Search Results (289)

For nearly 30 years, a chronic disease causing severe chronic subcutaneous edema of unknown etiology has been affecting cattle in the Central–Northern and Central–Southern mesoregions of the State of Bahia, Brazil. In this research we investigated 15 outbreaks of the disease, from October 2023 to April 2025, to determine its etiopathogenesis, epidemiology, clinical signs, and pathology. The disease occurs during the dry season in areas of native forest. It is characterized by chronic subcutaneous edema, especially in the regions of the head, dewlap, chest, and thoracic limbs, and by hydropericardium, hydrothorax, ascites, and right ventricular dilation. Marked hypertrophy of smooth muscle cells in the tunica media of arteries and arterioles, sometimes with an eccentric, irregular, and asymmetric arrangement, were the main histologic lesions observed. The thicknesses of the media of pulmonary and heart arteries and arterioles of 10 affected cattle were significantly thicker than those from 10 control cattle. The tunica adventitia was thickened with increased deposition of collagen, and the intima was hyperplasic. The aorta and carotid arteries showed multifocal smooth muscle cell proliferation in the tunica media. It is concluded that the disease is due to right heart failure due to pulmonary arterial hypertension (chronic cor pulmonale). Epidemiological data and inspections of affected pastures suggest that the disease is caused by a toxic plant. Full article

Background: Differentiating acute kidney injury (AKI) from chronic kidney disease (CKD) in children remains a critical unmet need due to the limitations of current clinical and biochemical markers. Conventional ultrasound lacks the sensitivity to discern subtle parenchymal alterations. This study explores the application of ultrasound radiomics—a novel, non-invasive, and quantitative image analysis method—for distinguishing AKI from CKD in pediatric patients. Methods: In this retrospective cross-sectional pilot study, kidney ultrasound images were obtained from 31 pediatric subjects: 8 with oliguric AKI, 14 with CKD, and 9 healthy controls. Renal parenchyma was manually segmented, and 124 advanced texture features were extracted using the open-source ©PyFeats. Features encompassed multiple categories (e.g., GLCM, GLSZM, WP). Statistical comparisons evaluated intergroup differences. Principal Component Analysis identified the top 10 most informative features, which were used to train supervised machine learning models. Model performance used five-fold cross-validation. Results: Radiomic analysis revealed significant intergroup differences (p < 0.05). CKD cases exhibited increased echogenicity and heterogeneity, particularly in GLCM and GLSZM features, consistent with chronic fibrosis. AKI cases displayed more homogeneous texture, likely reflecting edema or acute inflammation. While echogenicity separated diseased from healthy kidneys, it lacked specificity between AKI and CKD. Among ML models, XGBoost achieved the highest macro-averaged F1 score (0.90), followed closely by SVM and Random Forest, demonstrating strong classification performance. Conclusions: Radiomics-based texture analysis of grayscale ultrasound images effectively differentiated AKI from CKD in this pilot study, offering a promising, non-invasive imaging biomarker for pediatric kidney disease. These preliminary findings justify prospective validation in larger, multicenter cohorts. Full article

Background and Clinical Significance: Ischemic optic neuropathies (IONs) are significant causes of vision loss resulting from compromised blood flow to the optic nerve. Diabetes mellitus (DM) exacerbates the risk of IONs through chronic hyperglycemia and associated vascular dysfunction. Recently, semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has been linked to ocular complications, including non-arteritic anterior ischemic optic neuropathy (NAION), potentially due to the rapid glycemic changes or vascular effects. Case Presentation: A 55-year-old female with type 2 DM, hypertension, and hyperlipidemia presented with blurred vision and optic disc edema after four months of semaglutide therapy (Ozempic^®, Sydney, Australia). Initially diagnosed with diabetic papillopathy (DP), her condition progressed to NAION, leading to partial visual recovery with corticosteroid treatment and improved glycemic management. Diagnostic evaluations, including visual field testing, optical coherence tomography, and fluorescein angiography, supported the diagnosis. Conclusions: This case report describes the clinical course of a diabetic patient treated with a semaglutide who developed an ischemic optic event. The timing of symptom onset in relation to the initiation of semaglutide therapy raises the possibility of a causal association between the drug and this rare ocular complication. Close monitoring of ocular health is crucial for patients on GLP-1 receptor agonists, particularly those with pre-existing vascular risk factors. Further research is needed to elucidate the underlying mechanisms and guide clinical practice. Full article

Inflammatory pain is a worldwide health problem, affecting primarily women. Nonetheless, most research conducted in this field has involved male subjects, and only 10% of the results have been obtained using females. Gold Lotion (GL) is a formulated product made from the peels of six citrus fruits that have been proven, via experimental data, to possess several biological properties, such as anti-inflammatory, anticancer, and antibacterial activities. This research aims to investigate the response to GL administration in two models of peripheral inflammation to assess potential sex differences. Carrageenan was used to induce mechanical allodynia and maximal edema within hours, serving as a model of acute inflammation, while Complete Freund’s Adjuvant (CFA) was used to obtain similar results within days, resulting in a model of chronic inflammation. Acute GL administration reduced mechanical allodynia in both models and both sexes, with no anti-inflammatory effects observed. In conclusion, this study demonstrates the potential of GL to alleviate inflammatory pain in both males and females, thereby broadening its therapeutic applications. Full article

Background/Objectives: Brown–McLean syndrome (BMS) is a rare peripheral corneal edema that may arise years after cataract extraction or intraocular lens (IOLs) fixation. This article presents a case of IOL dislocation following scleral fixation in a patient with BMS, effectively managed by resuturing the existing IOL. Additionally, a literature review was conducted to summarize the clinical features, etiologies, and surgical outcomes of BMS. A PubMed search identified 30 reports encompassing 169 patients (244 eyes). Among these, corneal transplantation was performed in three eyes. Only four eyes underwent intraocular surgery after BMS onset, with no prior reports of IOL resuturing. Methods: A 73-year-old man with a history of left-eye trauma underwent vitrectomy and scleral fixation of a polymethyl methacrylate IOL 18 years prior. The patient presented with reduced vision in his left eye. Examination revealed BMS-related peripheral corneal edema and partial IOL dislocation. The dislocated haptic was resutured using an ab externo approach under a scleral flap. Results: Postoperative IOL fixation remained stable, with best-corrected visual acuity improving from 0.6 to 0.9. Edema persisted without central spread, and endothelial cell density decreased slightly (2496 to 2364 cells/mm²). One year postoperatively, no IOL tilt progression or suture-related complications were observed. Conclusions: Partial resuturing of a scleral-fixated IOL is effective for managing IOL dislocation in BMS when haptics remain stable. This approach minimizes incision size and potential endothelial trauma compared to explantation. However, aqueous dynamics correction may not reverse established BMS. Long-term endothelial monitoring is advised due to its chronic and progressive nature. Full article

Background: Enkephalins are endogenous opioid peptides that modulate cardiovascular and renal function and are overexpressed in patients with acute heart failure (AHF). Although biologically active enkephalins lack a favorable biomarker profile, their stable surrogate proenkephalin 119–159 (PENK) appears to display prognostic value in AHF settings. The aim of the present study was to evaluate the role of point-of-care (POC) PENK in predicting mortality and worsening renal function (WRF) in patients presenting to the emergency department (ED) with AHF. Methods: In this single-center observational study, 107 patients presenting to the ED with AHF were prospectively enrolled. We measured PENK levels upon ED presentation with a commercially available POC immunoassay and investigated their association with WRF within 48 h and all-cause mortality during a 1-year follow-up. Results: The patients had a mean age of 72 ± 13 years, and 58% were men. Moreover, 62% had acutely decompensated chronic heart failure (HF), 24% had pulmonary edema, 9% had cardiogenic shock, and 5% had right HF. The median PENK levels were 111 [60–193] pmol/L. PENK was independently associated with WRF (adjusted OR, 95% CI: 15.4 [2.0–120.2]; p = 0.009), with levels of ≥90.5 pmol/L identified as the optimal cut-off for predicting WRF (AUC: 0.690; p < 0.001). PENK was also an independent predictor of short- and long-term all-cause mortality, with an optimal cut-off of ≥95.8 pmol/L (AUC for 30-day, 90-day, and 1-year mortality: 0.717, 0.723, and 0.724, respectively; all p < 0.001). Conclusions: In patients presenting to the ED with AHF, POC PENK may serve as an early prognostic marker of WRF and short- and long-term mortality. Full article

Background/Objectives: Dermatitis is frequently treated with dexamethasone cutaneous application, which causes adverse effects mainly when it is chronically administered. Sesamol is a phytochemical compound known for its anti-inflammatory activity and low toxicity. Therefore, this study reports the optimization of a guar gum hydrogel with enhanced physicochemical and microbiological stability, providing an effective dosage form for topical application of sesamol nanocapsules to treat irritant contact dermatitis. Methods: Nano-based hydrogel containing 1 mg/g sesamol was prepared by adding the nanocapsule suspension to form a 2.5% (w/v) guar gum dispersion. Dynamic rheological analysis indicates that the formulations exhibit a non-Newtonian flow with pseudoplastic behavior. Hydrogels were evaluated by Fourier-transformed infrared (FTIR) spectroscopy, and, following spectrum acquisition, an unsupervised chemometrics model was developed to identify crucial variables. Additionally, the physicochemical and microbiological stability of the hydrogel was evaluated over a 60-day period. Results: ATR-FTIR spectra of all hydrogels evaluated are very similar after preparation and 60 days of storage. However, it showed a slight increase in average diameter and PDI and decreased pH values after 60 days. Microbiological assessment demonstrated that the hydrogel met the requirements for the microbial count over 60 days. The dermatitis model was induced by repeated applications of croton oil in the right ears of mice. The effectiveness of the hydrogels was evaluated by assessing ear edema and migration of polymorphonuclear cells. The nano-based hydrogel exhibited anti-inflammatory properties similar to those of dexamethasone. Conclusions: Therefore, the nano-based hydrogel containing sesamol exhibits therapeutic potential for treating cutaneous inflammatory diseases. Full article

Insulin resistance (IR), a core component in the development of type 2 diabetes mellitus (T2DM), is increasingly recognized for its role in cardiovascular and pulmonary complications. This review explores the relationship between IR, right ventricular dysfunction (RVD), and decreased lung volume in patients with T2DM. Emerging evidence suggests that IR contributes to early structural and functional alterations in the right ventricle, independent of overt cardiovascular disease. The mechanisms involved include oxidative stress, inflammation, dyslipidemia, and obesity—factors commonly found in metabolic syndrome and T2DM. These pathophysiological changes compromise right ventricular contractility, leading to reduced pulmonary perfusion and respiratory capacity. RVD has been associated with chronic lung disease, pulmonary hypertension, and obstructive sleep apnea, all of which are prevalent in the diabetic population. As RVD progresses, it can result in impaired gas exchange, interstitial pulmonary edema, and exercise intolerance—highlighting the importance of early recognition and management. Therapeutic strategies should aim to improve insulin sensitivity and cardiac function through lifestyle interventions, pharmacological agents such as SGLT2 inhibitors and GLP-1/GIP analogs, and routine cardiac monitoring. These approaches may help slow the progression of RVD and its respiratory consequences. Considering the global burden of diabetes and obesity, and the growing incidence of related complications, further research is warranted to clarify the mechanisms linking IR, RVD, and respiratory dysfunction. Understanding this triad will be crucial for developing targeted interventions that improve outcomes and quality of life in affected patients. Full article

Background: Stress hyperglycemia (SH), a transient elevation in blood glucose levels during acute stress such as stroke, has been increasingly recognized as a critical determinant of clinical outcomes. This review aims to evaluate the association between SH and clinical outcomes across different stroke subtypes and its role as a prognostic indicator. Methods: The current literature review was conducted through a comprehensive literature search of PubMed, Scopus, and Web of Science electronic databases. Initial title and abstract screening was conducted by two independent reviewers depending on the relevance to the topic of interest. Final study inclusion was based on the clinical relevance and agreement between reviewers. Results: Current evidence links SH with higher stroke severity (Higher national institutes of health stroke scale (NIHSS)), larger infarct volumes, increased risk of hemorrhagic transformation, and worse functional recovery (Lower modified rankin scale (mRS)), especially in ischemic stroke. In hemorrhagic stroke, SH is associated with hematoma expansion, perihematomal edema, and worsening neurological function. Although SH has been shown to be a reliable stroke outcome predictor, there is no scientific consensus regarding the most reliable measurement method. The use of absolute blood glucose values may not accurately reflect SH, particularly in diabetic patients, where chronic baseline hyperglycemia complicates interpretation. This underscores the necessity for individualized assessment rather than a uniform interpretation. Clinically, the early detection of SH may provide enhanced monitoring and supportive care; however, rigorous glucose management remains contentious due to the risk of hypoglycemia. Conclusions: This review synthesizes evidence from recent studies and supports SH as a prognostic marker of both short- and long-term adverse outcomes in stroke patients. Further research is warranted to evaluate the efficacy of targeted glycemic treatments on such outcomes. Full article

Background: Hyaluronic acid (HA) has emerged as a favored adjunct to restore volume after blepharoplasty and is very effective in the treatment of postoperative hollowness, sagging, and asymmetry. Its efficacy, rate of complications, and optimal injection technique are different in different clinical studies. Hyaluronidase has been studied by diverse methods in the treatment of HA complications, including chronic edema and surgical distortion. This study critically evaluated the efficacy, safety, and technical aspects of HA in the context of blepharoplasty outcomes. Methods: A systematic review was performed to evaluate the use of HA and hyaluronidase for post-blepharoplasty volume rejuvenation and the treatment of complications. Studies describing HA injection technique, time interval between blepharoplasty and injection, volumetric maintenance, complication rates, esthetic and functional results, and patient satisfaction scores were considered. Risk of bias was estimated with the ROBINS-I tool. Results: Sample sizes across the five included studies ranged from 5 to 109 patients, and follow-up intervals ranged from 1 month to 7 years. The age of patients ranged from 31 to 76 years, and females accounted for 86% of the participants in some studies. Injection of HA successfully restored meaningful volume, with retention persisting for over 12 months in the majority of cases. HA preoperative injection caused significant patient satisfaction in a short duration and was not associated with severe complications; delayed injection caused slight distortions in some revision operations. Lipofilling showed a reduced rate of complications (12%) compared with isolated blepharoplasty (20%), suggesting its utility as an adjuvant procedure of volume restoration. Hyaluronidase successfully treated recalcitrant edema, with improvements ranging from 50% to 100%, while the application of adjuvant RF microneedling caused complete remission (100%) in subjects with multiple treatments. The application of ultrasound imaging made measurements more precise, although methods of clinical assessment were significantly heterogeneous among the studies. Conclusions: HA displayed efficacy in terms of efficient volume restoration after blepharoplasty, especially when technique, time, and filler selection are meticulously optimized. In comparison to lipofilling, HA is seen as somewhat safer because of its reversibility and lower likelihood of adverse vascular events. Nonetheless, considerable variability in filler type, amount, timing of administration, and result evaluation constrains conclusive clinical recommendations. The use of hyaluronidase is an effective remedial approach for overcorrection or ongoing edema. Full article

Background: Acute heart failure (AHF) is a major cause of hospitalizations, posing significant challenges to healthcare systems. Despite advancements in management, the rate of poor outcomes remains high globally, emphasizing the need for timely interventions. This study aimed to identify early admission-based factors predictive of poor outcomes in hospitalized AHF patients, in order to contribute to early risk stratification and optimize patient care. Methods: This retrospective single-center study analyzed routine data of adult patients hospitalized for AHF at a public university teaching hospital in Switzerland. Outcomes included in-hospital death, intensive care (ICU) treatment, and length of hospital stay (LOHS). Potential predictors were limited to routine parameters, readily available at admission. Missing predictor data was imputed and predictors were identified by means of multivariable regression analysis. Results: Data of 638 patients (median age 84 years, range 45–101 years, 50% female) were included in the study. In-hospital mortality was 7.1%, ICU admission rate 3.8%, and median LOHS was 8 days (IQR 5–12). Systolic blood pressure ≤ 100 mmHg (Odds ratio (OR) 3.8, p = 0.009), peripheral oxygen saturation ≤ 90% or oxygen supplementation (OR 5.9, p < 0.001), and peripheral edema (OR 2.7, p = 0.044) at hospital admission were identified as predictors of in-hospital death. Furthermore, a stroke or transient ischemic attack in the patient’s history (OR 3.2, p = 0.023) was associated with in-hospital death. ICU admission was associated with oxygen saturation ≤ 90% or oxygen supplementation (OR 22.9, p < 0.001). Factors linked to longer LOHS included oxygen saturation ≤ 90% or oxygen supplementation (IRR 1.2, p < 0.001), recent weight gain (IRR 1.1, p = 0.028), and concomitant chronic kidney disease (IRR 1.2, p < 0.001). Conclusions: This study validated established predictors of AHF outcomes in a Swiss cohort, highlighting the predictive value of poor perfusion status, fluid overload, and comorbidities such as chronic kidney disease. The identified predictors imply potential for developing tools to improve rapid treatment decisions. Future research should focus on the prospective external validation of the identified predictors and the design and validation of risk scores, incorporating these parameters to optimize early interventions and reduce adverse outcomes in AHF. Full article

Oxalis pes-caprae is one of the most widespread invasive plants in the Mediterranean areas, especially in central and southern Italy, Sicily, and Sardinia. It is an herbaceous species of South African origin, very common in uncultivated areas, in meadows, and at the edges of roads but also in vegetable gardens and fields, where it can become a weed. Its negative impact on the economic sector is significant due to the presence of large quantities of oxalates, which are toxic and dangerous for grazing livestock; the ingestion of high amounts of oxalates causes the accumulation of oxalate crystals, which can lead to kidney failure and anuria. This work represents a descriptive, field-based case report of epidemiological relevance, describing two cases of acute and chronic poisoning by Oxalis pes-caprae found in two different sheep farms in southern Sardinia. In February 2024, the sudden death of about 40 animals was reported in a sheep farm. On another farm, seven animals died (between March and July 2024), while others showed poisoning symptoms such as weight loss, submandibular edema, and a barrel-shaped abdomen. This manuscript aims to highlight the damage caused by poor attention in pasture management and the importance of seasonal risk management; it is necessary to pay attention to the herbaceous species present in pastures, especially in our region, where climatic temperatures no longer respect seasonality and herbaceous species that normally grow in spring are easily found also in the winter months. Full article

Objectives: This review explores the role of swept-source optical coherence tomography (OCT) in diagnosing and monitoring optic nerve neuropathy in Wernicke’s encephalopathy (WE) due to hyperemesis gravidarum, including a case of neuropathy from intractable vomiting in pregnancy. Methods: A literature search was conducted in the PubMed database to select high-quality reviews and original articles on the use of swept-source OCT for assessing optic nerve involvement in WE due to hyperemesis gravidarum. Results: WE is a potentially fatal neuropsychiatric syndrome caused by thiamine deficiency due to various causes, like alcoholism, malnutrition, and prolonged parenteral nutrition. This condition can cause neurological disorders such as imbalance, altered mental status, nystagmus, and ophthalmoplegia. Sometimes, there is also a deterioration of visual acuity with swelling of the optic disc. OCT is a non-invasive imaging tool that can detect optic nerve involvement in WE by assessing peripapillary retinal nerve fiber layer (pRNFL) thickness. In the acute phase, optic disc edema and increased pRNFL thickness may be observed, while chronic-phase changes include optic nerve atrophy and pRNFL thinning. WE may occur in the course of hyperemesis gravidarum in pregnant women. We present a case of a 23-year-old woman at 14 weeks of gestation with WE due to severe hyperemesis gravidarum, manifesting as visual impairment and neurological deficits. MRI confirmed the diagnosis, while OCT revealed transient pRNFL thickening followed by optic nerve atrophy. Conclusions: Early diagnosis and thiamine supplementation are crucial to preventing severe complications. OCT is a valuable tool for detecting and tracking optic nerve changes in WE. Full article

Background: Advancements in surgical wound management have led to improved healing and reduced complications. Incisional negative pressure wound therapy (iNPWT) is a technique that applies sub-atmospheric pressure to closed surgical wounds, enhancing blood flow, minimizing edema, and promoting tissue repair. Initially developed for chronic wounds, its use has expanded across multiple surgical specialties, including orthopaedic trauma surgery, to reduce complications such as dehiscence, infection, and prolonged healing. While traditional wound care relies on standard closure methods with simple dressings, iNPWT offers additional mechanical support and may lower the risk of deep surgical site infections (SSIs). This review examines the current evidence on iNPWT’s role in preventing SSIs following surgery for lower extremity fractures to guide clinical decision-making and improve patient outcomes. Methods: A systematic search through PubMed and MEDLINE utilizing our inclusion and exclusion criteria yielded seven randomized controlled trials and randomized prospective cohort studies that were subsequently analyzed to determine iNPWT effectiveness. Results: Of the seven studies, five showed a decreased SSI rate compared to standard wound dressing, with the other two exhibiting an increased infection rate. Conclusions: This review critically examines existing literature on iNPWT, analyzing level I and II studies on deep SSI rates in traumatic fractures. The evidence remains inconclusive on whether iNPWT offers a significant advantage over standard wound dressings, highlighting the need for further research to clarify its efficacy and clinical application. Full article

Background and Clinical Significance: The coexistence of spinal hemangiomas and dural arteriovenous fistula (SDAVF) is uncommon. Unclear imaging and progressive neurological impairment require early surgical management. Case Presentation: A 76-year-old woman presented with progressive thoracolumbar pain and worsening bladder dysfunction. Magnetic resonance imaging (MRI) of the thoracic spine revealed a round-shape expansive lesion at T11 with spinal cord edema and homogeneous contrast enhancement. Despite a chronic presentation, the subacute progression of bladder dysfunction and spinal cord edema warranted timely intervention. Intraoperatively, a vascular malformation resembling a dural arteriovenous fistula (SDAVF), unrecognized at pre-operative imaging, was found in association, and histological examination confirmed the diagnosis of hemangioma. The mechanism of coexistence remains unclear, although venous hypertension due to fistula could induce vascular malformations. Conclusions: This case emphasizes the importance of thorough imaging, timely intervention and intraoperative assessment in patients presenting with a suspicion of spinal hemangioma; it may also provide awareness of potentially associated concurrent lesions such as SDAVFs, unrecognized at pre-operative imaging, and technical insights during surgery. Full article