דו״ח מאומת

The rapid rise in smartphone use has raised growing concern about its impact on ocular health. This narrative review explores current evidence on the visual consequences of prolonged smartphone exposure focusing on tear film instability, blink pattern alterations, accommodative stress, and intraocular pressure changes. Digital eye strain, increasingly prevalent across all age groups, presents with symptoms including dryness, visual fatigue, burning, and blurred vision. Reduced blink rate and incomplete blinking during screen use contribute to tear film instability and evaporative dry eye. Studies have documented decreased tear breakup time and increased ocular discomfort following even brief periods of smartphone use. In pediatric populations, prolonged screen exposure correlates with myopic progression. Diagnostic challenges arise due to temporary symptom amplification following recent device use warranting standardized preassessment protocols. Evidence-based interventions include blink training, screen time limitation, ergonomic modifications, and use of preservative-free lubricants. Blue light filters and nutritional supplements offer variable benefit with limited clinical validation. This review highlights the need for increased awareness and well-designed longitudinal studies to inform the diagnosis and management of smartphone-related ocular changes.…

PMID: 41288623

<b>Background</b>: Carbon dioxide (CO₂) is traditionally regarded as a metabolic by-product; however, growing evidence indicates that it plays an active regulatory role across multiple physiological systems. Acute hypercapnia elicits respiratory, cardiovascular, metabolic, immune, and neurocognitive responses, some of which may transiently influence exercise performance. This narrative review summarizes current evidence on CO₂ inhalation in healthy individuals and critically evaluates whether controlled hypercapnia may serve as a targeted stimulus in sport and exercise contexts. <b>Methods</b>: A narrative review of peer-reviewed English-language articles indexed in PubMed and Web of Science was conducted. A narrative approach was chosen due to the marked heterogeneity of study designs, hypercapnia-induction methods (e.g., CO₂ inhalation, voluntary hypoventilation, increased respiratory dead space), participant characteristics, and outcome measures, which precluded systematic synthesis. The review focused on studies involving healthy or physically active individuals and examined acute or short-term hypercapnic exposure. No strict publication date limits were applied. Studies conducted exclusively in clinical populations were excluded. <b>Results</b>: Short-term, controlled hypercapnia reliably increases ventilation, sympathetic activation, cerebral and muscular blood flow, and metabolic stress. Certain hypercapnia-based interventions-such as voluntary hypoventilation or added respiratory dead space-may enhance buffering capacity, reduce lactate accumulation and improve maximal oxygen uptake (VO₂max) during submaximal efforts and repeated-sprint performance during high-intensity, short-duration exercise. However, CO₂ inhalation frequently induces dyspnea, anxiety, and cognitive disruption, and higher concentrations pose clear safety risks. Current evidence does not support long-term improvements in VO₂max or long-duration endurance performance following hypercapnia-based interventions. <b>Conclusions</b>: Controlled, intermittent hypercapnia may provide a targeted metabolic and ventilatory stimulus that enhances tolerance to high-intensity exercise, yet its application remains experimental and context-dependent. The risks associated with CO₂ inhalation in healthy individuals currently outweigh its potential benefits, and safe, effective training protocols have not been fully established. Further research is needed to clarify the mechanisms, long-term adaptations, and practical utility of hypercapnia-based training strategies.…

PMID: 41517613

Healthy aging is a crucial goal in aging societies of the western world, with various lifestyle strategies being employed to achieve it. Among these strategies, hydrotherapy stands out for its potential to promote cardiovascular and mental health. Cold water therapy, a hydrotherapy technique, has emerged as a lifestyle strategy with the potential capacity to evoke a wide array of health benefits. This review aims to synthesize the extensive body of research surrounding cold water therapy and its beneficial effects on various health systems as well as the underlying biological mechanisms driving these benefits. We conducted a search for interventional and observational cohort studies from MEDLINE and EMBASE up to July 2024. Deliberate exposure of the body to cold water results in distinct physiological responses that may be linked to several health benefits. Evidence, primarily from small interventional studies, suggests that cold water therapy positively impacts cardiometabolic risk factors, stimulates brown adipose tissue and promotes energy expenditure-potentially reducing the risk of cardiometabolic diseases. It also triggers the release of stress hormones, catecholamines and endorphins, enhancing alertness and elevating mood, which may alleviate mental health conditions. Cold water therapy also reduces inflammation, boosts the immune system, promotes sleep and enhances recovery following exercise. The optimal duration and temperature needed to derive maximal benefits is uncertain but current evidence suggests that short-term exposure and lower temperatures may be more beneficial. Overall, cold water therapy presents a potential lifestyle strategy to enhancing physical and mental well-being, promoting healthy aging and extending the healthspan, but definitive interventional evidence is warranted.…

PMID: 39078461

It has been 10-years since the publication of Rhinosinusitis: evidence and experience, and since then a lot has changed in our understanding of the disease. Advances in pathophysiology, endotyping and new treatments such as biologics brought a new era in the management of our patients. This new guideline, developed jointly by ABR and ABORL-CCF, with the help of ASBAI presents an updated, evidence-based approach to the different forms of rhinosinusitis that aims to improve the diagnosis and treatment of this complex disease. The document covers a wide range of topics, including clear definitions of the different stages of acute sinusitis. It also introduces a new term called Prolonged Acute Viral Rhinosinusitis. Reviews phenotypes and endotypes of chronic rhinosinusitis, recommending methods for clinical and laboratory investigation, clinical and surgical treatment. We also discuss in detail fungal sinusitis and pediatric sinusitis. The objective of this updated Consensus is to clarify some already established and recent concepts, highlighting the importance of an accurate diagnosis to promote treatment approaches that reflect the best practices based on solid evidence. Therefore, we seek not only to improve the results of patients care, but also to guide thealth professionals through a clinical panorama that is in constant transformation.…

PMID: 40398368

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.…

PMID: 39388827

Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction. To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop. This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians. Our primary outcome measure was change in HRV from baseline during three mindfulness exercises. The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise. Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.…

PMID: 39466161

There exists a need for new methods to address treatment anxiety in pediatrics-at the same time, deep breathing exercises and virtual natural environments have both been known to have stress-reducing qualities. This article reports the combined effect of these two methods in a pediatric setting. A feasibility study was conducted in a local hospital. The study had a within-subjects design, and it included 21 child patients aged 8 to 12 years old, who used a virtual reality (VR) relaxation application developed for this purpose during an intravenous cannulation procedure related to their treatment. The key findings highlight a statistically very significant stress reduction associated with the utilized VR intervention, demonstrated by heart rate variability measurements (SDNN,…

PMID: 38132030

Mounting evidence suggests that the long-term effects of trauma and adversity are rooted not only in psychological distress, but in persistent dysregulation of the body's stress response and its associated neuroendocrine systems. This physiological dysregulation has emerged as a critical contributor to health outcomes, yet remains under-addressed in conventional clinical care. Emotional states are integrated with core physiological functions through dynamic, bidirectional autonomic signaling between the heart, lungs, brainstem, limbic system, and higher cortical areas. This interconnected network enables conscious regulation of breathing, heart rhythms and emotions to influence autonomic and higher cortical functions. Research has demonstrated that heart rhythm patterns become more ordered during HeartMath's…

PMID: 41445965

Pranayama, yogic breathing techniques, are considered a form of meditation. In classical yoga, the breath is associated with prana; thus, pranayama is a means to control the inner force, the prana shakti or life energy. Pranayama is more than regular breathing and if practiced in structured and methodical manner can reduce the body's physical symptoms of stress and anxiety. It has more recently gained popularity in the western world because of the many health benefits that come from a pranayama practice. Anxiety disorders are among the most common mental health conditions, affecting millions worldwide. Anxiety is an emotional state in which one perceives worry, danger, apprehension, and nervousness and has negative effects on all aspects such as social, personal, and academic performance. It is closely linked with autonomic nervous system dysregulation, often reflected in decreased heart rate variability (HRV), a biomarker of vagal tone and emotional and psychological resilience. HRV reflects the balance between sympathetic and parasympathetic nervous activities. Nonpharmacological approaches such as yogic breathing techniques have shown promising approaches in reducing anxiety symptoms. The modulation of HRV through slow breathing, often characterized by a prolonged expiratory phase, enhances vagal tone, restores sympathovagal balance, and promotes homeostasis. Research indicates that yoga interventions positively impact individuals with mental health disorders, improving positive symptoms and quality of life and reducing milder symptoms. This review explores the therapeutic potential of slow pranayama in reducing anxiety symptoms and managing anxiety disorders. It examines current evidence, limitations, and future research directions for integrating yoga-based practices into mental health care.…

PMID: 41624663