Search Results (1,012)

Objectives: Ensuring an effective triage to treat patients with chest pain in emergency settings is critical, but it can often be challenging, particularly when patients wear face masks or are unable to clearly communicate their pain. To address this limitation, this study presents a real-time facial expression–based system for chest pain intensity assessment as an initial step toward realizing intelligent emergency triage. The proposed system integrates deep learning with real-time video analysis to provide objective and rapid pain level recognition. Methods: A YOLOv12-based facial expression recognition model was trained using annotated facial images of patients experiencing chest pain, and the model categorizes pain into three intensity levels: no pain, slight pain, and moderate to severe pain. Multiple YOLOv12 variants were systematically evaluated to identify an optimal configuration for potential clinical use. The developed system supports two operational modes: real-time recognition, which analyzes continuous video streams and delivers immediate visual feedback through an interactive interface, and a manual upload mode for offline video analysis, review of results, and playback. Additional usability features, including error prompts and data reset functions, were implemented to enhance system stability and user experience. Results: Among the evaluated models, the YOLOv12-L model achieved the best performance with an accuracy of 98.81%, sensitivity of 98.76%, specificity of 98.79%, precision of 98.04%, and an F1-score of 98.41%, demonstrating stable and accurate recognition. The proposed system is designed to support the triage process of assessing patients with chest pain, particularly in cases where patients wear masks or cannot clearly express their pain. By providing real-time and objective pain intensity assessment, the system shows potential to assist healthcare professionals in identifying patients who may require priority attention and to serve as a supportive tool for emergency triage workflows. Conclusions: Future work will incorporate edge computing with a lightweight model to enable real-time pain assessment in ambulances, facilitating faster intervention and treatment. Full article

Spinal epidural empyema (SEE) is an uncommon but potentially severe cause of spinal cord compression and neurological dysfunction in veterinary patients. Bite wounds involving the vertebral column may result in deep tissue contamination, paraspinal abscessation, and secondary epidural infection; however, such injuries are poorly described in wildlife species. We report a case of SEE associated with chronically infected bite wounds in an adult Indian crested porcupine (Hystrix indica) with paraplegia. Physical and neurological examinations revealed exudative paravertebral wounds, paraplegia with preserved nociception, and findings consistent with a thoracolumbar spinal cord lesion. Survey radiography and contrast myelography demonstrated an extradural compressive lesion at L1–L2. Surgical exploration revealed a purulent tract extending from the skin and paraspinal tissues into the vertebral canal, and a left L1–L2 hemilaminectomy was performed with drainage, debridement, lavage, and Penrose drain placement. Staphylococcus aureus was isolated from the abscess, and antimicrobial therapy was adjusted based on susceptibility testing. Postoperative management included physiotherapy and environmental modifications to support ambulation. The porcupine regained ambulation within 4 days after surgery and was released back into the wild approximately 50 days postoperatively with normal gait and tail-rattling behaviour. This case highlights bite-wound-associated SEE as an important differential diagnosis in porcupines presenting with paraplegia and draining paraspinal wounds and suggests that surgical decompression combined with prolonged culture-guided antimicrobial therapy and environmental modifications may result in a favourable outcome. Full article

Background: The aim of this study is to determine the prevalence of malnutrition, frailty, and cachexia in patients with different cancer subtypes undergoing oncological treatment using various screening scales and to evaluate the distribution of these conditions by geriatric age groups. Methods: This cross-sectional study included 4595 patients with different cancer subtypes undergoing oncological treatment. Nutritional status was assessed using the Mini Nutritional Assessment—Short (MNA-S) form; frailty was evaluated with the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale; and cachexia was determined based on >5% weight loss in the last 6 months or a body mass index (BMI) < 20 kg/m², together with an additional >2% weight loss. Patients were divided into two groups by geriatric age. Results: A total of 36% of the patients included in the study were geriatric (≥65 years old). The prevalence of malnutrition, frailty, and cachexia in the general population was determined to be 40%, 45%, and 44%, respectively. All three conditions were found to be statistically significantly more prevalent in the geriatric age group (p < 0.001 for all comparisons). Conclusions: It was determined that the prevalence of malnutrition, frailty, and cachexia was high in cancer patients receiving systemic oncological treatments including chemotherapy, hormonal therapy, targeted therapy, and immunotherapy; these syndromes are significantly more common, particularly in the geriatric patient group. Full article

Background: Immersive virtual reality (VR) has emerged as a promising tool for standardized, engaging assessment of motor and cognitive function in people with multiple sclerosis (pwMS). However, patient-reported experiences with immersive VR tasks have not been systematically evaluated. Objective: To characterize patient-reported experience measures (PREMs) after a multidomain immersive VR task and explore relationships with clinical characteristics, therapeutic history, and task performance. Methods: In this prospective cross-sectional study, participants completed a seated immersive VR task comprising six upper-limb tasks with motor and cognitive components. Patient experience was evaluated immediately afterward using a PREM questionnaire. Upper-limb activity limitations were assessed with the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Results: A total of 129 pwMS (EDSS 3.5–8.0) participated. Median PREM item scores ranged from 1.0 to 2.0 (scale 0–10), indicating an overall positive experience. Over 80% rated staff support as excellent; more than half perceived the assessment as safe, comfortable, and appropriately timed. An amount of 40.3% of pwMS wished to use VR tasks more often than once per year. PwMS receiving upper-limb physiotherapy or occupational therapy reported greater perceived difficulty than those without therapy. In exploratory analyses, higher perceived difficulty and a preference for less frequent VR use were associated with higher EDSS (r = 0.208 and 0.200) and ambulation scores (r = 0.215 and 0.195). Difficulty ratings were also related to pyramidal (r = 0.188) and sensory (r = 0.174) impairments. Conclusions: PwMS reported a positive overall experience with the immersive VR tasks. Further studies should evaluate the suitability and validity of this approach compared with conventional assessments. Full article

Introduction: The costs associated with ambulance services are varied and poorly understood, which may contribute to financial burden and barriers to care for patients. Methods: We describe differences in ambulance service costs, comparing public versus private companies, by using the Centers for Medicare and Medicaid Services public use files. We determined the two largest public and two largest private ambulance companies in each state and calculated the average miles traveled per ambulance ride, number of trips by company, adjusted cost, and CPT code usage. We compared these variables between 2019 and 2021, across nine geographic divisions of the US. Results: In both 2019 and 2021, the average costs (adjusted for total service) of public companies were higher than the average costs of private companies. In both years, public companies had fewer average miles traveled compared to private companies. The distribution of CPT codes used was significantly different in public and private companies. The CPT code used most frequently by public companies was more expensive than the CPT code used most often by private companies. Conclusions: Differences in ambulance billing practices may contribute to financial uncertainty for patients. This study underscores the need for further investigation into the factors driving these disparities to inform policy decisions and improve cost transparency for patients. Full article

Background: Improper disposal of unused and expired medicines represents an environmental and public health concern. In Romania, Law No. 269/2023 assigned the responsibility for collecting household pharmaceutical waste to public and private hospitals, while operational procedures were further detailed in the Ministry of Health (MoH) Instruction No. 6226/2024. Objectives: This study aimed to assess knowledge, attitudes, and practices (KAP) related to the disposal of unused and expired medicines among the general public and community pharmacy staff during the early phase of implementation of the hospital-based medicine take-back system in Romania. Methods: A cross-sectional survey using convenience sampling was conducted between 1 and 31 August 2023. Two structured questionnaires were administered: one targeting the general public/patients and another addressing community pharmacy staff. Data were analyzed descriptively using frequencies and percentages. Several items allowed multiple responses. Results: Among public respondents (n = 108; predominantly male, 90.7%; urban, 75.0%), household waste disposal was the most frequently reported method (58.3%), followed by pharmacy return (43.5%). Willingness to use a dedicated collection system was very high (96.3%). Among pharmacy staff (n = 71; predominantly female, 78.9%; urban, 74.6%), 40.8% reported no collection activity; where collection occurred, it was typically on demand. Disposal routes included transfer to specialized waste companies (56.3%) and regulated destruction (43.7%). Only 1.4% of pharmacies offered incentives, while 45.4% of the public indicated discounts could motivate returns. Conclusions: Findings indicate an implementation and communication gap during the transition to a hospital-based pharmaceutical waste collection system. Strengthening public communication on official collection points and providing clearer operational guidance may support safer disposal practices. Full article

Background: Hungary operated a public health-focused primary care model programme with expanded preventive and community-based services between 2013 and 2017 in four disadvantaged regions. This study aimed at assessing the association of this programme in one region with the patterns of emergency ambulance care before (2012) the programme and 3 years later when all services were available (2016). Methods: Patients in the selected region who received emergency ambulance care in the hospital catchment area were included. De-identified demographic data, reason for emergency service, on-site and hospital diagnosis, and treatment outcomes were entered into an electronic database from paper-based records. Diagnoses were assigned separate codes at GBD 1 and 3 levels. Results: The proportion of patients in emergency ambulance care showed a significant, 0.85% increase (p = 0.013) from 2012 to 2016. The proportion of female/male patients was roughly equal, but males needed emergency ambulance care significantly, 7 years younger than females in both years. Among patients with GPs in the model programme, 3.41% fewer needed emergency ambulance care due to non-communicable diseases, and 1.98% fewer were referred to other institutions from the hospital A&ED compared to those whose GPs did not participate (p < 0.001 for all). Conclusions: Utilisation of emergency ambulance services rose in the region in line with global trends suggesting that expanding primary care services alone may not be sufficient to reduce demand for emergency ambulance services. Further research is warranted to identify individual and systemic factors with major influence on emergency care use, including patient-level differences in the use of acute and preventive primary care services, and the availability of primary care after work hours. Full article

Purpose: To evaluate the safety, technical feasibility, and clinical outcomes of a strict two-step protocol—CT/fluoroscopic-guided thermal ablation followed by Balloon-Assisted Acetabuloplasty (BAA)—for the treatment of painful acetabular metastases, utilized as an immediate mechanical stabilization bridge prior to radiotherapy. Materials and Methods: A retrospective study was conducted on 16 consecutive patients treated for severe mechanical pain (VAS ≥ 6) and impaired mobility due to osteolytic acetabular metastases. The physiological rationale mandated a strict procedural sequence: (1) preliminary thermal devitalization using radiofrequency or microwave ablation to reduce tumor pressure and vascularity, followed subsequently by (2) balloon-assisted cavity compaction and polymethylmethacrylate (PMMA) cement injection. Clinical outcomes included VAS for pain and the Functional Mobility Scale (FMS) assessed before treatment and up to 6 months post-procedure. Results: Technical success was 100% with a mean procedural time of 58 ± 14 min. No major complications occurred. At a mean follow-up of 8.2 months, all 16 patients were alive. The procedure yielded dramatic acute pain relief: mean baseline VAS dropped from 7.4 ± 0.8 to 2.3 ± 1.0 at 1 week, and to 0.9 ± 0.9 at 1 month (p < 0.001), remaining stable at 6 months. Functional mobility was rapidly restored, with mean FMS improving from 2.9 ± 0.7 pre-procedure to 1.1 ± 0.3 at 1 month (p < 0.001), allowing independent ambulation in 87.5% of patients. Conclusion: The strict “ablation-first” BAA strategy is safe and highly effective. It abolishes load-bearing pain and restores biomechanical stability immediately, allowing previously immobilized patients to rapidly regain independent ambulation and seamlessly transition to necessary consolidative radiotherapy. Full article

Background/objectives. Clostridioides difficile infection (CDI) remains a major cause of healthcare-associated infectious colitis, particularly among elderly and multimorbid patients. Disease severity and clinical evolution are influenced by the host’s systemic inflammatory response. This study aimed to evaluate the hematological and inflammatory profile of hospitalized CDI patients and to explore the prognostic value of routine laboratory parameters for prolonged hospitalization. Methods. A retrospective observational study was conducted on 50 adult patients hospitalized with laboratory-confirmed CDI (positive glutamate dehydrogenase, antigen and toxins A/B). Hematological parameters (WBC, hemoglobin, RDW) and inflammatory markers (CRP, fibrinogen) were analyzed at admission and discharge. Prolonged hospitalization was defined as length of stay (LOS) > 8 days (cohort median). Multivariable logistic regression was performed to assess admission predictors of prolonged hospitalization, and model discrimination was evaluated using leave-one-out cross-validation (LOOCV). Results. At admission, patients exhibited marked inflammatory activation accompanied by reduced hemoglobin and elevated RDW. Significant correlations were observed between inflammatory markers. All inflammatory and hematologic parameters improved at discharge. In multivariable analysis, lower admission hemoglobin and higher log-transformed CRP showed exploratory associations with prolonged hospitalization. The internally validated model demonstrated moderate discriminative performance (AUC = 0.65). Conclusions. CDI is associated with substantial systemic inflammatory activation and hematologic alterations. While no individual predictor reached statistical significance, the observed effect sizes provide hypothesis-generating estimates to inform future prospective validation studies. Full article

Background and Objectives: Parkinson’s disease (PD) is a neurodegenerative disorder marked by bradykinesia, rigidity, and tremor. While deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) effectively alleviates motor symptoms, the potential of targeting the substantia nigra pars reticulata (SNr) is less understood. This study investigates the effects of mid-term DBS of the SNr on motor function and neuroplasticity in a 6-hydroxydopamine (6-OHDA) rat model of PD. Methods: Adult male Sprague-Dawley rats (280–300 g) were divided into healthy control (n = 10), PD (n = 9), sham-DBS (n = 7), and SNr-DBS (n = 7) groups. Bilateral striatal 6-OHDA lesions induced PD. High-frequency (130 Hz, 60 µs) SNr-DBS was delivered for 14 days. Locomotor activity (open-field), gait (footprint method), and motor coordination (rotarod) were assessed. Tyrosine hydroxylase (TH) expression in the SN and c-Fos and BDNF expression in the cerebellum, prefrontal cortex (PFC), and ventrolateral thalamus were analyzed histologically. Results: SNr-DBS significantly improved ambulation and horizontal activity compared to the PD group (p < 0.05). Gait analysis showed significant improvements in forelimb/hindlimb stride length and stance width, while rotarod performance indicated enhanced motor coordination (p < 0.05). Histology revealed increased TH expression in the SN and elevated c-Fos and BDNF levels in the cerebellum, PFC, and thalamus in the SNr-DBS group vs. PD rats (p < 0.05). Conclusions: Mid-term SNr-DBS produced significant functional gains in motor activity and coordination in a 6-OHDA PD model, together with molecular evidence of dopaminergic enhancement and neuroplastic activation. These translational findings suggest that targeting the SNr may offer a clinically relevant alternative for patients with PD, particularly for those who may not optimally respond to conventional STN or GPi stimulation. Full article

Traffic variability along heavily congested signalised urban corridors undermines roadway safety, reduces energy efficiency, weakens operational reliability, and can hinder emergency response. Although many simulation-based studies have examined the impacts of Autonomous Vehicles (AVs), relatively few have combined high-resolution congestion observations with link-level microscopic calibration in a real urban network, particularly when evaluating implications for emergency mobility. This study develops and calibrates a microscopic Aimsun traffic simulation model for the Atakum district of Samsun, Türkiye, using a 10 min Google Traffic Index (GTI) observation stream converted into a four-level ordinal congestion scale. The calibration process began with an origin–destination (OD) matrix derived from 2020 traffic counts and was refined through link-level GTI synchronization, iterative OD scaling on mismatched corridors, and signal retiming at key intersections. GTI was validated as an ordinal congestion proxy through both categorical agreement and volumetric consistency, achieving 83% class agreement and GEH values below 5 for more than 90% of links. Five AV penetration scenarios (0%, 25%, 50%, 75%, and 100%) were simulated under peak-hour conditions. Network performance was evaluated using delay, stop time, mean speed, throughput, missed turns, and total journey time, while emergency mobility was assessed along a representative ambulance corridor on Atatürk Boulevard using seconds per kilometre. The results indicate that increasing AV penetration improves flow stability more clearly than nominal capacity. Mean speed increased from 36.2 to 39.2 km/h, delay and stop time declined steadily, and throughput remained nearly constant at 22.2–22.5 thousand vehicles/h. Along the ambulance corridor, travel time improved by 11.5%, from 112.4 to 99.4 s/km, between the baseline and full automation scenarios. These findings provide scenario-based evidence that, within a calibrated signalised urban network, increasing AV penetration can enhance operational stability and emergency response efficiency. More broadly, the study demonstrates the practical value of integrating GTI-based congestion observations with microscopic simulation for AV impact assessment in real urban networks. Full article

Osteochondral allograft transplantation is a safe and effective surgical option for the treatment of large, focal, full-thickness chondral and osteochondral defects, particularly in young patients. We describe a low-cost new hybrid workstation for osteochondral allograft transplantation based on modified Ilizarov components and its clinical application in a patient with a large osteochondral femoral defect. The technique was applied in a 28-year-old male with chronic knee pain following two prior failed arthroscopic surgeries. Osteochondral allograft transplantation was performed using our modified workstation instrumentation. At the 8-month follow-up, MRI revealed excellent incorporation of the graft, and the patient reported ambulation without pain with return to physical activity. Our hybrid workstation presents a cost-effective alternative for graft preparation while maintaining a high standard of surgical care. Full article

Background: Duchenne muscular dystrophy (DMD) is a rare, disabling, and life-threatening X-linked recessive disorder caused by mutations in the dystrophin gene. The current standard of care is treatment with corticosteroids, which aim to decrease inflammation-induced muscle damage and delay disease progression. Here, we aim to describe clinical, genetic, and diagnostic characteristics and evaluate current management practices of DMD patients in the Kingdom of Saudi Arabia (KSA). Methods: This was an ambispective (prospective and retrospective) observational multicenter study evaluating characteristics of patients aged 1–14 years with genetically confirmed DMD in the KSA. The variables of interest were demographics, genetic mutations, clinical characteristics, and initial management. The relationship between the age at diagnosis, initial management plan (standard of care), and age at initiation of treatment on disease outcomes was also evaluated. Results: A total of 226 patients (181 in the retrospective part and 45 in the prospective part) were enrolled. The most common type of genetic mutation was large deletions (134 patients, 59.3%). The median age of first symptom was 2.7 years (IQR: 2.0–4.6 years) and the median age at diagnosis was 7.0 years (IQR: 4.8–8.5 years). Among these patients, the most common initial symptoms were difficulty in walking (87.7%) and waddling gait (41%). The initial management plan for DMD patients involved medication (75.6%) and physical therapy (71.0%). The most frequently prescribed initial medications were vitamin D (82%) and corticosteroids (62.3%). In total, 6/226 patients (2.6%) received ataluren; they all had identified nonsense mutations. The median age of corticosteroid initiation was 7.1 years (IQR: 5.7–8.7). The median age at loss of ambulation (LoA) was 9.8 years (IQR: 8.0–11.4 years) in the non-treated patients; it was 10.1 years (IQR: 9.3–11.2 years) in the steroid-only group and 10.8 years (10.8, 10.8) in the combined ataluren and steroid treatment group. Discussion: Age of diagnosis and age of treatment initiation is relatively late in the KSA. However, early diagnosis and early treatment onset is associated with better clinical outcomes, mainly a delay in LoA. Therefore, there is an urgent need for raising awareness and enhancing early screening in the KSA. Full article

Background/Objectives: The COVID-19 pandemic substantially changed emergency care utilization patterns, but nationwide evidence comparing age-specific changes in 119 EMS-transported emergency department (ED) visits between children and adults remains limited. Using nationwide data from Korea’s public EMS system, we evaluated pre-COVID-19 and post-COVID-19 changes in 119 EMS-transported ED visits using KTAS-defined emergency acuity, ED disposition, and ED length of stay (ED LOS). Methods: We conducted a nationwide retrospective observational study using the National Emergency Department Information System. We included all 119 EMS-transported ED visits from 1 January 2019 to 31 December 2020 and used 23 February 2020 as the index date. Children were aged <20 years and adults were aged ≥20 years. The primary outcome was KTAS-defined emergency acuity; secondary outcomes were ED disposition and ED LOS. Multivariable logistic regression analyses were performed separately by age group. Results: A total of 2,104,163 119 EMS-transported ED visits were included. The proportion of pediatric visits decreased from 9.3% to 6.8% after COVID-19. Among children, crude emergency acuity decreased, whereas hospital admission and ED mortality increased; after adjustment, the odds of emergency acuity and hospital admission were slightly higher in the post-COVID-19 period. Among adults, emergency acuity, hospital admission, ED mortality, and ED LOS all increased, and adjusted odds of emergency acuity and hospital admission were also higher. Conclusions: Children showed mixed changes across severity-related indicators, whereas adults demonstrated a more consistent post-COVID-19 shift toward a higher-acuity clinical profile. Because these indicators were measured after ED arrival, the findings should be interpreted cautiously. Further studies using linked prehospital and hospital data are needed to better evaluate age-specific changes in EMS use. Full article

Background and Clinical Significance: Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disorder that can mimic infection or malignancy. Spinal involvement is exceedingly rare and usually limited to pachymeningitis or epidural pseudotumors. True vertebral bone destruction has been reported only sporadically. Case Presentation: A 54-year-old man presented to our emergency department with severe neck pain after a fall. CT and MRI revealed extensive osteolysis of the C1 posterior arch and odontoid process with atlantoaxial subluxation. Following a second inpatient fall, he developed acute tetraparesis. Emergency posterior occipitocervical fusion (C0–C4) with C1–C2 laminectomy and foramen magnum decompression was performed. Histopathology demonstrated dense lymphoplasmacytic infiltration and fibrosis with up to 36 IgG4⁺ plasma cells per high-power field and an IgG4⁺/IgG ratio > 40%, confirming IgG4-RD. The patient recovered substantial motor function postoperatively and regained independent ambulation after neurological rehabilitation. Conclusions: IgG4-RD can rarely present as destructive craniovertebral osteolysis with neurological compromise. Unexplained C1–C2 osteolytic lesions should prompt evaluation for IgG4-RD, a rare but treatable cause of cervical instability. Full article