background and Objectives: A COVID-19 model with a viral first-week phase and an inflammatory second phase has been proposed. It has been suggested that immunosuppressive treatment in the first week is harmful. This study aimed to analyze the potential damage of corticosteroids (CS) administered in the first week of COVID-19. Materials and Methods: This study was performed on a large cohort of consecutive COVID-19 patients admitted to Bellvitge University Hospital (Barcelona, Spain) from March 2020 to April 2021. Patients diagnosed with COVID-19 who were treated with 6 mg of dexamethasone a day for 10 days, and whose initiation of administration occurred within the first 2 weeks from symptom onset were included. We divided the cohort into the following two groups: patients for whom CS were initiated within the first 7 days after symptom onset vs. patients for whom CS were initiated between days 8 and 14. The degree of analytical inflammation (based on lymphocyte count, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer) upon admission was taken into account. The primary outcome was in-hospital mortality. Results: A total of 581 patients met the inclusion criteria. The results included, as follows: differences in age at baseline between groups (70.8 years old vs. 62.7, p < 0.001); moderate-to-severe dependency (11.9% vs. 4.2%, p = 0.003); the lymphocyte count (840 × 10⁶/L vs. 900, p = 0.033); D-dimer (400 ng/mL vs. 309, p < 0.001); and PaO₂/FiO₂ (290 vs. 311, p < 0.001). In-hospital mortality in patients who received CS in the first week of symptom onset was higher (29% vs. 12.8%, p < 0.001). The following risk factors were associated with higher in-hospital mortality: age (OR = 1.06, p < 0.001); Charlson index (OR = 1.34, p = 0.001); tachypnea > 20 bpm (OR = 2.58, p < 0.001); ≥3 high-risk criteria of inflammation (OR = 1.94, p = 0.012); and CS onset in the first week (OR = 2.17, p = 0.004). A higher PaO2/FiO2 (OR = 0.99, p < 0.001) and the use of remdesivir (OR = 0.53, p = 0.021) were identified as protective factors. However, when stratified by analytical inflammation criteria, the onset of CS in the first week did not reach statistical significance. Conclusions: The early administration of CS did not demonstrate a significant detrimental effect. These results highlight the need for a nuanced approach to CS therapy in COVID-19 that carefully weighs the risks and benefits based on individual patient characteristics and the severity of the inflammation. Full article

Background and Objectives: Ureteral stents are widely used in the field of urology but can cause varying degrees of side effects. This study utilized a network meta-analysis to evaluate stent-related discomfort (SRD) in patients with alpha-blockers (alfuzosin, tamsulosin, and silodosin), antimuscarinics (solifenacin), beta 3-agonists (mirabegron), and phosphodiesterase 5-inhibitors (tadalafil) versus a placebo. Materials and Methods: Relevant randomized controlled trials (RCTs) from 2006 to 2021 were identified from electronic databases, including PubMed, EMBASE, and the Cochrane Library. The following identifiers were included to assess the urinary symptom score (USS): participants (patients with ureteral stents), interventions (patients who took medication for stent discomfort), and outcomes (comparisons of the Ureteric Stent Symptoms Questionnaire (USSQ)). We also executed an independent quality assessment using the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 16 RCTs were identified, and they included 1865 patients. Compared with the placebo, mirabegron (mean difference (MD): −3.87; 95% confidence interval (CI): −10.6–2.35), tadalafil (MD: −4.47; 95% CI: −10.8–1.63), and silodosin (MD: −4.02; 95% CI: −12–4.01) did not show significant differences to the placebo, whereas others did. Alfuzosin, mirabegron, silodosin, solifenacin, and tadalafil were not inferior to tamsulosin in terms of the USS using Bayesian analyses. In the random effect model, P-score tests showed that solifenacin possessed the highest P-score (p = 0.8484); tamsulosin was the second highest (p = 0.7054). As a result of the rank-probability test, solifenacin was also ranked highest in terms of USS, and tamsulosin was ranked second. Conclusions: Compared with the placebo, solifenacin, tamsulosin, and alfuzosin significantly decreased the USS. In our study, solifenacin may be considered the most effective medication for SRD. Full article

Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in the tissues, causing swelling primarily in the limbs, though other body parts can also be affected. It commonly develops after lymph node removal, or radiation therapy, or due to congenital lymphatic system defects. Effective management is essential due to its significant impact on physical function and quality of life. Complete Decongestive Therapy (CDT) is the primary treatment for lymphedema. This comprehensive approach combines manual lymphatic drainage (MLD), compression bandaging, skincare, and exercise. An early diagnosis and initiation of CDT are critical to preventing irreversible damage to the lymphatic system and worsening symptoms. Successful outcomes depend on timely treatment, patient adherence, and the consistent use of all CDT components, with compression therapy and exercise playing particularly vital roles. Recent research highlights how skin and fat tissue characteristics, such as increased skin thickness and adipose tissue accumulation, complicate lymphedema management, especially in advanced stages. In these cases, where fibrosis and fat deposition are more prominent, traditional CDT may need to be supplemented with advanced treatments like liposuction or enhanced compression techniques. This study explores the factors influencing the success of decongestive therapy, including the stage of lymphedema at the diagnosis, treatment protocols, and individual patient characteristics like skin and fat tissue properties. Full article