Search Results (1,245)

Background: Non-thyroidal illness syndrome is frequent in critically ill patients, but the prognostic value of dynamic changes in thyroid function tests remains unclear. This study evaluated whether serial measurements of thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) provide additional predictive value for 30-day mortality beyond conventional severity scores in ICU patients. Methods: This single-center retrospective observational study included 74 adult patients treated for ≥72 h in a general ICU who had TSH and FT3 measured within 24 h of admission and repeated at 48–72 h. Patients aged 18 years or above admitted to the intensive care unit were included in the study. Demographic characteristics, comorbidities, APACHE II, SOFA, modified NUTRIC (mNUTRIC) scores, and routine laboratory data (including albumin, CRP, and lactate) were recorded. The primary outcome was 30-day mortality. Between-group comparisons were performed using t-tests, Mann–Whitney U, and Chi-square tests. Variables significant in univariate analyses were entered into binary logistic regression models, and predictive performance was assessed using receiver operating characteristic (ROC) curves and the Youden index. Results: The mean age was 68.7 ± 14.7 years, and 41.9% (n = 31) of the patients died within 30 days. Non-survivors had higher APACHE II, SOFA, and mNUTRIC scores and lower albumin, lymphocyte count, and second FT3 levels compared with survivors (all p ≤ 0.003). Baseline FT3 and TSH were not associated with mortality, whereas both the subsequent FT3 measurements and the ΔT3 (variance in former to latter FT3) were remarkably predictive. The latter FT3 < 1.63 pg/mL produced an AUC of 0.835 (sensitivity: 77%, specificity: 74%), and a ΔT3 log ratio threshold of −0.09 (≈20% early FT3 decline) produced an AUC of 0.835 (sensitivity: 71%, specificity: 81%). The APACHE II + ΔT3 (numeric) model showed the best discrimination (AUC: 0.921; sensitivity: 87.1%, specificity: 81.4%), outperforming APACHE II alone (AUC: 0.861). Conclusions: In critically ill adult patients, dynamic T3 kinetics—particularly premature decline in FT3 within the first 72 h—provide incremental prognostic value for 30-day mortality beyond APACHE II. Serial FT3 monitoring may help identify high-risk patients whose endocrine adaptation to critical illness is failing. Full article

Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Accurate prognosis prediction is essential for timely intervention and personalized treatment planning. However, previous studies have often overlooked the role of patients’ medical history, age-specific risk factors, and time-dependent mortality patterns. This study aimed to develop and evaluate machine learning models for predicting mortality in stroke patients by incorporating vital signs, blood test results, demographic characteristics, and medical history, while also exploring subgroup-specific factors. Methods: We retrospectively analyzed data from 1780 stroke patients admitted to Hallym University Sacred Heart Hospital between 2018 and 2023. Input features included both original and binarized forms of vital signs and blood test values, along with age and medical history. Random Forest models were developed to predict mortality at 1, 2, and 3 years post-admission, as well as overall mortality. Model performance was assessed using AUC and 95% confidence intervals, and variable importance was evaluated using Mean Decrease Gini and SHAP values. Results: The highest predictive performance was observed in a model for patients under 60 using binarized input features, achieving an AUC of 0.995 (CI: 0.98–1). Across all models, pulse rate consistently emerged as the most important predictor. Additional key features included platelet count and diastolic blood pressure. SHAP analysis revealed that pulse rate was associated with higher mortality risk. Subgroup analyses based on age and medical history improved interpretability and predictive power. Conclusions: This study demonstrates that integrating clinical indicators with demographic and medical history variables can significantly enhance the accuracy and interpretability of mortality prediction models in stroke patients. The results underscore the importance of stratified modeling and continuous monitoring of vital signs, particularly pulse rate, to support precision stroke care. Full article

Background and Objectives: Halitosis is a common condition with substantial psychosocial impact, frequently driven by intra-oral biofilm, tongue coating, and reduced salivary clearance. This study compared the short-term effectiveness of standardized counseling alone, probiotic lozenges containing Streptococcus salivarius K12, and a zinc-containing mouthrinse in adults with persistent intra-oral halitosis. Materials and Methods: In this 4-week, parallel-group, randomized pragmatic trial, 117 adults with bothersome halitosis for at least 3 months and baseline organoleptic score ≥ 2 were allocated 1:1:1 to standard care, probiotic lozenges, or zinc mouthrinse. All participants received standardized counseling and tongue cleaning instructions. The primary endpoint was change in volatile sulfur compounds (VSCs) measured by portable sulfide monitoring. Secondary outcomes included organoleptic score, Halitosis Associated Life-Quality Test (HALT), Oral Health Impact Profile-14 (OHIP-14), tongue coating, plaque, and salivary Solobacterium moorei quantified by qPCR. Results: Baseline demographic, clinical, and biochemical characteristics were comparable across groups. All interventions improved outcomes over 4 weeks, but improvements followed a consistent gradient favoring zinc mouthrinse, followed by probiotic lozenges, then standard care. Mean VSC reduction was −12.7 ± 33.9 ppb with standard care, −47.3 ± 42.2 ppb with probiotics, and −78.5 ± 36.3 ppb with zinc mouthrinse (p < 0.001). Organoleptic scores improved by −0.2 ± 0.7, −0.8 ± 0.8, and −1.2 ± 0.8, respectively (p < 0.001). HALT and OHIP-14 scores showed parallel reductions, and moderate/severe halitosis at week 4 remained most frequent in the standard care group (58.9%) and least frequent in the zinc group (20.5%; p = 0.004). Conclusions: Both active adjunctive strategies improved intra-oral halitosis beyond standardized counseling alone, but the zinc-containing mouthrinse produced the greatest short-term benefits across objective, clinician-rated, and patient-reported outcomes. These findings support zinc-based rinses as a practical short-term adjunct for managing persistent intra-oral halitosis in outpatient dental care. Durability after discontinuation and potential relapse beyond 4 weeks were not assessed in this trial. Full article

Background/Objectives: Multidrug-resistant (MDR) Gram-negative bacteria represent a significant public health concern worldwide, particularly in resource-limited settings. In Ghana’s Tamale Metropolis, limited data exist on the prevalence and trends of MDR bacteria, posing challenges to effective antimicrobial stewardship. Methods: This study analyzed microbiological data from 2020 to 2023 to address these knowledge gaps. Results: Among the 4859 clinical samples analyzed, 1570 (33.7%) yielded Gram-negative bacterial isolates, with an MDR prevalence of 40.6%. The most frequently isolated organisms were Klebsiella spp. (28.9%) and Escherichia coli (20.4%). Resistance to cephalosporins (51%) and ciprofloxacin (46%) was particularly pronounced, highlighting the diminishing efficacy of commonly used antibiotics. Older adults (aged 60 years and above) presented the highest MDR prevalence, reflecting the vulnerability of this demographic group. Conclusion:These findings underscore the urgent need for enhanced antimicrobial stewardship programs, improved infection prevention and control measures, and continuous resistance monitoring to combat the growing threat of MDR bacteria in the region. Strengthening laboratory capacity and adherence to strict antibiotic usage policies are crucial for reducing the burden of MDR infections and improving patient outcomes. Full article

Background/Objectives: Swift achievement of an optimal functional status after stroke may substantially reduce patients’ stay in a medical facility and enable their return home. The study aimed to assess the functional status in patients after their first stroke, depending on the time after stroke incident and the patient’s length of stay in the stroke rehabilitation ward. Methods: The data from 229 patients, aged 69.4 ± 11.3 years (120 men and 109 women), formed part of the analysis. Based on medical records, basic socio-demographic, clinical data, and the results of the tests—Mini Mental State Examination (MMSE), Barthel Index (BI), Time Walk Test 10 m (TWT), Trunk Control Test (TCT), Up and Go Test (TUG), and Berg Balance Scale (BBS)—were collected. Results: The risk groups for patients with longer post-stroke rehabilitation stays and poorer rehabilitation outcomes included women, older adults, those with poorer functional status, and patients admitted to the stroke rehabilitation ward after a longer period of time after stroke. Conclusions: The functional status and the length of stay in the post-stroke rehabilitation ward should be monitored and analyzed to find and support groups of patients who may rehabilitate more slowly and stay longer in the ward. A shorter patient stay can allow for more effective management of beds in the post-stroke rehabilitation wards. Full article

Purpose: To investigate the association between COVID-19 infection and the 1-year risk of acute urinary retention (AUR) and related urological complications in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTs). Materials and Methods: Using the TriNetX global network, patients with BPH and LUTs between January 2020 and January 2024 were identified. Participants were classified into a COVID-19 cohort (N = 32,948) and a non-COVID control cohort (N = 434,123). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory parameters. The primary outcome was AUR within one year. Secondary outcomes included Foley catheterization, urinary tract infection (UTI), gross hematuria, bladder stones, and prostate-related surgery. Results: After matching, 32,918 patients remained in each cohort. The COVID-19 group showed a significantly higher 1-year incidence of AUR compared with controls (2.18% vs. 0.32%; aHR 6.89, 95% CI 5.62–8.45; p < 0.0001). Increased risks were also observed for Foley catheterization (aHR 4.10), UTI (aHR 3.52), and prostate-related surgery (aHR 6.02). Kaplan–Meier analysis demonstrated persistent divergence in AUR-free survival. Conclusion: COVID-19 infection is independently associated with a markedly increased risk of AUR and urological complications in patients with BPH, highlighting the need for closer post-infection monitoring. Full article

Background/Objectives: Palpitations are among the most common reasons for cardiology referrals. Despite widespread use of ambulatory cardiac monitoring, contemporary data from the Middle East are scarce. Extended Holter monitoring provides detailed evaluation of arrhythmia burden, autonomic regulation, and symptom–rhythm correlation in routine clinical practice. Methods: We conducted a prospective observational study of consecutive patients presenting with palpitations who underwent 24–96 h ambulatory Holter monitoring at a cardiology outpatient clinic in Saudi Arabia in 2025. Demographic and clinical characteristics, comorbidities, medication use, echocardiographic parameters, heart rate variability (HRV), ventricular and supraventricular ectopy, tachyarrhythmias, and symptom diary activations were systematically evaluated. Results: Among 251 patients (mean age 41.9 ± 16.4 years; 35.5% male), Holter monitoring showed excellent recording quality (mean analyzable time 98.7 ± 9.5%). Premature ventricular contractions (PVCs) were detected in 53.4% of patients, but burden was low (median 0.0%, IQR 0–0.1%), with only 4.4% exceeding 10%. Atrial premature contractions (APCs) were common (92.0%), though usually low-burden (median burden 0.0%, IQR 0–0.1%); atrial fibrillation and supraventricular tachycardia were rare (0.8% each). Symptom diary activation occurred in 116 patients (46.2%), with 996 events; most (87.9%) correlated with sinus tachycardia, while only 8.6% correlated with PVCs and 2.6% with APCs. In the remaining 53.8% of patients, no symptom–rhythm correlation was documented during monitoring. Heart rate variability showed expected age-related changes. Conclusions: In this predominantly young cohort, Holter monitoring revealed frequent low-burden atrial and ventricular ectopy, whereas clinically significant tachyarrhythmias were uncommon. Holter monitoring up to 96 h provided a diagnostic yield in approximately 50% of patients and should be considered a first-line screening tool. Patients without diagnostic findings may require prolonged monitoring using external or implantable devices. Full article

Background/Objectives: B-cell maturation antigen (BCMA)-directed immunotherapies, including chimeric antigen receptor T-cell (CAR-T) therapies and bispecific antibodies (BsAbs), have improved clinical outcomes in multiple myeloma. However, cytokine release syndrome (CRS) remains a major safety concern, and comparative real-world evidence across BCMA-directed agents remains limited. This study aimed to evaluate and compare CRS reporting patterns associated with BCMA-targeted CAR-T and BsAb therapies using the FDA Adverse Event Reporting System (FAERS) data and to identify predictors of CRS reporting using machine learning-based approaches. Methods: A pharmacovigilance analysis was conducted using FAERS reports from 2021 Q1 to 2025 Q3. Disproportionality analyses were performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and information component (IC), and signals were considered present when predefined thresholds were met. Multivariable logistic regression was applied to estimate adjusted odds ratios (aORs) for CRS reporting while adjusting for demographic and reporting characteristics. Machine learning models, including XGBoost, LightGBM, and random forest were developed to predict CRS reporting. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: Among 4046 reports included in the final dataset, CAR-T therapies showed higher CRS reporting odds than BsAbs (aOR: 2.55, 95% CI: 2.16–3.01). Disproportionality analyses identified significant CRS signals for CAR-T therapies across all indices, whereas BsAbs did not meet signal detection thresholds. At the agent level, idecabtagene vicleucel was the only agent meeting all predefined signal detection criteria and exhibited the strongest reporting pattern in multivariable analysis (aOR: 6.96, 95% CI: 5.53–8.75). Among the evaluated models, LightGBM achieved the highest predictive test AUROC (0.762). SHAP analysis identified idecabtagene vicleucel, United States region, and reporting year as the most influential predictors of CRS reporting. Conclusions: CAR-T therapies, particularly idecabtagene vicleucel, exhibited higher CRS reporting odds than BsAbs, with substantial agent-level heterogeneity observed across BCMA-directed immunotherapies. Integrating pharmacovigilance and machine learning approaches may facilitate more individualized safety monitoring by identifying agent-specific differences in CRS risk among BCMA-targeted therapies. Full article

Background: Obstructive jaundice is a common clinical condition, often caused by malignant tumors such as hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA). Percutaneous transhepatic cholangiodrainage (PTCD) is a widely used intervention method to relieve biliary obstruction in patients with obstructive jaundice; however, the impact of PTCD on hepatitis B virus (HBV) reactivation has not been thoroughly studied. Methods: A retrospective analysis was conducted from January 2016 to December 2024 on 235 patients with obstructive jaundice who underwent PTCD. Demographic, clinical, and procedural data were collected, and multivariate logistic regression was used to identify risk factors for HBV reactivation. Additionally, Cox regression was used to evaluate the time-to-reactivation variables. Results: The HBV reactivation rate in the PTCD group was 21.7%, significantly higher than the 8.9% in the non-PTCD group. Key risk factors for HBV reactivation in the PTCD group included the absence of antiviral prophylaxis, postoperative infection, elevated preoperative HBV-DNA levels, and multiple biliary punctures. Moreover, Cox regression revealed that a lack of antiviral therapy and postoperative infection were associated with earlier HBV reactivation. Conclusions: PTCD significantly increases the risk of HBV reactivation in patients with obstructive jaundice, especially in those with high preoperative HBV-DNA levels and without antiviral prophylaxis. Early detection of HBV reactivation and the initiation of antiviral therapy are critical to improving patient outcomes. These findings underscore the need for careful monitoring of HBV status in patients undergoing PTCD. Full article

Protected areas are increasingly expected to reconcile biodiversity conservation with socio-economic sustainability, yet operational tools for assessing local sustainability are limited. This study develops a replicable viability index as an operationalization of socio-economic sustainability at the settlement scale, focusing on the capacity of rural communities to maintain demographic balance and housing dynamics over time. The framework was applied to the West Estonian Archipelago Biosphere Reserve (WEABR), an inhabited UNESCO “Man and the Biosphere” site. Using harmonized census data from 1979 to 2021, the index combines three village-level binary indicators: population dynamics, residential construction activity, and demographic balance. Binary scoring reduces statistical volatility in small settlements and enables comparison across time. Approximately 60% of rural settlements remained viable over four decades, while highly viable settlements declined from 14% to 7%. Population stabilization increased, but ageing intensified and new construction decreased. Viability concentrates near urban centres, ports, transportation corridors, and coastal areas, while inland peripheral villages stagnate. Compared with mainland rural Estonia, WEABR shows a relatively resilient middle tier of viable settlements. The framework provides a transferable tool for monitoring settlement level socio-economic sustainability in inhabited protected areas. Full article

Postpartum depression (PPD) affects a substantial proportion of women globally and is often underdiagnosed due to barriers in screening, stigma, and limited access to care. This study presents the design and pilot evaluation of an mHealth application (“HeartHabit”) intended to support user awareness, self-monitoring, and potential identification of symptoms of PPD among Greek-speaking mothers. An alpha version of the application was evaluated through an online survey with 30 women within the first postpartum year, using a walkthrough video. The evaluation focused on perceived usability and acceptability rather than clinical outcomes or real-world use. Usability and app quality were assessed via the System Usability Scale (SUS) and a qualitative version of the user Mobile Application Rating Scale (uMARS), respectively, adopting a mixed-methods approach. Demographics, and mood and stress screening data were also captured. Quantitative data were analysed via descriptive statistics and qualitative responses via Framework Analysis. The results indicated high perceived usability (mean SUS = 83.7/100). Qualitative findings highlighted the importance of practical usability, self-regulation tools, personalisation, and connectivity with healthcare professionals. Privacy, data transparency, and user control over personal data were perceived as critical for trust. The application was perceived as a potentially useful adjunct to formal care or as at-home support when access to services is limited. Larger, controlled trials, clinical implementation protocols and clinician training are needed to promote the app’s safe integration into formal care. This mixed-methods evaluation, incorporating usability assessment and patient involvement, may offer a useful paradigm for early-stage digital mental health intervention development. Full article

Background: Therapeutic drug monitoring (TDM) of anti-TNF biologics may help optimise treatment in rheumatoid arthritis (RA), but current therapeutic ranges do not always reflect clinical response in routine practice. Methods: We conducted a retrospective observational study including 224 adults with RA treated with infliximab (IFX), adalimumab (ADL), or etanercept (ETN) during the maintenance phase at Hospital Universitario Puerto Real between May 2016 and May 2023. Drug and anti-drug antibody levels were measured by sandwich ELISA and analysed against clinical response using DAS28. Demographic and clinical variables, associations between drug levels and response, the effect of antibodies, correlations between serum concentrations and DAS28, and the performance of current and proposed therapeutic ranges were evaluated. Results: The cohort was mainly female (62.1%), with a mean age of 57.7 years, BMI of 28.5 kg/m², and mean DAS28 of 3.33. ETN was most frequently used (62.5%), followed by ADL (21.9%) and IFX (15.6%). Drug levels were significantly associated with response (p < 0.001). Anti-drug antibodies were strongly linked to non-response, especially with IFX and ADL. Serum drug levels correlated inversely with disease activity for IFX and ADL, but not for ETN. Current therapeutic ranges showed low sensitivity, while lower proposed ranges improved sensitivity considerably. Conclusions: Current anti-TNF therapeutic ranges have limited ability to identify responders in real-world RA. Lowering the lower bound improves sensitivity and supports more individualised TDM, particularly for IFX and ADL, pending prospective validation. Full article

Syphilis and HIV are sexually transmitted disease (STDs) that interact synergistically. However, data on HIV–syphilis co-infection in Romania remain limited. We conducted a retrospective cohort study at a single Romanian HIV/AIDS Day Clinic, including 439 adult people living with HIV (PLWH) monitored between 2020 and 2025. Demographic, epidemiological, clinical, and laboratory data were collected, including HIV staging and syphilis history. Syphilis co-infection was identified in 81 patients (18.5%), and 61.5% met criteria for AIDS. Viral suppression was achieved in 82.2%, and 78.4% achieved CD4 counts >350 cells/mm³. Male sex, urban residence, unmarried status, sexual HIV transmission, genital condyloma, and other STIs were independently associated with syphilis. First episodes of syphilis were predominantly secondary (61%), neurosyphilis was present in 5%, and serofast evolution occurred in 12%, more frequently after reinfection. Among deceased patients, 20.9% had a history of syphilis, but co-infection was not significantly associated with mortality. Nine of 28 patients lost to follow-up had prior syphilis, suggesting a potential impact on retention in care. These findings indicate that HIV–syphilis co-infection is increasingly prevalent in Romania, driven primarily by behavioral factors, and highlight the need for targeted STD screening and prevention strategies among high-risk PLWH. Full article

Measles remains one of the most contagious infectious diseases globally and continues to pose substantial public health risks despite decades of effective vaccination. This narrative review examines both classical and contemporary computational approaches used for measles monitoring, prediction, and control, with particular attention given to the emerging role of artificial intelligence (AI). We synthesized findings from 46 studies; 31 focused directly on measles and 15 on methodologically relevant studies from related infectious diseases (COVID-19, influenza, malaria), selected through searches of PubMed, Scopus, Web of Science, IEEE Xplore, and preprint servers, conducted between June and December 2025. Traditional compartmental models (SIR, SEIR, MSEIR), statistical tools (ARIMA, SARIMA), and seroepidemiological analysis provide transparent, well-characterized frameworks for estimating transmission dynamics and simulating intervention scenarios. Spatial modeling, network analysis, and Monte Carlo simulations have added geographic granularity to outbreak characterization. More recently, AI and machine learning (ML) methods, including supervised algorithms (Random Forest, XGBoost, SVM), deep learning architectures (CNN, LSTM), and hybrid mechanistic ML models, have shown improved predictive performance by integrating multiple data sources: epidemiological records, demographic profiles, mobility patterns, and behavioral indicators. AI-based approaches appear most valuable for high-dimensional risk prediction and image-based diagnostic tasks, while classical models retain clear advantages for policy-oriented scenario analysis. However, no AI-based or hybrid model identified in this review has been adopted into routine national measles surveillance or used for vaccination policy decisions at scale. Important challenges remain: data quality varies across settings, model generalizability cannot be assumed, and computational infrastructure disparities limit deployment in high-burden regions. Explainable AI, federated learning, workforce training for model interpretation, and integration of vaccination registries with mobility and genomic surveillance data represent concrete future directions for strengthening computational support for measles elimination. Full article

This study examines workplace bullying within the middle-management tier of a large Gauteng-based retail organisation in South Africa, with a focus on structural organisational pressures and perceptual differences among managers. While traditional research often emphasises individual personality traits or victim demographics, this study explores how organisational conditions—particularly the “middle management squeeze” and performance-driven Key Performance Indicators (KPIs)—are reflected in workplace behaviours. Grounded in a positivist paradigm, a quantitative cross-sectional survey was conducted among a probability-based sample of 253 retail managers. Data were collected using the Negative Acts Questionnaire (NAQ-22) and analysed using Exploratory Factor Analysis (EFA) and nonparametric inferential tests. The findings indicate that task-related negative acts, such as micromanagement (M = 2.00) and persistent monitoring (M = 1.87), are frequently experienced. EFA identified two dimensions—General Harassment and Managerial Control—accounting for 62% of the total variance. Inferential results show that perceptions of General Harassment differ significantly across educational groups (p = 0.0268), whereas perceptions of Managerial Control remain consistent (p = 0.3378). These findings indicate that social forms of incivility are interpreted differently across educational cohorts, while task-related managerial practices are widely normalised. The study highlights the importance of understanding workplace bullying as both a structural and perceptual phenomenon and underscores the need for organisational interventions that address systemic pressures rather than relying solely on individual-level approaches. Full article