Placental and Renal Pathways Underlying Pre-Eclampsia.

Pre-eclampsia is a serious complication of pregnancy characterized by a state of multiorgan hypertensive disorders, with or without proteinuria and possible multiorgan dysfunction. Chronic kidney disease is an established risk factor for the development of pre-eclampsia, as angiogenic homeostasis is altered and the maternal circulation is already hypertensive. Facing pre-eclampsia in the context of chronic kidney disease is a challenging emergency for both the mother and the fetus. The clinical features and the management of this multi-organ disorder are clearly defined in the modern literature but the underlying pathophysiologic mechanisms remain not fully elucidated. Understanding the pathophysiology that mediates the onset of pre-eclampsia itself and in synergy with chronic kidney disease is fundamental for developing prompt prevention strategies, treatment planning, and patient counseling. This review aims to summarize the main molecular mechanisms involved in the process of pre-eclampsia, with a particular focus on the role of the kidneys and hormonal pathways related to renal function in normal pregnancy and pre-eclamptic syndromes.

Potential impact of trained innate immunity on the pathophysiology of metabolic dysfunction-associated fatty liver disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) occurs in a low-grade inflammatory milieu dependent on highly complex networks that span well-beyond the hepatic tissue injury. Dysfunctional systemic metabolism that characterizes the disease, is further induced in response to environmental cues that modify energy and metabolic cellular demands, thereby altering the availability of specific substrates that profoundly regulate, through epigenetic mechanisms, the phenotypic heterogeneity of immune cells and influence hematopoietic stem cell differentiation fate. This immuno-metabolic signaling drives the initiation of downstream effector pathways and results in the decompensation of hepatic homeostasis that precedes pro-fibrotic events. Recent evidence suggests that innate immune cells reside in different tissues in a memory effector state, a phenomenon termed trained immunity, that may be activated by subsequent exogenous (e.g., microbial, dietary) or endogenous (e.g., metabolic, apoptotic) stmuli. This process leads to long-term modifications in the epigenetic landscape that ultimately precondition the cells towards enhanced transcription of inflammatory mediators that accelerates MAFLD development and/or progression. In this mini review we aimed to present current evidence on the potential impact of trained immunity on the pathophysiology of MAFLD, shedding light on the complex immunobiology of the disease and providing novel potential therapeutic strategies to restrain the burden of the disease.

Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study.

BACKGROUND: Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration. METHODS: This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach. RESULTS: A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists' moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists' constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists' moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant's best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists' colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists' constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time. CONCLUSIONS: We concluded that neonatologists' moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.

COVID-19 mRNA Vaccine Effectiveness against Elderly Frail People.

The frail, elderly population is often characterized by poor immunogenicity post COVID-19 mRNA vaccination. "Inflame-ageing" and "immune-senescence" are pathogenetic mechanisms that might explain this phenomenon. Complex interplay with cytokines and microbiota is also implicated in this inflammatory cascade. The abovementioned population, although very important from immunologic perspective, has barely been included in the mRNA vaccination clinical trials.

Ofeleein i mi Vlaptin-Volume II: Immunity Following Infection or mRNA Vaccination, Drug Therapies and Non-Pharmacological Management at Post-Two Years SARS-CoV-2 Pandemic.

The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people's physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of "ofeleein i mi vlaptin", that is, to help or not to harm.

Predicting Future Birth Rates with the Use of an Adaptive Machine Learning Algorithm: A Forecasting Experiment for Scotland.

The total fertility rate is influenced over an extended period of time by shifts in population socioeconomic characteristics and attitudes and values. However, it may be impacted by macroeconomic trends in the short term, although these effects are likely to be minimal when fertility is low. With the objective of forecasting monthly deliveries, this study concentrates on the analysis of registered births in Scotland. Through this approach, we examine the significance of precisely forecasting fertility trends, which can subsequently aid in the anticipation of demand in diverse sectors by allowing policymakers to anticipate changes in population dynamics and customize policies to tackle emerging demographic challenges. Consequently, this has implications for fiscal stability, national economic accounts and the environment. In conducting our analysis, we incorporated non-linear machine learning methods alongside traditional statistical approaches to forecast monthly births in an out-of-sample exercise that occurs one step in advance. The outcomes underscore the efficacy of machine learning in generating precise predictions within this particular domain. In sum, this research will comprehensively demonstrate a cutting-edge model of machine learning that utilizes several attributes to assist in clinical decision-making, predict potential complications during pregnancy and choose the appropriate delivery method, as well as help in medical diagnosis and treatment.

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis.

The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.

The Potential Impact of the Gut Microbiota on Neonatal Brain Development and Adverse Health Outcomes.

Over the past decade, microbiome research has significantly expanded in both scope and volume, leading to the development of new models and treatments targeting the gut-brain axis to mitigate the effects of various disorders. Related research suggests that interventions during the critical period from birth to three years old may yield the greatest benefits. Investigating the substantial link between the gut and brain during this crucial developmental phase raises fundamental issues about the role of microorganisms in human health and brain development. This underscores the importance of focusing on the prevention rather than the treatment of neurodevelopmental and neuropsychiatric disorders. The present review examines the gut microbiota from birth to age 3, with a particular focus on its potential relationship with neurodevelopment. This review emphasizes the immunological mechanisms underlying this relationship. Additionally, the study investigates the impact of the microbiome on cognitive development and neurobehavioral issues such as anxiety and autism. Importantly, it highlights the need to integrate mechanistic studies of animal models with epidemiological research across diverse cultures to better understand the role of a healthy microbiome in early life and the implications of dysbiosis. Furthermore, this review summarizes factors contributing to the transmission of gut microbiome-targeted therapies and their effects on neurodevelopment. Recent studies on environmental toxins known to impact neurodevelopment are also reviewed, exploring whether the microbiota may mitigate or modulate these effects.

Correlation between Breastfeeding, Maternal Body Mass Index, and Childhood Obesity.

Breast milk is a unique and highly beneficial source of nutrition for infants. It contains a wide range of nutrients that are specifically tailored to meet the specific needs of a growing infant. On the other hand, obesity is a major health issue that affects people around the world. The aim of this study is to investigate the relationship between breastfeeding and child BMI and the role of maternal BMI, which may influence this relationship. This study revealed that a longer duration of exclusive breastfeeding was associated with a decrease in the prevalence of overweight children. Additionally, the research found that children born to overweight or obese women had a higher probability of being overweight or obese themselves. Considering that mothers with a higher pre-pregnancy body weight are more likely to have children with a higher BMI, it is important that they receive information about the advantages of breastfeeding for a minimum of 6 months for both themselves and their children. Additionally, they should be offered ongoing support, to encourage them to start breastfeeding and continue with it beyond this period.

Post-Traumatic Stress Disorder Symptoms among Pediatric Healthcare Workers.

Post-traumatic stress disorder symptoms related to work in pediatric departments aremajor public health problems, as they directly affect health organizations, healthcare workers, and, due to the poor quality of care, the patients as well. The post-traumatic symptoms that a healthcare worker may experience are related to intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. The aim of the present investigation was to identify risk factors that contribute to the development of PTSD in pediatric healthcare workers, in order to implement necessary workplace measures. A sample of four hundred and forty-five pediatric workers at seven Greek public hospitals consented to participate in the survey. Socio-demographic data and a post-traumatic checklist (5th edition) were used to diagnose post-traumatic stress disorder. According to the results, risk factors for the development of post-traumatic symptoms include medical or nursing errors, threats to a child's life, and incidents of workplace bullying. More specifically, 25.2% of the participants had a provisional PTSD diagnosis, 72.8%of the sample experienced an incident involving a medical or nursing error in their workplace related to the treatment or care of a child, 56% experienced an incident involving a child's death or a threat to a child's life due to a serious illness or injury, and 55.5% experienced an incident of workplace bullying. In addition, it was found that having a university-level education, master's, or PhD, working in a circular shift, being assigned to a department by management rather than the worker, and dissatisfaction with salary were associated with post-traumatic stress disorder. The high rates of PTSD symptoms among participants highlight the need for prevention and management measures to protect and support the mental health of workers in pediatric departments. We propose frequent evaluations of the mental health of employees, more time for rest, incentives for professional development, utilization of their specializations and specialties, support from mental health specialists when symptoms are diagnosed, and the option for employees to change departments if they wish or if they show symptoms of mental trauma.

Displaced Distal Fibular Epiphysis in a Child: A Clinical and Radiological Evaluation of a Rare Injury Hidden From the Initial Radiological Examination.

Fractures of the lateral malleolus are common in children. Isolated lesions of the distal fibula physis commonly comprise nondisplaced or minimally displaced fractures. An isolated, completely displaced epiphysiolisthesis of the distal fibula is an extremely rare lesion. This study introduces the case of an 11-year-old boy presenting an extremely rare lesion of an isolated, completely displaced distal fibular epiphysis that was difficult to diagnose on X-ray. Initial radiographic examination of the injured ankle showed normal configuration of the tibia and fibula on AP projection, with soft tissue swelling of the lateral malleolus. On the lateral projection, the talus completely covered the distal fibular epiphysis, and particular attention was required to reveal the complete displacement of the distal fibular epiphysis. A CT scan confirmed the diagnosis of an isolated, completely displaced distal fibular epiphysiolisthesis. The patient was treated with a closed reduction and made an uneventful recovery. This report highlights the importance of accurate clinical and radiological assessment of an isolated, completely displaced, distal fibular epiphysiolisthesis.

Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism with JAK Inhibitors versus TNF Inhibitors in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.

Objective: The aim of this study was to compare the risk of major cardiovascular events (MACE) and venous thromboembolic events (VTE) between tumour necrosis factor (TNF) and Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA). Methods: We researched PubMed, Scopus, Cochrane Library, and clinicaltrials.gov until December of 2023 for randomised controlled trials (RCTs) and observational studies. The outcomes studied were MACE (stroke, heart attack, myocardial infarction, sudden cardiac death) and VTE (deep vein thrombosis, pulmonary embolism). We pooled data using random effects model. Risk for the reported outcomes was expressed as odds ratio (OR) with a 95% confidential interval (CI). We performed a subgroup analysis based on study design. Results: We identified 23 studies, 20 of which compared the odds for MACE and 14 the odds for VTE between JAK and TNF inhibitors in RA patients. Ten studies were RCTs and the rest were observational. Regarding MACE risk we pooled data from a total of 215,278 patients (52,243 were treated with JAK inhibitors, while the rest 163,035 were under TNF inhibitors). Compared with TNF inhibitors, the OR for JAK inhibitors in regards with MACE risk was 0.87 (0.64-1.17, p<0.01). Regarding VTE, a total of 176,951 patients were analysed (41,375 JAK inhibitors users and 135,576 TNF inhibitors users). The OR for VTE for JAK inhibitors compared with TNF inhibitors was 1.28 (0.89-1.84, p<0.01). Conclusion: According to our results, there is no statistically significant difference for MACE or VTE in RA patients who receive either JAK or TNF inhibitors.

Effect of Physiotherapy on Preterm Neonates and its Results on Five-Year-Old Children, According to GMFM - GMPM Evaluation Scales.

OBJECTIVE: The purpose of this study is to emphasize the necessity and possibilities of early intervention and physiotherapy rehabilitation of premature infants, as they are reflected in five-year olds according to the gross motor function measure (GMFM) and gross motor performance measure (GMPM) evaluation scales for gross function and quality of movement. In addition, the present study examined the importance of using assessment tools for children who have received or not therapeutic intervention, through which both the child's abilities and appropriateness of the help received by him/her are evaluated based on individual needs. MATERIAL AND METHODS: Our specific exploratory process was carried out through a literature review as well as a process of primary research, in order to obtain and collect all necessary information and data which would finally lead us to the nearest and best conclusions. Our goal was to collect 20 complete and graded GMFM and 20 GMPM assessment tests, so that our research was based on a satisfactory sample of participants. In the next year, the scores received by participants were recorded and analyzed using the statistical software program SPSS (Superior Performance Software System). The analysis was performed through descriptive and inductive statistical analysis in the SPSS statistical program. Specifically, the SPSS version 20.0 and specifically the one-way ANOVA variance analysis and the Tukey's parametric test were used for the statistical analysis of the results. RESULTS: The use of physiotherapy care was found to be important for premature infants, as the level of statistical significance was set at p <0.05, while the data were reported as average. The final overall scores of the evaluations (on average) were higher in the group who received early intervention and specialized physiotherapy intervention from the first day after birth. CONCLUSIONS: The effect of physiotherapy on premature infants is positive in five-year-old children, who have completed almost all their developmental stages at that age. These benefits become apparent not only in a better handling of kinetic patterns and sequences but also in the ability to execute kinetic models, conquer developmental motor stages and perform them with quality in terms of alignment, sequence, synergy of movements, separation and stability.

Thyroidectomy in children and adolescents: a systematic review.

Background: Thyroid surgery in pediatric population is not as common as that in adults, although they share the same indications, techniques and complications. This review aims to evaluate the surgical management of thyroid disease in patients under 18 years old. Methods: We conducted a bibliographic search in the international literature. Data from the identified studies such as demographics, indication for surgery, type of procedure, complications and length of hospital stay were recorded. A retrospective review study of all patients under 18 years old who underwent thyroidectomy was performed. Results: We included 37 retrospective studies and a total of 12,728 patients. Thyroidectomy was more common in female patients and the mean age was approximately 14 years old. The leading indication for surgery was benign thyroid pathology. Due to the surgical treatments' safety and effectiveness in young patients, total and subtotal thyroidectomy, whether for malignancies or benign diseases, is becoming more popular today. The most often occurring complication of pediatric thyroid surgery is hypoparathyroidism. Despite the high likelihood of recurrence of pediatric malignancies, overall survival rates of pediatric thyroid cancer are excellent. Conclusions: Thyroidectomy performed by high-volume thyroid surgeons in children and adolescents is considered an efficient and safe method of treatment of thyroid disease.

The Role of Helicobacter pylori and Metabolic Syndrome-Related Mast Cell Activation Pathologies and Their Potential Impact on Pregnancy and Neonatal Outcomes.

Helicobacter pylori infection, a significant global burden beyond the gastrointestinal tract, has long been implicated in various systemic pathologies. Rising evidence suggests that the bacterium's intricate relationship with the immune system and its potential to induce chronic inflammation impact diverse pathophysiological processes in pregnant women that may in turn affect the incidence of several adverse pregnancy and neonate outcomes. Helicobacter pylori infection, which has been linked to metabolic syndrome and other disorders by provoking pericyte dysfunction, hyperhomocysteinemia, galectin-3, atrial fibrillation, gut dysbiosis, and mast cell activation pathologies, may also contribute to adverse pregnancy and neonatal outcomes. Together with increasing our biological understanding of the individual and collective involvement of Helicobacter pylori infection-related metabolic syndrome and concurrent activation of mast cells in maternal, fetus, and neonatal health outcomes, the present narrative review may foster related research endeavors to offer novel therapeutic approaches and informed clinical practice interventions to mitigate relevant risks of this critical topic among pregnant women and their offspring.