Search Results (96)

Background/Objectives: Cancer patients increasingly present to emergency departments, posing unique clinical and organizational challenges. Data on this population in Poland remain limited. Methods: A retrospective study was conducted in two hospitals in northern Poland (January–March 2023). All adult patients with active cancer presenting to the ED were included (n = 552, 3.1% of visits). Data included demographics, cancer type, presenting complaints, Emergency Severity Index (ESI), disposition, and in-hospital mortality. Multivariable logistic regression models were used to assess predictors of hospitalization, hospice referral, and mortality, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Mean age was 68 years; 51% were female. The most common cancers were lung, breast, colorectal, and prostate. Leading complaints included abdominal pain (15%), trauma (7.5%), and dyspnea (7%). Most patients were triaged as ESI 3–4 (87%). Hospitalization rate was 58%, hospice referral 6%, and in-hospital mortality 7.1%. Lower ESI levels were significantly associated with hospitalization (OR 0.57; 95% CI 0.44–0.73), hospice referral (OR 0.40; 95% CI 0.25–0.63), and in-hospital mortality (OR 0.29; 95% CI 0.18–0.47). Conclusions: Oncology patients represent a small but high-risk ED population. While ESI reflects acute severity, it may not adequately capture palliative care needs. These findings suggest opportunities to improve integration of palliative care in ED settings. 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

Objective: Individuals with reactive hypoglycemia (RH) may be more likely to develop obesity and type 2 diabetes, but the ability to identify RH has been hampered by the lack of clear criteria. This study used calculus-based curve parameters from a mixed macronutrient liquid meal test (MMTT) to define RH in men and women with obesity. Methods: A total of 69 non-diabetic adults aged 35 ± 8.3 years with obesity (BMI 32.3 ± 4.2 kg/m²) underwent a 4 h MMTT to define RH, and an intravenous glucose tolerance test (IVGTT) to characterize RH (via insulin sensitivity, the acute insulin response to glucose (AIRg), insulin clearance, and the disposition index). Perceived hunger and fullness were assessed by visual analog scale. Results: RH was defined using curve properties of the MMTT. A total of 19 of the 69 participants had a reactive hypoglycemic response to the MMTT. Glucose AUC and nadir were lower, timing of glucose nadir was earlier, and insulin sensitivity was higher in RH compared to non-RH. Sex (female) and race (AA) were significant predictors of RH presence. Conclusions: Among individuals with obesity, RH is characterized by greater sensitivity to insulin and greater disposition index. We introduce a novel and reproducible method to define RH using curve-based criteria from a mixed meal test integrated with gold-standard IVGTT-derived outcomes. Full article

Background: Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, and emergency department (ED) management requires early risk assessment to guide monitoring and disposition. Because key decisions are often needed while diagnostic evaluation is ongoing, the simplified Pulmonary Embolism Severity Index (sPESI) may provide limited discrimination for in-hospital outcomes. We evaluated whether explainable machine-learning (ML) models integrating routine ED variables with validated risk scores can predict in-hospital mortality in adults evaluated for suspected acute PE. Methods: A retrospective single-center cohort study was performed, including 220 consecutive adults evaluated for suspected acute PE in the ED between January 2021 and March 2025, comprising both PE-confirmed and PE-excluded cases. Predictors included demographics, vital signs, arterial blood gas indices, available imaging/echocardiographic findings, and Wells, Revised Geneva, and sPESI scores. Seven ML algorithms were trained and internally evaluated using the area under the receiver operating characteristic curve (AUC) and complementary metrics. Model interpretability was assessed using SHAP (SHAPley Additive exPlanations), and a sensitivity analysis was conducted in the PE-confirmed subgroup. Results: Tree-based ensemble models demonstrated higher discrimination for in-hospital all-cause mortality than simpler classifiers. SHAP analyses consistently highlighted sPESI, oxygenation/arterial blood gas indices, and malignancy as key contributors to mortality risk. Findings were similar in the PE-confirmed sensitivity analysis. Conclusions: Explainable ML models combining established risk scores with routinely collected ED variables may complement risk stratification along the suspected-PE pathway. External multicenter validation and prospective impact studies are warranted before clinical implementation. Full article

This study investigates the role of Agreeableness as a personality trait in promoting psychological well-being, with a specific focus on the potential mediating mechanism of social support, and how this pathway is influenced by family’s income. 3206 college students from China’s universities were recruited from Internet, randomly. Subjects were demanded to complete the Agreeableness Subscale of Chinese Big Five Inventory Brief version (CBF-PI-B), the Chinese Campbell Index of Well-Being (Campbell IWB), the Chinese Perceived Social Support Scale (PSSS) and demographic variables. The results, analyzed using a moderated mediation procedure, confirmed that perceived social support mediates the relationship between Agreeableness and subjective well-being. Furthermore, family yearly income was found to significantly moderate the first stage of this mediation pathway. Specifically, the positive associative effect of Agreeableness on perceived social support was stronger for individuals with lower annual family income. This result suggests that, for those with fewer economic resources, a prosocial and agreeable disposition is a particularly critical asset for building the social support networks that subsequently enhance well-being. The findings highlight the complex interplay between personality and socioeconomic context, indicating that social support serves as a healthy coping mechanism, the utility of which is conditionally shaped by an individual’s financial circumstances. Full article

The early identification of cognitive decline is crucial for well-timed intervention and diagnosis, particularly in the context of preclinical Alzheimer’s disease (AD). In this study, we investigated the complex interplay between trait affect, objective cognitive performance, and subjective memory estimations in a sample of 105 older adults. Using path analysis, we aimed to determine whether trait affect and objective cognitive control abilities predict individuals’ subjective perceptions of their own memory abilities. The results revealed that both positive and negative trait affect significantly predicted subjective memory estimations, while objective cognitive control performance did not significantly predict these estimations. These findings highlight a crucial dissociation between objective and subjective cognitive measures. Therefore, the present results underscore the critical importance of complementing self-reported cognitive estimations, which can be biased by stable emotional dispositions, with objective cognitive tools like the R4Alz-pc (preclinical) index. This approach enables a more accurate evaluation of cognitive health in advancing age, especially for the early detection of subtle dysfunction in preclinical AD. Full article

Background/Objectives: Hypertension is a growing public health concern in Saudi Arabia, driven by rapid socioeconomic changes. This study investigated the interplay between habitual, behavioral, and dietary risk factors associated with hypertension among Saudi adults. Methods: A cross-sectional survey was conducted among 3312 Saudi adults using multistage stratified random sampling. The data were collected via validated questionnaires assessing sociodemographic, anthropometric indicators, lifestyle behaviors, dietary patterns, and medical history. Hypertension status was determined through self-reported diagnosis. Bivariate analyses and multiple logistic regression identified independent predictors (p < 0.05). Results: Hypertension prevalence was 13% (mean age: 34 ± 15 years; 50% male). The strongest predictors were age (OR = 1.08/year; 95% CI: 1.07–1.10; p < 0.001), increased body mass index (OR = 1.03; 95% CI: 1.01–1.06; p = 0.011), smoking (OR = 1.55; 95% CI: 1.04–2.29; p = 0.030), and family history of hypertension (OR = 7.71; 95% CI: 5.61–10.75; p < 0.001). Participants with diabetes mellitus had 89% higher odds of hypertension (OR = 1.89; 95% CI: 1.42–2.51; p < 0.001), and those with dyslipidemia had more than double the odds (OR = 2.45; 95% CI: 1.38–4.22; p = 0.002). Protective factors included higher income (≥15,000 SAR; OR = 0.54; 95% CI: 0.36–0.81; p = 0.003) and regular whole grain consumption (OR = 0.60; 95% CI: 0.46–0.77; p < 0.001). Conclusions: Hypertension risk in Saudi adults is shaped by age, obesity, smoking, comorbid metabolic conditions (diabetes and dyslipidemia), and genetic pre-disposition. In contrast, higher income and whole grain intake may offer protection. These findings underscore the need for comprehensive prevention strategies that address both lifestyle and cardiometabolic comorbidities, in alignment with Saudi Vision 2030 health priorities. Full article

Background/Objectives: While the correlation between bodily states and cognitive processing has been extensively investigated concerning pain elaboration, little is known about how chronic, subjectively experienced pain (self-pain) following traumatic spinal cord injury (SCI) affects embodied cognition, such as empathy for pain. This study aimed to determine whether individuals with SCI differ from healthy controls in these cognitive responses, and if such differences can be quantified through varying reaction times to pain-related and non-pain-related stimuli involving others. Methods: We assessed reactions to others’ pain through behavioral responses in a classification task involving 15 participants with SCI (13 men; age range 19–56 years) and 15 healthy controls (11 men; age range 25–48 years). Additionally, we measured general empathic dispositions using the Interpersonal Reactivity Index (IRI) and subjective pain intensity using a numeric rating scale following standard guidelines for neuropathic pain assessment. Results: The findings revealed that participants with SCI exhibited lower empathy levels (IRI: mean SCI = 55.06 ± 3.64) than healthy controls (IRI: mean HC = 67.6 ± 2.46), as measured through both cognitive and affective components. We found that higher chronic pain unpleasantness was associated with lower empathic dispositions (r = −0.63; p = 0.01) in participants with SCI. Compared to healthy controls, individuals with SCI exhibited a reduced empathic response when observing others in pain from a third-person perspective. Conclusions: These findings reveal an association between chronic pain following SCI and diminished empathic processing, offering new insights into the mechanisms underlying interpersonal reactivity after SCI. Full article

Background/Objectives: Accurate and timely triage is essential for optimizing clinical outcomes and resource allocation in emergency departments (EDs). The Peripheral Perfusion Index (PPI), a non-invasive and objective parameter derived from pulse oximetry, may offer added value in early risk stratification. This study aimed to analyze the correlation between the PPI measured at triage and at Emergency Severity Index (ESI) levels, as well as to determine if the PPI may function as a predictive tool to facilitate early risk identification before patient disposition. Methods: In this prospective cross-sectional study, adult ambulatory patients presenting to a tertiary care ED were enrolled. At triage, PPI and standard vital signs were recorded, and patients were classified using the five-level ESI system. The diagnostic performance of PPI and ESI in predicting ED discharge was assessed using receiver operating characteristic (ROC) curve analysis, with comparative evaluation performed via DeLong’s test. Results: Lower PPI values were consistently associated with higher ESI acuity levels and more intensive care requirements. Patients who were discharged had significantly higher median PPI values (4.0) compared to those admitted to wards (2.1) or intensive care units (1.9). PPI also distinguished survivors from non-survivors (median PPI: 3.60 vs. 1.15). ROC analysis showed that the PPI demonstrated a good discriminative capacity for forecasting ED discharge, equal to the efficacy of ESI (AUC: 0.926 vs. 0.903; p < 0.001). Conclusions: The PPI could improve post-triage risk classification and enhance current triage techniques like ESI, especially in cases of unclear or borderline presentations, but further validation in prospective trials is required. Full article

Propolis is a natural resinous substance produced by honeybees that has many biological activities. For thousands of years, it has been widely used as a dietary supplement and traditional medicine to treat a variety of ailments due to its antimicrobial, anti-inflammatory, antioxidant, immunomodulatory, and wound-healing properties. Nutritional supplements and foods may interact with drugs both pharmacodynamically and pharmacokinetically, which could raise clinical concerns. Background/Objectives: This study aimed to investigate the effect of propolis on the plasma disposition of enrofloxacin and to assess the potential pharmacokinetic interaction in rabbits. Methods: In this study, enrofloxacin was applied per os (20 mg/kg) and IM (10 mg/kg) and with propolis (100 mg resin/kg) administration in four groups of rabbits (each of six individuals). Heparinized blood samples were collected at 0, 0.1, 0.3, 0.5, 1, 2, 4, 8, 12, and 24 h post-administration. HPLC-FL was used to analyze the plasma concentrations of enrofloxacin and its active metabolite ciprofloxacin following liquid–liquid phase extraction, i.e., protein precipitation with acetonitrile and partitioning with sodium sulfate. Results: The results revealed that propolis coadministration significantly affected the plasma disposition of enrofloxacin and its active metabolite after both per os and intramuscular administration routes. Significantly greater AUC (48.91 ± 11.53 vs. 26.11 ± 12.44 µg.h/mL), as well as longer T_1/2λz (11.75 ± 3.20 vs. 5.93 ± 2.51 h) and MRT (17.26 ± 4.55 vs. 8.96 ± 3.82 h) values of enrofloxacin and its metabolite ciprofloxacin, were observed after the coadministration of propolis compared to enrofloxacin alone following both per os and IM routes in rabbits. Conclusions: The concurrent use of propolis and prescription medications may prolong the half-life (T_1/2λz) and increase the systemic availability of chronically used drugs with narrow therapeutic indices. The repeated use of drugs such as antibiotics, heart medications, and antidepressants, or drugs with a narrow therapeutic index such as antineoplastic and anticoagulant agents, can cause toxic effects by raising blood plasma levels. Considering the varied metabolism of rabbits and humans, further validation of this study may require thorough clinical trials in humans. Full article

Background: Although the value of point-of-care ultrasound (PoCUS) is well-established for specific diseases and in the hands of trained users, its broader impact on overall ED efficiency is not yet fully known. This study aims to evaluate the association of early PoCUS, performed within 1 h of presentation, with ED patient flow, healthcare resource utilization, and quality of care in adults with non-traumatic abdominal pain. Method: This retrospective cohort study included 44,863 adult patients (≥18 years) presenting with non-traumatic abdominal pain from January 2021 to December 2023. Patients were grouped into PoCUS and no-PoCUS categories, with a subgroup analysis for those receiving PoCUS within 1 h, to evaluate ED LOS, and costs for different ED dispositions. Outcomes measured included hospital LOS, costs, mortality, and ICU admission. Results: The mean age of the subjects was 44.4 ± 17.9 years, and 61.2% were female. PoCUS was performed in 39.7% of cases, with 69.6% of these conducted within one hour. Additionally, 30.5% underwent CT. The PoCUS group had a significantly shorter ED LOS compared to the no-PoCUS group among patients admitted to general wards (p < 0.001), but not in outpatient dispositions (p = 0.282) or ICU admissions (p = 0.081). Subgroup analysis of patients receiving PoCUS within 1 h showed a significantly shorter LOS for both outpatient dispositions (p < 0.001) and general ward admissions (p < 0.001), with no effect on ICU admissions (p = 0.869). The presence or absence of CT did not alter these findings. Multivariable analysis indicated that patients who received PoCUS within one hour alone at index visit and admitted after an unscheduled return visit had lower initial ED costs (−9436.1 TWD, p < 0.001) and shorter ED LOS (−11.59 min, p < 0.001) than patients admitted directly at the index visit, with no significant increase in total resource utilization or adverse outcomes after return visits. Conclusions: PoCUS, especially when performed within one hour, was associated with reduced ED LOS and healthcare resource utilization for both outpatient dispositions and inpatient admissions without compromising patient safety or quality of care. Full article

Type 2 diabetes mellitus (T2DM) represents a significant global health burden, especially in populations where rice constitutes a dietary staple. Parboiled rice (PBR), known for its lower glycemic index compared to conventional white rice (WR), may offer benefits in managing postprandial hyperglycemia. Nevertheless, the impact of PBR consumption on insulin sensitivity, β-cell function, and incretin hormone responses remains poorly understood. Methods: This randomized crossover pilot study aimed to assess and compare the acute effects of PBR and WR intake on postprandial glucose regulation, insulin sensitivity, β-cell functionality, and glucagon-like peptide-1 (GLP-1) responses in healthy subjects and individuals with T2DM. A total of 20 participants were recruited and evenly allocated into healthy (n = 10) and T2DM (n = 10) groups. Following the ingestion of either PBR or WR, blood samples were collected at fasting and various postprandial intervals to determine glucose, insulin, and GLP-1 levels. Insulin sensitivity and β-cell function were evaluated using HOMA-IR, Matsuda Index (MI), and Disposition Index (DI). Results: As expected, T2DM participants exhibited significantly elevated fasting glucose and insulin levels compared to healthy controls. Consumption of PBR led to significantly lower postprandial glucose responses in healthy subjects relative to WR. Although a similar trend of reduced glucose levels was observed in T2DM subjects after PBR intake, this reduction did not reach statistical significance. Parallel trends were observed in insulin secretion patterns. Moreover, GLP-1 responses were notably diminished in T2DM individuals compared to healthy participants. Importantly, MI and DI values significantly increased after PBR consumption in healthy individuals compared to those with T2DM, indicating improved insulin sensitivity and β-cell responsiveness. Conclusions: These preliminary findings suggest that PBR consumption may confer beneficial effects by lowering postprandial glucose and enhancing insulin sensitivity. Further studies with larger cohorts are warranted to confirm these outcomes and elucidate the physiological mechanisms behind PBR’s potential role in dietary management strategies for T2DM. Full article

Background: Recent evidence has shown that insulin resistance (IR), a hallmark of nonalcoholic fatty liver disease, predicts bladder cancer (BC) presence. However, the best surrogate marker of IR in predicting BC is still unclear. This study examined the relationships among ten surrogate markers of IR and the presence of BC. Methods: Data from 209 patients admitted to two urology departments from September 2021 to October 2024 were retrospectively analyzed. Individuals (median age 70 years) were divided into two groups (123 and 86 patients, respectively) based on the presence/absence after cystoscopy/TURB of non-metastatic BC. Univariate logistic regression was used to determine the relationships between groups, and the following IR parameters: Triglyceride–Glucose (TyG) index, TyG-BMI, HOMA-IR HOMAB, MetS-IR, Single Point Insulin Sensitivity Estimator, Disposition Index, non-HDL/HDL, TG/HDL-C ratio and Lipoprotein Combine Index. Stepwise logistic regressions were carried out to evaluate the significant predictions and LASSO regression to confirm any significant variable(s). The predictive value of the index test for coexistent BC was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Results: The univariate analysis revealed that the TyG index and MetS-IR were associated with the BC presence. Specifically, the associations of the TyG index and MetS-IR were more significant in participants =/> 65 years old. In multivariate analysis, the stepwise logistic regression, evaluating the most representative variables at univariate analysis, revealed a prediction of BC by only TyG index (OR 2.51, p = 0.012), confirmed by LASSO regression, with an OR of 3.13, p = 0.004). Assessing the diagnostic reliability of TyG, it showed an interesting predictive value for the existence of BC (AUC = 0.60; 95% CI, 0.51–0.68, cut-off 8.50). Additionally, a restricted cubic spline model to fit the dose–response relationship between the values of the index text (TyG) and the BC evidenced the presence of a non-linear association, with a high predictive value of the first knot, corresponding to its 10th percentile. The decision curve analysis confirmed that the model (TyG) has utility in supporting clinical decisions. Conclusions: Compared to other surrogate markers of IR, the TyG index is effective in identifying individuals at risk for BC. A TyG threshold of 8.5 was highly sensitive for detecting BC subjects and may be suitable as an auxiliary diagnostic criterion for BC in adults, mainly if less than 65 years old. Full article

Background/Objectives: Despite advances, large vessel occlusion strokes (LVO) remain associated with significant morbidity. Recent studies have suggested that blood transfusions may help manage critically ill LVO patients. We sought to evaluate the patient characteristics, complications, and clinical outcomes associated with blood transfusions in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy. Methods: A query of the 2016–2019 National Inpatient Sample was conducted to identify AIS patients who underwent endovascular thrombectomy, using International Classification of Disease 10th Revision diagnostic codes. Demographic, clinical characteristics, severity of presentation, complications, and outcomes were analyzed. Multivariate binary logistic regression was used to assess complications, length of stay (LOS), discharge disposition, and inpatient mortality. Results: A total of 47,835 AIS patients undergoing endovascular thrombectomy were identified. Of these patients, 1215 (2.5%) received blood transfusions. After controlling for age, gender, National Institutes of Health Stroke Scale scores, Elixhauser Comorbidity Index, and location of stroke, blood transfusions were significant positive predictors for higher rates of inpatient death (OR: 1.96; 95% CI: 1.681, 2.286; p < 0.001), lower rates of routine discharge (OR: 0.425; 95% CI: 0.342, 0.527; p < 0.001), and prolonged LOS (OR: 2.928; 95% CI: 2.572, 3.333; p < 0.001). Conclusions: Blood transfusions in AIS patients receiving endovascular thrombectomy are associated with elevated complication rates, extended hospital stays, and increased mortality, even after for controlling for predictors of poor outcome. Understanding the broader effects of blood transfusions in AIS patients is essential to ensure that the balance between potential benefits and risks upholds best care practice for all patients. Full article

Objectives: Social factors play a crucial role in health outcomes for pediatric patients, yet in the neurosurgery pediatric literature, these factors are rarely reported. To develop a deeper understanding of pediatric spine trauma outcomes, we investigate demographic and social factors measured by the Child Opportunity Index (COI) and Social Deprivation Index (SDI). We hypothesize that social factors predict clinical presentation, injury severity, and clinical outcomes. Methods: We conducted a retrospective cohort study of pediatric patients treated for spinal trauma at a Level 1 trauma center in Sacramento, California. We collected patient clinical data such as mechanisms of injury (MOIs), length of stay (LOS), treatment type, hospital disposition, polytrauma incidence, and follow-up attendance. Each patient’s social environment was characterized using COI and SDI metrics. Statistical comparisons were performed to assess associations between social factors and clinical outcomes. Results: Patients with worse childhood opportunity (lower COI and higher SDI) were more likely to be insured through Medi-Cal, identify as Hispanic, and experience violent MOI. Female patients were more likely to sustain polytrauma and had a higher likelihood of requiring surgical intervention. Additionally, patients from underserved communities demonstrated longer hospital stays and poorer follow-up adherence, with COI and SDI scores correlating with these disparities. Conclusion: Social disparities are associated with worse outcomes in pediatric spine trauma. We found COI and SDI to be valuable clinical metrics, motivating further research to be carried out at the state and national levels. These findings highlight health disparities in pediatric spine trauma. Full article