Search Results (5,167)

Background/Objectives: Pelvic injuries are frequently associated with severe hemorrhage and may contribute to early trauma-induced coagulopathy (TIC). Whether pelvic injury is independently associated with TIC beyond overall injury severity remains unclear. The objective of this study was to evaluate the association between pelvic injury and TIC in severe trauma patients. Methods: We conducted a retrospective single-center study including adult severe trauma patients (injury severity score > 15) admitted between January 2012 and July 2020. Patients with moderate to severe traumatic brain injury (because of its specific coagulopathy and mortality), inter-hospital transfer, pregnancy, or long-term anticoagulant or antiplatelet therapy were excluded. Pelvic injury was defined as any traumatic lesion involving the pelvic girdle identified on admission computed tomography. TIC was defined by an international normalized ratio (INR) > 1.2 and/or fibrinogen < 1.5 g/L and/or platelet count < 100 G/L. Multivariable logistic regression was performed to identify factors associated with TIC. Results: Among 388 included patients (79.6% male, median age 39 years), 114 (29.4%) had a pelvic injury. TIC was present in 160 patients (41.3%), and TIC prevalence was significantly higher in patients with pelvic injury (n = 73–64.0%) compared to those without (n = 87–31.8%) (p < 0.001). After multivariate analysis, TIC was independently associated with pelvic injury (OR 2.81, 95% CI 1.63–4.89), shock index > 0.9 (OR 1.94, 95% CI 1.12–3.37), hemoglobin < 10 g/dL (OR 4.27, 95% CI 1.77–11.49), and lower base excess values on admission (OR per unit increase 0.92, 95% CI 0.87–0.97). Injury severity score and number of lesions (AIS ≥ 3) were not independently associated with TIC. Conclusions: Pelvic injury was independently associated with TIC after adjustment for injury severity, number of severe injuries, and markers of hemodynamic and metabolic shock, including shock index, hemoglobin level, and base excess. These findings suggest that patients with pelvic injury may represent a high-risk subgroup for early coagulopathy, supporting the need for early recognition and adapted resuscitation strategies. Further prospective studies are required to explore underlying mechanisms. Full article

Background: Young adulthood represents a critical period for the emergence of early metabolic disturbances, potentially influenced by dietary shifts toward convenience and ultra-processed foods. However, evidence linking dietary patterns and cooking practices with objective metabolic biomarkers in Romanian university students remains limited. Methods: This cross-sectional study included 693 students aged 18–24 years at the Victor Babeș University of Medicine and Pharmacy, Romania (June–July 2025). Dietary habits, food preferences, and cooking practices were assessed using a structured online questionnaire, while anthropometric and biochemical data were obtained from university health records. The primary outcome was glycated hemoglobin (HbA1c), a marker of average blood glucose levels over the previous 2–3 months. Prediabetes was defined as HbA1c 5.7–6.4%. Dietary patterns were identified using k-means clustering based on fast-food consumption frequency, main meal of the day, fruit and vegetable intake frequency, and predominant cooking method. Multivariable regression models assessed associations between dietary variables and glycemic or lipid outcomes. Results: Prediabetes prevalence was 21.1% (diabetes: 1.4%). Three dietary patterns were identified: health-conscious (prediabetes 15.4%), mixed (20.0%), and fast-food oriented (27.3%; χ² p = 0.003). Fast-food consumption frequency was independently associated with higher prediabetes risk (OR = 1.78 per category; 95% CI 1.38–2.30; p < 0.001) and higher HbA1c levels (β = 0.147; p < 0.001), while fruit and vegetable intake showed an inverse association with HbA1c (β = −0.109; p < 0.001). A dose–response relationship was observed between fast-food frequency and both HbA1c and prediabetes prevalence (p-trend < 0.001). An interaction between high-temperature cooking methods and frequent fast-food consumption was observed for HbA1c (p = 0.023). BMI and sex were the strongest predictors of lipid outcomes, although fast-food intake was associated with higher triglyceride levels (p = 0.034). Conclusions: Among Romanian university students, dietary patterns characterized by frequent fast-food consumption were associated with higher HbA1c levels and greater prediabetes prevalence. A high-temperature cooking method was associated with higher glycemic levels when combined with frequent fast-food intake. These findings suggest that early dietary behaviors during university years may be relevant for metabolic risk profiles in young adults. Full article

Background/Objectives: Gastric cancer remains one of the most frequent abdominal malignancies, being the 5th in incidence, and it is often diagnosed at advanced stages. Perioperative chemotherapy has been introduced to improve oncological outcomes, although concerns persist regarding increased postoperative complications after radical gastrectomy following neoadjuvant treatment (NAT). Methods: We performed a retrospective study on a continuous series of gastric cancer patients who underwent radical gastrectomy between January 2016 and December 2025. Patients were divided into two groups: those receiving NAT and those undergoing upfront surgery (US). Demographic data, clinical characteristics, operative variables, postoperative complications, 30-day mortality, and pathological findings were compared. Results: There were 383 patients included in the study; NAT was performed in 105 (27.4%) cases and US in 278 (72.6%) cases, with a mean age of 64.99 (63.09–66.88) vs. 67.83 (66.44–68.91) years. Baseline characteristics (Charlson score 3.8 vs. 4.26, p = 0.131), hemoglobin, and albumin levels, were similar between groups. Tumors in the NAT group were more frequently located in the upper stomach 19 (18.1%) vs. 33 (11.9%) or at the gastro-esophageal junction (only Siewert III tumors were included) 17 (16.2%) vs. 23 (8.3%) p = 0.04. Tumor stage was most frequently stage IIIB for radical surgery 111 (28.9%) and for the NAT group 20 (19.1%) and surgery first group 91 (32.7%). The overall grade III and above complication rates were 26 (6.8%) esojejunal fistula, 19 (4.9%) duodenal stump fistula, seven (1.8%) hemorrhagic complications, 31 (8.1%) cases of sepsis, and 33 (8.6%) medical complications. Anastomotic fistulas were more frequent in the surgery-first group, with 23 cases (8.3%), compared with the neoadjuvant group, with 3 patients (2.9%)—the result were not statistically significant. The number of resected lymph nodes was similar (35.4 vs. 35.2; p = 0.96), while NAT group had significantly fewer positive lymph nodes (5.7 vs. 8.0; p < 0.001). Complete pathological response was achieved in 10 (9.5%) of NAT patients. Conclusions: Neoadjuvant treatment does not appear to increase the complications rate following radical gastrectomy. This study supports the surgical safety of the perioperative adjuvant treatment for advanced gastric cancer patients. Further studies are necessary to assess long-term outcomes. Full article

Background/Objective: The most common hemoglobin disorder in the world is SCD. The majority of SCD cases come from Africa, accounting for up to two-thirds of the 300,000 annual births of individuals with SCD worldwide. In Tanzania, 11,000–14,000 babies are born with SCD each year. Despite treatment advancement, pain is still an attributable cause of admissions among patients with SCD. However, data are still lacking regarding the adequacy of pain control in patients with SCD in Tanzania. The aim of this study was to determine factors affecting pain control among patients with SCD presenting with painful events at Mwananyamala Regional Referral Hospital (MRRH) and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a cross-sectional study conducted at MRRH and MNH, which are tertiary referral hospitals in Dar es Salaam, Tanzania. Patients with SCD aged 8 years and above who presented at the hospitals with painful events (from August 2022 to February 2023) were enrolled in the study. We used a structured questionnaire to collect data on participants’ socio-demographic characteristics and clinical parameters. The adequacy of pain control was assessed using the WHO Pain Management Index. Multivariable binary logistic regression was used to determine factors associated with pain control. Differences were considered statistically significant when the p-value was <0.05. Results: A total of 390 patients with SCD were analyzed. The mean age (±SD) was 15 (±6) years. Most patients were recruited from outpatient clinics (88.2%). The male-to-female ratio was 1:1. The majority of patients had less than three pain episodes per year (77.9%), and about 64.6% presented to the hospital with mild pain. The proportion of patients on hydroxyurea was 62.3%. Furthermore, one-third of patients had inadequate pain control. Factors associated with inadequate pain control included receiving initial pain management in other health facilities (adjusted odds ratio [aOR] and 95% confidence interval [CI] = 2.5 (1.5–4.5), p = 0.001), presenting to the hospital with moderate pain (aOR = 2.2, 95% CI [1.3–3.8], p = 0.0060), and presenting to the hospital with a fever (aOR = 3.8, 95% CI [1.1–13.9], p = 0.04). Having severe pain and receiving initial treatment at MRRH and MNH seemed to be protective factors (aOR = 0.33, 95% CI [0.11–0.97], p = 0.04, and aOR = 0.29, 95% CI [0.14–0.61], p = 0.001, respectively). Conclusions: A considerable proportion of patients with SCD receive suboptimal pain control. Receiving initial pain management from another healthcare facility, presenting to the hospital with moderate pain, and having a fever were associated with inadequate pain control. Further research is warranted to elucidate ways of optimizing the management of pain in patients with SCD in Tanzania. Full article

Background: Elevated prolactin levels are associated with disturbances in female sexual function. While long-term therapy with dopamine agonists has been shown to improve these disturbances, the therapeutic benefits appear to be reduced in the presence of vitamin D deficiency or insufficiency. Therefore, the present study aimed to examine whether vitamin D status modulates the effects of metformin—a medication with less pronounced prolactin-lowering properties—on sexual function and depressive symptoms. Methods: The study cohort comprised three groups of reproductive-age women with drug-induced hyperprolactinemia and prediabetes, matched for age, glycated hemoglobin, and prolactin concentrations. Group I included 25 women with normal vitamin D status who were not receiving vitamin D supplementation. Group II consisted of 25 women with vitamin D deficiency or insufficiency that was adequately corrected through supplementation, while group III included 25 women with untreated vitamin D deficiency or insufficiency. All participants received metformin throughout the six-month study period. Female sexual function and depressive symptoms were assessed before and after metformin therapy using the Female Sexual Function Index (FSFI) and the Beck Depression Inventory-II (BDI-II), respectively. Additional outcome measures included plasma 25-hydroxyvitamin D, fasting plasma glucose, glycated hemoglobin (HbA_1c), the homeostatic model assessment of insulin resistance (HOMA-IR), prolactin, gonadotropins, and sex hormones. Results: Improvements in glucose homeostasis were observed across all groups; however, these changes were more pronounced in groups I and II than in group III. Reductions in prolactin concentrations (total and monomeric), accompanied by increases in gonadotropins, estradiol, and testosterone, were observed exclusively in women with normal vitamin D status. In groups I and II, metformin therapy resulted in significant improvements in total FSFI scores as well as in all individual domain scores. In contrast, in group III, the effects of metformin were limited to increases in the domain scores for lubrication and sexual satisfaction. Improvements in sexual function were positively associated with baseline 25-hydroxyvitamin D levels, reductions in prolactin concentrations, and, to a lesser extent, treatment-related changes in HbA_1c and increases in testosterone. A treatment-induced reduction in total BDI-II scores was observed only among women with normal vitamin D status. Conclusions: Low vitamin D status diminishes the beneficial effects of metformin on sexual function and depressive symptoms in reproductive-age women with iatrogenic hyperprolactinemia. Full article

Background/Objectives: Eliglustat is an oral therapy for Gaucher disease type 1 (GD1) that may reduce infusion-related logistical burden, particularly in resource-constrained settings. Post-approval evidence from routine clinical practice in China remains limited. This study evaluated its real-world effectiveness and safety in Chinese adults with GD1. Methods: This retrospective, multicenter study included adults with GD1 receiving eliglustat monotherapy for ≥6 months. Outcomes included plasma glucosylsphingosine (lyso-Gb1), hemoglobin (HGB), platelet count (PLT), liver and spleen volumes, and adverse events (AEs). Depending on distribution, paired changes were analyzed using paired t tests or Wilcoxon signed-rank tests. p < 0.05 was considered statistically significant. Results: Nineteen patients were included in the effectiveness analysis, with a median follow-up of 7 months (range, 6–9). Lyso-Gb1 decreased from 468 to 210 ng/mL (p < 0.0001). HGB increased from 123 to 131 g/L (p = 0.147); among six patients with baseline anemia, 83.3% improved and 33.3% normalized. PLT increased from 109 to 132 × 10⁹/L (p = 0.019); among 12 patients with baseline thrombocytopenia, 58.3% improved. Liver volume decreased from 1808 to 1747 mL (p = 0.016) (1.22 to 1.01 multiples of normal; p < 0.001). Spleen volume decreased from 473 to 452 mL (p = 0.016) (4.69 to 5.17 multiples of normal; p = 0.015). Lyso-Gb1 reduction was greater in patients without prior enzyme replacement therapy (ERT) exposure than in those with prior ERT exposure (−55.1% vs. −43.1%; p = 0.049). In the safety analysis group (n = 90), suspected drug-related AEs occurred in 27.8% of patients, mainly gastrointestinal or skin-related, and were limited to grade I/II. No serious AE or treatment discontinuation occurred. Conclusions: In routine clinical practice in China, eliglustat was associated with rapid substantial reductions in plasma lyso-Gb1, early improvements in hematologic and visceral parameters, and favorable short-term tolerability in adults with GD1. Full article

Background: In many low- and middle-income countries, access to advanced cardiac biomarkers such as B-type natriuretic peptide (BNP) and NT-pro BNP remains limited, posing challenges for early risk stratification in patients hospitalized with acute heart failure (AHF). Identifying simple, inexpensive, and universally available laboratory markers with prognostic value is of practical clinical importance. Methods: Consecutive patients (≥18 years) hospitalized with acute heart failure (AHF) between May 2022 and November 2024 were retrospectively analyzed. After exclusion of patients with incomplete outcome data, in-hospital mortality was assessed using logistic regression analysis. Hemoglobin, serum albumin, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein–albumin–lymphocyte (CALLY) index were evaluated as potential predictors of in-hospital mortality. Results: A total of 211 patients were included in the mortality analysis, with an in-hospital mortality rate of 10.0%. Patients were stratified by anemia and hypoalbuminemia status, revealing significant differences in unadjusted mortality rates across groups (p = 0.04). However, after adjustment for age, sex, and chronic kidney disease, the prognostic impact of anemia and hypoalbuminemia was attenuated. Elevated LDH levels remained independently associated with in-hospital mortality (adjusted odds ratio 2.84, 95% confidence interval 1.01–8.02). Higher NLR values and lower CALLY index levels showed nonsignificant trends toward adverse outcomes. Conclusions: In this real-world cohort from a resource-limited setting, LDH emerged as a practical and independent predictor of in-hospital mortality in patients with AHF. When access to natriuretic peptides is limited, LDH—supported by routinely available laboratory parameters—may assist early risk stratification and clinical decision-making. Full article

Background/Objectives: Blood loss is a major concern in elderly patients undergoing hip fracture surgery. Tranexamic acid (TXA) is used to improve bleeding outcomes; however, randomized clinical trials (RCTs) report mixed findings, with some studies finding no improvements. This meta-analysis was conducted to evaluate the effectiveness of intravenous TXA in patients with extracapsular proximal femur fractures undergoing surgery. Methods: A systematic literature review was performed to identify relevant RCTs. Evaluated outcomes were total blood loss (TBL), hidden blood loss (HBL), change in hemoglobin (Hb), change in hematocrit (Hct), risk for transfusion and number of transfused units per patient. Review Manager 5.3 was used. Results: Twenty-five RCTs were included. TXA administration was associated with significant reductions in TBL (MD = −255.59 mL, 95% CI −306.50 to −204.68) and HBL (MD = −219.28 mL, 95% CI −286.93 to −151.62) compared with control. Patients receiving TXA had significantly smaller changes in Hb (MD = 0.65 g/dL, 95% CI 0.39–0.90) and Hct (MD = 4.22%, 95% CI 2.04–6.40). TXA significantly reduced the risk of transfusion (RR = 0.55, 95% CI 0.43–0.70) and number of transfused units per patient (SMD = −0.66, 95% CI −1.15 to −0.17). Subgroup analyses showed consistent effects. Sensitivity analyses confirmed robustness of results, except for the significance in reducing the number of transfused units when studies with ‘liberal’ transfusion thresholds were excluded. Conclusions: These findings show statistically significant improvements in bleeding outcomes with the use of intravenous TXA in patients with extracapsular proximal femur fractures undergoing surgery. Further high-quality RCTs are needed to standardize TXA timing and dosing. Full article

Background: The advancements in antiretroviral treatment (ART) have led to a 69% reduction in AIDS-related deaths. However, people living with HIV (PLWH) face age-related comorbitidies like coronary artery disease (CAD), which can be 50% higher compared to HIV-negative individuals. This study explores the prevalence and extent of early CAD in PLWH without a history of cardiovascular disease using computed tomography angiography (CTA). Methods: A 320-detector row CTA (Aquilion ONE, Canon Medical Systems) was utilized to determine prevalence of coronary atherosclerosis. Logistic regression analysis and ROC analysis were performed to predict risk factors for the presence of atherosclerosis. Results: A total of 186 individuals participated in this study, including 74 PLWH and 112 HIV-seronegative controls. A notable disparity in the occurrence of coronary atherosclerosis was observed between the two groups, with 20% of individuals in PLWH showing plaque in the coronary arteries as detected by CTA, compared to 7% in the control group (p = 0.015). In the plaque group, a significant increase in age was observed (p = 0.001) along with elevated levels of fasting blood glucose and hemoglobin A1c (p < 0.001 and p = 0.017 respectively). HIV seropositivity and age were significantly associated with the presence of plaque (aOR, 5.5 [95% CI, 1.7–25.8] and 21.7 [95% CI, 5.5–88] respectively). When evaluating age, fasting blood sugar and HbA1c through ROC analysis to predict plaque presence, age is the strongest predictor, with an AUC of 0.899 (p < 0.001, 95% CI: 0.847–0.939) and a cutoff value of 35 years. Additionally, HbA1c and fasting blood sugar had an AUC of 0.664 (p = 0.0047, 95% CI: 0.574–0.746) and 0.759 (p < 0.001, 95% CI: 0.688–0.822) respectively. Youden cutoff values were 5.5 for HbA1c and 92.4 for fasting blood sugar. Conclusions: The higher prevalence of CAD in PLWH may indicate that inflammation is a substantial risk. It is important to remember that CAD can develop early in PLWH. Moreover, including HbA1c and fasting blood sugar measurements in routine follow-up may help facilitate earlier detection of atherosclerosis. Full article

Background: Medical progress and sustainability pressures have made reducing hospital Length Of Stay (LOS) for total joint arthroplasty increasingly feasible and necessary. Monitoring rehabilitation duration and outcomes after surgical ward discharge needs equal attention. The aim of this retrospective, cohort study is to evaluate perioperative predictors of Inpatient Rehabilitation LOS (IRLOS), Discharge Destination (DD) (home versus residential care unit) and Need for Assistance at Discharge (NAD), in patients undergoing inpatient rehabilitation after total hip or knee arthroplasty in a high-volume, specialized research hospital. Methods: Electronic hospital datasets were employed to identify all adults with hip or knee osteoarthritis who received specialistic inpatient rehabilitation after total joint replacement between January and December 2019. Associations between demographic, clinical, surgical and functional variables and postoperative outcomes were examined using binary logistic regression for dichotomous outcomes (DD, NAD) and linear regression for continuous outcomes (IRLOS). Results: Based on a cohort of 1679 patients, we found various patient-related (age, working status, living alone, pre-existing comorbidities, osteoarthritic characteristics), surgical (duration of intervention, LOS, joint approach) and postoperative (hemoglobin levels, functional status) predictors. Overall, the regression models explained a modest but meaningful proportion of the variability in rehabilitation duration and post-discharge outcomes (R² ranging from 0.12 to 0.34), resulting in marginal changes compared to a preliminary version of the same study on a smaller dataset. Conclusions: External validation on another cohort from the same hospital could be used to test the model’s predictivity at the local level, supporting the continuity of care between an orthopedic hospital hub and outpatient care and rehabilitation. Gains in predictive capacity may follow from including local factors like the operating surgeon and team. Although these factors could significantly improve the model performance at the local level, they would not be generalizable in different settings. Full article

Pregnancy (HP), defined as the coexistence of intrauterine and ectopic gestations, is a rare condition, especially in spontaneous conception, but it is a life-threatening obstetric emergency when rupture occurs, with a reported maternal mortality rate of 0.03%. Diagnosis is often delayed because confirmation of an intrauterine pregnancy can mask clinical signs of a concurrent ectopic gestation. Early recognition and prompt surgical intervention are therefore critical to maternal safety and preservation of intrauterine viability. This case highlights the diagnostic challenges and successful management of a spontaneous ruptured heterotopic pregnancy. Case presentation: A 34-year-old Middle Eastern woman, gravida 4, with a spontaneous conception, presented with sudden severe lower abdominal pain and signs of acute hemoperitoneum (hypotension, tachycardia, and marked peritoneal signs). Transvaginal ultrasound demonstrated a viable intrauterine pregnancy at 9 weeks 4 days gestation, together with a ruptured left tubal ectopic pregnancy of similar gestational age. The patient underwent urgent laparoscopic left salpingectomy with evacuation of approximately 1200 mL of intraperitoneal blood and clots. Postoperatively, she developed significant anemia (hemoglobin drop from 11.2 g/dL on admission to 6.5 g/dL) requiring transfusion of four units of packed red blood cells. Serial ultrasonographic follow-up confirmed ongoing viability of the intrauterine pregnancy, which ultimately resulted in a live birth at term. Progressive resolution of the postoperative pelvic hematoma was also noted. Conclusions: Ruptured heterotopic pregnancy remains a diagnostic and therapeutic challenge. This case, along with a synthesis of the contemporary literature, demonstrates that a high clinical index of suspicion, timely ultrasound diagnosis, and immediate minimally invasive surgical management are paramount. Furthermore, rigorous postoperative monitoring and resuscitation, including targeted transfusion, are essential to achieve maternal stabilization while allowing continuation of a viable intrauterine pregnancy, with reported live birth rates exceeding 70% following timely intervention. Full article

Background/Objectives: Total knee arthroplasty (TKA) is often associated with extensive bleeding and the need for intraoperative and postoperative blood transfusions. Due to concern about the risks associated with them, a push has been made in surgery toward the development of new intraoperative blood management devices and innovative postoperative care strategies. Tranexamic acid (TXA), fibrin sealant and standard electrocautery are widely used in orthopedic surgery, since several studies provided evidence about their efficacy and safety. A new device, the bipolar sealer system (BSS), provides hemostasis at lower temperature (<100°) than conventional electrocautery. It does not produce smoke, necrosis or burn tissue. Methods: In this study, we retrospectively analyzed data from 480 patients who underwent TKA between January 2017 and December 2024. The cohort was divided into two groups based on the hemostatic protocol adopted. The control group enrolled 240 patients who received the standard protocol with TXA and fibrin sealant, while the study group enrolled 240 patients who followed protocol with Aquamantys BSS and TXA. Hematological parameters, including hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) were analyzed preoperatively (T0) and postoperatively: immediately after surgery (T1), at day one (T2) and day three (T3). Results: Changes in hemoglobin from baseline to postoperative follow-up were significantly lower among patients who received TXA plus BSS and those receiving TXA plus fibrin sealant, with p-values of 0.0003 at T1 (immediately after surgery), 0.027 at T2 (one day post-op), and 0.0001 at T3 (three days post-op). Comparable results were observed for HCT and RBC values. Conclusions: These data demonstrate that Aquamantys is more effective than fibrin glue in controlling blood loss after knee replacement surgery, not only immediately after the procedure but also in the following days. Full article

Background: Long-term glycemic control in type 1 diabetes (T1D) varies substantially among affected individuals, but the role of baseline characteristics at diagnosis and their association with later glycemic control remain incompletely understood. Identifying early predictors of glycemic control may facilitate timely, individualized therapeutic interventions. Methods: We retrospectively analyzed electronic health records of individuals with newly diagnosed T1D between 2001 and 2022 to assess anthropometric and metabolic parameters at the first presentation of the condition across age groups and determine predictors of glycated hemoglobin (HbA_1c) trajectories over 24 months. The multicentric cohort, which comprised people who were diagnosed with T1D in the Austrian federal state of Styria, was classified as children (<10 years), adolescents (10–18 years) or adults (≥18 years). Variables of interest included demographic and anthropometric data, positivity and titers of diabetes-specific autoantibodies, treatment setting (inpatient/outpatient), and presence and severity of diabetic ketoacidosis (DKA). Results: The cohort consisted of 281 individuals (23.1% were children, 41.3% were adolescents, and 35.6% were adults at T1D diagnosis; 46.6% were female). In the unadjusted analyses, younger age (age < 18 years), female sex, and receiving treatment in a general ward were associated with higher HbA_1c levels over 24 months. However, after adjustment for important covariates, only younger age remained a significant predictor of inferior glycemic control over 24 months, emphasizing the importance of structured, age-appropriate follow-up care. Conclusions: Younger age at T1D diagnosis independently predicts suboptimal glycemic trajectories over the first two years after T1D onset. Early identification may enable targeted, age-specific interventions to improve long-term outcomes. Full article

Background: Euthyroid Sick Syndrome (ESS) is a clinical condition characterized by reduced free triiodothyronine (FT3) levels in response to acute or chronic stress. Proximal femur fractures in geriatric patients are associated with high morbidity and mortality rates and ESS may influence outcomes in this population. This study aimed to investigate the role of ESS as a predictor of complications in elderly patients with hip fractures, analyzing its association with inflammatory and nutritional markers, including the Monocyte-to-Lymphocyte Ratio (MLR), Controlling Nutritional Status (CONUT) score and Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score. Materials and Methods: We conducted a single-center retrospective analysis of patients aged 65 and older who were admitted with proximal femur fractures requiring surgical intervention. Thyroid hormone profiles, inflammatory markers and other clinical variables were analyzed preoperatively (T0) and on the first (T1) and third (T2) postoperative days. Logistic regression was used to identify predictors of complications and transfusion requirements. Results: The study included 103 patients (72 men, 31 women; mean age 85 ± 6.27 years). ESS was present in 30 patients (29%) and was associated with longer surgery duration (83.9 ± 35.5 vs. 68.9 ± 21.3 min; p = 0.042). At admission (T0), ESS patients had lower FT3 (1.91 ± 0.25 vs. 2.75 ± 0.28 pmol/L; p < 0.001) and higher TSH (1.55 ± 0.75 vs. 1.20 ± 0.80 mIU/L; p = 0.057). Postoperatively, MLR was significantly altered at T1 (p = 0.026) and T2 (p = 0.040). ESS was a significant predictor of complications at T0 but lost significance postoperatively, while MLR emerged as a key predictor at T2 (p = 0.003). Logistic regression confirmed MLR at T2 as an independent predictor of complications. Hemoglobin levels at T0 (p < 0.001), T1 (p < 0.001), and T2 (p < 0.001), along with albumin at T1 (2.67 ± 0.34 vs. 2.94 ± 0.33 g/dL; p = 0.001) and calcium at T1 (p = 0.006), were significant predictors of transfusion requirements. Nutritional and inflammatory scores were not predictive. Conclusions: ESS is a significant initial predictor of complications in geriatric patients with hip fractures, but inflammatory markers such as MLR assume greater relevance in the postoperative period. These findings emphasize the importance of monitoring ESS and MLR to enhance risk stratification and guide personalized management strategies. Full article

Background and Objectives: This study aimed to identify the clinical factors associated with the need for surgical intervention in women with uterine fibroids (UFs) and develop a data-driven clinical decision helper algorithm. By comparing hematologic and fibroid characteristics and prospectively assessing clinical concordance with the model predictions, we sought to create an objective tool for surgical decision-making. Materials and Methods: This retrospective study enrolled 618 women with UFs who were evaluated at three participating hospitals. Of these, 238 (38.5%) underwent surgery. Comparative statistical analyses were conducted between patients who underwent myomectomy and those who did not. Machine learning (ML) models were trained to predict myomectomy necessity. A clinical concordance assessment was conducted using 50 cases that were evaluated in real time by a gynecologist blinded to both the clinical outcomes and the model outputs. Agreement between clinical assessment and algorithm-based predictions was subsequently evaluated. Results: Hemoglobin and ferritin concentrations were significantly reduced in the surgery group compared with the non-surgery group (p < 0.001). ML analyses integrating fibroid characteristics with anemia-related markers identified support vector ML models as the most accurate classifiers. Ferritin-based models achieved accuracies of 98–99% and near-perfect ROC–AUC values. ML models combining UF number or volume with ferritin demonstrated the highest precision, sensitivity, and F1-scores. Clinical concordance analysis showed 98% agreement with the blinded gynecologist, with only one borderline discordant case. Conclusions: This decision helper algorithm provides a highly accurate and objective tool for predicting surgical necessity in patients with UFs. Anemia status and fibroid characteristics were the strongest predictors. By reducing subjective variability and closely reflecting expert reasoning, the model offers a practical framework for integration into routine gynecologic decision-making. Full article