Medicina

Background and Objectives: Diabetes mellitus is frequently encountered in critically ill patients and is associated with increased short-term mortality. However, the biological and clinical determinants of mortality within the diabetic intensive care unit (ICU) population remain incompletely understood. This study aimed to evaluate laboratory parameters at ICU admission and key early ICU course variables, including acute complications and organ support interventions, associated with short-term ICU mortality in critically ill patients with diabetes mellitus. Materials and Methods: We conducted a retrospective observational cohort study including adult patients with diabetes mellitus admitted to a tertiary care ICU between January and December 2024. Demographic data, laboratory parameters at ICU admission, acute complications, and ICU interventions were collected. Patients were stratified according to ICU outcome (survivors vs. non-survivors). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of ICU mortality. Model performance was assessed using the area under the receiver operating characteristic curve (AUC/ROC), Hosmer–Lemeshow test, and Brier score. Results: A total of 443 critically ill patients with diabetes mellitus were included, of whom 239 (54.0%) died during ICU hospitalization. Non-survivors exhibited higher admission blood glucose, lactate levels, and serum creatinine, as well as lower lymphocyte counts compared to survivors. Acute complications, including sepsis, acute kidney injury, and acute respiratory failure, were significantly more frequent among non-survivors. In multivariate analysis, admission lactate levels (OR = 1.02 per mg/dL increase), mechanical ventilation (OR = 47.30), and hemodialysis (OR = 3.38) remained independently associated with ICU mortality. The predictive model demonstrated good discrimination (AUC = 0.87) and adequate calibration. Conclusions: Critically ill patients with diabetes mellitus who do not survive ICU hospitalization present with early metabolic stress, immune dysregulation, and organ dysfunction. Admission lactate levels and the need for advanced organ support are key predictors of short-term mortality, supporting their role in risk stratification within the diabetic ICU population.

Background and Objectives: Chronic tinnitus in patients with bilateral sensorineural hearing loss (SNHL) is frequently linked to psychological distress and affective temperament traits. This study examined audiological characteristics, psychological profiles, and their interrelations in adults with tinnitus. Materials and Methods: In this cross-sectional single-centre study, 38 adults with chronic tinnitus and bilateral SNHL underwent otoscopy, tympanometry, and pure-tone audiometry. Participants were classified into two audiometric groups: high-frequency gently sloping (N = 19) and ski-slope hearing loss (N = 19). The audiological and psychological assessment included the THI, TFI, TEMPS-A, and STAXI-2. Groups were compared using non-parametric statistics (Mann–Whitney U, Chi-square). Relationships between anger and psychological variables were examined using Spearman correlations. Results: Females were more frequently represented in the gently sloping group (p = 0.044) and showed greater quality-of-life impairment (p = 0.045) and lower hyperthymic scores (p = 0.004). Patients with gently sloping loss had longer tinnitus duration (p = 0.026), while cyclothymic temperament was higher in the ski-slope group (p = 0.013). THI scores differed significantly between audiometric groups (p = 0.011). State and trait anger were strongly associated with several affective temperaments, and sleep disturbance correlated with both anger and anxious temperament. THI correlated positively with anxious temperament and sleep impairment. Conclusions: Audiometric phenotype, affective temperament, and anger-related traits are closely intertwined with tinnitus severity and its psychological burden. These findings support the need for multidisciplinary assessment in the management of tinnitus.

Tetanus, a disease caused by the neurotoxin-producing bacteria Clostridium tetani (C. tetani), remains a serious threat, particularly among individuals who are unvaccinated or under-vaccinated. Although public health guidelines in the United States continue to recommend a well-established, multi-dose vaccination schedule to prevent tetanus, recent revisions to the Centers for Disease Control and Prevention webpage language on vaccine safety prompted renewed public discussion. Despite this, extensive evidence continues to demonstrate the effectiveness and safety of tetanus immunization, and certain demographic groups remain disproportionately at risk. Globally and within the United States, natural disaster zones remain especially high-risk environments for tetanus infection. This review examines the pathophysiology of tetanus, current vaccination recommendations, and the social and geographic inequities that influence vaccine uptake. It also evaluates strategies of protection and prevention. Particular emphasis is placed on tetanus risk in disaster settings, where disrupted infrastructure, greater likelihood of contaminated wounds, and preexisting disparities in vaccination coverage compound vulnerability. A clearer understanding of these factors is essential for strengthening public health preparedness and ensuring equitable protection against tetanus, especially for populations disproportionately affected by disasters.