Clinics and Practice

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to classic sicca symptoms (ocular and oral dryness). Sjogren Disease (SD) can be categorized as “primary” when occurring independently or “secondary” when accompanying another autoimmune connective tissue disorder such as rheumatoid arthritis, systemic lupus erythematosus, or systemic sclerosis. Additionally, systemic disease is common in pSD and can manifest with kidney dysfunction resulting in nephrolithiasis and distal renal tubular acidosis (dRTA). Methods: This report details a case series drawing patients from the literature as well as patients from our institution which serves to demonstrate key points in clinical hallmarks. We utilize a literature search with key words Sjogren Disease, nephrolithiasis, renal tubular acidosis, and nephrocalcinosis in addition to pSD patients with concomitant nephrolithiasis at our institution to characterize clinical and serologic findings as well as treatment modalities. Results: We find well demonstrated clinical hallmarks such as female predominance and presence of dRTA amongst the cohort of pSD patients. We also find that further research on pSD serologies could prove beneficial in risk stratifying those most likely to develop renal disease and nephrolithiasis. Furthermore, we review signs, symptoms, pathophysiology, and management of SD with added emphasis on associated renal disease including nephrolithiasis and dRTA. Conclusion: Overall, pSD associated renal disease remains an area of ongoing research and further study on patient serologies may aid clinicians in better serving and surveilling patients at risk of systemic involvement. Full article

Background: Adverse reactions to tattoo pigments are increasingly recognized, yet severe systemic complications remain rare and poorly characterized. Red tattoo ink, in particular, is associated with delayed hypersensitivity reactions, but widespread manifestations affecting multiple organ systems have not been documented. This case report aims to describe an unusual constellation of erythroderma, alopecia universalis, anhidrosis, and vitiligo triggered by red tattoo ink and to highlight the diagnostic and therapeutic challenges associated with such reactions. Case presentation: This case report describes a 36-year-old Caucasian male who developed erythroderma, alopecia, anhidrosis, and vitiligo as complications of a red ink tattoo, marking a rare and previously unreported case of such extensive reactions. Four months after getting the tattoo, the patient began to develop itchy eczematous changes, which progressed to erythroderma over several months, along with alopecia universalis and anhidrosis. Results: After months of ineffective treatment with glucocorticosteroids, cyclosporine, methotrexate, and acitretin, patch tests confirmed hypersensitivity to possible components of the red tattoo ink, prompting surgical removal of the inflamed tattoo fragments. Unfortunately, aside from resolving the erythroderma, this did not improve the patient’s clinical condition, and he developed vitiligo. Only after the complete removal of the red tattoo ink from the same series that caused the sensitization and the use of immunosuppressive and immunomodulatory drugs, including JAK inhibitors, was hair growth restored and the progression of vitiligo halted, but with no effect on anhidrosis. Conclusions: This case highlights the challenges in managing systemic reactions to tattoo ink and the importance of thorough evaluation and treatment strategies. Full article

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy. Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated to facilitate esophageal mobilization. Bronchoscopy on the first postoperative day showed no abnormalities; however, by the second postoperative day, the patient developed pneumonia and septic shock, requiring mechanical ventilation. On the fifth postoperative day, bronchoscopy revealed extensive epithelial injury extending from the trachea to both main bronchi, indicating ischemic airway damage. He was diagnosed with airway necrosis and referred to our respiratory department. Serial bronchoscopic examinations and suctioning of the sloughed epithelium were performed, and a tracheostomy enabled weaning from mechanical ventilation. By the twenty-fourth postoperative day, bronchoscopy revealed the accumulation of large, hardened secretions within the trachea, carina, and both main bronchi, resulting in airway narrowing and a high risk of asphyxiation. A silicone Y-shaped airway stent was inserted to maintain patency. Following stent placement, airway secretions progressively decreased, and the patient was discharged on the sixty-third postoperative day. The stent was removed six months later, with no recurrence of airway or respiratory complications. Conclusion: This case illustrates a rare but severe complication of extensive airway necrosis, likely caused by intraoperative bronchial artery ligation and dissection of the tracheal membranous portion. Although preservation of the bronchial arteries and meticulous surgical technique are essential preventive strategies, such complications may be unavoidable. In cases of extensive airway necrosis, airway stenting can serve as an effective therapeutic option to prevent obstruction and support recovery. Full article

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance of stem cell-based tissue engineering approaches for regeneration of periodontal bone lesions. Methods: Following PRISMA guidelines, a systematic search was conducted across multiple databases, resulting in the inclusion of 17 studies in humans that met predefined PICO criteria. The study protocol was registered on PROSPERO (CRD420251229271). These studies assessed various stem cell sources, including dental and bone marrow-derived cells among others, both on their own and in combination with scaffolds or growth factors. Results: Most studies reported favorable outcomes in terms of clinical attachment gain, radiographic bone fill, probing depth reduction, and implant stability. No major adverse effects were noted, indicating good safety. However, results varied based on cell type, culture protocols, and defect characteristics. Conclusions: Stem cell therapy shows strong potential for periodontal regeneration, with outcomes that may potentially surpass those of conventional methods in selected cases. Further standardization, cost reduction, and long-term clinical trials are essential to confirm these findings and support their integration into daily dental practice. Full article

Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that affect the incidence of UEDVT (upper extremity deep vein thrombosis). Methods: We performed a systematic search using the PubMed, EBSCO, Ovid, EMBASE, Cochrane, and Google Scholar databases. Randomized controlled trials (RCTs), prospective or retrospective cohort studies, or case–control studies were examined. We included adult patients over 18 years old undergoing elective upper limb surgery and receiving Prophylactic measures for Upper Extremity Deep Venous Thrombosis. Results: After a literature search and quality assessment, 6 studies were included. All the studies were of good quality but significantly heterogeneous in terms of sample size, population size, treatment modalities, and baseline characteristics. In these studies, the reported incidence of symptomatic venous thromboembolism (VTE) varied widely, ranging from 0.41% to 13%. However, thromboprophylaxis did not have a significant impact on the rates of deep vein thrombosis (DVT). Certain factors such as older age and trauma as the cause of surgery were identified as notable risk factors for symptomatic VTE. Conclusions: This systematic review highlights the complexity of preventing upper extremity deep vein thrombosis (UEDVT) following elective upper limb surgeries. The reported incidence of symptomatic VTE varies considerably across studies, and thromboprophylaxis was not associated with a significant reduction in its rates. The evidence is characterized by substantial heterogeneity in patient populations and surgical contexts. More research is needed to better understand the role of thromboprophylaxis in preventing DVT. Full article

The aim of this study was to evaluate the factors associated with the occurrence of oral infection sources in patients scheduled for total hip or knee arthroplasty, with the purpose of establishing standardized preoperative dental triage criteria. Materials and Methods: A retrospective research was conducted on a study group of 89 patients diagnosed with hip osteoarthritis and knee osteoarthritis at the Clinical Rehabilitation Hospital (Iasi, Romania). Patients were divided according to the status of their oral cavity: study group (n = 51)—patients with diagnosed oral infection sites (oral foci of infection); control group (n = 38)—patients without oral foci of infection. The statistical analysis included a univariate stage followed by a multivariate binary logistic regression to identify demographic and clinical factors associated with the presence of oral foci of infection. Results: The strongest predictor of the presence of oral foci of infection was and Oral Hygiene Index (OHI) scorer of 2, which increased the risk 14.583-fold, followed by being aged between 50 and 65 years (OR = 4.038), tooth brushing once a day or less (OR = 3.488), and male sex (OR = 3.433). An OHI score of 2 raises the probability of oral infectious pathology to 30.3%, which increases to 85.1% when combined with being aged between 50 and 65 years. Conclusions: The risk factors for the presence or oral foci of infection in patients scheduled for total knee or hip arthroplasty support the inclusion of the preoperative assessment and management of these factors in order to reduce the risk of the postoperative periprosthetic joint infections. Full article

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened fascia and hernia susceptibility. Aging further impairs ECM remodeling through fibroblast senescence, cross-linking deficits, and elastic fiber attrition, while oxidative stress and inflammation amplify tissue degradation and impair repair mechanisms. Evidence from clinical and experimental studies underscores the interplay between surgical technique, mesh choice, redox balance, and recurrence risk. Understanding the combined impact of aging and oxidative stress provides a mechanistic framework for targeted therapeutic and surgical strategies aimed at preventing hernia development and recurrence. Full article

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most often present with lower urinary tract symptoms (LUTS) or hematuria, though some cases are incidental findings. Associations with syndromic conditions such as Peutz–Jeghers, Beckwith–Wiedemann, Goldenhar, and Loeys–Dietz have been reported. Transurethral resection is the preferred treatment and has generally been curative. We report the first case in Germany—and the 16th worldwide—of urinary bladder hamartoma, occurring in a young adult male with bothersome LUTS. Because of its proximity to both ureteral orifices, only partial transurethral resection was performed, which provided durable symptom relief at 14 months of follow-up. This case highlights partial TUR as a pragmatic, organ-preserving alternative when complete resection is anatomically unsafe, while emphasizing that TURBT remains the standard of care. We provide a detailed discussion of the histopathological features, differential diagnosis, treatment considerations, and an updated narrative review of all reported cases. Full article

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity and inflammation, they are promising candidates for assessing skin barrier disruption in CD. Methods: Stratum corneum samples were collected by tape stripping from experimentally induced and chronic lesions, as well as healthy non-lesional skin. Biomarkers Cholesterol Sulfate (Chol-Sulf), Cholesterol Glucosyl (Chol-Glc) and their ratio were quantified. Data were analyzed using ANOVA, Pearson’s correlation, logistic regression and ROC curves. Results: Chol-Glc and the Chol-Glc/Chol-Sulf ratio differed significantly across the diagnostic groups, while Chol-Sulf did not. Logistic regression and ROC analyses revealed a limited standalone diagnostic accuracy for the individual biomarkers (all AUC < 0.6). Conclusions: Chol-Glc and the ratio exhibit disease-specific patterns relevant for subtype discrimination. Although insufficient as independent diagnostic tools, these markers may contribute to future multivariate diagnostic models for CD diagnosis. Full article

Background/Objective: Worldwide, ~45% of hypertensives remain undiagnosed, and ~26% are adequately controlled. The active involvement of all healthcare professionals in diagnosing hypertension at primary health care units (PHCUs) is linked to better blood pressure (BP) control. There is currently no research examining the potential role of senior medical students in the diagnosis of hypertension. This study aimed to evaluate the contribution of final-year medical students’ active participation in the diagnosis of hypertension. The study also examined the prevalence and control of hypertension among health service users in Greek PHCUs. Methods: This is a cross-sectional convenience sample study. During clinical placement in PHC, sixth-year medical students received systematic training and performed BP measurements, according to the guidelines, in private, well-organized spaces. Adult patients and visitors were enlisted for BP measurements. The BP readings were provided to the participants so they could discuss any concerns about their BP with their physician. Statistical analysis was performed with SPSS. Categorical variables are presented as frequencies. Continuous variables were assessed for normality and, based on their distribution, are expressed as mean ± standard deviation or median (interquartile range). Appropriate tests were performed for the comparisons across groups (chi-square for the categorical variables, and two-sample t-test or Mann–Whitney test for continuous variables). A p-value < 0.05 was considered statistically significant. Results: In the present study, 124 medical students performed BP measurements in 68 PHCUs. BP was measured in 704 individuals, aged 61 (IQR: 48.0–73.0) years old; 58.8% were female, 68.3% of whom were patients. The prevalence of hypertension was 56.7%. The control rate was 44.9% (BP < 140 and 90 mmHg among all hypertensives), and the control rate under treatment was 61.0% (BP < 140 and 90 mmHg among treated hypertensives). The involvement of medical students contributed positively, increasing the diagnosis of hypertension in individuals who might not have their BP measured in routine clinical practice. Ninety-nine newly diagnosed hypertensives were detected. Students identified 220 uncontrolled hypertensives and 112 uncontrolled under-treated patients, who were then referred to the consultant physicians. Conclusions: Students played a critical role in diagnosing hypertension and identifying newly diagnosed hypertensive patients. Embracing interprofessional care in the diagnosis and management of hypertension is essential for achieving better outcomes for our patients. Engaging medical students in BP measurements is a practical and feasible approach to improve hypertension diagnosis and control, taking into consideration the increased workload of PHC physicians. While this action has important medical education implications, the impact on the knowledge level of medical students was not evaluated. Limitations of this study include the assessment of BP in one visit without home BP measurements or a second visit, lack of follow-up of newly diagnosed hypertensives, and the low average number of BP measurements per student. Full article

Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population. Full article

Background/Objectives: Previous studies have shown that hypothyroidism with myxedema may significantly affect the vocal folds. The aim of this study was to investigate thyroid dysfunction and other possible risk factors, including smoking, for the development of Reinke’s edema (RE) in a group of men. Methods. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured in a group of men with first occurrence or recurrent RE and in age- and gender-matched control subjects without laryngeal pathology. All participants completed a questionnaire on other possible etiologic factors for the development of RE, especially smoking. Risk factors were compared between the two groups. Levels of TSH and thyroid hormones were also compared between patients with recurrent disease and those with a first occurrence of RE. Results. A total of 53 men with RE (mean age 53.82 years) and 45 controls (mean age 57.71 years) completed the study protocol. TSH and thyroid hormone levels were within the normal limits in all participants. Serum fT3 levels were significantly higher in patients with RE compared to controls (p = 0.034). After univariate analysis, all risk factors were included in a multivariate regression model. Only smoking remained a significant variable. Thyroid hormone levels did not differ between patients with first-onset RE and those with recurrent RE. Conclusions. An association between hypothyroidism and the development of RE was not confirmed. The significantly higher fT3 levels in patients compared to controls were still within the normal range and may reflect normal variation. Regression analysis of possible risk factors for RE showed the primacy of smoking. Full article

Background/Objectives: An increasing number of older individuals require general anaesthesia for major non-cardiac surgery, with 20% displaying postoperative complications. Regional cerebral oxygen saturation (rSO₂) correlates with the gold standard of mixed venous oxygen saturation, indicating global perfusion. We hypothesised that rSO₂-based anaesthesia reduces organ dysfunction and morbidity after major non-cardiac surgery. Methods: In Singapore and Toronto, we conducted a prospective, double-blind, randomised controlled trial in elderly patients undergoing major non-cardiac surgery, after obtaining research ethics board permission and informed consent. This RCT followed the CONSORT guidelines. Patients received bilateral cerebral oximetry sensors, and the control group received standard care. In the intervention group, an algorithm restored rSO₂ if it dropped 10% below baseline for >15 s by adjusting cerebral perfusion pressure, inspired oxygen concentration, end-tidal carbon dioxide, depth of anaesthesia, haemoglobin, and cardiac index. Postoperative complications and outcomes were noted. Categorical data were analysed using Chi-square or Fisher’s exact tests and continuous data using a t-test or a Mann–Whitney U test. The study was powered for 394 patients, but due to the COVID-19 pandemic and funding constraints, this study was terminated at 101 patients. Results: Of 101 patients, 49 were randomised to the control and 52 to the intervention group. A total of 31 (63%) patients in the control group and 30 (58%) in the interventional exhibited bilateral cerebral desaturation. Time of cumulative cerebral desaturation was longer in the control group (23 ± 48 min vs. 9 ± 15 min, respectively, p = 0.01). A total of 142 algorithm-based treatments were employed, restoring rSO₂ in 29 (86%) patients. Both groups displayed equal postoperative outcomes. Conclusions: In major non-cardiac surgery, cerebral desaturation is prevalent in over 85% of patients. Although algorithm-guided therapy restored rSO₂ in the majority of patients, it did not result in reduced postoperative morbidity. Full article

Background: Emergency contraception (EC), also known as postcoital contraception, is a method used to prevent an unintended pregnancy following unprotected or inadequately protected sexual intercourse. The available options include emergency contraceptive pills or the insertion of an intrauterine device (IUD). Emergency contraception pills contain either levonorgestrel (a single 1.5 mg dose, effective within 72 h) or ulipristal acetate (a single 30 mg dose, effective within 120 h), both of which are most effective when taken as soon as possible after unprotected intercourse. Another highly effective option is the insertion of a copper or levonorgestrel-releasing intrauterine device, although IUDs are not registered for EC use in all countries. The aims of this cross-sectional, comparative, observational study were to collect data on the emergency contraception methods used by adolescent girls and young women to examine their association with various factors, such as religious beliefs, and to evaluate the effectiveness of different emergency contraception methods, including hormonal options and intrauterine devices. Methods: Data were collected from 240 women who attended our Family Planning Clinic using a structured questionnaire that included items on their demographic characteristics, religious beliefs, medical history, lifestyle factors, contraceptive use and side effects, prior use of emergency contraception, method selected, and reasons for seeking emergency contraception. Descriptive statistics were used to summarize the data, comparisons between religious groups were conducted using chi-square tests, and factors related to the timing of emergency contraceptive use were investigated using multinomial logistic regression analysis. Results: Most of the reasons for emergency contraception use did not differ significantly between Christian and Muslim participants. However, Christians were significantly more likely to use emergency contraception due to missed contraceptive doses (20.9% vs. 6.7%, p = 0.004) or the failure to take a progesterone-only pill (19.1% vs. 3.3%, p = 0.001). Levonorgestrel was the most frequently used method in both groups (48.9% of Christians vs. 60% of Muslims, p = 0.132), followed by ulipristal acetate (30.9% vs. 40%, p = 0.180). Notably, 18.5% of Christian participants used an intrauterine device (IUD) for emergency contraception, while no Muslim participants reported IUD use (p < 0.001), indicating a significant difference potentially influenced by cultural or religious factors. Conclusions: Both religious and individual sociodemographic factors affect not only the choice of emergency contraception but also the urgency with which the emergency contraception is used. Interventions aimed at improving contraception education, addressing partner-related challenges, and promoting timely access could improve reproductive health outcomes. Full article

Background/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein–Barr virus (EBV)-positive NK/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. This report presents a case of an ASP-related HSR and reviews the incidence within our institutional cohort. Detailed Case Description: A 60-year-old female presented an immediate Grade 2 HSR during her second PEG-asparaginase infusion, with pruritus, vomiting, and presyncope. The infusion was discontinued, and she was subsequently transitioned to crisantaspase—an alternative formulation—which was well tolerated without further adverse events. She remains disease-free to date. A retrospective review of institutional records (2015–2025) identified six patients with NKTCL treated with ASP-containing chemotherapy. The incidence of HSRs in this cohort was 1 of 6 (16.7%). Conclusions: As in acute lymphoblastic leukemia, HSRs to asparaginase remains a major challenge in the management of NKTCL with potential implications for treatment safety and efficacy. The establishment of standardized, consensus-based criteria for the diagnosis, classification, and management of ASP-related HSRs is urgently needed to optimize patient outcomes. Full article

Objectives: The aim of our study was to assess the efficacy and safety of two different labor induction methods in patients after fetal demise beyond 28 weeks, with an unfavorable cervix: misoprostol—prostaglandin E1 analog (PGE1) and dinoprostone—prostaglandin E2 analog (PGE2). Methods: This retrospective single-center cohort study included all labor cases after fetal demise (intrauterine fetal death or termination of pregnancy with feticide) from 28 to 40 weeks of gestation, where labor was induced by either PGE1 or PGE2. The primary outcome was the induction-to-delivery time interval. Secondary outcomes included the proportion of patients who delivered within 24 h, the failed induction rate, the length of labor, pain during induction, the adverse outcome rate, and the post-labor hospital stay. Results: The induction-to-delivery time interval was shorter in the PGE1 group (p = 0.048). There was no statistically significant difference in the proportion of patients who delivered within 24 h (p = 0.651) and failed inductions (p = 0.18) between groups. The duration of labor was longer in the PGE2 group (p = 0.01). Oxytocin augmentation was more common in the PGE2 group (p < 0.001). Pain during induction was greater in women in the PGE1 group (p < 0.001). There were no statistically significant differences in adverse effects between groups. There was no significant difference in induction to delivery interval between the two methods when comparing lower and higher gestational ages (28 to 34 weeks, p = 0.18; 35 to 40 weeks, p = 0.343). Conclusions: Our findings support the use of a PGE1 regimen for third-trimester labor induction after fetal demise, when no contraindications exist. This approach appears to improve the efficiency of induction and may enhance overall patient care by reducing intervention needs. Full article

Background/Objectives: Phrenic nerve conduction (PNC) studies are essential for evaluating respiratory dysfunction and neuromuscular disorders. Despite international reference data, no normative values exist for the Mexican population. This study aimed to establish reference values for PNC latency and amplitude in healthy Mexican adults. Methods: We conducted a cross-sectional study between June 2022 and February 2023 including healthy adults (>18 years). Bilateral PNC studies were performed using surface electrodes and a 4-channel stimulation device. Latency and amplitude were recorded, and demographic and anthropometric data were collected. Results: Fifty subjects (22 women, 44%; 28 men, 56%) were enrolled. Mean latency was 6.10 ms (SD ± 1.48), and mean amplitude was 0.60 mV (SD ± 0.20). Significant differences were observed in left phrenic nerve latency between women and men (median 5.83 vs. 6.37 ms, p = 0.0348) and in amplitude between left and right phrenic nerves (0.55 vs. 0.65 mV, p = 0.0036). No significant correlations were found between latency and age or between amplitude and thoracic perimeter; however, the correlation coefficient suggests a positive relationship for both that should be confirmed in future studies with a larger sample size. Conclusions: This is the first report of PNC normative values in Mexican adults. Findings are consistent with international data and provide locally relevant reference values. Larger multicenter studies are warranted to validate and expand these results. Full article

Background/Objectives: Written discharge explanations are crucial for patient understanding and safety in emergency eye care, yet their tone and clarity vary. Large language models (LLMs, artificial intelligence systems trained to generate human-like text) can produce patient-friendly materials, but direct, blinded comparisons with clinician-written texts remain scarce. This study compared patient perceptions of a routine clinician-written discharge text and a GPT-5-generated explanation, where GPT-5 (OpenAI) is a state-of-the-art LLM, based on the same clinical facts in emergency ophthalmology. The primary objective was empathy; secondary outcomes included clarity, detail, usefulness, trust, satisfaction, and intention to follow advice. Methods: We conducted a prospective, single-blind, within-subject study in the Emergency Ophthalmology Unit of the University Hospital Centre Split, Croatia. Adults (n = 129) read two standardized texts (clinician-written vs. GPT-5-generated), presented in identical format and in randomized order under masking. Each participant rated both on Likert scales with 1–5 points. Paired comparisons used Wilcoxon signed-rank tests with effect sizes, and secondary outcomes were adjusted using the Benjamini–Hochberg false discovery rate. Results: Empathy ratings were lower for the GPT-5-generated text than for the clinician-written text (means 3.97 vs. 4.30; mean difference −0.33; 95% CI −0.44 to −0.22; p < 0.001). After correcting for multiple comparisons, no secondary outcome differed significantly between sources. Preferences were evenly split (47.8% preferred GPT-5 among those expressing a preference). Conclusions: In emergency ophthalmology, GPT-5-generated explanations approached clinician-written materials on most perceived attributes but were rated less empathic. A structured, human-in-the-loop workflow—in which LLM-generated drafts are reviewed and tailored by clinicians—appears prudent for safe, patient-centered deployment. Full article

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain limited. Objective: The objective of this study was to describe a single healthcare system’s implementation and early experience with an AI-enabled triage tool for pulmonary embolism patients across a multi-hospital network. Methods: This retrospective observational study evaluated the deployment of an AI-based clinical decision support system within a healthcare network. The AI tool detected PE and right ventricular (RV) strain and alerted the PE response team (PERT) to facilitate timely transfer and intervention. Three cohorts were evaluated: pre-AI, Year 1 post-AI, and Year 2 post-AI. Outcomes included transfer volumes, advanced therapy rates, and hospital length of stay (LOS). Results: A total of 183 PE transfer patients were analyzed: 36 pre-AI, 72 in Year 1 post-AI, and 75 in Year 2 post-AI. Transfers increased by 100% in Year 1 (p = 0.0005) and 108% in Year 2 (p = 0.011) compared to pre-AI. Catheter-based thrombectomy increased from 10 pre-AI to 18 in Year 1 (+80%, p < 0.0001) and 28 in Year 2 (+180%, p = 0.0006). After-hours diagnosis rose from 69.4% pre-AI to 70.8% in Year 1 (p = 0.027) and 77.3% in Year 2 (p = 0.088). Surgical embolectomy showed a borderline increase in Year 2 (p = 0.04), though case numbers were small. Conclusions: Implementation of an AI-assisted triage platform for PE was associated with sustained increases in interhospital transfers and advanced interventions, and a reduction in hospital length of stay. These findings support the potential for AI to standardize and expedite acute PE care in a multi-hospital health system. Full article