Search Results (12,569)

Background: Invasive Aspergillosis (IA) is a rare but life-threatening fungal infection in immunocompromised hosts, including solid organ transplant (SOT) recipients. While extensively studied in other SOT populations, data on IA in pancreas transplant (PT) recipients are limited. Earlier studies reported mortality rates nearing 100%, whereas more recent data show that 12-week mortality still exceeds 20% despite improvements in antifungal therapy. Current prophylaxis strategies for PT recipients mainly focus on Candida species, and there are no clear, standardized recommendations for Aspergillus prevention. Given the paucity of focused data, the epidemiology, clinical characteristics, and outcomes of IA in PT recipients are not well defined. This study aimed to assess the incidence, clinical characteristics, and outcomes of IA among hospitalized PT patients using a nationally representative dataset. Methods: We conducted a descriptive analysis using the National Inpatient Sample (NIS) from 2016 to 2020. PT admissions were identified using International Classification of Diseases, Tenth Revision (ICD 10) codes for transplant status and procedures. IA was defined using validated ICD 10 codes. Baseline demographics, hospital characteristics, comorbidities, and outcomes, including sepsis, acute kidney injury (AKI), acute respiratory failure (ARF), invasive mechanical ventilation (IMV), all-cause in-hospital mortality, length of stay, and total hospitalization costs and charges were compared between PT admissions with and without IA. National estimates were calculated using discharge weights, and comparisons were performed using the chi-square test and adjusted Wald test. Multivariable analysis was performed to identify predictors of all-cause in-hospital mortality among PT admissions complicated by IA. Two-sided p values < 0.05 were considered statistically significant. Results: Between 2016 and 2020, 65,980 PT-related hospitalizations were identified, of which 250 (0.4%) had IA. PT admissions complicated by IA were more commonly aged 41 to 60 years (59% vs. 46%, p = 0.012) and were less likely to have a Charlson Comorbidity Index greater than 3 (54% vs. 68.6%, p < 0.001) compared with PT hospitalizations without IA. The PT with the IA cohort had higher rates of sepsis (100% vs. 46.1%, p < 0.001), AKI (60% vs. 36.7%, p < 0.001), ARF (28% vs. 9.4%, p < 0.001), and IMV use (18% vs. 4%, p < 0.001) compared with the PT without the IA cohort. Among PT hospitalizations with IA, IMV use was independently associated with higher all-cause in-hospital mortality (adjusted odds ratio 48.777, p = 0.009). Overall, in-hospital mortality was significantly higher in PT hospitalizations with IA compared with those without IA (12% vs. 2%, p < 0.001). Mean length of stay was longer (24.86 vs. 6.13 days, p < 0.001), and total charges ($378,494 vs. $94,938, p < 0.001), and total costs ($93,019 vs. $24,463, p = 0.023) were significantly higher compared with PT hospitalizations without IA. Conclusion: Although rare, IA in PT recipients is associated with higher rates of sepsis, AKI, ARF, venous thromboembolism, prolonged hospitalization, increased mortality, and greater healthcare utilization. Despite the inherent limitations of administrative datasets, this nationally representative analysis highlights the substantial clinical and economic burden of IA in this high-risk population. These findings emphasize the need for targeted surveillance, early diagnosis, and evidence-based antifungal strategies in this vulnerable population. Full article

One of the apostolic fields in which the Society of Jesus was involved since its foundation in 1540 was the missiones ad gentes [missions among non-Christians], which produced a constant flow of European missionaries to other continents. Specifically, the Jesuit provinces of Spain sent many missionaries beyond their borders, creating administrative units that were initially dependent on the metropolis and later became autonomous Jesuit territories. There are many partial studies of many of the realities related to the Jesuit missions; We now intend to take a brief historical overview to illustrate this centrifugal trend in Spain within the Jesuit sphere, both in the old Society (before its suppression by Pope Clement XIV in 1773) and in the contemporary one (since its restoration by Pope Pius VII in 1814). To this end, we will briefly review demographic and geographical data, which provide overall figures and territorial configurations throughout the history of the Society of Jesus. Full article

Background/Objectives: Dental anxiety and uncooperative behavior present significant challenges in pediatric dentistry and may adversely affect treatment outcomes and oral health. The main goal of this study was to evaluate the predictive performance of machine learning models in classifying dental anxiety measured using the Abeer Children Dental Anxiety Scale (ACDAS), predicting uncooperative behavior, estimating continuous dental anxiety scores, and identifying key predictors among children aged 6–11 years attending pediatric dental clinics in Jeddah, Saudi Arabia. Methods: This is an analytical cross-sectional study conducted among 952 children to evaluate whether machine learning models could predict dental anxiety and cooperative behavior based on demographic, clinical, and behavioral variables. Twenty variables captured demographic, medical, and dental history, BMI, and anxiety/behavioral measures. Data preprocessing included removing sparse variables, imputing missing values, and encoding categorical and ordinal variables appropriately. Logistic Regression models were trained to classify dental anxiety and cooperative behavior. A Random Forest Regressor was used to predict continuous anxiety scores, and a Random Forest Classifier was used for feature importance analysis. Principal Component Analysis (PCA) and K-Means clustering were applied to explore behavioral subgroups. Results: This dataset shows the Logistic Regression model with 0.92 accuracy (ROC AUC 0.98) for predicting dental anxiety and 0.91 accuracy (ROC AUC 0.95) for cooperative behavior. The Random Forest Regressor predicted anxiety scores with R² = 0.97. Feature importance revealed that sensory and cognitive responses were key predictors of anxiety and cooperation. Unsupervised clustering identified two behavioral profiles: one with lower and another with higher anxiety and cooperation. Conclusions: ML models demonstrated strong prediction of dental anxiety and cooperation in this pediatric sample. While promising for early detection and personalized management of anxious or uncooperative children, further validation is essential before clinical use. Full article

Background/Objectives: This study aimed to determine the prevalence of aphthous ulcers following periodontal surgery and to identify demographic, behavioral, and clinical predictors of ulcer history before surgery and ulcer development after surgery. Methods: A cross-sectional study was conducted among 227 adult patients undergoing periodontal surgical procedures between November 2024 and May 2025. Demographic, medical, behavioral, and oral health data were collected. Postoperative follow-up at 1 and 2 weeks included a standardized clinical assessment of aphthous ulcers. Statistical analyses included descriptive statistics, chi-square tests, and Chi-squared Automatic Interaction Detection (CHAID) decision tree modeling. Results: Aphthous ulcers developed in 47 patients (20.7%), predominantly within the first postoperative week. CHAID analysis identified age, marital status, and smoking as predictors of preoperative ulcer history (classification accuracy: 73.6%), whereas age and family history predicted postoperative ulcer development (79.4%). Periodontal procedure type was significantly associated with postoperative medication prescription (χ² = 300.45, p < 0.001), suture selection (χ² = 69.19, p = 0.024), and ulcer number (χ² = 48.43, p = 0.031), but not ulcer size or anatomical location. Most ulcers were minor and primarily involved the buccal mucosa. Conclusions: Postoperative aphthous ulceration is a common complication of periodontal surgery, affecting approximately one-fifth of patients. Distinct risk profiles for pre- and post-surgical ulceration highlight the roles of patient-related susceptibility and surgical complexity. These findings support the use of structured risk stratification to guide preoperative counseling and targeted postoperative management. Full article

Background/Objectives: Tenosynovial giant cell tumours (TGCT) are a group of mesenchymal tumours involving the synovium, bursae, and tendon sheaths, comprising two subtypes: nodular and diffuse. Although predominantly benign, diffuse forms can be locally aggressive, resulting in bone destruction. The pathogenesis of TGCTs is still poorly understood. The aim of this study was to systematically review the current literature on the factors, mechanisms, and markers involved in TGCT disease, focussing on their potential role in bone destruction. Methods: This systematic review was conducted using the PRISMA guidelines. A search was performed using PubMed, Scopus, and Cochrane Library, and all original scientific research into mechanisms/pathways/signalling involving TGCTs was included. Results: After the review process, 51 studies were included for data extraction. Extracted data included authorship, publication year, patient numbers and aetiology (nTGCT/dTGCT), demographics, investigative methods, and studied biological factors, mechanisms, and markers. Cross-tabulation of reported elements revealed 159 unique factors, with most appearing only once. Eight elements were reported five or more times: CSF1, CD68, Ki-67, MMP9, CD163, TRAP, TNF-α, and IL-1β. Although representing just 5% of all identified factors, these appeared in 69% of the included studies, highlighting their prominence in the literature. Conclusions: Apart from the well-known osteoclastogenesis factor CSF1, inflammatory cytokines (TNF-α and IL-1β) and monocyte–macrophage lineage makers (CD68, CD163) are signalling pathways key to TGCT disease progression and associated bone destruction. Full article

Background/Objectives: The global increase in metabolic dysfunction-associated steatotic liver disease underscores the need for accessible and reliable markers to assess hepatic steatosis. The triglyceride–glucose (TyG) index, derived from fasting plasma glucose and triglyceride levels, has emerged as a practical surrogate marker of insulin resistance and has been increasingly associated with metabolic liver involvement. This study aimed to evaluate the relationship between the TyG index and the severity of hepatic steatosis assessed by ultrasonography. Methods: This retrospective cross-sectional study included 480 adult patients without a prior diagnosis of diabetes mellitus or hypertension who underwent fasting laboratory testing and abdominal ultrasonography between January 2024 and May 2025. Fasting plasma glucose and triglyceride levels were obtained on the same day as ultrasonographic evaluation. Hepatic steatosis was assessed by a single experienced radiologist using standardized ultrasonographic criteria, and patients were categorized into three groups according to steatosis grade (grade 0, grade 1, and grade 2–3; n = 160 for each group). Demographic data and laboratory parameters, including glucose, triglycerides, HbA1c, platelet count, neutrophils, lymphocytes, monocytes, ALT, AST, and total cholesterol levels, were recorded. The TyG index was calculated using the formula: TyG = ln[(fasting triglycerides × fasting glucose)/2]. Results: A total of 480 patients (30.6% male) were included in the analysis. Mean fasting glucose, triglyceride, and TyG index values were 94.20 ± 11.15 mg/dL, 146.91 ± 83.94 mg/dL, and 8.70 ± 0.55, respectively. Metabolic and inflammatory parameters increased significantly with advancing steatosis grades (all p < 0.05). The TyG index demonstrated a clear stepwise increase from grade 0 (8.29 ± 0.42) to grade 1 (8.74 ± 0.42) and grade 2–3 steatosis (9.07 ± 0.49) (p < 0.001), with all pairwise comparisons remaining statistically significant. Receiver operating characteristic (ROC) analysis showed good discriminative performance of the TyG index for hepatic steatosis (AUC = 0.829), and an optimal cutoff value of 7.90 was identified using the Youden index, yielding high sensitivity for detection. In multivariable logistic regression analysis, the TyG index remained the strongest independent predictor of hepatic steatosis (adjusted OR 11.41, 95% CI 6.10–21.34; p < 0.001). Conclusions: The TyG index increased progressively with the severity of hepatic steatosis and showed strong associations with metabolic and inflammatory parameters. These findings support the TyG index as a simple and accessible marker reflecting metabolic dysfunction and hepatic steatosis, with potential value for early risk stratification in clinical practice. Full article

In the spirit of the recent debate on the 15-minute city, two concepts are central: urban proximity and resilience. They became cornerstones of new urban planning perspectives on sustainability, livability, and inclusiveness in cities and metropolitan areas. Very recently, the notion of ‘proxilience’ has been introduced as an integration of urban planning views on the drivers of citizens’ wellbeing. The present study seeks to conceptualize and operationalize the proxilience concept for the case of metropolitan agglomerations, in which the core is termed here ‘Superbowl Economy’. Consequently, the paper presents a data-driven analytical approach that uses detailed empirical data on spatial density patterns, demographic factors, socioeconomic indicators, environmental quality attributes, infrastructure accessibility, and access to services and amenities. The empirical part of the study is based on a blend of geostatistical and econometric models (correlation and regression analysis, AHP modelling, and Random Forest model). The analysis framework and the underlying propositions on the proxilience impacts on spatial patterns of disparities in wellbeing are applied and tested for the greater Iași Metropolitan Area, which is one of the largest urban poles in Romania. The findings confirm proxilience as a novel, multidimensional tool that advances spatial (urban–regional) livability in a polarized yet fragmented urban system. Full article

Background: Advanced HIV disease (AHD) remains highly prevalent and is associated with increased morbidity and mortality. Missed opportunities for early diagnosis continue to represent a major public health challenge. Methods: We conducted a multicenter retrospective cohort study including antiretroviral-naive people with HIV (PWH) presenting with AHD (CD4 < 200 cells/µL and/or AIDS) diagnosed between 1 January 2019 and 31 December 2024 in four Italian infectious diseases units. Demographic, clinical and viro-immunological data were collected at baseline and during follow up. Information on healthcare contacts, HIV-related symptoms, and prior HIV testing in the two years preceding diagnosis was obtained through structured interviews. Results: Among 658 newly diagnosed participants with HIV, 224 (34%) presented with AHD, of whom 54% presented with AIDS. Most participants (86.2%) had never undergone HIV testing before diagnosis. In the year preceding diagnosis 29.3% accessed healthcare services for symptoms compatible with HIV infection without being tested for HIV. At one year, 84.2% achieved virological suppression, with a median CD4 count of 260 cells/µL. Overall loss to follow-up was 27.2%. Five-year survival was significantly higher in non-AIDS presenters compared with AIDS presenters (100% vs. 85%, p = 0.005). Conclusions: Missed diagnostic opportunities remain frequent among PWH presenting with AHD, despite prior healthcare contacts. Wider implementation of indicator condition-guided HIV testing is urgently needed to reduce late diagnosis and improve long-term outcomes. Full article

Background/Objectives: Sex and age influence inflammatory responses, but researchers have not fully characterized their combined association with complicated acute appendicitis (CAA). This study assessed the independent and interactive associations of sex, age, and inflammatory cell counts with CAA. Methods: We conducted a retrospective observational study of 708 patients with histopathologically confirmed uncomplicated appendicitis (UAA) or CAA. We analyzed demographic and clinical data, including preoperative complete blood counts, stratified by sex. We used multivariable logistic regression models with interaction terms to evaluate associations and possible effect modification by sex and age. We explored the direction and magnitude of these interactions by estimating marginal predicted probabilities. Results: The incidence of CAA was significantly higher in men than in women. In men with CAA, complete blood count analysis showed elevated neutrophil and monocyte counts and reduced lymphocyte counts. Male sex (odds ratio (OR) 2.197, 95% confidence interval (CI) 1.610–2.999), continuous age (1.017, 1.002–1.033), lymphocyte count (0.656, 0.526–0.820), monocyte count (1.551, 1.036–2.321), and platelet count (1.004, 1.001–1.006) were independently associated with CAA. Interaction analysis revealed significant interactions between neutrophils and both sex and age (p < 0.05), while lymphocyte counts showed significant interaction with age but not with sex. Conclusions: This study provides new insight into complex sex- and age-related immune cell patterns in CAA and may inform future diagnostic and management strategies by highlighting immune profile variability. Full article

Background and Objectives: Many patients present with urgent endodontic conditions characterized by pain and swelling, requiring prompt intervention. Failure to return for definitive root canal treatment (RCT) after urgent care can compromise tooth prognosis. This study examined the frequency and diagnostic patterns of urgent endodontic visits at a university dental college and evaluated predictors of follow-up after urgent treatment, considering demographic, anatomical, and clinical factors. Materials and Methods: A retrospective cohort analysis of 1619 patient records (August 2023–May 2025) was conducted. Data on urgency type, pulpal/periapical diagnosis, tooth characteristics, urgent treatment modality, and follow-up attendance were collected. Descriptive statistics and chi-square tests were used to assess bivariate associations. Multivariable logistic regression was performed to evaluate factors associated with completing follow-up after urgent care. Results: Approximately 50.2% of visits involved urgent endodontic care, most commonly symptomatic irreversible pulpitis (SIP) with symptomatic apical periodontitis (SAP), particularly in posterior teeth. Pulpectomy was the most frequently provided urgent treatment. Overall, 72.8% of urgent-care patients returned for completion of RCT (overall OR = 2.67). While urgency incidence and follow-up rates did not differ by gender, arch, or region, gender-stratified comparisons within urgent cases showed significant differences by arch and region. In multivariate analysis, mandibular teeth demonstrated higher odds of follow-up than maxillary teeth, whereas gender and region showed no association. Patients diagnosed with asymptomatic irreversible pulpitis (AIP)/SAP had lower odds of returning, and those treated with canal debridement with occlusal reduction (CD/OD) were also less likely to complete treatment. No other diagnostic or treatment categories showed significant associations. Conclusions: In this university-based cohort, urgent endodontic visits were common and primarily involved SIP/SAP. While the overall follow-up rate was high, certain diagnostic and treatment scenarios, specifically AIP/SAP and CD/OD, were associated with a reduced likelihood of returning for completion of RCT. Given the study’s limitations, these findings should be interpreted with caution. Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS) can present as a complex interplay of widespread symptomatology and multisystem involvement, posing diagnostic and treatment challenges. Objective characterization of cervical spine and neurovascular findings in hEDS has been limited. Previous studies have emphasized upper cervical spine complications in hEDS, yet the relevance and mechanisms underlying associated symptomatology have not been elucidated. This study examined objective test findings in patients with hEDS at an outpatient neck clinic to explore cervical spine and neurovascular pathology that could contribute to further understanding the clinical profile of a subset of patients with hEDS. Methods: This single-center, retrospective observational study included patients with hEDS aged 20–50 years from 1 January 2022–31 December 2024, at an outpatient neck center. It excluded previous neck surgery, traumatic events, or related injury. Demographic, clinical, and diagnostic data were collected through a retrospective chart review, including measurements from standard clinical diagnostic protocols: digital motion X-ray (videofluoroscopy), cone beam CT, Doppler ultrasound, and tonometry. Results: More than 71% of patients reported ≥29 symptoms. Nearly all patients exhibited co-occurring forward head, decreased depth of curve, ligamentous cervical instability, and decreased internal jugular vein (IJV) and vagus nerve cross-sectional area (CSA). Vagus nerve CSA was found to be significantly smaller than the comparative healthy/normal population. IJV CSA was significantly smaller at C1 than at C4–C5, suggesting evidence of carotid sheath compression at C1. Conclusions: This study offers novel evidence that cervical spine pathology, IJV compression, and vagus nerve degeneration are uniformly prevalent in hEDS, which may contribute to, or be an etiological basis for, the multisystem involvement in a subset of patients with this disorder. These findings provide hypothesis-generating data to inform future mechanistic and therapeutic studies, including exploration of new diagnostic and treatment targets. Full article

Background: Hemoglobin (Hb) and hematocrit (Hct) reference intervals (RIs) are critical for diagnosing hematological disorders. However, existing reference values often do not account for demographic and environmental variability. Particularly in countries with altitude gradients, such as Colombia, the absence of locally adjusted intervals may lead to the misclassification of anemia and polycythemia. Therefore, this study aims to establish sex-, age-, and altitude-specific reference intervals for Hb and Hct within the Colombian adult population via an indirect, big-data-based methodology. Methods: This retrospective cross-sectional study used 3.1 million Hb and Hct test results nationwide between 2022 and 2024. After applying the exclusion criteria, Hb data from 667,857 individuals and Hct data from 662,024 individuals were included. The population was stratified by sex, age, and altitude into <1100 m above sea level (m.a.s.l.), 1100–2000 m.a.s.l., and 2000–3000 m.a.s.l. Reference intervals (RIs) were estimated via the refineR algorithm, and the results were compared across altitude categories and against World Health Organization (WHO) anemia and polycythemia thresholds. Results: Hb and Hct concentrations increased with altitude in all sexes and age groups. Compared with women, men presented higher mean values and narrower RIs, whereas older adults presented greater variability. Compared with WHO thresholds, a significant proportion of individuals living above 2000 m exceeded polycythemia cutoffs without clinical evidence of disease, suggesting the need for altitude-adjusted diagnostic criteria. Conclusions: This study provides the first large-scale, data-driven reference intervals for Hb and Hct in Colombia, adjusted for altitude, sex, and age. The implementation of locally derived RIs may improve diagnostic accuracy and prevent the over- or underdiagnosis of hematological disorders, with direct implications for clinical decision-making and public health policy. Full article

Scarcity of healthcare resources requires prioritisation decisions that raise complex ethical, economic, and social challenges. While normative frameworks provide guidance on how such decisions ought to be made, growing evidence suggests that individuals differ substantially in how they approach morally charged allocation choices. This study investigates heterogeneity in decision-making styles and support for healthcare prioritisation criteria using an interdisciplinary approach that integrates health economics, social psychology, and computational methods to identify latent decision-making profiles among a sample of adults residing in Portugal. Data were collected from adults residing in Portugal using a structured online questionnaire comprising socio-demographic characteristics, decision-making styles, and preferences elicited through twenty hypothetical healthcare rationing scenarios. The results reveal three meaningful decision-making profiles characterised by different combinations of cognitive styles and ethical prioritisation patterns: analytically oriented decision-makers prioritising health gains; intuitive, context-sensitive decision-makers balancing clinical and social criteria; heuristic-driven decision-makers relying on simpler or less differentiated heuristics. These findings demonstrate that, within this sample, healthcare prioritisation preferences are shaped by systematic variations in decision style rather than a single moral or rational framework. By linking behavioural heterogeneity with ethical decision-making, this study contributes to theoretical debates on healthcare rationing and demonstrates the value of clustering techniques for uncovering latent structures in complex decision data. The results provide insights relevant for the design of decision-support systems and rationing policies, which may be adapted to accommodate heterogeneous decision styles in comparable settings. Full article

Objective: This study aimed to investigate the association between the neutrophil-to-albumin ratio (NAR) and coronary atherosclerotic burden, assessed using the Gensini score, in patients referred for coronary angiography (CAG). Methods: A total of 987 patients who underwent CAG at Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2020 and June 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, including complete blood count, albumin, lipid profile, and creatinine, were collected prior to angiography. The NAR was calculated as the ratio of absolute neutrophil count to serum albumin. Coronary atherosclerotic burden was assessed using the Gensini scoring system and analyzed across predefined score categories representing increasing anatomical disease extent: normal (score 0), mild (1–24), and severe (≥25). Statistical analyses included group comparisons and multivariable regression analyses appropriate to the study design. Results: Higher NAR values were associated with increased angiographic coronary atherosclerosis severity at the group level across Gensini score categories. This association remained statistically significant after prespecified multivariable adjustment for established cardiovascular risk factors. Conclusions: Higher NAR values were associated with greater angiographic coronary atherosclerotic burden, as quantified by the Gensini score, in an angiography-referred population. Full article

Background: Cupriavidus is an aerobic Gram-negative bacterium and a rare conditional pathogen that mainly infects immunocompromised patients or those undergoing invasive procedures. Methods: We present the case of a 70-year-old male with diabetes mellitus who developed septic shock following influenza A virus (IAV) pneumonia. Cupriavidus gilardii (C. gilardii) was identified in his blood and sputum samples. Through a literature review, we identified 31 reported cases of Cupriavidus infections. Clinical data, including demographic information, clinical characteristics, comorbidities, laboratory results, Cupriavidus species, treatment, and clinical outcomes, were collected. Results: Among these 32 patients (including our patient), 23 were male (71.9%) and 9 were female (28.1%). The median patient age was 32.5 (2.12–70) years. Most patients had relevant risk factors or comorbidities before Cupriavidus infection, including exposure to polluted environments and recent invasive procedures (68.9%). Among these cases, Cupriavidus pauculus was the most common strain, accounting for 56.3% of cases. The mortality rate was the highest for Cupriavidus pauculus infections. Conclusions: Cupriavidus is a rare opportunistic pathogen in patients with compromised immune function. Early identification of pathogen and timely treatment are crucial. When traditional microbiological detection methods encounter difficulties, gene sequencing can be used as an auxiliary diagnostic tool and can further predict drug resistance. Targeted anti-infection treatment is effective in most cases, but some severe infection cases may lead to death due to serious complications. Full article