Search Results (30,247)

Background/Objectives: Ketamine use in emergency departments is expanding for the management of agitation, procedural sedation, and rapid sequence intubation. We aim to describe the indications and characteristics of ketamine administration in emergency department patients in Saudi Arabia through retrospective chart review. Methods: This was a single-center, retrospective chart review conducted at an academic medical center. The study population included patients who received intravenous (IV) or intramuscular (IM) ketamine in the emergency department between 1 January 2023, and 31 December 2024. Patients younger than 18 years of age or those who were pregnant were excluded. Results: A total of 192 patients were included. The median ketamine dose was 50 mg (a total range of 20–240 mg). Procedural sedation was the primary indication (79%), followed by pain management (12.5%), rapid sequence intubation (4.7%), and agitation (2.1%). Nearly all patients (99.5%) received ketamine intravenously, and 83.9% received it in conjunction with other medications. For procedural sedation, ketofol was the most common combination therapy, accounting for 83.6% of combination cases. No procedural failures, need for additional sedatives, or redosing within an hour were reported for procedural sedation. For pain management, ketamine was predominantly administered for musculoskeletal pain (50%) and was most often used as monotherapy (58.3%). Notably, no documented adverse effects were observed post ketamine administration across all indications. Conclusions: Among patients who received ketamine in emergency departments in Saudi Arabia, its administration was frequent, particularly for procedural sedation and acute pain management. In this study we found no adverse events or procedural failures were documented. Further research is warranted to validate these findings. Full article

Youth substance abuse represents a complex social and security problem which cannot be adequately captured solely through crime statistics. In the context of the Slovak Republic, there is a lack of systematic research linking healthcare data on intoxications with criminological indicators, which limits the effective design of preventive measures. The research analyses substance abuse (according to ICD 10 F10–F19) among youth in the NUTS 3 regions of the Slovak Republic during 2019–2024 and their descriptive association with drug-related crime. Analysis is based on data provided by public administration entities—the National Health Information Centre of the Slovak Republic (data on youth hospitalisation), the Operational Centre of the Emergency Medical Service of the Slovak Republic (data on EMS call-outs) and the Ministry of Interior of the Slovak Republic (data on crime). The provided data represent the whole population of the Slovak Republic. To enable comparison between datasets, two standardised indices are constructed: an EMS index representing a number of EMS call-outs and urgent hospitalisations per 100,000 inhabitants of the respective youth age group and a crime index representing a number of drug-related criminal offences per 100,000 total regional inhabitants. A total of 4486 emergency interventions with F10–F19 diagnoses were identified, with the highest proportion being disorders caused by alcohol (F10), more common among juveniles (14–17) than in minors (6–13). The analysis identifies a moderate positive association between the regional EMS index for F10 and F11–F19 diagnoses (correl youth = 0.66; correl juveniles = 0.55) and a weak negative association between the F11–F19 EMS index and the drug-related crime index (correl youth = −0.28; correl minors = −0.52). The Pearson correlation coefficients are reported as descriptive indicators. Formal statistical inference was not the aim of this study. The findings suggest that crime statistics alone inadequately reflect the health risks of youth substance abuse, underscoring the need to link healthcare, criminological, and demographic data and to develop regionally targeted prevention. Full article

Background/Objectives: Following the COVID-19 pandemic, pertussis resurged sharply across Europe, with 209,674 cases reported in the EU/EEA in 2024. This study characterises the epidemiology of the 2024 pertussis resurgence across five counties of southeastern Romania, with emphasis on vaccination status, clinical severity, and regional surveillance performance. Methods: A retrospective, population-based analysis was conducted on 452 cases notified between February 2024 and January 2025, extracted from the national surveillance database. A pre-specified reclassification of PCR-positive cases yielded 326 confirmed cases. Categorical, non-parametric, correlation, and multivariate logistic regression analyses were performed. Results: The epidemic peaked in September 2024, with 56.0% of cases occurring between August and October. Children under five years accounted for 63.2% of confirmed cases, and 72.1% were not vaccinated according to age-appropriate schedule, predominantly due to parental refusal (43.0%) and non-attendance (36.6%). Pneumonia affected 36.8% of confirmed cases, ranging from 81.0% in infants under two months to 0% in adolescents. Age-appropriate vaccination was independently protective against pneumonia (adjusted OR = 0.53, 95% CI 0.29 to 0.96, p = 0.035; population attributable risk 37.3%). Significant inter-county heterogeneity was identified in PCR implementation (72 to 100%) and reporting delays. Conclusions: Vaccination gaps were the principal modifiable driver of the resurgence, supporting targeted coverage improvement and the introduction of a national maternal Tdap programme. Full article

Background: Early and objective identification of cognitive decline in aging populations remains a clinical challenge. Pupillary light reflex (PLR) and eye movement parameters represent non-invasive, quantitative biomarkers of autonomic and central nervous system integrity, yet their diagnostic utility for cognitive impairment in community-dwelling older adults, particularly in those with mild or borderline impairment (predominantly GDS-Stage 2), remains underexplored. Methods: This cross-sectional study analyzed 383 community-dwelling older adults (mean age 69.78 ± 6.29 years; 68.7% female). Ten PLR parameters (n = 202 with complete PLR measurements) and ten eye movement parameters were measured. Associations with cognitive decline (deterioration grade, GDS 2–4) were evaluated using Spearman correlation analysis and multivariate linear regression (adjusted for age, sex, BMI, and hypertension). Stratified analyses and ordinal logistic regression sensitivity analysis were performed to assess robustness. FDR correction (Benjamini–Hochberg) was applied for multiple comparisons. Predictive modeling was conducted using ElasticNet regression with 5-fold cross-validation. Results: After FDR correction, resting pupil diameter (ρ = −0.47, q < 0.001), constriction amplitude (ρ = −0.40, q < 0.001), mean constriction velocity (ρ = −0.36, q < 0.001), mean dilation velocity (ρ = −0.36, q < 0.001), and all eye movement velocity parameters (ρ = −0.22 to −0.41, q < 0.001) demonstrated significant negative correlations with cognitive decline. Multivariate regression confirmed resting pupil diameter (β = −0.286, q < 0.001) and constriction amplitude (β = −0.223, q < 0.001) as independent predictors. Sensitivity analysis using ordinal logistic regression yielded consistent results. Predictive modeling yielded modest performance for the primary outcome (PLR-only cross-validated R² = 0.184), whereas models using eye movement features alone or in combination with PLR features performed near chance (R² ≤ 0.04) or showed instability, indicating that these parameters are not yet suitable as standalone diagnostic tools. Exploratory analyses of depression and anxiety were limited by floor effects (≥89% zero scores). Conclusions: PLR and eye movement parameters show significant negative associations with cognitive decline in older adults, particularly in a sample skewed toward mild impairment (predominantly GDS-Stage 2). These findings provide preliminary, hypothesis-generating signals that warrant validation in clinical samples with broader cognitive impairment distributions, and these parameters should not yet be considered standalone diagnostic biomarkers. Full article

Background: Chronic kidney disease (CKD) is a major public health problem, primarily affecting patients with diabetes mellitus and/or hypertension. Early detection is critical to delay progression to renal replacement therapy. Therefore, this study aims to evaluate the implementation of a digital module for CKD detection in at-risk patients within the Peruvian Social Health Insurance system (EsSalud) during 2024. Materials and Methods: Data were collected through the Renal Health Module (MOSARE), a digital tool integrated into EsSalud’s electronic health record for monitoring patients at risk of CKD. Key indicators were assessed using the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Quantitative analyses evaluated patient identification, screening, and diagnosis, while qualitative analyses of technical documents identified barriers, facilitators, and stakeholder perceptions. Results: In 2024, MOSARE was implemented in a population of 1,667,856 insured individuals with CKD-related risk conditions, predominantly women (55.7%) and adults aged > 55 years (88.3%). Nationwide, 93,266 patients were screened (5.59% reach), with 34.3% diagnosed with CKD. Screening coverage showed substantial geographic variability (0.35–29.59%). A total of 32,004 CKD cases were identified, with 84.2% in early stages (1–3A). Adoption reached 66.8% of level I and II healthcare facilities, with variability across networks. Regarding maintenance, 65% of trained facilities sustained active use. Implementation gaps were associated with interoperability issues, resource limitations, and training variability. Conclusions: MOSARE proved to be a feasible and operationally sensitive tool for CKD screening and risk identification, improving integration of renal care. However, addressing technical, training, and resource barriers is essential to ensure sustainability and scalability. Full article

Background/Objectives: Celiac disease (CD) is a complex multifactorial disorder driven by genetic susceptibility and environmental triggers, with ultra-processed foods (UPFs) acting as potential disruptors of immune homeostasis. This study aimed to characterize the patterns and temporality of UPF consumption in a pediatric population with CD to provide evidence-based insights that can optimize the nutritional quality of a gluten-free diet (GFD) beyond mere gluten avoidance. Methods: A total of 128 children aged 5–14 years were enrolled, comprising a baseline cohort of 48 children newly diagnosed with CD (pre-GFD), 88 patients who had followed a GFD for at least 6 months (post-GFD), including 44 participants from the pre-GFD cohort prospectively re-evaluated after 12 months and 44 additional patients with established GFD adherence and a control group of 36 healthy children (CTRL). Dietary intake was assessed using three-day 24 h recalls. Food processing levels were determined using the NOVA classification system, and adherence to the Mediterranean Diet was evaluated via the KIDMED index. Results: At baseline, UPFs (NOVA 4) were the primary daily energy source for both celiac patients and controls, accounting for over 57% of total caloric intake, peaking during breakfast (~74%) and afternoon snacks (~81%). Longitudinal analysis showed that the nutritional profile and global UPF consumption remained remarkably stable after 12 months on a GFD, though a significant increase in vitamin B6 intake was observed (0.9 ± 0.4 vs. 1.1 ± 0.5 mg; p = 0.034). However, meal-pattern shifts occurred over the 12 months: celiac children significantly reduced their daily intake of culinary ingredients (NOVA 2; p = 0.029) and processed foods (NOVA 3; p = 0.025). Compared to healthy controls, post-GFD patients exhibited significantly lower Vitamin D intakes (4.6 ± 9.4 vs. 6.2 ± 12.3 µg/day; p = 0.008), meeting only 30.8% of the reference intake. Both groups presented inadequate intakes of iron, calcium, folate, magnesium, and zinc. Conclusions: Pediatric celiac patients exhibit a high, deeply ingrained consumption of UPFs that mirrors healthy controls and persists 12 months after starting a GFD. While the GFD alters meal processing dynamics, it fails to resolve baseline micronutrient insufficiencies and is associated with lower dietary vitamin D intake, highlighting the urgent need for targeted nutritional interventions that focus on whole food quality rather than just gluten elimination. Full article

Background/Objectives: Dietary habits are important modifiable factors influencing survival among cancer patients. The dietary quality among cancer survivors may differ from those of the general population and may vary according to age at cancer diagnosis. This study aimed to compare dietary quality between cancer survivors and the general population and to examine whether age at diagnosis is associated with dietary quality. Methods: This retrospective cross-sectional study used data from 8706 adults aged ≥ 30 years (641 cancer survivors and 8065 controls) from the 2019–2021 Korea National Health and Nutrition Examination Survey. Dietary quality was assessed using the Diet Quality Index-International (DQI-I; range 0–100). Survey-weighted multiple linear regression models were used to compare DQI-I scores between cancer survivors and controls. Subgroup analyses were stratified by age at diagnosis, and quadratic age terms were included to assess nonlinear associations. All analyses accounted for the complex survey design. Results: Cancer survivors had significantly higher mean DQI-I scores than controls (69.1 ± 0.4 vs. 66.1 ± 0.2; p < 0.001). Among survivors diagnosed before age 50, dietary quality was significantly higher in those currently under 65 years than in controls (mean difference +3.02, 95% CI 1.44–4.60), but notably lower in those aged ≥ 65 years (−3.18, 95% CI −6.16 to −0.20). In contrast, survivors diagnosed at age ≥ 50 consistently showed higher dietary quality than controls across all age groups (+3.76, 95% CI 2.83–4.68). Conclusions: While cancer survivors generally exhibit better dietary quality than the general population, this positive trend was not observed among younger-onset survivors in older age groups. These findings suggest that age at cancer diagnosis may be associated with dietary quality and highlight the need for sustained, age-specific nutritional support strategies in cancer survivorship. Full article

Background: The styloid process exhibits considerable anatomical variability, and its elongation is frequently identified as an incidental finding on panoramic radiographs. However, limited evidence exists regarding its prevalence and possible association with craniofacial skeletal characteristics in adult orthodontic patients. Therefore, the aim of this study was to evaluate the prevalence, morphological characteristics, mineralisation patterns, and possible association of styloid process elongation with skeletal class and facial pattern in an adult orthodontic population. Methods: A retrospective cross-sectional study was conducted on 340 adult orthodontic patients (130 males and 210 females; mean age: 51.55 ± 6.62 years). Panoramic radiographs were used to assess styloid process elongation, defined as ≥30 mm, as well as its morphology and mineralisation patterns according to the Langlais classification. Lateral cephalograms were analysed to determine skeletal class and facial pattern. Statistical analysis included descriptive and inferential methods, with significance set at p < 0.05. Results: Styloid process elongation was identified in 47.65% of patients. Elongated processes showed significantly greater length and side asymmetry (p = 0.001). The most frequent morphology was normal (Type IV), while complete mineralisation (Type D) predominated. No significant associations were found between elongation and age or sex. Furthermore, no statistically significant relationship was observed between elongation and skeletal class (p = 0.479) or facial pattern (p = 0.531). Only a small proportion of patients reported symptoms according to the available clinical records, with no clear association with styloid process elongation. Conclusions: Styloid process elongation is a common incidental finding in adult orthodontic patients and does not appear to be associated with skeletal class or facial pattern. Its recognition on panoramic radiographs may improve the differential diagnosis of orofacial and cervical symptoms. Full article

Population ageing is reshaping the use and evaluation of everyday urban green spaces, especially in old urban districts where nearby public spaces support walking, resting, exercise, and social contact. Conventional age-friendly assessments often emphasise whether formal infrastructure is provided, but facility provision alone does not ensure experiential fit with older adults’ functional capacities, daily routines, and social practices. This exploratory multiple-case study examines user-initiated informal adaptations in three neighbourhood-scale green spaces in Gulou District, Nanjing, China. Facility audits, approximately 30 h of non-participant observation, semi-structured interviews with 36 older users, and 220 valid questionnaires were combined through cross-case coding and qualitative triangulation. Three adaptation types were identified: supplementary, modifying, and appropriative adaptations. These practices were interpreted as context-dependent behavioural signals potentially associated with safety and convenience, ergonomic support and material-thermal comfort, social accessibility and spatial accommodation, and social support. Adaptation patterns varied descriptively across sites and age groups in relation to facility conditions, spatial organisation, activity intensity, and user characteristics. The findings suggest that, when interpreted alongside facility audits, interviews, and site context, older adults’ everyday adaptations may help identify possible mismatches between formal provision and actual use, offering a low-cost interpretative perspective for inclusive, incremental, and socially sustainable green-space renewal. Full article

Background: Wrist-hand radiographic skeletal maturation methods are widely used for forensic age estimation of living individuals, remaining among the most widely accepted imaging modalities in forensic practice despite limited evidence supporting their use at the legally relevant 18-year threshold. This systematic review aims to provide a quantitative synthesis of the widely recognized but previously unsynthesized body of evidence regarding their diagnostic accuracy (sensitivity, specificity, AUC-curve, mean absolute error-MAE) for forensic adult age estimation. Methods: Six databases (Scopus, PubMed, Google Scholar, Embase, Cochrane, Clarivate) between 1980 and 2026 were searched. Studies evaluating wrist-hand skeletal maturation for forensic age estimation in individuals ≥16 years with verified chronological age were included. Two reviewers independently screened studies and extracted data. Quality was assessed using QUADAS-2. DerSimonian-Laird random-effects model estimated the sensitivity and specificity of the wrist-hand bones maturation at the age of 18 years, and pooled MAE. GRADE assessed the certainty of evidence. Results: From 747 records, 23 studies (11,425 participants, 15 countries, 2003–2025) were included. Pooled MAE was 0. 537 years (95% CI: 0.387–0.686; 95% PI: 0.33–0.79 years), but obtained from 3 Italian studies conducted on clinical populations, and all characterized by high risk of bias. At the 18-year threshold, pooled sensitivity was 69.5% (95% CI: 61.6–77.3%; 95% PI: 35.3–100%) and specificity 85.56% (95% CI: 83.53–87.60%; 95% PI: 77.2–93.9%). Nevertheless, the heterogeneity was extreme (I² > 98%) for all diagnostic measures, and calculated prediction intervals confirm that individual study results are expected to vary widely. QUADAS-2 assessment revealed 82.6% of studies with high/unclear patient selection bias. GRADE-certainty was VERY LOW for both outcomes due to serious risk of bias, very serious inconsistency, and serious indirectness. Conclusions: Wrist-hand skeletal maturation shows low accuracy and high rates of misclassification for age estimation at the 18-year threshold. The wide prediction intervals (sensitivity 35–100%, specificity 77–94%, MAE 0.33–0.79 years) indicate that performance in a new study population may differ substantially from the pooled estimates. Very low certainty evidence, extreme heterogeneity, and substantial methodological limitations preclude confident application. Results should be interpreted with caution in forensic contexts, preferably combining multiple age indicators, in particular dental evidence. Full article

Background: Respiratory failure (RF) is a frequently fatal complication of chronic liver disease (CLD), yet population-level data on RF-related mortality trends among adults with CLD are lacking. This study characterized temporal trends and demographic disparities in RF-related mortality among U.S. adults with CLD from 1999 to 2024. Methods: Death certificate data were obtained from the CDC WONDER database for adults aged ≥25 years with both RF (ICD-10: J96) and CLD (ICD-10: K70–K76) listed as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified temporal inflection points and annual percentage change (APC). Results: Among 241,075 deaths, the overall AAMR increased 3.2-fold from 2.237 (1999) to 7.162 (2021) per 100,000, then declined to 6.132 by 2024. Joinpoint analysis identified four segments: moderate increase (1999–2006; APC +2.40%), accelerated increase (2006–2018; APC +5.37%), late acceleration period (2018–2021; APC +13.10%), and post-pandemic decline (2021–2024; APC −4.32%; all p < 0.001). The 2024 AAMR remained 174.2% above baseline. The male-to-female rate ratio narrowed from 2.02 to 1.50, with females showing steeper acceleration (+14.38% vs. +12.36%). American Indian or Alaska Native individuals had the highest AAMRs and the most dramatic surge (APC +26.90%). Rural areas surpassed urban AAMRs by 2020, with steeper post-2007 acceleration (+8.74% vs. +5.51%). The Western U.S. consistently had the highest regional rates. Younger adults aged 25–34 and 35–44 showed 2.96-fold and 2.37-fold increases in crude mortality rates, respectively. Approximately 80% of deaths occurred in inpatient settings. Conclusions: RF-related mortality among U.S. adults with CLD increased more than threefold from 1999 to 2021, with a dramatic surge followed by incomplete decline. Persistent disparities by sex, race/ethnicity, urbanization, and region highlight the need for targeted interventions, including expanded screening for alcohol-associated and metabolic liver disease and improved access to hepatology services in underserved communities. Full article

Background: The Semipalatinsk Nuclear Test Site (SNTS) represents a unique example of long-term population exposure to ionizing radiation. This study aimed to assess the health status of individuals from three generations permanently residing in territories affected by radioactive contamination resulting from nuclear weapons testing at the SNTS, based on the findings of a population screening examination. Materials and Methods: A cross-sectional screening study was conducted among 2802 adults aged 18 years and older. The exposed group consisted of residents of the Abay and Beskaragai districts of the Abay Region and their descendants (n = 1358). The control group included residents of Arshaly village in the Akmola Region with no history of radiation exposure (n = 1444). All participants underwent a structured questionnaire survey, clinical examination, biochemical and hematological testing, and assessment of thyroid function. Individual radiation doses were obtained from the State Scientific Automated Medical Registry of Persons Exposed to Radiation (SSAMR). Results: Arterial hypertension (p < 0.001), chronic ischemic heart disease (p < 0.001), thyroid disorders (p < 0.001), malignant neoplasms (p = 0.003), renal diseases, and respiratory diseases were significantly more prevalent in the exposed population than in the control group. Exposed individuals also demonstrated significantly higher levels of total cholesterol, triglycerides, and the triglyceride-glucose (TyG) index, indicating increased insulin resistance. After adjustments, the only outcome that retained a statistically significant association with radiation dose was thyroid disorders (adjusted OR per 10 mSv increase = 1.017; 95% CI: 1.009–1.025; p < 0.001). ROC analysis demonstrated a moderate discriminative ability of radiation dose with respect to arterial hypertension (AUC = 0.715), chronic ischemic heart disease (AUC = 0.735), and ischemic stroke (AUC = 0.711). Conclusions: The findings suggest long-term adverse health effects associated with radiation exposure among populations residing near the SNTS. Continued epidemiological surveillance and medical monitoring of exposed individuals and their descendants are warranted. Full article

Background: Among infants undergoing cardiac surgery, AKI may affect as many as 40% of this population and carries an unfavorable prognosis. A range of contributors has been implicated, including early age, cyanotic physiology, and extended time on cardiopulmonary bypass (CPB). Nadir-indexed oxygen delivery (DO₂) is an important determinant for early detection of hypoperfusion and anaerobic metabolism during CPB. This study aimed to explore the relationship between nadir DO₂ during pediatric CPB and postoperative acute kidney injury. Methods: Between 1 October 2024 and 1 December 2024, we enrolled 40 children who underwent cardiac surgery with CPB [median age 6 months (IQR 4–8), median weight 5.5 kg (IQR 5–7 kg)] into an observational cohort. DO₂ was tracked intraoperatively for every patient, and pre- as well as intraoperative variables were examined for independent links to AKI. Postoperative outcomes were then compared between patients who did and did not develop AKI. Results: In our patient population (n = 40), 16 patients (40%) developed AKI according to the pRIFLE criteria (75% risk; 18.7% injury; 6.2% failure; no patient was in the loss or end-stage renal disease categories). Lower nadir DO₂ values were associated with postoperative AKI in this exploratory pilot cohort. ROC analysis identified an exploratory nadir DO₂ threshold of 360 mL/min/m² (sensitivity 70%, specificity 80%) associated with postoperative AKI. Because this threshold was both derived and evaluated within the same cohort without validation, it should be regarded only as a preliminary, hypothesis-generating observation with no implication of clinical applicability and requires validation in larger independent cohorts. Conclusions: In this exploratory pilot cohort, lower nadir DO₂ during cardiopulmonary bypass was independently associated with postoperative AKI. An exploratory ROC-derived threshold of 360 mL/min/m² was identified; however, this threshold should be considered hypothesis-generating rather than clinically validated. The consistency of findings across both dichotomous and continuous DO₂ analyses strengthens the robustness of the observed association, although larger prospective studies are required to externally validate this threshold, which at present carries no implication of clinical applicability. Full article

Background: Despite the therapeutic advances made in castration-sensitive prostate cancer, progression to castration-resistant disease is inevitable. Lutetium-177 vipivotide tetraxetan (¹⁷⁷Lu-PSMA-617) is a novel radioligand approved for use in metastatic castration-resistant prostate cancer (mCRPC). With promising efficacy, it is not without numerous potential side effects, namely cytopenias, which are often a reason for early discontinuation of ¹⁷⁷Lu-PSMA-617. We sought to describe the incidence of cytopenias associated with permanent discontinuation of ¹⁷⁷Lu-PSMA-617 at our institution. Methods: We conducted a retrospective review of patients who received ¹⁷⁷Lu-PSMA-617at the University of Virginia Comprehensive Cancer Center from 2018 to 2025. From this we assessed for the incidence of toxicities resulting in permanent discontinuation of ¹⁷⁷Lu-PSMA-617, which we refer to as dose-limiting toxicities. Descriptive statistics were used to summarize characteristics of the study population. Median overall survival from time of initiation of ¹⁷⁷Lu-PSMA-617 was estimated using a Kaplan–Meier curve. Results: Of the patients who received ¹⁷⁷Lu-PSMA-617 (n = 64), grade 3 or greater anemia occurred in 36% (n = 23), thrombocytopenia in 3% (n = 2), leukopenia in 3% (n = 2), neutropenia in 0% (n = 0), and lymphopenia in 33% (n = 21). In our cohort, 10.9% (n = 7) developed toxicities necessitating permanent discontinuation. Of these, 9.3% (n = 6) were attributable to cytopenias. Those cytopenias consisted of anemias in 100% (n = 6) of cases, leukopenia in 83% (n = 5), thrombocytopenia in 67% (n = 4), lymphopenia in 100% (n = 6), and neutropenia in 33% (n = 2). Aside from cytopenias, the remaining 1.6% (n = 1) of dose-limiting toxicities were attributable to renal injury. In the VISION trial, the ¹⁷⁷Lu-PSMA-617 treatment arm reported dose-limiting toxicities necessitating permanent discontinuation in 11.9% of participants, but did not report if these were attributable to cytopenia or other toxicities. Notably, 2 patients developed grade 5 pancytopenia and 1 patient developed grade 5 bone marrow failure in the VISION ¹⁷⁷Lu-PSMA-617 treatment arm. Compared to the VISION ¹⁷⁷Lu-PSMA-617 treatment arm, our cohort differed in the distribution of organ metastases, younger median age of patients, and a higher portion of those with ECOG 2 functional status. From the time of ¹⁷⁷Lu-PSMA-617 initiation, median overall survival was estimated to be 18.5 months, compared to 15.3 months in the VISION ¹⁷⁷Lu-PSMA-617 treatment arm. Conclusions: In our real-world analysis, 85% of dose-limiting toxicities necessitating ¹⁷⁷Lu-PSMA-617 discontinuation were attributed to cytopenias. Though a direct comparison cannot be made with the VISION ¹⁷⁷Lu-PSMA-617 treatment arm in terms of dose-limiting toxicity attributable specifically to cytopenias, they reported total dose-limiting toxicity to a similar degree, and cytopenias were the most common causes of grade 3 or greater toxicities. Therefore, it is important to recognize the ubiquity of these adverse events as well as the role that they play in therapy-limiting toxicity. Full article

Population aging represents one of the major demographic challenges of the 21st century, driving the need for strategies that promote active aging and overall well-being. In this context, tourism has been identified as a potentially relevant activity associated with quality of life in older age, as it integrates physical, psychological, and social components. The aim of this systematic review was to synthesize the scientific evidence published between 2015 and 2026 on the relationship between tourism participation and active aging in older adults (≥60 years). Following the PRISMA 2020 guidelines, a systematic search was conducted in Web of Science, Scopus, and PubMed, identifying 1187 records, of which 18 studies met the inclusion criteria. Overall, the evidence indicates associations between tourism participation and improvements in functional physical health, psychological well-being, and social participation, with no consistent evidence of adverse effects. As a theoretical contribution, the Tourism-Active Aging Multidimensional Model (TAMM) is proposed as a conceptual framework that integrates the key mechanisms identified in the literature into three interrelated dimensions, behavioral engagement, emotional processes, and social interaction, all of which are influenced by individual and contextual factors. The evidence obtained suggests potential of tourism as a complementary strategy to promote active aging. Full article