Search Results (4,892)

Background: Acute ischemic stroke (AIS) induces a severity of inflammatory response that varies depending on the individual and may depend on the type of reperfusion treatment used. The aim of this study was to compare values of inflammatory response indices between AIS patients treated with endovascular mechanical thrombectomy (EMT) only and those in whom EMT was preceded by intravenous thrombolysis (IVT). Patients and methods: Retrospective analysis of medical documentation of 2242 consecutive, real-world patients hospitalized in one center due to AIS between 1 January 2014 and 31 May 2025. Several single and composite inflammatory indices were analyzed. Results: Patients who underwent double reperfusion treatment (IVT + EMT) (n = 1201; 53.57%) had lower C-reactive protein (CRP)-to-albumin, CRP-to-lymphocyte, CRP-to-neutrophil, and CRP-to-platelet ratios; lower platelet-to-lymphocyte, platelet-to-albumin, and platelet-to-hemoglobin ratios; and a lower inflammatory burden and systemic inflammatory index than those who were treated only with EMT (n = 1041; 46.43%). Compared to patients treated only with EMT, those treated with IVT + EMT also had a shorter length of in-hospital stay, were less likely to be readmitted within 14 days of discharge, and were more likely to achieve a modified Rankin score of 0–1 at discharge. Conclusions: Patients with AIS treated with IVT + EMT may exert a lower inflammatory magnitude of response and better functional status at discharge than those treated with EMT only. Biomarkers of inflammatory response to AIS require further study to confirm their usefulness in AIS patients’ management and personalized qualification for reperfusion and non-reperfusion targeted treatment. Full article

Background: Massive pulmonary hemorrhage is a life-threatening complication of pulmonary endarterectomy (PEA) with limited evidence to guide standardized management. Methods: We retrospectively evaluated consecutive PEA procedures performed at a high-volume center and analyzed the incidence, perioperative characteristics, management strategies, and early outcomes of patients who developed massive pulmonary hemorrhage. Results: Among 1123 patients who underwent PEA, massive pulmonary hemorrhage occurred in 51 (4.54%) and developed intraoperatively after completion of PEA and separation from total circulatory arrest. Primary suturing achieved hemostasis in 12 patients (23.5%), and bronchial isolation was applied in 18 (35.3%). Local adjuncts included intraoperative bronchial clamping in 1 patient (2.0%) and biological glue occlusion in 2 (3.9%). Extracorporeal membrane oxygenation (ECMO) was required in 25 patients (49.0%), initiated intraoperatively in 22 and postoperatively in 3. Overall in-hospital mortality was 41.2%, while 30 patients (58.8%) survived to hospital discharge; among survivors, mean hospital length of stay was 16.1 ± 6.8 days. Conclusions: Massive pulmonary hemorrhage after PEA remains associated with substantial early mortality and resource utilization; a stepwise institutional algorithm combining bronchoscopy-guided localization, targeted airway/surgical control, and timely ECMO support may help standardize management in this critical setting. Full article

Background: The Canada Health Act (CHA), enacted in 1984, guarantees universal access to medically necessary care, yet inequities in hospital use persist. Acute length of stay (ALOS) is a key indicator of hospital efficiency, patient recovery, and healthcare system performance, with prolonged stays linked to higher costs, avoidable infections, and strain on acute care capacity. Understanding patterns in ALOS is critical not only for hospital management but also for public health, as extended stays can limit timely access to care and exacerbate population-level health inequities. Objective: This study examines social, geographic, and clinical gradients in ALOS and investigates whether the effects of admission urgency vary by sex, neighbourhood income, and rural–urban residence within a universal healthcare system. Methods: Using 2024–2025 hospital discharge data from the Canadian Institute for Health Information, this study examined ALOS as a function of comorbidity, sex, socioeconomic status, rural–urban residence (geography), and admission type (urgent versus elective). Interaction effects between admission urgency and key social and geographic variables were evaluated to assess subgroup differences in ALOS. Results: Disparities in ALOS were evident. Older age, male sex, urgent admission, and greater comorbidity were associated with longer stays, whereas higher neighbourhood income and urban residence were linked to shorter stays. Interaction analyses revealed substantial heterogeneity: compared with elective rural admissions, urgent urban admissions had 30.4% longer ALOS. Urgent admissions also amplified socioeconomic and sex-based differences, with male patients experiencing 27.9% longer stays than females. Conclusions: From a public health perspective, these findings highlight how system capacity constraints and social inequities jointly shape hospital use. Reducing avoidable variation in ALOS will require policies that strengthen acute care surge capacity, improve coordination for urgent admissions, and address upstream socioeconomic and geographic barriers to care, thereby promoting more equitable and efficient hospital services. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Objective: The aim of this case series was to investigate the safety and efficacy of vancomycin–gentamicin embedded PMMA beads (VGPB) in the setting of acute pyogenic soft tissue infections (STIs) of the extremities. Materials and Methods: A retrospective study of 19 cases diagnosed with pyogenic STIs of the lower or upper extremity in two academic institutions was conducted between January 2017 and December 2023. All patients underwent surgical debridement, systemic antibiotics and intrawound deposition of vancomycin and gentamicin embedded cement beads (2 g of vancomycin plus 1 g of gentamicin diluted in 40 g of PMMA). Upon second look (4th–7th day post-index surgery) the cement beads were removed, serum samples from the surgical site of infection and from peripheral blood were obtained and the concentration of eluted vancomycin and gentamicin was measured. Furthermore, the white blood cell count (WBC), C reactive protein serum levels (CRP) and erythrocyte sedimentation rate (ESR) were measured before the surgical debridement and after the end of the bead therapy. All patients were reevaluated after discharge with a mean follow-up of 4.4 years (range, 1 to 7.6). Results: Wound vancomycin and gentamicin levels were significantly higher than those measured in the serum (34.01 ± 4.47 μg/mL versus 11.96 ± 2.79 μg/mL, p < 0.001 and 5.75 ± 1.22 μg/mL versus 0.51 ± 0.14 μg/mL, p < 0.001 respectively). Serum vancomycin and gentamicin concentrations were below the level of toxicity and no adverse events related to antibiotic-embedded bead treatment were documented. Serum WBC, ESR and CRP levels before debridement (13,446 ± 935.7 c/μL, 42.3 ± 18.7 mm/h and 113.9 ± 20.26 mg/L respectively) were significantly higher than those after the end of treatment (7889 ± 1203.6 c/μL, p < 0.001; 30.3 ± 9.14 mm/h, p = 0.017; and 22.7 ± 6.68 mg/L, p < 0.001 respectively). Two cases (10.5%) had a local recurrence of their STIs. Both of them relapsed within 4 months after their treatment and both had Gram-negative pathogens. Conclusions: Vancomycin–gentamicin PMMA bead pouch therapy appears to be a safe and effective adjuvant treatment for pyogenic soft tissue infections, offering high local antibiotic availability without systemic adverse effects. Full article

Background/Objectives: Congestion is a hallmark of heart failure (HF) and a major determinant of outcomes. Non-invasive tools enable detection of subclinical congestion, but their correlation and prognostic relevance remain incompletely defined. The present study aimed to assess the prevalence, evolution, interrelationships, and prognostic impact of clinical and subclinical congestion markers in patients hospitalized for HF. Methods: This single-centre, prospective cohort study included adults admitted with HF who underwent serial evaluations at admission, 72 h, pre-discharge, early outpatient follow-up and at 6 months. Clinical congestion was assessed using a standardized physical examination score. Subclinical congestion was evaluated using lung ultrasound (LUS), Venous Excess Ultrasound Score (VExUS), and Remote Dielectric Sensing (ReDS). Patients were classified according to the presence of clinical and/or subclinical congestion at discharge. The primary endpoint was a composite of all-cause mortality, HF readmission, or unscheduled visits requiring intravenous diuretics within six months. Results: Ninety-four patients (mean age 74 ± 11 years, 68% male) were included. While clinical congestion improved significantly during hospitalization, approximately 30% of patients remained clinically congested at discharge. Among clinically euvolemic patients, only 47% showed no evidence of subclinical congestion. Correlations between congestion markers were weak to moderate, suggesting complementary pathophysiological information. At discharge, pulmonary B-lines were the strongest predictor of the composite endpoint (hazard ratio [HR] 3.50, 95% CI 1.41–8.72), followed by clinical congestion (HR 2.67, 95% CI 1.13–6.30). Patients with clinical and subclinical congestion exhibited lower event-free survival. Conclusions: Subclinical congestion is common despite apparent clinical euvolemia and is associated with worse outcomes. Integrating clinical assessment with non-invasive congestion markers may improve post-discharge risk stratification in HF. Full article

Background and Objectives: Hip fracture surgery is considered a major operation due to the risk of complications and increased mortality. COVID-19 is a newly recognized risk factor for increased mortality in regard to various diseases. Materials and Methods: The aim of this retrospective observational study, conducted from January 2018 to April 2022, was to analyze mortality among rehabilitation ward patients after surgical treatment of acetabular or femoral fractures in both the COVID-19 and pre-COVID-19 periods. The association between mortality and age, gender, comorbidity status, and number of complications during hospital stay was also examined. Results: Higher mortality was observed in the COVID-19-period group during all analyzed periods: cumulative three-year mortality was 2.3 times higher (14.2% vs. 6.2%, p = 0.013); two-year mortality was 3.7 times higher (9.2% vs. 2.5%, p = 0.005); and first-year mortality was 8.3 times higher (5.0% vs. 0.6%, p = 0.006). The Charlson Comorbidity Index (CCI) and admission during the COVID-19 period were strong predictors of mortality, while the number of complications, age, and gender did not significantly influence the mortality rate. An increase of one point in CCI resulted in a 42% increase in the likelihood of mortality, while hospitalization during the COVID-19 period was associated with an odds ratio of 2.44 for death compared to the pre-COVID-19 period (p = 0.013, 95% CI [1.19, 4.94]). Conclusions: The excess mortality may be attributed to the COVID-19 pandemic because the groups were comparable in all other aspects (Barthel index, CCI, complications, age, and gender). Additional five-year mortality data will be useful for analyzing mortality dynamics, as pre-COVID-19 patients will enter the COVID-19 period and COVID-19 patients will enter the post-COVID-19 period. Full article

Background/Objectives: Secondary prevention after a first acute myocardial infarction (AMI) is crucial to reduce complications and improve long-term outcomes. Persistent gender inequalities in cardiovascular care suggest differences in post-AMI healthcare pathways between men and women. Understanding these trajectories could guide post-discharge clinical management, secondary prevention, and follow-up after acute myocardial infarction. This study aimed to describe healthcare pathways following a first AMI and explore gender inequalities within these trajectories. Methods: We conducted an observational, population-based study using real-world data (RWD) from the CARhES cohort. A total of 4298 individuals discharged alive after a first AMI between 2017 and 2022 were included. Healthcare trajectories during the 90 days following discharge were reconstructed across primary and specialised care, emergency services, and hospital admissions, and stratified by sex and the occurrence of clinical outcomes. Results: Post-AMI care pathways were highly heterogeneous. Although general practitioners often served as the first point of contact, most trajectories began in emergency departments. Patients with clinical outcomes showed higher healthcare utilisation. Women accessed primary care more frequently, whereas men showed greater use of specialised services and higher readmission rates, patterns that may reflect differences in follow-up strategies and clinical management during the early post-discharge period. Despite this variability, overall trajectories showed no significant sex-based differences. Conclusions: Post-AMI care pathways are complex and variable, with gender differences in patterns of service use. Women more often accessed scheduled care, while men relied more on emergency services. These findings highlight the need for gender-sensitive post-discharge follow-up to guide clinicians in secondary prevention strategies for AMI. Full article

Wireless medical sensor networks (WMSNs) enable continuous patient monitoring by transmitting sensitive physiological data over open wireless links. Given the resource-constrained nature and large-scale deployment of such networks, authentication mechanisms must be both lightweight and privacy-preserving. Moreover, due to the frequent turnover of patients and devices in hospital environments, timely member revocation is crucial to prevent discharged or compromised entities from injecting forged reports that could mislead medical diagnosis. Although existing pairing-free certificateless aggregate authentication schemes are efficient, they often suffer from critical security and privacy vulnerabilities. Recently, an efficient certificateless authentication scheme with revocation has been proposed. However, our analysis reveals that the scheme presents the following security vulnerabilities: (i) member witnesses can be recovered from public information, (ii) revocation checks can be bypassed via identity grafting attack, and (iii) user identities can be linked due to the long-term use of static pseudonyms. To address these issues, we propose a security-enhanced certificateless aggregate authentication protocol with revocation for WMSNs. Our design enforces strong identity–membership binding to resist grafting attacks, employs a non-interactive zero-knowledge membership proof to preserve witness secrecy, and adopts dynamic pseudonym rotation to achieve unlinkability. We provide formal security proofs and comprehensive performance comparisons. The results indicate that, at the same security level, our protocol achieves more efficient signature verification while maintaining communication overhead comparable to existing schemes. In addition, the overhead introduced by our revocation mechanism remains constant, making it well suited for large-scale WMSNs deployments with frequent membership changes. Full article

Background: Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating neurological condition, with patients presenting with poor-grade aSAH having a particularly limited potential for recovery. Data on outcome trajectories after microsurgical clipping in this subgroup are scarce. The objective of this study was to analyze the functional outcomes in patients with poor-grade aSAH treated with microsurgical clipping, and to identify clinical factors associated with recovery. Methods: This retrospective study included 38 patients (median age 55 years; 60.5% female) with World Federation of Neurosurgical Societies (WFNS) grades 4–5, who underwent microsurgical clipping at a single tertiary care centre between 2016 and 2023. Functional outcome was assessed using the modified Rankin Scale (mRS) at hospital discharge and 6 months follow-up, and functional outcome was analyzed in relation to clinical variables (delayed cerebral ischemia (DCI), intracerebral hemorrhage (ICH), initial seizures, the need for decompressive craniectomy) using correlation and group comparison analyses. Results: The indication for microsurgical clipping was primarily driven by the need for ICH evacuation (50%) or by aneurysm configuration (47.5%). Microsurgical aneurysm clipping was performed on the day of hemorrhage in 25 patients (65.8%), with 16 patients (42.1%) undergoing immediate surgery following direct transfer from the emergency department to the operating theatre. ICH was present in 60.5% and IVH in 92.1%. Decompressive craniectomy was performed in 42.1%. DCI occurred in 21.6% of patients. In-hospital mortality was 15.8%, increasing to 22.6% at 6 months follow-up. Good functional outcome (mRS 0–2) was observed in 10.5% of patients at discharge and improved to 25.8% at 6 months. At hospital discharge, higher mRS scores were associated with the need for immediate aneurysm repair (p = 0.04), primary decompressive craniectomy (p = 0.02), and DCI (p = 0.006). Primary decompressive craniectomy (p = 0.04), reflecting greater disease severity, and DCI (p = 0.002) remained associated with worse functional outcome at 6 months. Conclusions: In poor-grade aSAH patients undergoing microsurgical clipping, mortality remains substantial; however, functional recovery may extend beyond hospital discharge. The need for immediate surgical intervention and primary decompressive craniectomy likely reflects a particularly severe hemorrhagic burden in patients and is associated with worse early functional outcomes, whereas DCI remains an important factor in overall functional recovery. Full article

Background/Objectives: Hepatitis E virus (HEV) infection is an increasingly recognized cause of acute hepatitis in Europe, but short-term in-hospital laboratory dynamics remain insufficiently described in hospitalized cohorts. We aimed to characterize admission biochemical abnormalities and paired admission-to-discharge laboratory changes in hospitalized patients with acute hepatitis E from Craiova, Romania, with exploratory sex- and age-stratified analyses. Methods: We conducted a single-center retrospective observational study including 40 consecutive hospitalized patients with acute hepatitis E during 2024–2025. Admission and discharge laboratory values were compared at the within-patient level, and exploratory subgroup analyses by sex and age class were performed. Given the limited sample size, multivariable analyses were restricted to parsimonious age-adjusted models for selected endpoints. Results: The cohort comprised 22 females (55%) and 18 males (45%), with a mean age of 53.05 ± 21.44 years; two in-hospital deaths occurred. At admission, marked transaminase elevation and frequent hyperbilirubinemia were observed, with 70% of patients having total bilirubin ≥ 2 mg/dL and 40% ≥ 10 mg/dL. During hospitalization, ALT and AST declined markedly, whereas total and direct bilirubin improved more modestly, indicating slower resolution of jaundice/cholestatic abnormalities. Platelets increased, while prothrombin index changes were heterogeneous. Male patients had higher bilirubin values at admission and discharge and more frequent clinically relevant hyperbilirubinemia thresholds; however, these findings should be interpreted cautiously given the small sample size, the retrospective design, and the absence of standardized clinical confounders and mechanistic data. Exploratory age-stratified analyses did not identify robust differences after multiplicity control. Conclusions: In hospitalized hepatitis E, hepatocellular injury markers improved rapidly during hospitalization, whereas cholestatic abnormalities resolved more slowly and often remained clinically relevant at discharge. The observed sex-related cholestatic pattern should be considered exploratory and requires confirmation in larger studies with standardized clinical covariates and longer follow-up. These findings support closer monitoring of bilirubin trajectories at discharge, particularly in male patients, and highlight the need for integrating laboratory dynamics into short-term clinical assessment of hospitalized HEV cases. Full article

We report the case of a 69-year-old Hispanic female with end-stage renal disease (ESRD) on hemodialysis and a complex medical history who presented with acute altered mental status shortly after initiating valacyclovir at a non-renally adjusted dose. The patient was admitted to inpatient services and treated with a presumptive diagnosis of valacyclovir-associated neurotoxicity (VAN). The patient received hemodialysis for three consecutive days, resulting in neurologic improvement. Additional competing causes of altered mental status and encephalopathy were investigated and ruled out over the course of a five-day hospitalization. The patient was subsequently discharged with a diagnosis of VAN. This case underscores the importance of proper renal dose adjustment and medication safety in patients with ESRD to prevent serious, avoidable adverse drug events. Full article

Background: Comorbidities are common among stroke survivors and may substantially influence functional recovery during rehabilitation; therefore, in this study, we aimed to evaluate the impact of individual comorbidities on functional outcomes in stroke patients after inpatient rehabilitation. Methods: In this retrospective cohort study, we included 289 patients with first-ever ischemic or hemorrhagic stroke who had undergone inpatient rehabilitation and assessed functional outcomes using the Barthel Index (BI), gait speed, Berg Balance Scale (BBS), and Action Research Arm Test (ARAT) at admission, after three weeks, and at discharge. The impact of selected comorbidities, including hypertension, diabetes mellitus, depression, cardiomyopathy, peripheral arterial disease, hyperlipidemia, and atrial fibrillation, was analyzed using multivariable logistic regression. Results: Significant improvements were observed across all functional measures (p < 0.0001). Diabetes mellitus and depression were independently associated with poorer improvement in BI, while reduced improvement in gait speed was associated with higher National Institutes of Health Stroke Scale (NIHSS) score, older age, female sex, cardiomyopathy, atrial fibrillation, and depression. Cardiomyopathy was also associated with reduced balance improvement measured by BBS, while vascular comorbidities were linked to less favorable upper limb recovery. Conclusions: Inpatient rehabilitation leads to significant functional recovery after stroke; however, specific comorbidities adversely affect rehabilitation outcomes. Targeted assessment and management of metabolic, cardiovascular, and psychological comorbidities may enhance functional recovery in stroke patients. Full article

Background: Determining the optimal duration of extracorporeal cardiopulmonary resuscitation (ECPR) remains challenging, as patient outcomes may vary significantly based on individual characteristics. We aimed to establish critical time thresholds for achieving favorable neurological outcomes with ECPR across different risk groups, potentially providing more tailored guidance for clinical decision-making. Methods: This single-center retrospective study screened 279 adult patients who received ECPR between 2013 and 2020. Through multivariate analysis of various clinical parameters, we developed a pragmatic bedside risk stratification framework to identify groups with different prognostic profiles. The primary outcome was neurological status at discharge, assessed by the Cerebral Performance Categories scale. Results: In multivariate analysis, age greater than 50 years with asystole (adjusted odds ratio [OR]: 4.89, 95% confidence interval [CI]: 1.41–17.00) or pulseless electrical activity (adjusted OR: 9.70, 95% CI: 2.80–33.60), aspartate transaminase (adjusted OR: 1.52, 95% CI: 1.15–1.99), creatinine (adjusted OR: 2.08, 95% CI: 1.30–3.34), initial lactate (adjusted OR: 1.88, 95% CI: 1.27–3.45), and low-flow time (adjusted OR: 3.50, 95% CI: 2.02–6.06) were associated with poor neurological outcomes. Based on these findings, we identified three distinct risk groups showing different acceptable low-flow time thresholds: low-risk (38 min), moderate-risk (27 min), and high-risk (20 min). Notably, no favorable neurological outcomes were observed beyond 70 min in the low-risk group and 90 min in moderate/high-risk groups. Risk group stratification effectively predicted neurological outcomes across different low-flow time intervals. Conclusions: Risk-stratified evaluation of low-flow time (cardiac arrest to ECMO pump-on) provides clinically relevant thresholds for different patient groups, suggesting that continuation of ECPR may be warranted in low-risk patients even with extended low-flow times. This approach may enable more personalized decision-making in ECPR implementation. Full article

Takotsubo cardiomyopathy (TCM) is characterized by contractile impairment of the left ventricular apex and excessive contraction of the base of the heart, resulting in transient cardiac dysfunction. Here, we report a case of an implantable cardioverter defibrillator (ICD) that was activated for ventricular fibrillation (VF) caused by TCM one day after removal of maxillomandibular exostoses. The patient was a 53-year-old female who underwent removal of maxillomandibular exostoses in the mid-palate area, bilateral molars of the maxilla, and bilateral mandibular premolars under general anesthesia. Because the patient had a history of VF, an ICD was implanted. Removal was performed without any problems, but VF occurred on the following day, and the ICD was frequently required. Ultrasound examination suggested contractile impairment of the ventricular apex and excessive contraction of the base. Examinations led to a diagnosis of TCM using the Mayo Clinic diagnostic criteria. VF was resolved by administration of amiodarone hydrochloride. The wound in the oral cavity healed favorably, and the patient was discharged from hospital on day 33 without further occurrence of VF. This case highlights important perioperative risk assessment and anesthesia considerations for oral and maxillofacial surgeons managing medically compromised patients undergoing oral surgery. Full article