Clin. Pract., Volume 16, Issue 3 (March 2026) – 19 articles

Background: Low cardiac output syndrome (LCOS) is a significant cause of postoperative morbidity and mortality in children with congenital heart disease. Prophylactic levosimendan is increasingly used to prevent LCOS, but its superiority to other strategies remains unproven. Based on the pharmacokinetics of levosimendan, we hypothesize that preoperative administration is beneficial for preventing LCOS in a specifically at-risk population. Methods: This is a retrospective single-center cohort study in a tertiary pediatric intensive care unit. All patients under one year of age undergoing surgery for congenital heart disease using cardiopulmonary bypass and receiving levosimendan within 24 h before or after surgery were included and classified into two groups: preoperative and postoperative administration. Results: Overall, 107 patients were included. Fifty-three patients (49.5%) received levosimendan before surgery, with significantly lower mortality, fewer LCOS markers, and lower LCOS scores compared to patients receiving levosimendan after surgery. Although not significant, the use of extracorporeal membrane oxygenation, renal replacement therapy, and temperature control was also lower in the preoperative group. There was no difference in mechanical ventilation duration and length of stay. Conclusions: Preoperative administration of levosimendan seems associated with a lower incidence of LCOS and reduced mortality in high-risk children with congenital heart surgery. Full article

Background/Objectives: More than 50% of adult women experience at least one urinary tract infection (UTI) during their lifetime, and approximately 25% develop recurrent UTIs (rUTIs), defined as ≥2 episodes within six months. Management of rUTI is challenging and often requires long-term, multimodal preventive strategies. Escherichia coli Nissle 1917 (EcN) is a non-pathogenic probiotic strain with demonstrated antagonistic activity against pathogenic enterobacteria. This study evaluated the efficacy and safety of EcN in preventing symptomatic recurrences in premenopausal women with rUTI. Methods: In this prospective observational study, 40 premenopausal women with rUTI were enrolled. Twenty patients received EcN prophylaxis (twice daily for four weeks, followed by once daily for eight weeks), while 20 patients received no prophylaxis and served as controls. Patients were followed for six months (three months of treatment and three months post-treatment). The primary outcome was the frequency of symptomatic rUTI episodes during follow-up. Results: Forty patients were analyzed (20 EcN; 20 controls). During the six-month observation period, 55% (11/20) of patients in the EcN group remained UTI-free compared with 35% (7/20) in the control group. Two patients (10%) in the EcN group experienced a single recurrence versus three (15%) in the control group. Recurrent episodes (≥2 UTIs) occurred in 35% (7/20) of EcN-treated patients compared with 50% (10/20) of controls. Overall, EcN prophylaxis was associated with a lower proportion of patients experiencing multiple recurrences. Conclusions: Prophylaxis with E. coli Nissle 1917 was associated with a reduced rate of recurrent UTIs compared with no prophylaxis in premenopausal women, supporting its potential role as a non-antibiotic preventive strategy in rUTI management. Full article

Introduction: Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. Methods: This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20–25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Results: Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3–T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Conclusions: Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population. Full article

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women’s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA/SUFU/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach. Full article

Background/Objectives: The ocular surface is continuously exposed to microorganisms, and disruption of host–microbial balance may lead to infection or postoperative complications. Increasing antimicrobial resistance and biofilm formation have highlighted the need for alternative or complementary non-antibiotic strategies to control ocular surface microbial burden. Liposomal ozonated oil eyedrops have demonstrated antimicrobial and antibiofilm activity in preclinical and preliminary clinical studies. The aim of this study was to evaluate changes in ocular surface microbiological culture results before and after treatment with liposomal ozonated oil eyedrops in a real-world clinical setting. Methods: This was a prospective, observational, real-world pre–post study including 101 eyes from 101 patients undergoing ocular surface microbiological sampling in routine clinical practice. Two samples were obtained per patient: Sample I immediately before treatment and Sample II at the routine follow-up visit after short-course treatment with liposomal ozonated oil eyedrops (1 drop, four times daily, for 4 days). The interval between samples ranged from 3 to 5 days (median 3 days). Microbiological cultures were classified as positive or showing no growth. Paired changes in culture positivity were analyzed using McNemar’s exact test. Results: At baseline, 87 of 101 samples (86.1%) yielded positive cultures, while 14 (13.9%) showed no growth. Following treatment, culture positivity decreased to 11 of 101 samples (10.9%), with 90 samples (89.1%) showing no growth. Among baseline-positive samples, microbiological clearance was observed in 76 cases (87.4%). No cases converted from culture-negative to culture-positive at follow-up. The reduction in culture positivity after treatment was statistically significant (McNemar’s exact test, p < 0.001). Recent antibiotic exposure within 14 days prior to baseline sampling was reported in 8 patients (7.9%). Persistent positive cultures were observed in a minority of cases and were mainly associated with common ocular surface pathogens. Conclusions: In routine clinical practice, short-term treatment with liposomal ozonated oil eyedrops was associated with a significant reduction in ocular surface culture positivity over a short follow-up interval. Full article

Background: Delirium is a frequent and serious complication in elderly patients with hip fractures and is associated with adverse outcomes. Early identification requires a brief and reliable screening tool suitable for routine clinical practice. The 4 ‘A’s Test (4AT) is a rapid instrument for delirium detection that requires minimal training. Objective: To translate, culturally adapt, and validate the Greek version of the 4AT in elderly patients with hip fractures. Methods: A total of 103 patients aged ≥65 years who were admitted with hip fracture were enrolled. The 4AT was translated using a forward–backward translation process and culturally adapted according to established guidelines. Delirium diagnosis was established using DSM-5 criteria by trained clinicians, serving as the reference standard. The 4AT was administered independently within 3 h. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). The optimal cut-off was determined using Youden’s index. Results: At a cut-off score ≥4, the Greek 4AT demonstrated a sensitivity of 87.5% and specificity of 91.1%, with PPV 75% and NPV 96%. The AUC was 0.94, indicating excellent diagnostic performance. Conclusions: The Greek version of the 4AT is a valid and reliable screening tool for detecting delirium in elderly patients with hip fractures. Full article

Background and Aims: Chronic liver diseases (CLD) represent a significant healthcare burden, mostly due to late diagnosis and numerous co-morbidities. We evaluated the effect of co-morbidities, cirrhosis, and disease etiology on hospitalization duration. Methods: Hospitalizations due to alcohol-related, viral, autoimmune, and overlapping liver disease in Belgrade, Serbia (2016–2022), were identified using pre-defined discharge codes. We investigated the hospitalization trend descriptively by plotting the relative mean change in the hospitalization length against time. Assuming the covariate relationship in the directed acyclic graph, we estimated the direct causal effect of the diagnosis type on the length of stay (LOS) by fitting pre-specified Bayesian distributional lognormal models based on domain knowledge. We conducted a post hoc analysis of the impact of cirrhosis on LOS per primary diagnosis. Results: The empirical data show a decrease in the estimated average LOS (8.25–5.51 days). For the same period, the median LOS decreased (4 days (IQR 0–12) to 1 day (IQR 1–7)). In 2021, the share of short-term hospitalizations rose to 46.94%, while the median long-term hospitalization peaked at 11.5 days (IQR 7–21). The expected LOS was the highest for the primary diagnosis of autoimmune liver disease (15.89, 95% CI [14.74, 17.2] days), followed by alcohol-related liver disease (14.22, 95% CI [13.68, 14.79] days). The largest impact of cirrhosis on LOS was observed among patients hospitalized due to viral disease (4.19, 95% CI [2.29, 6.33] days). Conclusions: The presence of co-morbidities and cirrhosis significantly affects LOS. In order to provide better treatment and reduce healthcare costs, there is the need to detect liver disease at earlier stages and better manage its associated co-morbidities. Full article

Background/Objectives: Gambling disorder (GD) is a behavioral addiction characterized by persistent and repetitive gambling behaviors that cause significant psychological distress and functional impairment. Increasing evidence indicates that difficulties in emotion regulation are a key factor in the development and persistence of GD. This systematic review aimed to summarize and critically evaluate the existing literature on the relationship between emotion regulation strategies and gambling disorder, with a specific focus on studies using the Emotion Regulation Questionnaire (ERQ) and the Cognitive Emotion Regulation Questionnaire (CERQ). Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Systematic searches were performed in PubMed and Scopus databases for studies published between 25 October 2015 and 25 October 2025. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and JBI Checklist for Randomized Controlled Trials. Data extraction and synthesis were performed manually by two independent reviewers. Eligible studies included adult participants (≥18 years) diagnosed with gambling disorder or pathological gambling and using the ERQ or CERQ to assess emotion regulation. Results: Nine studies met the inclusion criteria, comprising a total of 607 patients with GD. Across studies, individuals with GD consistently showed reduced cognitive reappraisal, greater expressive suppression, and higher use of maladaptive cognitive strategies such as rumination, catastrophizing, and self-blame. All studies identified impulsivity, emotion dysregulation, alexithymia, or gambling-related cognitive distortions as significant predictors of gambling severity. Neuroimaging evidence from one study further revealed altered activation of frontal regions during negative emotion regulation. Conclusions: This review highlights the central role of emotion regulation in GD. However, the limited available ERQ/CERQ studies in GD were mostly cross-sectional, limiting causal inferences. Second, samples were predominantly male, reducing generalizability to women. Finally, only one study used neurobiological measures, hindering integration of self-report and neural data. These findings emphasize the importance of integrating emotion regulation-based interventions within therapeutic programs for gambling disorder, with ERQ and CERQ being useful tools to assess the pathology. Full article

Introduction: Clinical diagnosis of chronic heart failure (HF) in ambulatory patients can be difficult. Echocardiography is the most widespread diagnostic imaging technique, although the usefulness of the global longitudinal strain (GLS) of the left ventricle (LV) in this clinical setting is less clear. Methods: We performed a cross-sectional study of stable outpatients and GLS was obtained with an automatic software that uses the three apical planes of the LV. We analyzed the improvement of the diagnostic capacity of including GLS above all the clinical and echocardiographic parameters using reclassification indexes. Results: We included 1362 patients, including 12.9% with HF who presented lower values of ejection fraction (EF) and GLS and worse diastolic function. Most patients (92.8%) with HF had a GLS < −14 as compared to patients without HF (36.1%). LV EF (OR: 0.93) and GLS (OR: 1.27 CI 95% 1.20–1.35) were associated with the presence of HF. The AUC was significantly higher (p < 0.001) in the logistic model that included GLS vs. without GLS, and the reclassification index for GLS was 19.8%. GLS was more affected in patients with HFpEF vs. controls as well as diastolic function parameters. The logistic regression model only identified age (OR: 1.07 95% CI 1.02–1.06) and GLS (OR: 1.29 95% CI 1.21–1.38) as independently associated with the presence of HFpEF. The AUC of the model for the presence of HFpEF with GLS was significantly higher (p < 0.01). The reclassification index for GLS was 38.8%. Conclusions: LV GLS assessment increased the diagnostic discrimination of chronic HF in stable patients. Full article

Background: Dental radiographs are essential for diagnosis and treatment planning in modern dentistry. However, their manual interpretation is time-consuming and subject to variability, highlighting the need for automated tools to improve efficiency and consistency. This study aims to validate ORTHOSEG, a deep learning-based system designed to automate the segmentation of anatomical, pathological, and non-pathological elements in radiographs, including orthopantomograms, bitewings, and periapical images. Methods: ORTHOSEG’s performance was evaluated using a rigorously curated dataset of 150 dental radiographs, including 50 orthopantomograms, 50 bitewings, and 50 periapical images, with manual annotations by expert clinicians serving as the ground truth. The system’s segmentation performance was assessed using standard evaluation metrics, including mean Dice Similarity Coefficient (mDSC) and mean Intersection over Union (mIoU), and inference time was also recorded. Results: The system achieved high accuracy, with mDSC and mIoU values of 0.635 ± 0.233 and 0.576 ± 0.214, respectively. In particular for orthopantomograms, it achieved an mDSC of 0.756 ± 0.174 and an mIoU of 0.684 ± 0.172, surpassing existing benchmarks. Its segmentation capabilities extend to approximately 70 distinct elements, underscoring its comprehensive utility. The system demonstrated efficient computational performance, with processing times of 19.745 ± 3.625 s for orthopantomograms, 8.467 ± 0.903 s for bitewings, and 5.653 ± 0.897 s for periapical radiographs on standard clinical hardware. Conclusions: ORTHOSEG demonstrates efficiency suitable for integration into routine workflows. This study confirms ORTHOSEG’s reliability and potential to improve diagnostic workflows, offering clinicians a valuable tool for faster and more detailed radiograph analysis. Future research will focus on extending validation across diverse clinical scenarios to ensure broader applicability. However, this study has limitations, including the use of a dataset derived from a European population and the absence of usability and clinical workflow evaluation, which should be addressed in future studies. Full article

Background/Objectives: Permanent cardiac pacemakers (PPMs) are small electronic implanted devices that regulate cardiac rhythm. Measurement of quality of life (QoL) serves as a powerful tool for gaining in-depth insights into pacing therapy and ultimately guiding patient-centered management strategies. The aim of the present study was to evaluate factors affecting QoL among PPM patients by applying the two generic questionnaires: SF-36 and EQ-5D-5L. Materials and Methods: A total of 120 patients with PPM were enrolled. QoL data were collected through interviews using the 36-Item Short Form Health Survey (SF-36) and the Euro QoL 5-Dimensions 5-Levels Health Questionnaire (EQ-5D-5L). Patients’ characteristics were also recorded. Results: The majority of participants were male (54.2%), retired (83.3%) residents in urban areas (75.5%), had a DDD pacemaker (82.5%), had rate response programmed on (77.5%), and had comorbidities (83.3%). Regarding QoL measured by SF-36, the Physical Component Summary Score (PCS) was significantly associated with programming rate response in their pacemaker (p = 0.046), comorbidities (p = 0.047), and the NYHA functional class (p = 0.047). The Mental Component Summary Score (MCS) was significantly associated with sex (p = 0.034), place of residence (p = 0.003), NYHA functional class (p = 0.001), and patients’ level of information about the device (p = 0.039). Patients’ QoL, as measured by the EQ-5D-5L, was significantly associated with sex (p = 0.001), age (p = 0.019), occupation (p = 0.040), pacing mode (p = 0.034), comorbidities (p = 0.019), NYHA functional class (p = 0.047), and level of information about the device (p = 0.005). Conclusions: NYHA functional class, comorbidities, and level of information as reported by patients were the factors associated with QoL, as shown by the two scales. All three factors guide a personalized care plan since NYHA class shows the burden of disease, comorbidities add to the complexity, and patient information determines the effectiveness of management. Full article

Introduction: Falls and subsequent fractures represent a major public health concern among older adults. While fall prevention interventions have demonstrated efficacy in reducing falls, their impact on fracture outcomes remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple databases up to 7 June 2025 for studies investigating fall prevention interventions and fracture outcomes in community-dwelling older adults. A primary outcome was hip fractures; secondary outcomes included any fractures, falls, and serious fall injuries. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, using random-effects meta-analysis where appropriate. Results: Seventeen studies were included, spanning over 25,000 participants. Interventions included exercise programs, multifactorial approaches, medication optimization, and vitamin D supplementation. For hip fractures, only two randomized controlled trials (RCTs) reported extractable outcome data (12,489 participants; 132 events); both showed non-significant reductions favoring intervention (RR 0.80–0.87), precluding pooled meta-analysis. For any fractures, five studies (18,519 participants; 1343 events) demonstrated no significant effect (RR 0.91, 95% CI 0.72–1.14; p-value = 0.40) with significant heterogeneity (I² = 65%). Fall prevention interventions significantly reduced falls across 14 studies. GRADE assessment indicated very low certainty for both hip fractures and any fractures due to limited studies, inconsistency, and imprecision. Conclusions: Current evidence suggests fall prevention interventions may reduce hip fractures but do not significantly prevent fractures overall. Despite consistent fall reduction, the translation to fracture prevention remains uncertain, highlighting the need for integrated interventions targeting both fall risk and bone health. Full article

Objectives: This systematic review evaluated enamel surface alterations and residual composite following the removal of clear aligner attachments, with particular emphasis on the influence of removal techniques, instrument selection, operator experience, and the use of magnification on enamel preservation and cleaning efficiency. Methods: A comprehensive electronic search was performed in PubMed, Scopus, Embase, Web of Science, and Scielo up to October 2025. In vitro, ex vivo, and clinical studies assessing enamel loss, residual composite, surface roughness, or removal time after clear aligner attachment removal were included. Study selection, data extraction, and methodological assessment followed the PRISMA 2020 guidelines and Cochrane Handbook recommendations. Risk of bias was evaluated using a modified Joanna Briggs Institute checklist for laboratory-based studies. Due to substantial methodological heterogeneity, a narrative synthesis was conducted. Results: Of 656 identified records, three in vitro/ex vivo studies were assessed for eligibility. Reported enamel loss ranged from approximately 15 µm to more than 50 µm, depending on the removal protocol and visualization conditions. Residual composite covered approximately 20–40% of the treated enamel surface. Multi-step protocols combining tungsten carbide burs with silicone polishers under magnification demonstrated the most favorable balance between composite removal efficiency and enamel preservation. Fiberglass burs were associated with smoother enamel surfaces but increased enamel loss, whereas one-step polishing systems (OneGloss, Enhance, SM104) resulted in reduced surface roughness and shorter procedural time. The use of magnification loupes (≥2.5×) consistently improved removal precision and reduced residual composite. Meta-analysis was not feasible due to heterogeneity in outcome measures and testing methodologies. Overall risk of bias was deemed acceptable. Conclusions: Based on the limited number of available in vitro/ex vivo studies, removal of clear aligner attachments appears to be associated with measurable enamel loss and residual composite, largely influenced by the instruments and visualization aids used. Sequential carbide–silicone polishing protocols performed under magnification appear promising based on limited in vitro/ex vivo evidence, demonstrating a favorable balance between composite removal and enamel preservation under controlled laboratory conditions. However, given the scarcity of evidence and absence of clinical trials, these findings cannot be directly extrapolated to routine clinical practice. Further well-designed studies are required before definitive clinical recommendations can be established. Full article

Background: Australian guidelines recommend conducting thyroid function tests (TFTs) before commencing amiodarone and every six months subsequently. This study sought to investigate thyroid monitoring in Australian general practice patients with atrial fibrillation (AF) who commenced amiodarone. Methods: We performed a retrospective observational analysis using a nationwide primary care dataset to examine whether TFTs were conducted according to guidelines following amiodarone initiation in euthyroid patients aged 18 years or older with AF. Secondary outcomes included the prevalence of amiodarone-induced thyroid dysfunction (AITD) and the identification of factors associated with its development. Results: In total, 12,932 patients with AF were included. Of these, 1306 (10.1%) had commenced long-term amiodarone. Two hundred twenty-six (17.3%) of the patients commenced on amiodarone did not have any recorded TFT results during an 18-month follow-up period. During follow-up, 18.1% and 4.4% of patients developed hypothyroidism in the amiodarone-treated and amiodarone-untreated groups, respectively (p < 0.0001). The corresponding values for hyperthyroidism were 7.3% and 2.5% in the amiodarone-treated and amiodarone-untreated groups, respectively (p < 0.0001). In the subset of patients commenced on amiodarone, after controlling for the number of TFTs within the follow-up, the risk factors independently associated with the development of hypothyroidism were baseline thyroid stimulating hormone (TSH) level (adjusted odds ratio/AOR: 3.80 (95% confidence interval: 3.00–4.82)) and the comorbidities heart failure (AOR: 1.64 (1.09–2.46)) and chronic kidney disease (AOR: 2.29 (1.26–4.18)). Baseline TSH (AOR: 0.43 (0.28–0.63)) was significantly associated with the development of hyperthyroidism in patients taking amiodarone. Conclusions: AITD was relatively common, occurring in one-quarter of patients within 18 months of initiation of amiodarone. Increased awareness is required amongst both clinicians and patients of the need for regular thyroid monitoring during therapy with amiodarone. Full article

Background/Objectives: Cardiovascular diseases represent a considerable burden on healthcare systems. In coronary intensive care units (CICU), nursing staff play a key role in the care of critically ill patients. Nursing diagnoses (NDs) based on the NANDA-I (North American Nursing Diagnosis Association-International) taxonomy enable the identification of human responses to various clinical conditions. However, their association with adverse outcomes, such as in-hospital mortality, remains understudied. Therefore, we evaluated the association between NDs and in-hospital mortality in patients with cardiac disease. Methods: A retrospective cohort study was conducted in a tertiary care hospital. The paper clinical records of 195 patients admitted to the CICU for at least 48 h between January 2023 and March 2025 were reviewed. The association of interest was assessed using Poisson regression models adjusted for confounding variables. Results: Mortality was 24.1%. NDs focusing on cardiac and extracardiac responses, such as fluid volume excess (risk ratio [RR] = 2.67; 95% confidence interval [CI] = 1.23, 5.76), impaired cardiac output (RR = 1.84; 95% CI = 1.50, 2.25), risk of shock (RR = 3.12; 95% CI = 1.91, 5.11), risk for impaired cardiovascular function (RR = 2.01; 95% CI = 1.28, 3.17), and impaired gas exchange (RR = 2.67; 95% CI = 1.64, 4.34) were significant predictors of mortality. In contrast, diagnoses such as anxiety (RR = 0.46; 95% CI = 0.23, 0.91), impaired psychological comfort (RR = 0.31; 95% CI = 0.09, 0.95), and risk of unstable glycemia (RR = 0.46; 95% CI = 0.23, 0.91) were associated with a lower risk of death. Conclusions: NDs are independently associated with in-hospital mortality in critically ill patients with cardiac disease and may represent useful clinical markers for risk stratification in intensive care settings. Full article

Background: During the first wave of the COVID-19 pandemic, the importance of the recognition of vulnerable workers was well-established, but the specific impact of the timing of their recognition remains less understood. Objective: This study evaluates the impact of early recognition of vulnerable healthcare workers (VHCWs) and identifies factors associated with SARS-CoV-2 infection. Methods: We performed a retrospective cohort study at the Virgen Macarena University Hospital (HUVM) in Seville and included employees classified as VHCWs between January 2020 and December 2021. All data, including demographic, occupational, and clinical data, were collected from occupational health records and the Andalusian digital health system. The incidence of COVID-19 was analyzed using descriptive, bivariate statistics, and Cox regression. Results: A total of 471 VHCWs were included. Most of the VHCWs were women (79.8%) with a median age of 50 years. The most common vulnerability criteria were pregnancy (32.9%) and age > 60 (28.7%). During the study period, 58 VHCWs (12.3%) were diagnosed with COVID-19, compared to 18.35% of the general workforce. Recognition of VHCW status after the pandemic was declared was strongly associated with higher infection risk (HR = 48.84; 95% CI: 26.21–90.99; p < 0.001). Conclusions: The timing of vulnerability recognition emerged as the most critical protective factor in this cohort. Healthcare workers whose vulnerability was not proactively identified before the pandemic onset faced a substantially higher risk of infection (HR = 44.68; 95% CI: 26.21–90.99; p < 0.001) compared to those recognized early. These findings underscore that pre-pandemic identification facilitated the immediate implementation of task adaptations and workplace restrictions, effectively mitigating high-risk exposure during the most critical early stages of the crisis. Full article

Background: In recent years, aesthetic medicine and cosmetic surgery have seen significant growth, reflecting changing sociocultural views on beauty and self-care; however, public knowledge and awareness of associated risks remain inconsistent. This study aimed to assess knowledge, attitudes, and behaviours toward aesthetic medicine and cosmetic surgery in a large metropolitan population in Southern Italy using the Knowledge–Attitude–Practice (KAP) framework. Methods: A cross-sectional survey was conducted between June 2021 and January 2022 among 1079 adults aged 18–72 years residing in the metropolitan area of Naples. A structured questionnaire collected socio-demographic data and assessed knowledge, attitudes, and behaviours related to surgical and non-surgical aesthetic procedures. Descriptive statistics and multiple linear regression analyses were performed to identify predictors of knowledge, attitudes, and behaviours. Results: Overall, 66.8% of participants reported having undergone general beauty treatments, while 9.8% declared the use of cosmetic medicine procedures. A total of 5.1% had undergone botulinum toxin treatments, 11% reported filler injections, and 9.8% had experienced plastic surgery. A majority had strong knowledge, especially on non-surgical procedures, but there were gaps in their knowledge on side effects, regulations, age limits, and qualifications. Most viewed appearance as important, though with critical views of excessive aesthetic treatments and claimed limited social media influence. Female sex and parental status were positively associated with aesthetic behaviours, while attitudes emerged as the strongest predictor of engagement. Conclusions: Aesthetic practices are widely accepted within this urban population, yet important informational deficiencies persist. Targeted educational interventions based on the KAP framework are warranted to enhance health literacy, promote safe decision-making, and foster realistic expectations regarding aesthetic medicine and cosmetic surgery. Full article

Objectives: To evaluate the impact of non-invasive imaging techniques such as dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to monitor the efficacy of risankizumab on plaque psoriasis of the legs by analyzing morpho-histological changes. Materials and Methods: Multicentre, real-world retrospective study involving 37 adults with moderate-to-severe plaque psoriasis. Assessments performed during routine visits at baseline, Week 4 and Week 12 included clinical response, dermoscopy, RCM and OCT. Results: Thirty-seven patients were included (mean age 52.1 years; 54% male; mean BMI 27.0 kg/m²). Dermoscopy showed progressive vascular normalization: at Week 12, 94.29% of lesions had minimal or no vascular pattern. White and yellow scales decreased significantly. On RCM, dilated vessels, inflammatory infiltrate, and papillomatosis progressively normalized. OCT showed reduction in epidermal and stratum corneum thickness and a decline in vascular intensity at multiple depths. Baseline haemorrhagic dots predicted early complete response: 44.8% of lesions with dots achieved complete clearance at Week 4 versus 0% without. Conclusions: Risankizumab induced rapid, significant regression of psoriatic changes, normalizing vascular patterns and skin architecture and reducing epidermal thickness. Findings support its efficacy and rapid onset of action in difficult-to-treat areas and highlight the value of non-invasive imaging for monitoring. Full article

Background/Objectives: Inflammatory bowel disease (IBD) is associated with significant morbidity worldwide. While global epidemiological trends are well-documented, data on the clinical and demographic characteristics of IBD patients in Saudi Arabia remain limited. This study aimed to evaluate the distribution of multimorbidity among IBD patients in a tertiary Saudi hospital and assess associated clinical features and outcomes. Methods: A retrospective cross-sectional study of IBD patients treated at the National Guard Hospital over a seven-year period was conducted. Data on demographics, body mass indices (BMIs), hospitalizations, comorbidities, complications, and surgical interventions were extracted from medical records. Associations between categorical and continuous variables were analyzed using chi-square and t-tests, respectively, with significance being set to p < 0.05. Results: A total of 465 patients were included: 54.6% had Crohn’s disease (CD) and 45.4% had ulcerative colitis (UC). CD predominated in males (60.6%), while UC was more common in females (55.5%, p = 0.001). BMI distribution differed significantly between groups (p = 0.004). Hospital admission rates and length of stay were higher among CD patients (p = 0.032). CD patients experienced greater complication rates, including fistulas (41.3% vs. 7.1%, p < 0.001) and strictures (26.1% vs. 1.4%, p < 0.001). Surgical interventions such as fistulotomy (4.3% vs. 0.5%, p = 0.009) and stricturoplasty (9.1% vs. 1.9%, p = 0.001) were more frequent in patients with CD. Conclusions: This study characterizes IBD patients in Saudi Arabia, highlighting gender differences, BMI variations, and the greater severity of CD compared with UC. The higher rates of complications and surgical interventions among CD patients emphasize the need for tailored management strategies. Future prospective studies are warranted to investigate disease progression and optimize care for this population. Full article