Search Results (4,638)

Background: SARS-CoV-2 infection, its late complications, and SARS-CoV-2 vaccines are known to cause pericardial effusion. We sought to investigate the influence of the COVID-19 outbreak on trends in pericardiocentesis. Methods: We performed a retrospective population study including all >18 years patients undergoing pericardiocentesis in a single tertiary hospital between January 2018 and April 2022. The effusion characteristics and patient outcomes were compared between patients admitted before and after the COVID-19 outbreak. Results: 92 patients underwent pericardiocentesis cases during the COVID-19 period compared to 65 patients during the pre-COVID-19 period (χ² = 3.07, p = 0.0796). Only 15% of the post-COVID-19 outbreak cases were related to COVID-19 infection or vaccine. In-hospital mortality was numerically higher during the post-COVID-19 group (7.7% vs. 14.4%), but this difference did not reach statistical significance (p = 0.22). The 90-day mortality was also similar between groups. Conclusions: A numerical, yet statistically insignificant increase in pericardiocentesis was observed following the COVID-19 outbreak. We assume this observation cannot be attributed solely to the virus and vaccines per se. Neglect of other chronic diseases, social distancing, and widespread availability of point-of-care ultrasound may have contributed to this observation. Full article

Background: Intra-abdominal infections (IAIs) are one of the leading causes of non-traumatic death in emergency surgery units. The appropriateness of empirical antibiotic therapy is fundamental for outcomes and for limiting the spread of resistance. This study aimed to assess the epidemiology and antibiotic resistance patterns of microorganisms recovered from complicated intra-abdominal infections due to colorectal perforation at an Italian University Hospital during a nine-year period. Methods: This study evaluated a cohort of patients subjected to emergency surgery for colonic perforation with collected intrabdominal fluid samples from 2015 to 2024. Patterns of isolated bacteria and antibiotic resistance status were collected and correlated to patient outcomes. Results: 321 patients were enrolled; the average age was 70.2 years. The main diagnoses were complicated diverticulitis (58%), colorectal carcinoma perforation (18%), and acute intestinal ischemia (24%). 80.4% were immunocompromised; average hospital stay (HLOS) was 15.6 days; 60.1% developed postoperative complications. Microbiological cultures were available for 111 patients: 56.7% had mono-microbial infections and 43.3% multi-microbial infections. 53 antibiotics and 9 antifungals were tested, with resistance rates exceeding 20% for many pathogens. Multivariate analyses showed that documented IAIs are associated with longer postoperative hospital stays (p 0.003 CR 8.075) but not with patient mortality (p 0.031). Prolonged HLOS was more commonly observed in patients with polymicrobial infections or infections caused by multi-drug-resistant organisms (p 0.03; p 0.003). Conclusions: Microbiological characteristics of isolated bacteria do not directly influence mortality; however, the presence of polymicrobial infections and resistant pathogens directly affects the duration of hospitalization and often leads to the development of chronic disease conditions. Full article

Background and objectives: Colorectal cancer (CRC) presents a variety of molecular and pathological characteristics due to its location in the large intestine, which influences its management and prognosis. We aimed to evaluate the clinicopathological disparities between right colon (RCC), left colon (LCC), and rectal carcinomas. Materials and methods: A retrospective observational study was conducted to examine consecutive cases of colorectal carcinomas diagnosed at the “Pius Brinzeu” County Emergency Clinical Hospital (PBCECEHT), Romania. The clinicopathological characteristics and metastatic spread were analyzed by the site of the malignant tumor (right colon, left colon, or rectum). Results: A total of 1812 patients met the inclusion criteria, predominantly males (57.95%). Patients with RCC had an almost equal distribution between sexes, while patients with LCC and rectal carcinomas were more frequently males (p < 0.0001). RCC tumors were mostly high-grade (p < 0.0001), deeply invasive (p < 0.0001), and mucinous (p = 0.0109), with lymphovascular invasion and distant metastases. Conclusions: We observed different clinicopathological characteristics of CRC depending on the site of origin. We emphasize that tumor location is a parameter worth considering in CRC patients, both in therapeutic management and in future clinical trials. Full article

Background: Secondary hepatic dysfunction is a frequent yet often under-recognized complication in critically ill children. It commonly arises as a consequence of systemic processes—particularly sepsis, hypoperfusion, hypoxia, and multiorgan dysfunction—rather than primary hepatobiliary disease. This study aimed to determine the incidence, clinical characteristics, and prognostic significance of secondary hepatic dysfunction in a pediatric intensive care unit (PICU) cohort, and to evaluate its relationship with PRISM III and PELOD-2 scores. Methods: This retrospective study included patients hospitalized in a tertiary PICU between January 2022 and December 2024. Children with pre-existing liver disease or primary acute liver failure were excluded. Hepatic dysfunction was defined by elevations in age-adjusted biochemical markers. Demographic variables, clinical interventions, laboratory values, and outcomes were recorded. Mortality risk and prolonged PICU stay (>7 days) were analyzed in relation to hepatic dysfunction, PRISM III, and PELOD-2 scores. Results: Among 567 PICU admissions, 50 patients (8.8%) met criteria for secondary hepatic dysfunction. The cohort had a median age of 57.5 months and 66% were male. Hepatocellular injury predominated (96%), while cholestatic patterns were less common (4%). Overall mortality was 22%. Mortality was significantly associated with sepsis (p = 0.04), mechanical ventilation (p < 0.01), and inotropic support (p < 0.01). Both PRISM III and PELOD-2 scores were higher in non-survivors on day 1 and day 7 (p ≤ 0.01). ALT ≥ 2 × ULN and total bilirubin > 2 mg/dL were not independently predictive of mortality. Conclusions: Secondary hepatic dysfunction is relatively common in critically ill children and is associated with adverse clinical outcomes. Its prognostic relevance appears to extend beyond conventional severity scores, particularly with respect to morbidity-related outcomes such as prolonged PICU stay, suggesting that routine hepatic assessment may contribute to early risk stratification in the PICU setting. Full article

Background: High-resolution computed tomography reveals a marked radiological heterogeneity in bronchiectasis; however, the clinical characteristics have not been clearly elucidated. Method: We conducted a prospective observational cohort of 334 bronchiectasis patients at Wuhan Union Hospital. Patients were classified into distal airway (DA) and proximal–intermediate airway (PIA) phenotypes and followed every six months for exacerbations. Clinical, inflammatory, microbial, and metabolic features were compared between groups. Results: Among 334 patients, 206 were classified as DA and 128 as PIA. Most allergic bronchopulmonary aspergillosis cases belonged to the PIA group (p < 0.001). The DA group showed a lower FEV₁%pred (p = 0.010) and Bhalla scores (p < 0.001), higher BSI (p = 0.003) and FACED scores (p < 0.001), more frequent exacerbations (p = 0.002), and a greater prevalence of Pseudomonas aeruginosa (PA) colonization (p < 0.001). Radiologically, the DA group exhibited more extensive structural lung damage (all p < 0.05). Inflammatory profiling showed higher neutrophil counts (p = 0.047) and elevated CRP levels (p = 0.006) in DA, whereas the PIA group was characterized by eosinophilic inflammation (p = 0.026); no significant differences were observed in inflammatory cytokine levels. Microbial interaction network analysis revealed distinct ecological structures between phenotypes. The PIA group showed strong negative correlations with Streptococcus, Rothia, and other commensal taxa, whereas the DA group exhibited no significant associations between Pseudomonas aeruginosa and other species. Furthermore, metabolomic analyses revealed elevated 4-hydroxynonenal levels in the DA group, which also experienced a higher rate of acute exacerbations during follow-up (p = 0.003). Conclusions: Distinct radiological phenotypes based on airway generation in bronchiectasis are associated with different clinical severity, inflammatory profiles, and microbiome features which enable personalized bronchiectasis management. Full article

Background/Objectives: The Global Leadership Initiative on Malnutrition (GLIM) recently updated its inflammation criterion through a Delphi consensus to standardize its assessment. This study aimed to assess the impact of these new recommendations on the concurrent and predictive validity of the GLIM criteria in hospitalized medical patients. Methods: This post hoc analysis re-evaluated a previously published cohort of 119 hospitalized patients with acute medical conditions, originally assessed using the GLIM criteria and the Subjective Global Assessment (SGA) as the reference standard. Inflammation was redefined according to the 2024 GLIM Delphi consensus, and the concurrent and predictive validity of the modified GLIM criteria (GLIM-I) were examined. Receiver operating characteristic (ROC) curves were used to compare the discriminative ability of SGA, original GLIM, and GLIM-I to predict prolonged hospital stay. Results: With the updated inflammation definition, all patients met the etiologic criterion, increasing malnutrition prevalence from 41.7% to 52.2%. GLIM-I showed a sensitivity of 78.0% and specificity of 67.7% versus SGA, not reaching the predefined ≥80% threshold for concurrent validity. Predictive validity was maintained (adjusted odds ratio (OR) = 3.40; 95% CI: 1.31–8.83). SGA achieved the highest discriminative ability (area under the curve (AUC) = 0.783; 95% CI: 0.693–0.874), significantly outperforming the original GLIM (AUC = 0.723; 95% CI: 0.616–0.830; p = 0.049). GLIM-I showed similar performance (AUC = 0.731; 95% CI: 0.620–0.843; p = 0.727). Conclusions: SGA should continue to be considered the method of choice for nutritional diagnosis in hospitalized medical patients. Further research is needed to determine how the new inflammation criteria influence the validity of the GLIM framework in other clinical contexts before their widespread implementation. Full article

Objectives: This study aimed to explore the association between left ventricular relative wall thickness (RWT) and postoperative acute kidney injury (AKI) in elderly patients who underwent hip fracture surgery. Additionally, we evaluated the prognostic value of RWT for postoperative clinical outcomes in this high-risk group. Methods: This prospective study included 131 patients aged ≥ 65 years who underwent surgery for femoral neck or intertrochanteric hip fractures. Preoperative echocardiographic parameters, including RWT, were recorded and their associations with postoperative AKI were analyzed. Postoperative cardiovascular complications and clinical outcomes were assessed. Results: Postoperative AKI occurred in 19.1% of patients and was significantly associated with higher in-hospital mortality (20% vs. 5.6%; p = 0.036). Patients who developed AKI had significantly higher RWT (0.54, 0.503, p = 0.048, respectively). Receiver operating characteristic (ROC) curve analysis was performed for preoperative echocardiographic parameters, such as interventricular septum (IVS), posterior wall thickness (PWT), left atrium (LA) diameter, and RWT, to evaluate their predictive ability for AKI. The area under the curve (AUC) values were 0.645 for IVS, 0.632 for PWT, 0.713 for LA diameter, and 0.628 for RWT (all p < 0.05). Although LA diameter had the highest AUC, RWT showed the highest sensitivity (96%) at the cut-off value of 0.435. Subgroup analyses comparing patients with RWT < 0.435 and ≥0.435 showed no significant differences in AKI, mortality, delirium, intensive care unit admission rates, cardiac complications, or ischemic events (all p > 0.05). Conclusions: Preoperative RWT demonstrated a modest but statistically significant association with postoperative AKI in elderly hip fracture patients with preserved left ventricular ejection fraction. Although its standalone predictive value is limited, RWT may contribute to perioperative risk stratification when interpreted alongside other echocardiographic, clinical, and biochemical parameters in this vulnerable high-risk patient population. Full article

Background/Objectives: Acute mesenteric ischemia (AMI) is a time-dependent condition associated with exceptionally high in-hospital mortality, particularly among elderly and comorbid patients. Early identification of patients at high risk of death remains challenging and has important implications for clinical decision-making. The objective of this study was to derive and internally validate a prognostic score for in-hospital mortality of patients with AMI. Materials and Methods: We conducted a multicenter, observational, retrospective cohort study including patients with AMI from 10 participating hospitals. A descriptive and analytical approach was performed. A Classification and Regression Tree (CART) model was used to determine cut-off points for continuous variables and assess their association with mortality. Based on these thresholds, a univariate analysis was performed, and variables with statistical significance (p < 0.05) were incorporated into a multivariate logistic regression model. A score—the RADIAL score—was then derived from the beta coefficients. The discriminative ability of the score was evaluated using the receiver operating characteristic (ROC) curve. Results: A total of 693 patients were studied. Thee mean age was 81 years (IQR 73–86) and 54.2% were women. A history of cardiovascular disease was present in 75.3% of participants. Overall mortality was 62.4%. Most patients (74%) were managed conservatively. Significant variables in the bivariate analysis included hypotension, age > 65 years, pH < 7.3, creatinine > 1.7 mg/dL, and absence of rectal bleeding. These variables were incorporated into the multivariate model. The resulting score showed an area under the ROC curve of 0.78 (95% CI: 0.74–0.82). Conclusions: The RADIAL score demonstrated robust predictive performance and allowed the identification of three mortality-risk groups: 30–40% (low), 50–60% (intermediate), and 80% (high). This tool may support clinical decision-making in the management of patients with AMI. Full article

Background: Pediatric heart transplantation (HTx) is the standard therapy for end-stage heart failure in children, and the use of durable left ventricular assist devices (LVADs) as a bridge to transplant is increasing. However, comparative long-term data for LVAD-bridged versus directly transplanted pediatric recipients remain limited. In this study, we aimed to compare the early and long-term outcomes of pediatric heart transplantation with and without LVAD bridging. Methods: We retrospectively reviewed all pediatric patients who underwent orthotopic HTx at our institution between 2004 and 2024. 34 recipients were included, 17 bridged with durable LVAD support, and 17 transplanted without mechanical circulatory support. Perioperative characteristics, early postoperative complications, and long-term outcomes were compared between groups. Results: LVAD recipients had more advanced ventricular dysfunction, longer cardiopulmonary bypass and aortic cross-clamp times, and more frequent red blood cell transfusion requirements. Despite this higher-risk profile, early postoperative complications, early mortality, and ICU and hospital length of stay were similar between groups. Ten-year survival was 70.6% in the LVAD group, and 82.4% in the non-LVAD group (log-rank p = 0.365), and freedom from CAV and treated rejection did not differ significantly. Conclusions: In this single-center, two-decade experience, durable LVAD support enabled successful transplantation of high-risk pediatric candidates without compromising early or long-term post-transplant outcomes. LVAD bridging appears to be a safe and effective strategy in pediatric HTx. Full article

Cytomegalovirus (CMV) colitis is a significant entity in hospitalized patients with ulcerative colitis, particularly during immunosuppressive therapy. The factors associated with antiviral treatment duration remain incompletely defined. This retrospective cohort study included hospitalized adult patients with ulcerative colitis and immunohistochemically confirmed CMV colitis. Baseline demographic, clinical, endoscopic, and laboratory characteristics were evaluated for the cohort and stratified by antiviral treatment duration of ≤14 days and >14 days. Correlation analyses were performed between tissue CMV polymerase chain reaction (PCR) viral load and laboratory parameters. Receiver operating characteristic analysis identified a tissue CMV PCR cut-off associated with prolonged antiviral therapy. The study included 52 patients (median age, 41.5 years; 65.4% male). Fourteen patients received biologic therapy and were younger and had higher C-reactive protein levels than those who did not receive biologics. Tissue CMV PCR viral load was higher in patients who received antiviral therapy for >14 days. The analysis identified a tissue CMV PCR cut-off value of 162,000 IU/mg, with an area under the curve of 0.69, sensitivity of 70.4%, and specificity of 76.0%. Tissue CMV PCR viral load showed a weak negative correlation with serum albumin levels (Spearman ’s r = −0.34, p < 0.05). Tissue CMV PCR viral load is associated with antiviral treatment duration and may help identify patients with ulcerative colitis–associated CMV colitis who require prolonged therapy. Full article

Background/Objectives: Patients undergoing chronic hemodialysis are at increased risk of severe COVID-19 outcomes. This study aimed to evaluate the clinical characteristics and prognostic factors associated with mortality in hemodialysis patients infected with SARS-CoV-2. Methods: We conducted a retrospective study including 130 chronic hemodialysis patients diagnosed with COVID-19 and admitted to a nephrology unit between March 2020 and April 2021. Demographic data, comorbidities, clinical manifestations, hospitalization duration, and outcomes were analyzed using univariate and multivariate statistical methods. Results: The cohort was predominantly male (64.6%), with a mean age of 64.0 ± 13.9 years. The mean hospitalization duration was 13.6 ± 9.7 days. Cardiovascular disease, chronic respiratory disease, dyspnea at presentation, and hospital-origin admission were significantly associated with mortality. While diabetes mellitus and hypertension were highly prevalent, they did not independently predict mortality after adjustment. Overall mortality was 34.6%, particularly among older patients with multiple comorbidities. Conclusions: COVID-19 infection is associated with substantial morbidity and mortality among patients on chronic hemodialysis. Early identification of high-risk patients based on clinical presentation and comorbidity profile may support timely intervention and improved outcomes in this vulnerable population. Full article

Background: Traumatic brain injury (TBI) is a global healthcare problem, and post-traumatic amnesia (PTA) is a known predictor of long-term and societal outcomes. However, factors influencing PTA recovery during the inpatient rehabilitation phase remain underexplored, particularly in Asian populations. Objective: To identify factors associated with PTA duration and emergence during inpatient rehabilitation and examine their impact on functional outcomes. Materials and Methods: We conducted a retrospective, single-center cohort study over a 7-year period among patients with acute TBI who were admitted to an inpatient rehabilitation hospital. Outcomes included PTA emergence and duration, discharge Functional Independence Measure (FIM), rehabilitation length of stay, and Glasgow Outcome Scale (GOS) at ≥1 year. Results: A total of 100 patients were analyzed. In an adjusted Cox regression, age ≥ 55 years (Hazard Ratio [HR] 0.47) and non-infective medical complications during rehabilitation (HR 0.31) were associated with reduced likelihood of PTA emergence, while mild admission GCS (13–15; HR 4.80) and epidural hemorrhage (EDH) (HR 2.00) were associated with PTA emergence. PTA non-emergence was associated with approximately a 20-point lower discharge FIM total score (adjusted model, p < 0.001). A PTA duration of ≥90 days was associated with a lower total discharge FIM score by approximately 45 points compared with those with a PTA duration of <28 days (p < 0.001). PTA emergence was associated with better GOS at ≥1 year (odds ratio [OR] 3.92, p = 0.02). Conclusion: Both acute injury characteristics and intra-rehabilitation factors were associated with PTA recovery functional outcomes. PTA emergence, beyond PTA duration, was strongly associated with discharge functional status and long-term global outcome, supporting the clinical value of PTA in prognostication, rehabilitation planning, and goal setting. Full article

Background and Objectives: The aim of this study was to compare the clinical and radiological outcomes of the nail-plate combination (NPC) and double-plate (DP) fixation techniques in revision surgery performed after fixation failure of periprosthetic distal femur fractures. Materials and Methods: Patients who underwent revision surgery for periprosthetic distal femur fractures following fixation failure between 2018 and 2023 at a tertiary referral center were retrospectively reviewed. Based on the surgical technique, patients were divided into two groups: NPC group (n = 27) and DP group (n = 45). Demographic characteristics, operative time, intraoperative blood loss, and fluoroscopy time were recorded. Radiological evaluation included union time, while clinical outcomes were assessed with the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) health survey. Complications (infection, thromboembolism, implant failure, nonunion, malalignment), reoperation, and 1-year mortality rates were also analyzed. Results: The NPC group had significantly shorter operative time (107 vs. 134 min, p < 0.001) and lower intraoperative blood loss (412 vs. 634 mL, p < 0.001). Hospital stay was shorter in the NPC group (6.9 ± 1.5 vs. 10.2 ± 3.3 days, p < 0.001). Mean union time was approximately three weeks shorter in the NPC group (15.4 vs. 18.8 weeks, p < 0.001). Functional outcomes (KSS, WOMAC, SF-36) did not differ significantly between groups. Complication rates were comparable; implant failure was the most frequent complication (NPC: 3.7% vs. DP: 13.3%). One-year mortality did not differ significantly (NPC: 7.4% vs. DP: 11.1%). Conclusions: Compared with DP fixation, the NPC technique offers clear perioperative advantages in revision surgery performed after fixation failure of periprosthetic distal femur fractures, including shorter operative time, reduced blood loss, and faster union. Functional outcomes and complication rates were similar between techniques. These findings suggest that the NPC may represent a safer and more feasible alternative. Full article

Background and Objective: Postoperative hospital length of stay (LOS) reflects surgical recovery and resource demand but remains difficult to predict due to heterogeneous perioperative trajectories. We aimed to develop and validate an interpretable machine learning framework that integrates multimodal perioperative data to accurately predict LOS and uncover clinically meaningful drivers of prolonged hospitalization. Methods: We studied 97,937 adult surgical cases from a large perioperative registry. Routinely collected perioperative data included patient demographics, comorbid conditions, preoperative laboratory values, intraoperative physiologic summaries, and procedural characteristics. Length of stay was modeled using a supervised regression approach with internal cross-validation and independent holdout evaluation. Model performance was assessed at both the cohort and individual levels, and explanatory analyses were performed to quantify the contribution of clinically defined perioperative domains. Results: The model achieved R² = 0.61 and MAE ≈ 1.34 days on the holdout set, with nearly identical cross-validation performance (R² = 0.60, MAE ≈ 1.34 days). Operative duration, diagnostic complexity, intraoperative hemodynamic variability, and preoperative laboratory indices—particularly albumin and hematocrit—emerged as the strongest determinants of postoperative stay. Patients with shorter recoveries typically had brief operations, stable physiology, and normal laboratory profiles, whereas prolonged hospitalization was linked to complex procedures, malignant or respiratory diagnoses, and lower albumin levels. Conclusions: Interpretable machine learning enables accurate and generalizable estimation of postoperative LOS while revealing clinically actionable perioperative domains. Such frameworks may facilitate more efficient perioperative planning, improved allocation of hospital resources, and personalized recovery strategies. Full article

This study investigated the clinical and genomic characteristics of Enterobacter cloacae complex (ECC) and Klebsiella aerogenes bloodstream infections (BSIs) in pediatric patients. A total of 115 BSI episodes (ECC: 86, K. aerogenes: 29) from 110 children hospitalized between 2011 and 2024 were retrospectively analyzed. Whole-genome sequencing was performed on available isolates to determine species, sequence types, and antimicrobial resistance (AMR) genes. Clinical characteristics, antibiotic usage, and outcomes were compared between groups. Patients with K. aerogenes BSI were younger and more likely to be preterm or diagnosed with urosepsis, while ECC infections were more frequently associated with hematologic malignancies. According to a multivariable analysis of the entire cohort (n = 115), K. aerogenes infection (OR [6.26], 95% CI [1.36–28.78]) and gentamicin resistance (OR [10.06], 95% CI [1.88–53.87]) were independently associated with 30-day mortality. Enterobacter hormaechei was the most common ECC species (68.4%) and exhibited the highest prevalence of AMR genes, particularly those conferring resistance to aminoglycosides, β-lactams, and trimethoprim–sulfamethoxazole. In contrast, K. aerogenes harbored few resistance genes. Multi-locus sequence typing analysis revealed high genetic diversity in both ECC and K. aerogenes, without evidence of dominant clonal expansion. Despite similarities in clinical presentation, ECC and K. aerogenes exhibit distinct age distributions, resistance profiles, and genetic diversity in pediatric BSIs. These findings underscore the importance of species-level identification and continued genomic surveillance to inform empirical antibiotic strategies and prevent the spread of resistant strains. Full article