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Open Access March 31, 2025

Flat Foot and Its Association with Mechanical Low Back Pain: A Case-Control Study Utilizing Clarke’s Angle Measurement

Filjordan Andrisoni Imanuel Lulupoy, Tasya Meidy Pradhana, Yusak Mangara Tua Siahaan
World Journal of Clinical Medicine Research 2025, 5(1), 34-39. DOI: 10.31586/wjcmr.2025.6048
Abstract Background: Mechanical low back pain (MLBP) is a leading cause of disability worldwide, with well-established risk factors such as obesity, occupational ergonomics, and core muscle strength. However, the role of pes planus (flat foot) as a contributing factor remains underrecognized. This study aims to investigate the association between flat foot and MLBP using Clarke’s angle as an [...] Read more.
Background: Mechanical low back pain (MLBP) is a leading cause of disability worldwide, with well-established risk factors such as obesity, occupational ergonomics, and core muscle strength. However, the role of pes planus (flat foot) as a contributing factor remains underrecognized. This study aims to investigate the association between flat foot and MLBP using Clarke’s angle as an objective measure of foot posture. Methods: A case-control study was conducted in South Timor Tengah Regency, East Nusa Tenggara, Indonesia, from December 2024 to February 2025. Fifty patients diagnosed with MLBP and 50 healthy controls were enrolled. Foot type assessment was performed using Clarke’s angle, with a cutoff of ≤30° indicating flat foot. Pain severity in the LBP group was recorded using the Numerical Rating Scale (NRS). Statistical analysis was conducted using chi-square and independent t-tests, with significance set at p < 0.05. Results: Flat foot was significantly more prevalent in the LBP group (58%) than in the control group (18%) (p = 0.000; OR: 6.29, 95% CI: 2.52-15.69), indicating that individuals with flat feet are over six times more likely to experience MLBP. No significant differences were observed between the groups regarding BMI, age, or gender. Conclusion: These findings suggest that flat foot is an independent risk factor for MLBP, likely due to altered spinal biomechanics and compensatory postural changes. Clinicians should consider foot posture assessments in MLBP patients and explore targeted interventions, such as orthotic support, to mitigate symptoms.
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Open Access February 26, 2024

A Case of Early Initiation of Veno-venous Extracorporeal Membrane Oxygen in Morbid Obesity with Severe Legionella Pneumonia

Ayumu Masuoka, Masafumi Seki, Futoshi Kotajima, Ryosuke Tsuchiya, Hiroshi Ogawa, Yoshitaka Inoue, Manabu Nemoto, Masahito Kaji
Global Journal of Medical Case Reports 2024, 4(1), 9-13. DOI: 10.31586/gjmcr.2024.890
Abstract We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of [...] Read more.
We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of severe pneumonia complicated by morbid obesity, he was transferred to our hospital for further management. Upon admission, he was promptly intubated and placed on mechanical ventilation. Due to a positive urinary Legionella antigen test indicating a risk of deterioration, V-V ECMO was initiated immediately after intubation. During ECMO support, the patient received Levofloxacin Hydrate at 500 mg/day and Prednisolone Sodium Succinate at 100 mg/day. He was successfully weaned off ECMO after 12 days and transferred back to the referring hospital on day 20. While ECMO therapy for morbidly obese patients was traditionally considered relatively contraindicated, this case suggest that obesity alone is not a contraindication to initiating ECMO.
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Case Report
Open Access June 07, 2021

Long term data on obstructive sleep apnea treatment in insomnia and anxiety related disorders - importance in the post-covid19 era?

Silvia Gavliakova, Vladimira Bellova, Diana Vitazkova, Peter Bullo
Open Journal of Medical Sciences 2021, 1(1), 1-9. DOI: 10.31586/ojms.2021.010101
Abstract Patients with comorbid neurotic and anxiety disorders are more receptive of the discomfort accompanying continuous positive airway pressure therapy than average obstructive sleep apnea patients. The purpose of the study was to analyze short-term and long-term continuous positive airway pressure therapy adherence data of patients with obstructive sleep apnea and comorbid anxiety and stress-related [...] Read more.
Patients with comorbid neurotic and anxiety disorders are more receptive of the discomfort accompanying continuous positive airway pressure therapy than average obstructive sleep apnea patients. The purpose of the study was to analyze short-term and long-term continuous positive airway pressure therapy adherence data of patients with obstructive sleep apnea and comorbid anxiety and stress-related dyssomnias, as this group of disorders is expected to rise in the post-covid era. Study retrospectively analyzed clinical outcomes of obstructive sleep apnea patients. All subjects with obstructive sleep apnea were diagnosed based on in-lab video polysomnography, further referred to CPAP titration and were invited for regular follow-up visits. The results showed that subjects with comorbid obstructive sleep apnea and anxiety-related disorders used ventilation therapy more hours per day (6,690 hours/day vs. 5,000 hours/day, ****p<0,0001, anxiety (n=19) vs. controls (n=60)). Patients from the anxiety group remained longer in our therapy program (7,086 years vs. 2,905 years, ****p<0,0001) and had markedly better control over their weight, as the body-mass index of the control group increased by +1,065 kg/m2 per year and the body-mass index in the examination group increased only by +0,296 kg/m2 every year. Our data document that obstructive sleep apnea patients on ventilation therapy, who do not have enough control over their increasing body weight might highly benefit from therapy approaches similar to patients with anxiety-related dyssomnias and that management of obstructive sleep apnea is not an obstacle in concomitant treatment of neurotic and anxiety-related dyssomnias.
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Open Access May 20, 2025

Periprosthetic Joint Infections in Total Hip Arthroplasty: Diagnostic Advances, Treatment Algorithms, and Technological Innovations — A Comprehensive Review

Lauro Barbosa Neto, Gabriel Rodrigues Silva, Leandro Alves de Oliveira, Andrei Machado Viegas da Trindade, Hamilton Leão Bucar, Reuder Pereira Prado, Renner Kesley Silva Lima, Fernanda Grazielle da Silva Azevedo Nora
Global Journal of Orthopedics 2025, 1(1), 38-50. DOI: 10.31586/gjo.2025.6088
Abstract Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: [...] Read more.
Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively. Results: PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. Conclusion: Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.
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Review Article
Open Access April 03, 2025

Depression, Subjective Health, Obesity, and Multimorbidity are Associated with Epigenetic Age Acceleration

Shervin Assari, John Ashley Pallera
Journal of Biomedical and Life Sciences 2025, 5(1), 42-57. DOI: 10.31586/jbls.2025.6041
Abstract Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between [...] Read more.
Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between multiple epigenetic age acceleration measures and three key health indicators, including self-rated health, depressive symptoms, and body mass index (BMI), in a nationally representative sample of U.S. middle-aged and older adults. Methods: We analyzed data from 4,018 adults in the 2016 wave of the Health and Retirement Study (HRS), which included several epigenetic age acceleration measures: HORVATH, HANNUM, LEVINE, HORVATHSKIN, LIN, WEIDNER, VIDALBRALO, YANG, ZHANG, BOCKLANDT, GARAGNANI, and GRIMAGE. Linear regression models were used to assess the associations between epigenetic age acceleration and self-rated health (poor health), depressive symptoms, and BMI, adjusting for age and sex. Results: We found significant positive associations between epigenetic age acceleration and worse self-rated health, higher depressive symptoms, and increased BMI. However, these associations varied across different epigenetic clocks, with some measures potentially having more consistent utility for specific health outcomes than others. Conclusion: Epigenetic age acceleration is linked to poorer self-rated health, greater depressive symptoms, and higher BMI, but choosing which epigenetic clock(s) to use is also important. These findings underscore the need to consider multiple epigenetic aging markers when assessing health risks and highlight the potential for particular clocks to serve as more sensitive indicators of physical and mental health outcomes.
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Article
Open Access February 17, 2025

Gender Differences in the Association Between Socioeconomic Status and Cardiometabolic Health: National Health and Nutrition Examination Survey

Shervin Assari, Hossein Zare
Global Journal of Cardiovascular Diseases 2025, 4(1), 50-58. DOI: 10.31586/gjcd.2025.1198
Abstract Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the [...] Read more.
Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. Results: Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. Conclusion: The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.
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Open Access November 21, 2024

Diminished Returns of Educational Attainment on Body Mass Index Among Latino Populations: Insights from UAS Data

Shervin Assari, Hossein Zare
Global Journal of Epidemiology and Infectious Disease 2024, 4(1), 92-104. DOI: 10.31586/gjeid.2024.1096
Abstract Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: [...] Read more.
Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: This study examines whether the association between educational attainment and BMI is weaker among Latino individuals compared to non-Latino individuals, in line with the MDRs framework. Methods: Data were drawn from the 2014 wave of the Understanding America Study (UAS), a nationally representative internet-based panel. Body mass index (BMI) was the outcome of interest. Linear regression models were used to analyze the association between educational attainment and BMI, with an interaction term for ethnicity to explore differences in the relationship between Latino and non-Latino people. Models were adjusted for age, sex, marital status, and labor market participation and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower BMI for both Latino and non-Latino participants (p < 0.001). However, the interaction between educational attainment and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller reductions in BMI because of higher education compared to non-Latino people. Conclusion: This study provides evidence of diminished returns from educational attainment on BMI among Latino individuals. These findings support the MDRs framework, suggesting that structural barriers may limit the health benefits of education for Latino populations. While education is a key determinant of physical and mental health, its benefits are not equitably distributed across ethnic groups. Structural inequalities, chronic stress, poor neighborhood environments, and adverse educational and occupational conditions likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote health equity for Latino populations.
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Open Access November 14, 2024

When Common Becomes Normal: Weaker Association Between Neighborhood Stress and Body Mass Index Among Black Adolescents Compared to White Adolescents

Shervin Assari, Hossein Zare
Global Journal of Cardiovascular Diseases 2024, 3(1), 1-12. DOI: 10.31586/gjcd.2024.1121
Abstract Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress [...] Read more.
Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. Results: A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. Conclusions: The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.
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Open Access December 25, 2021

Contributions of Physical Activity in Individuals with a Diagnosis of Depression: A Literature Review

Herick de Paula, Elena Marie Peixoto Ruthes, Lucca Arbigaus Gritten, Antonio Beira de Andrade Junior
Open Journal of Psychology 2021, 1(1), 32-39. DOI: 10.31586/ojp.2021.191
Abstract This study is a literature review with a qualitative approach. It is justified by the significant increase in diseases acquired through lifestyle habits that generate health risks, which impair and are responsible for decreasing longevity and decreasing quality of life, such as hypertension, depression, obesity and respiratory tract diseases. Physical activity is recognized as a protective factor [...] Read more.
This study is a literature review with a qualitative approach. It is justified by the significant increase in diseases acquired through lifestyle habits that generate health risks, which impair and are responsible for decreasing longevity and decreasing quality of life, such as hypertension, depression, obesity and respiratory tract diseases. Physical activity is recognized as a protective factor for health, and its benefits are associated with the reduction of chronic diseases and a decrease in the risk of premature death from diseases related to a sedentary lifestyle. The objective of this research is to search and identify, within the scientific literature, if there are in fact contributions from the practice of physical activity in subjects diagnosed with depression. For the categorization of studies and selection of materials, the following keywords were determined: physical exercise and depression and physical activity and depression. As inclusion criteria for data analysis and interpretation, the following were considered: articles in Portuguese, full texts, published in health journals, between the years 2005 to 2015. As exclusion criteria, we considered articles found by descriptors that did not contain one or more of the inclusion criteria. In this study, articles were selected by searching the Scientific Electronic Library Online (SciELO) and Lilacs. The choice of these databases was prioritized due to the quality and reliability of the materials available, and their easy access. 77 articles were found, of which 4 were selected to be part of this research. It can be noted that physical activity showed positive aspects and possible contributions and can be considered as a bias in an adjunct to conventional pharmacological treatments. The need for further clarification about the disease in relation to psychological, social and physiological issues is also evident, thus opening the possibility for further studies and research on the subject, so that in this way they can guide possible interventions that help in the treatment of the depression.
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Review Article

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