Search Results (898)

CR is a cornerstone of secondary prevention for cardiovascular disease, offering well-established benefits across mortality, hospital readmission, functional capacity, and quality of life. Despite Class I guideline endorsements and decades of supporting evidence, CR remains vastly underutilized, particularly among women, racial and ethnic minorities, older adults, and individuals in low-resource settings. This review synthesizes the current evidence base for CR, with emphasis on disease-specific benefits across different cardiovascular diseases, and highlights recent data on its role in expanding populations, including patients with HFpEF, older adults, patients with advanced heart failure, and those undergoing transcatheter interventions. We also examine persistent barriers to CR access and participation, including system-level and referral limitations, as well as patient-level disparities by age, sex, race and ethnicity, and socioeconomic status. Building on this, we explore innovative delivery models and recent policy initiatives such as hybrid programs and reimbursement reform, all designed to expand access, promote equity, and modernize CR delivery. The findings underscore the need for continued investment, advocacy, and innovation to ensure equitable access to CR and its life-saving benefits across the full cardiovascular care continuum. Full article

Hospital in the Home (HITH) programs are emerging as a key pillar of smart city healthcare infrastructure, leveraging technology to extend care beyond traditional hospital walls. The global healthcare sector has been conceptualizing the notion of a care without walls hospital, also called HITH, where virtual care takes precedence to address the multifaceted needs of an increasingly aging population grappling with a substantial burden of chronic disease. HITH programs have the potential to significantly reduce hospital bed occupancy, enabling hospitals to better manage the ever-increasing demand for inpatient care. Although many health providers and hospitals have established their own HITH programs, there is a lack of research that provides healthcare executives and HITH program managers with management models and frameworks for such initiatives. There is also a lack of research that provides strategies for improving HITH management in the health sector. To fill this gap, the current study ran a systematic literature review to explore state-of-the-art with regard to this topic. Out of 2631 articles in the pool of this systematic review, 20 articles were deemed to meet the eligibility criteria for the study. After analyzing these studies, nine management models were extracted, which were then categorized into three categories, namely, governance models, general models, and virtual models. Moreover, this study found 23 strategies and categorized them into five groups, namely, referral support, external support, care model support, technical support, and clinical team support. Finally, implications of findings for practitioners are carefully provided. These findings provide healthcare executives and HITH managers with practical frameworks for selecting appropriate management models and implementing evidence-based strategies to optimize program effectiveness, reduce costs, and improve patient outcomes while addressing the growing demand for home-based care. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Since late 2023, an increase in Bordetella pertussis infections has been noticed in Europe, particularly among children. Our data showed the upward trend of B. pertussis cases in the Lazio region, even among adults with severe influenza-like illnesses, highlighting the necessity for maintaining high vaccination rates across both children and adults. These findings underscore the urgent need for clinicians to maintain a high index of suspicion for B. pertussis in patients with respiratory symptoms, prioritize nasopharyngeal swabs for accurate diagnosis, assess for co-infections, verify booster vaccination status in adults, and support timely reporting to public health authorities. Full article

An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article

Sepsis is a serious public health problem. sTREM-1 is a marker of inflammatory and infectious processes that has the potential to become a useful tool for predicting the evolution of sepsis. A prediction model for sepsis was constructed by combining sTREM-1, CRP, and a leukogram via a Bayesian network. A translational study carried out with 32 children with congenital heart disease who had undergone surgical correction at a public referral hospital in Northeast Brazil. In the postoperative period, the mean value of sTREM-1 was greater among patients diagnosed with sepsis than among those not diagnosed with sepsis (394.58 pg/mL versus 239.93 pg/mL, p < 0.001). Analysis of the ROC curve for sTREM-1 and sepsis revealed that the area under the curve was 0.761, with a 95% CI (0.587–0.935) and p = 0.013. With the Bayesian model, we found that a 100% probability of sepsis was related to postoperative blood concentrations of CRP above 71 mg/dL, a leukogram above 14,000 cells/μL, and sTREM-1 concentrations above the cutoff point (283.53 pg/mL). The proposed model using the Bayesian network approach with the combination of CRP, leukocyte count, and postoperative sTREM-1 showed promise for the diagnosis of sepsis. Full article

Background/Objectives: Romania remains a tuberculosis (TB) hotspot in the European Union, yet host-derived factors of poor outcomes are poorly characterised. We quantified circulating pro-inflammatory cytokines and examined their interplay with behavioural risk factors, the nutritional status, and the clinical course in adults hospitalised with pulmonary TB. We analysed 80 adults with microbiologically confirmed pulmonary TB and 40 respiratory symptom controls; four TB patients (5%) died during hospitalisation, all within 10 days of admission. Methods: A retrospective analytical case–control study was conducted at the Constanța regional TB referral centre (October 2020—October 2023). Patients with smear- or culture-confirmed TB were frequency-matched by sex, 10-year age band, and BMI class to culture-negative respiratory controls at a 2:1 ratio. The patients’ serum interferon-γ (IFN-γ), interleukin-1α (IL-1α), interleukin-1β (IL-1β), and tumour-necrosis-factor-α (TNF-α) were quantified within 24 h of admission; the neutrophil/lymphocyte ratio (NLR) was extracted from full blood counts. Independent predictors of in-hospital mortality were identified by multivariable logistic regression; factors associated with the length of stay (LOS) were modelled with quasi-Poisson regression. Results: The median TNF-α (24.1 pg mL⁻¹ vs. 16.2 pg mL⁻¹; p = 0.009) and IL-1β (5.34 pg mL⁻¹ vs. 3.67 pg mL⁻¹; p = 0.008) were significantly higher in the TB cases than in controls. TNF-α was strongly correlated with IL-1β (ρ = 0.80; p < 0.001), while NLR showed weak concordance with multiplex cytokine patterns. Among the patients with TB, four early deaths (5%) exhibited a tripling of TNF-α (71.4 pg mL⁻¹) and a doubling of NLR (7.8) compared with the survivors. Each 10 pg mL⁻¹ rise in TNF-α independently increased the odds of in-hospital death by 1.8-fold (95% CI 1.1–3.0; p = 0.02). The LOS (median 29 days) was unrelated to the smoking, alcohol, or comorbidity load, but varied across BMI strata: underweight, 27 days; normal weight, 30 days; overweight, 23 days (Kruskal–Wallis p = 0.03). In a multivariable analysis, under-nutrition (BMI < 18.5 kg m⁻²) prolonged the LOS by 19% (IRR 1.19; 95% CI 1.05–1.34; p = 0.004) independently of the disease severity. Conclusions: A hyper-TNF-α/IL-1β systemic signature correlates with early mortality in Romanian pulmonary TB, while under-nutrition is the dominant modifiable determinant of prolonged hospitalisation. Admission algorithms that pair rapid TNF-α testing with systematic nutritional assessment could enable targeted host-directed therapy trials and optimise bed utilisation in high-burden settings. Full article

Background: A precise radiographic evaluation of adolescent idiopathic scoliosis (AIS) is essential for effective treatment planning and follow-up. The pelvic axial rotation (PAR) and horizontal balance of the pelvis are critical factors to consider throughout the treatment and monitoring of AIS. While some previous studies have examined spinal curvature in relation to PAR direction and the direction of the major curve (DMC) in AIS patients, this study aims to explore the relationship between scoliosis morphology, pelvic axial rotation (PAR), and the direction of the major curve in patients with adolescent idiopathic scoliosis. Methods: Radiographic images of 397 patients diagnosed with AIS between 2023 and 2024 at a Tertiary Referral Hospital were retrospectively evaluated. Morphological and morphometric measurements, including sex, Lenke and Risser classifications, lower leg discrepancy, Cobb angle, PAR direction, and major curvature direction, were performed. Results: The mean age of the 397 patients (246 female, 151 male) was 14.47 ± 2.29. There is no significant correlation between PAR and DMC (p = 0.919). No significant differences were found in terms of sex (p = 0.603). Regardless of the PAR direction, major curvature was more common on the left side (57.7%). Furthermore, a positive correlation was noted between the Cobb angle and LLD. Conclusions: Our study contributes to a growing body of literature questioning the deterministic role of PAR in AIS. While previous reports have emphasized the directional correlation between the pelvis and spinal curvature, our findings suggest that pelvic rotation may not be a reliable indicator of curve direction in all patients. This highlights the complexity of AIS biomechanics and underscores the need for individualized radiographic and clinical evaluation rather than a reliance on generalized compensatory models. Full article

Background: Around one-quarter of all people in the developed world die of cancer, with primary care being the main setting in which the disease is first suspected because the majority of patients consult a general practitioner (GP) when they present with symptoms. Diagnostic delay may thus be attributable to the patient, the GP, or the healthcare system. While some findings suggest that as much as half of the total delay consists of patient delay, more research is nonetheless needed into how GPs can facilitate access to diagnostic evaluation when patients experience symptoms. Methods: A retrospective observational study will be conducted to evaluate a cohort of patients diagnosed with cancer, with data being obtained from both primary and specialised care settings. Different time intervals will be analysed, dating from onset of first symptoms to diagnosis or initiation of treatment, and will be classified as: patient interval; primary-care interval; healthcare-system interval; diagnostic interval; treatment interval; and total interval. Study variables will include patient characteristics (socio-demographic, risk factors, morbidity, etc.), tumour characteristics (tumour stage, symptom onset, alarm symptoms, etc.), and healthcare characteristics (place of initial consultation, referral to specialised care, etc.). Discussion: The study will describe diagnostic delays in patients with cancer in primary care, considering the time elapsed between symptom onset and initial consultation, request for tests and/or patient referral, first evaluation in the hospital setting, and date of diagnostic confirmation and treatment initiation. Additionally, the study will make it possible to identify the patient-, healthcare-, and disease-related variables that intervene in the duration of such delays. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

Background/Objectives: Robot-assisted radical cystectomy (RARC) has become the primary approach for treating bladder cancer, replacing the traditional open procedure. The robotic approach, when combined with ureterocutaneostomy (UCS), offers significant advantages for octogenarians, who are at increased risk for perioperative complications. Methods: This observational, prospective, multicenter analysis is based on data from the Italian Radical Cystectomy Registry (RIC), collected from January 2017 to June 2020 across 28 major urological centers in Italy. We analyzed consecutive male and female patients undergoing radical cystectomy (RC) and urinary diversion via the open, laparoscopic, or robot-assisted technique. Inclusion criteria: patients aged 80 years or older, with a WHO Performance Status (PS) of 2–3, an American Society of Anesthesiologist score ≥3, a Charlson Comorbidity Index (CCI) ≥ 4, and a glomerular filtration rate (GFR) <60 mL/min. Results: A total of 128 consecutive patients were included: 41 underwent RARC with UCS (Group 1), 65 open RC (ORC) with UCS (Group 2), and 22 laparoscopic RC (LRC) with UCS (Group 3). The cystectomy operative time was longer in robotic surgeries, while the lymph node dissection time was shorter. RARC with UCS showed statistically significant advantages in terms of lower median estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) compared to open and laparoscopic procedures. Intra- and postoperative complications were also lower in the RARC groups. Conclusions: Robotic cystectomy in high-volume referral centers (≥20 cystectomies per year) provides the best outcome for fragile patients. Beyond addressing the baseline pathology, RARC with UCS may represent a leading option, offering oncological control while reducing complications in this vulnerable age group. Full article

Background and Objectives: To characterize the epidemiological profile of patients undergoing revision total hip arthroplasty (THA) using bone allografts from a tissue bank, and to identify clinical and surgical factors associated with the selection of graft type in cases of severe periprosthetic bone loss. Materials and Methods: This observational, cross-sectional study involved a retrospective review of medical records from a specialized referral center, including revision THA procedures performed between 2013 and 2019. Data were collected on 36 variables covering demographic details (age, sex), surgical history of both hips, comorbidities, medication use, perioperative complications, hospitalization, surgical technique, and characteristics of the bone grafts used. Patients were grouped based on the type of allograft received—structured or morselized (impacted)—and comparative analyses were performed. Results: A total of 67 revision THA cases were evaluated, with a mean patient age of 63.2 years. Nearly half (47.8%) had no prior hip revision. The average number of previous procedures per patient was 1.73, and the mean interval from primary THA to revision was 178.4 months. Morselized bone allografts were used in 66.7% of cases, and structured allografts in 33.3%. Patients receiving structured grafts had undergone a significantly higher number of prior surgeries (p = 0.01) and had a longer duration since the initial THA (p = 0.04). Conclusions: These findings suggest that younger patients undergoing primary total hip arthroplasty may be at increased risk for complex revision procedures involving structured grafts later in life, underscoring the need for long-term monitoring and tailored surgical planning in this population. Full article

Background and Objectives: Bell’s palsy, characterized by acute idiopathic facial nerve paralysis, exhibits variable recovery outcomes influenced by treatment timing, modality, and patient comorbidities. This study aimed to compare the effectiveness of corticosteroid-based treatment (Ear, Nose, and Throat [ENT]), nerve blocks/physical therapy (Pain Medicine), and acupuncture/herbal medicine (Traditional Korean Medicine [KM]) and identify predictors of recovery and recurrence. This retrospective cohort study leverages South Korea’s pluralistic healthcare system, where patients choose specialties, to provide novel insights into departmental treatment outcomes. Materials and Methods: We analyzed 600 patients treated within 72 h of Bell’s palsy onset (2010–2024) at Wonkwang University Hospital, South Korea, using propensity score matching (PSM) (1:1:1) for age, sex, comorbidities, and initial House–Brackmann (HB) grade. The primary outcome was complete recovery (HB grade I) at 6 months; secondary outcomes included recovery time, recurrence, complications, and patient satisfaction. Multivariate logistic regression identified predictors. Results: The ENT group achieved the highest complete recovery rate (87.5%, phi = 0.18) versus Pain Medicine (74.0%) and KM (69.5%) (p < 0.001), with the shortest recovery time (4 weeks, Cohen’s d = 0.65 vs. KM). Synkinesis was lowest in the ENT group (6.0%). ENT treatment (OR: 1.75; 95% CI: 1.29–2.37) and early corticosteroid application (OR: 1.95; 95% CI: 1.42–2.68) predicted recovery. Hypertension (OR: 4.40), hyperlipidemia (OR: 8.20), and diabetes (OR: 1.40) increased recurrence risk. Subgroup analyses showed that ENT treatment was most effective for severe cases (HB grade IV: 90% recovery vs. 65% in KM, p < 0.01). Conclusions: Corticosteroid-based treatment (ENT) yielded superior recovery outcomes. Comorbidity management is critical for recurrence prevention. Early ENT referral and integrated care models are recommended to optimize outcomes in diverse healthcare settings. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Background and Objectives: Cardiovascular (CV) diseases account for about 32% of deaths in women, with differing risk factors between women and men. Our study aimed to compare sex-related risk factors and comorbidities in patients at very high CV risk. Materials and Methods: We consecutively enrolled adult patients hospitalized for myocardial infarction or unstable angina at a tertiary referral center in western Romania between October 2016 and June 2017. A total of 299 adults underwent clinical and biochemical evaluations between 6 months and 2 years after their coronary event. We assessed patients’ specific characteristics, comorbidities, and risk factors. Results: Women made up only a quarter of the survey participants (74 women, 24.7%) and were generally older (63.32 ± 9.3 vs. 60.51 ± 9.3, p = 0.02) and more obese (31.20 ± 6.0 vs. 29.48 ± 4.9, p = 0.02). There were no significant differences in the prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, or peripheral artery disease, though women had slightly higher rates for most comorbidities. Regarding smoking habits, both groups had high percentages of current and former smokers, with women being significantly less likely to smoke (20.9% vs. 44.6%, p = 0.003). Multivariable logistic regression adjusting for age, BMI, smoking status, diabetes, and eGFR revealed that sex was not a statistically significant independent predictor for myocardial infarction, PCI, or CABG. Conclusions: We observed that women with previous coronary events had a worse risk factor profile, while there were no significant sex differences in overall comorbidities. Risk factor control should be based on sex-specific prediction models. Full article