Search Results (11,161)

Background/Objectives: Virtual reality (VR) is increasingly used to reduce pain during pediatric needle procedures, but its effectiveness may vary by developmental stage and gender. This study evaluated whether immersive VR reduces venipuncture pain in children and adolescents and examined parent–patient agreement and gender-specific response patterns. Methods: A prospective nonrandomized clinical study was conducted within a hospital-based pediatric venipuncture service using an alternating 1:1 allocation sequence. Participants aged 4–18 years underwent venipuncture with either VR (n = 49) or standard care (n = 29). Procedural pain was measured using the Faces Pain Scale–Revised (FPS-R) with independent parent ratings. Analysis of covariance (ANCOVA) compared post-procedural FPS-R scores while adjusting for baseline pain. Exploratory age and gender-specific analyses were also performed. Results: VR led to a clear reduction in pain for children, even after adjusting for baseline scores (3.55 vs. 4.73; p = 0.003). Adolescents, however, reported similarly low pain in both groups (2.81 vs. 2.79; p = 0.60), and several mentioned that the PEGI 3 content felt too young for them, which likely limited how engaged they were. Among children, girls showed the most noticeable drop in pain, which matches the subgroup’s adjusted significance (p = 0.011). Parent–patient agreement was stronger in children (r ≈ 0.7–0.8) than in adolescents (r ≈ 0.4–0.5), and VR did not change this pattern. Most participants said they would choose VR again for future procedures. Conclusions: Immersive VR helped reduce venipuncture pain in children but had little effect in adolescents, underscoring the need for age-appropriate or more interactive VR content for older patients. Overall, these findings support using VR selectively as a distraction tool that fits the developmental needs of pediatric groups. Full article

Background/Objectives: The growing population of women aged ≥ 80 years poses a new challenge for urogynecology. Advanced age, comorbidities, and polypharmacy raise concerns regarding the safety of procedures in the management of pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and overactive bladder (OAB). Individualized, frailty-based assessment is essential in this group. The aim of the study was to evaluate the safety profile of urogynecological surgical procedures among women aged ≥ 80 years at a single tertiary center. Methods: In a retrospective observational single-center study, we analyzed the medical documentation of 774 hospitalizations of women aged ≥ 80 years admitted between 2014 and 2023. The analysis included indications, comorbidities, treatment types, anesthesia, and complications. Comorbidity and surgical risk were evaluated using the Charlson Comorbidity Index (CCI) and Clavien–Dindo classification. Results: A total of 720 admissions with complete medical records were analyzed, of which 65% were for urogynecological conditions. In this group, the mean age was 83.0 years and mean BMI was 27.2 kg/m². Most patients (92.9%) had comorbidities, mainly hypertension (84.2%) and diabetes (21.1%). POP was the leading indication (52%), followed by SUI (35%) and OAB (27%). Surgical management was performed in 95% of POP cases, predominantly via vaginal native tissue repair (80%), especially LeFort colpocleisis (20%). The transobturator sling (TOT) was the most frequent SUI surgery. Intraoperative complications occurred in 1.5% of cases and postoperative ones were mainly minor (Clavien–Dindo I–II). No procedure-related deaths were recorded. Conclusions: In this cohort, surgical treatment of urogynecological problems in women ≥80 years was associated with a low rate of major complications, suggesting that it can be safely offered to elderly patients. Careful preoperative assessment based on frailty and comorbidity rather than chronological age remains essential. Full article

Antimicrobial resistance (AMR) poses a global health threat, with urban wastewater systems serving as key reservoirs for resistance dissemination. This study aimed to investigate the relationships among urban environments, bacterial communities, and AMR patterns, and evaluate the specific municipal-scale drivers of resistance gene distribution. Shotgun metagenomic analysis was conducted on 45 wastewater samples collected from 15 municipalities across Latvia to determine the composition of the resistome and its correlation with local factors. The analysis identified 417 distinct antibiotic resistance genes (ARGs) belonging to 108 families, with geographic location serving as the primary driver of ARG distribution, which explained 65.87% of community variation (p = 0.001). Local industrial factors demonstrated significant effects, with food industry wastewater significantly influencing both bacterial taxonomy and ARG profiles (p < 0.05). While the presence of a regional hospital did not shape the overall municipal resistome, hospital-associated wastewater showed 19 overlapping ARGs, including clinically critical carbapenemases. Municipal wastewater systems function as geographically structured reservoirs of AMR that are shaped by localized industrial and healthcare outputs. These findings support wastewater-based AMR surveillance as a valuable tool for tracking specific resistance sources. Full article

Background: Acinetobacter baumannii (AB), particularly carbapenem-resistant strains (CRAB), is a major cause of difficult-to-treat infections associated with substantial mortality. Contemporary data from Central and Eastern Europe remain scarce. We aimed to characterize the epidemiology, clinical features, and survival of patients with AB bloodstream infection in a multicenter Polish cohort. Methods: We conducted a retrospective multicenter study including consecutive adults with microbiologically confirmed AB bloodstream infection. Clinical and demographic data, comorbidities, infection origin, and antimicrobial treatments were collected. Outcomes included all-cause in-hospital mortality and infection-attributed mortality. Survival was assessed using Kaplan–Meier curves and log-rank tests, while factors associated with death were examined with univariable and multivariable Cox regression. Results: Among 245 patients with CRAB bloodstream infection, overall mortality was 69.4%, and infection-attributed mortality reached 51.8%. Most infections (75.1%) were hospital-acquired. In univariable analyses, male sex (HR = 0.66; p = 0.008) and colistin-based therapy (HR = 0.71; p = 0.037) were associated with improved survival. Conversely, hospital-acquired infection (HR = 0.43; p < 0.001) and acute kidney injury (HR = 1.40; p = 0.038) were linked to higher mortality. In the multivariable model, male sex remained protective (HR = 0.61; p = 0.006), while hospital-acquired infection (HR = 0.35; p < 0.001) and COVID-19 (HR = 1.64; p = 0.049) independently predicted death. After adjustment, no other comorbidities or antimicrobial regimens showed significant associations. Conclusions: In this multicenter cohort of patients with CRAB bloodstream infection, mortality remained extremely high. Hospital-acquired infection, acute kidney injury, and COVID-19 were strong independent predictors of poor outcomes, whereas male sex was associated with better survival. Although colistin-containing therapy appeared beneficial in univariable analysis, this effect did not persist after adjustment, underscoring potential confounding. These findings highlight the urgent need for early recognition, optimized antimicrobial strategies, and prevention of healthcare-associated spread to improve outcomes in CRAB bacteremia. Full article

Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings. Full article

Turkey is located on an active seismic belt, making the accurate determination of soil properties and earthquake effects essential for safe and reliable structural design. This study investigates the influence of ground improvement on the dynamic behavior of the soil at the construction site of the 950-bed Aydın City Hospital. Evaluations were carried out in terms of the dominant period, local site class and spectral characteristics to assess the effectiveness of the improvement applications. For this purpose, field tests conducted before the improvement were repeated afterward and the obtained data were compared. Local site classes were determined for both unimproved and improved soil conditions based on the relevant seismic code provisions. Furthermore, using site-specific data, nonlinear time-history analyses were performed and site-specific response spectra were obtained for 11 earthquake records at DD-1 and DD-2 seismic hazard levels (return periods of 475 and 2475 years). These spectra were then compared with the corresponding design spectra. The analyses revealed that ground improvement significantly affects not only the bearing capacity and liquefaction potential but also the dynamic behavior, dominant period and local site class of the soil. Full article

Background: Children and adolescents with autism spectrum disorder (ASD) frequently receive antipsychotics and are considered at increased risk for weight gain. Few studies have compared longitudinal weight trajectories between youth with ASD and those with other psychiatric disorders. Methods: This naturalistic, registry-based study used data from the SENTIA cohort, which prospectively monitors antipsychotic safety in individuals under 18 years at a university hospital in Spain. Clinical characteristics were compared between participants with and without ASD. Longitudinal body mass index (BMI) z-score trajectories were analysed using linear mixed-effects models. Results: The sample included 266 participants, of whom 113 (42.5%) had ASD. Individuals with ASD were more often male and initiated antipsychotic treatment at a younger age. Of the 26 participants prescribed an antipsychotic before age 6, 88.5% had ASD. Comorbidity profiles were similar across groups. Risperidone and aripiprazole were the most frequently prescribed antipsychotics. BMI z-scores increased over time (β = 0.130, p = 0.017), and baseline BMI z-score was the strongest predictor. ASD diagnosis did not modify the average linear rate of BMI z-score change (time × ASD: p = 0.251); however, a significant quadratic time × ASD interaction (β = −0.016, p = 0.041) was consistent with a more pronounced early increase followed by earlier attenuation of BMI z-scores in the ASD group. Conclusions: Although antipsychotic treatment was initiated earlier in youth with ASD, no clear difference was observed in the rate of BMI z-score change. Differences in weight trajectories underscore the need for metabolic monitoring in antipsychotic-treated youth. Full article

Background: Diabetes mellitus (DM) is a condition that may increase the severity of acute pancreatitis (AP) through chronic inflammation and disturbances in immune responses. However, the independent effect of DM on clinical outcomes in AP has not yet been fully elucidated. Methods: In this retrospective cohort study, 492 patients diagnosed with acute pancreatitis at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2022 and March 2025 were included. Patients were divided into two groups based on the presence of diabetes, and outcomes were compared using statistical methods. Results: Of the total 492 patients (mean age 58.6 ± 17.2 years; 50.2% female) included, 98 (19.9%) had DM. Moderate-to-severe AP occurred in 67.3% of diabetic versus 37.8% of non-diabetic patients (p < 0.0001), and severe disease developed more frequently in the diabetic group (6.1% vs. 1.0%, p = 0.0057). Systemic complications were significantly more common in patients with diabetes (45.9% vs. 26.9%, p = 0.0004). Hospital mortality was higher among patients with diabetes (9.2% vs. 4.6%, p = 0.0344), and Kaplan–Meier analysis demonstrated numerically lower overall survival in patients with diabetes (log-rank p = 0.095), with early divergence in survival curves. Cox proportional hazards analysis confirmed diabetes as an independent predictor of in-hospital mortality (adjusted HR 2.64, 95% CI 1.17–5.97; p = 0.019). After adjustment for confounders, diabetes remained independently associated with the development of moderate/severe pancreatitis (adjusted OR 2.00, 95% CI 1.24–3.22; p = 0.004). Diabetes also independently predicted in-hospital mortality (adjusted OR 3.36, 95% CI 1.35–8.34; p = 0.009), along with APACHE II score. ROC analysis demonstrated that adding diabetes mellitus to the APACHE II score significantly improved mortality prediction compared with APACHE II alone (AUC 0.785 vs. 0.724). The retrospective and single-center design of this study may limit its generalizability and create potential selection bias. There were insufficient data on the type of diabetes, its duration, and glycemic control (e.g., HbA1c), and therefore, we could not assess these factors, all of which may influence risk estimates. Although the survival curves showed early divergence, the borderline log-rank significance (p = 0.095) highlights the limited statistical power to detect long-term survival differences in this cohort. Conclusions: DM is associated with substantially increased severity and in-hospital mortality in AP, primarily through an elevated risk of systemic organ failure. Incorporation of diabetes status into early severity stratification may improve prognostic accuracy and guide closer monitoring and timely interventions in this high-risk population. Full article

Background: In recent years, Poland has observed fluctuations in kidney biopsy frequency and shifts in diagnostic patterns. These trends likely reflect evolving clinical practice, diagnostic advancements, and changing disease epidemiology. This study aimed to analyse these changes, assess biopsy-based diagnoses across age groups, and examine sex-related variability. Methods: We conducted a single-centre, retrospective study at a university hospital in southwestern Poland, covering 2010–2024. Data from 1969 kidney biopsies were collected, within 1291 native kidney cases analysed after excluding transplant recipients. Diagnoses were correlated with patients’ age, sex, presence of diabetes, and temporal trends, and compared with previous studies. Results: Biopsy numbers increased over time, peaking in 2021 (154 procedures). Most were performed in patients aged 40–64 years (46.1%), followed by 18–39 years (39.1%) and ≥65 years (14.8%), with a rising proportion of elderly patients. Repeated biopsies occurred in 7.7% (second) and 0.6% (third biopsy). The most frequent diagnoses were IgAN (16.9%), FSGS (14.7%), and lupus nephritis (11.4%). In patients ≥65 years, amyloidosis (13.6%), FSGS (13.1%), vasculitis (13.1%), and membranous nephropathy (12%) predominated. The most marked sex-related difference involved lupus nephritis, accounting for 20.3% of diagnoses in women, who made up 82.3% of lupus nephritis cases. While most diseases showed male predominance, this was not evident for several, including IgAN and diabetic nephropathy. Conclusions: Given CKD’s underdiagnosis and frequent late detection in Poland, updated multicentre studies are needed to better recognise disease patterns and raise public awareness. Full article

Background: Elastography is a non-invasive technique used to assess tissue stiffness. There are two main types of elastography: shear-wave elastography and strain imaging. Both are useful for evaluating the degree of liver fibrosis (LF). Shear-wave imaging is influenced by fibrosis and hepatic congestion, whereas strain imaging primarily reflects fibrosis progression and is less affected by congestion. We previously reported the clinical usefulness of combinational elastography in patients with heart failure (HF). However, its prognostic significance in this population remains unclear. Accordingly, in this prospective study, we aimed to evaluate the prognostic impact of combinational elastography in patients with HF. Methods: We included 77 patients with HF (median age: 79 years). Shear-wave imaging was used to obtain shear-wave velocity (Vs), whereas the liver fibrosis index (LF index) was derived from strain imaging. The Vs/LF index (V/L) was used as a prognostic indicator based on combinational elastography. Cardiac events were defined as cardiac death or hospitalization due to HF. Results: During a median follow-up of 716 days, 17 cardiac deaths or hospitalizations for HF were observed. The V/L demonstrated a cut-off value of 1.2 for predicting cardiac death or hospitalization for HF, with an area under the curve of 0.80, sensitivity of 0.82, and specificity of 0.68. Kaplan–Meier analysis demonstrated that patients with a high V/L (≥1.2) had significantly higher rates of hospitalization for HF than those with a low V/L (<1.2; log-rank test, p < 0.001). Conclusions: Combinational elastography demonstrated prognostic utility in patients with HF and may serve as a novel, non-invasive tool for assessing hepatic congestion. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early identification and timely intervention for COPD exacerbations can reduce hospitalizations and complications, as well as improve patient outcomes. Methods: To develop and evaluate predictive models for COPD exacerbations using machine learning (ML), we performed a retrospective study using intensive care unit patient records. Records including 31,667 clinical notes and 10,489 vital signs were used to train and validate two machine learning models to predict COPD exacerbations in patients with known or suspected COPD. Predictive performance was evaluated for support vector machine, quadratic discriminant analysis, and adaptive boosting algorithms using area under the receiver operating characteristic curve (AUC). Results: The clinical note-based support vector machine model achieved an AUC of 0.81 and accuracy of 84.0% in predicting COPD exacerbations. Data from patient monitors and hospital information systems provided sufficient information for accurate prediction, demonstrating the utility of combining physiological signals with clinical text data. Discussion: Clinically available patient data and vital signs can effectively predict COPD exacerbations, potentially enabling earlier interventions, improved outcomes, and reduced healthcare burden. These findings suggest that integrating unstructured clinical notes with structured vital signs using ML frameworks may improve early detection of exacerbation risk, thus enabling appropriate patient counseling, triage, and treatment based on COPD severity. Full article

Background: Artificial intelligence (AI) is rapidly transforming clinical medicine by enabling earlier disease detection, personalized risk stratification, precision diagnostics, and optimized therapeutic decision-making across multiple specialties. Methods: This narrative review synthesizes the most recent evidence from prospective randomized controlled trials, large cohort studies, and real-world implementations of AI in cardiology, pulmonology, neurology, hepatology, pancreatic diseases, and other key areas of internal medicine. Studies were selected based on clinical impact, external validation, and regulatory approval status where applicable. Results: AI systems now outperform traditional clinical tools in numerous high-stakes applications: >88% freedom from atrial fibrillation at 1 year with AI-guided ablation, noninferior stent optimization versus OCT guidance, >95% sensitivity for atrial fibrillation and low ejection fraction detection on single-lead ECG, substantial increases in adenoma detection rate and melanoma triage accuracy, automated pancreatic cancer detection on routine CT with 89–90% sensitivity, and significant improvements in palliative care consultation rates and post-PCI outcomes using AI-supported telemedicine. Over 850 FDA-cleared AI devices exist as of November 2025, with cardiology and radiology dominating clinical adoption. Conclusions: AI has transitioned from experimental to clinically indispensable in multiple specialties, delivering measurable reductions in mortality, morbidity, hospitalizations, and healthcare resource utilization. Remaining challenges include external validation gaps, bias mitigation, and the need for large-scale prospective trials before universal implementation. Full article

Out-of-hospital cardiac arrest (OHCA) is a major cause of death during mountain activities in the Alpine regions. Due to the time-critical nature of these emergencies and the logistical challenges of remote terrain, emergency medical services (EMS) are investigating the use of unmanned aerial vehicles (UAVs) to deliver automated external defibrillators (AEDs). This study presents a geospatial strategy for optimising AED delivery by UAVs in mountainous environments, using the Province of South Tyrol, Italy, as a model region. A Geographic Information System (GIS) framework was developed to identify suitable sites for vertical drone ports based on terrain, infrastructure, and regulatory constraints. A Low-Altitude-Flight Elevation Model (LAFEM) was implemented to generate obstacle-avoiding, regulation-compliant 3D flight paths using least-cost path analysis. The results identified 542 potential vertical-port locations, covering approximately 49% of South Tyrol within ten minutes of flight, and demonstrated significant time savings for AED delivery in field tests compared with manual and Euclidean routing. These findings show that integrating GIS-based vertical-port placement and terrain-adaptive UAV routing can substantially improve AED accessibility and response times in mountainous regions. The LAFEM model aligns with U-space airspace regulations and supports safe, automated AED deployment for improved outcomes in OHCA emergencies. Full article

Objective: To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. Methods: A retrospective study (2019–2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis associated with alcohol (ALC), or non-alcoholic cirrhosis (NALC). Data on demographics, clinical outcomes, and hospitalizations were analyzed using descriptive statistics, regression modeling, and clustering in IBM SPSS 27.0.1. Results: CHC patients were oldest (mean 67.5 ± 12.3 years), while ALH patients were youngest (56.0 ± 11.0 years). CHC prevalence increased with age (10.0% in ≤30-year-olds to 87.1% in ≥81-year-olds; γ = 0.535, p < 0.001). Females comprised 60–70% of CHC cases, males > 85% of ALH and >78% of ALC. Mean hospitalization duration decreased from 13.80 days (2019) to 9.10 days (2023), yet cirrhotic patients had the longest stays (NALC: 16.37 ± 14.34; ALC: 17.66 ± 12.96) versus CHC (10.38 ± 10.14). Etiology was the strongest predictor of hospitalization length. Portal hypertension (PH) was the most common complication (54.3%), with males bearing more severe hepatic complications (ascites—38.3%; PH—66.8%). Conclusions: Hospital-based Romanian cohort analysis revealed that patient presentation and outcomes are fundamentally shaped by the interplay of etiology, sex, and age. We found a distinct female predominance in CHC, a pronounced male predominance in alcohol-related diseases, and evolving trends in non-alcoholic cirrhosis. These determinants dictate specific epidemiological patterns, hospitalization burdens, and complication risks, underscoring the critical need for a paradigm shift toward personalized, etiology-driven, and sex-tailored clinical management. Full article

Background and objectives: During an outbreak, measles cases tend to aggregate into increasingly bigger clusters that show specific characteristics, different from the non-cluster cases. As the measles threat continues throughout Europe in 2025 with a high notification rate in Romania as well, exploring how clustering affects the disease propagation can provide additional insights into how to improve measles surveillance and control. Methods: National measles cases from 2020 to 2024 have been split into cluster (at least three related cases) and non-cluster-related cases and analyzed comparatively based on vaccination status, disease-related data (hospitalization) and patient-related data (age, location). Large outbreaks with at least 150 cases, allowing for more comprehensive R₀ analysis, have been described and the basic reproduction numbers computed for each of them. Results: There are statistically significant differences in vaccination status, age, and hospital stay between outbreak and non-outbreak cases. Large outbreaks (≥150 cases) show a high degree of variability, with R₀ values varying from as low to 1 to as high as 3.92, indicating limited measles transmission control. Conclusions: The findings in this research highlight the critical impact of clustering on measles transmission dynamics during outbreaks. Significant differences in vaccination status, age, and hospitalization rates between cluster and non-cluster cases underscore the importance of targeted surveillance and intervention strategies while the wide range of R₀ values observed in large outbreaks points to inconsistent control measures and emphasizes the need for strengthened vaccination campaigns and improved outbreak response protocols to better contain measles spread. Full article