Journal of Clinical Medicine

Background/Objectives: Acute mesenteric ischemia (AMI) is a time-dependent condition associated with exceptionally high in-hospital mortality, particularly among elderly and comorbid patients. Early identification of patients at high risk of death remains challenging and has important implications for clinical decision-making. The objective of this study was to derive and internally validate a prognostic score for in-hospital mortality of patients with AMI. Materials and Methods: We conducted a multicenter, observational, retrospective cohort study including patients with AMI from 10 participating hospitals. A descriptive and analytical approach was performed. A Classification and Regression Tree (CART) model was used to determine cut-off points for continuous variables and assess their association with mortality. Based on these thresholds, a univariate analysis was performed, and variables with statistical significance (p < 0.05) were incorporated into a multivariate logistic regression model. A score—the RADIAL score—was then derived from the beta coefficients. The discriminative ability of the score was evaluated using the receiver operating characteristic (ROC) curve. Results: A total of 693 patients were studied. Thee mean age was 81 years (IQR 73–86) and 54.2% were women. A history of cardiovascular disease was present in 75.3% of participants. Overall mortality was 62.4%. Most patients (74%) were managed conservatively. Significant variables in the bivariate analysis included hypotension, age > 65 years, pH < 7.3, creatinine > 1.7 mg/dL, and absence of rectal bleeding. These variables were incorporated into the multivariate model. The resulting score showed an area under the ROC curve of 0.78 (95% CI: 0.74–0.82). Conclusions: The RADIAL score demonstrated robust predictive performance and allowed the identification of three mortality-risk groups: 30–40% (low), 50–60% (intermediate), and 80% (high). This tool may support clinical decision-making in the management of patients with AMI.

Background/Objectives: Our objective was to assess the role of clinical and continuous glucose monitoring (CGM) parameters in predicting the risk of hypoglycemia in pediatric patients with type 1 diabetes. Methods: Pediatric patients with type 1 diabetes (n = 71) at the Oradea County Clinical Emergency Hospital, Romania, who underwent CGM during their initial visit and were followed for at least 6 months with in-clinic visits every 3 months were enrolled in this study. Age, body mass index, time in range, the mean daily glucose (MDG) concentration, and the coefficient of variation (%CV) were considered as potential predictors of the risk of hypoglycemia, which was defined as the percentage of time spent below two glycemic thresholds of 3.9 and 3.0 mmol/L, corresponding to mild and clinically significant hypoglycemia, respectively. Results: Among a total of 142 glycemic profiles, the MDG concentration was significantly lower in those with hypoglycemia compared to those without, whereas %CV was significantly higher (p < 0.0001). Regression tree models identified %CV as the dominant variable for both thresholds, whereas classification tree models identified %CV as the dominant variable for clinically significant hypoglycemia and MDG for mild hypoglycemia. In profiles with a %CV of less than 36.15% and an MDG concentration greater than 7.16 mmol/L, the mean percentage of time spent below the 3.9 mmol/L threshold was 4.8%, which is close to that recommended by the American Diabetes Association guidelines. Patients younger than 7 years presented the highest frequency for both mild and clinically significant hypoglycemic episodes. Conclusions: Our study supports %CV and the MDG concentration as key factors in predicting hypoglycemia risk. Minimizing the risk of hypoglycemia in pediatric patients requires a %CV of less than 36%.

Objectives: To systematically review and quantitatively synthesize lipid layer thickness (LLT) measurements in soft contact lens (CL) wearers obtained in the presence and absence of contact lenses in situ. Methods: A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted in accordance with PRISMA guidelines. Six studies meeting predefined inclusion criteria were included. Pooled mean LLT values were calculated using fixed-effects models, with heterogeneity, sensitivity analyses, and publication bias assessed. Results: In the absence of contact lenses, pooled LLT data from 86 healthy CL wearers yielded a mean LLT of 62.11 nm (95% CI: 47.33–76.90 nm). In the presence of contact lenses, pooled data from 330 subjects demonstrated a mean LLT of 69.52 nm (95% CI: 56.33–82.70 nm). Although LLT values were numerically higher with contact lens wear, the substantial overlap of confidence intervals indicated no consistent or statistically demonstrable difference between conditions. Conclusions: This meta-analysis provides the first quantitative synthesis of LLT in CL wearers and highlights the need for standardized methodologies to clarify the clinical relevance of LLT in contact lens-related tear film assessment.