Search Results (1,950)

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses. Full article

Background: Thyroid cancer is increasing, particularly the differentiated type, with decreasing incidence of the anaplastic type. Anaplastic thyroid carcinoma (ATC) is a rare, aggressive, and often lethal form. It frequently presents with metastatic disease, regional and systemic, with common distant metastasis to the lung, bone, brain, and adrenal, and rarely to other places. Case presentation: A 74-year-old Arab male presented with symptomatic anemia and melena and was admitted for investigation of the cause. The patient was found to have a large retrosternal goiter and gastric tumor. CT scan showed a pedunculated, nonobstructive mass, suggestive of a GIST or leiomyoma. The neck mass presented with compressive symptoms. He underwent a combined neck and abdominal surgical resection based on a multidisciplinary team decision, as prior biopsies were not conclusive. The final pathology report identified similar tumors in the two specimens and suggested an anaplastic thyroid carcinoma as the primary tumor with metastasis to the stomach. Furthermore, the workup, including a PET scan 2 weeks post-surgery, revealed widespread metastases in the bone, lung, and liver, and the treatment was palliative. He was followed up in the outpatient clinic for 4 and a half months post-operatively. The patient developed sepsis and cardiopulmonary arrest and died. Conclusions: ATC can metastasize to many places in the body, including the stomach (as shown in our case), which can cause significant upper gastrointestinal bleeding and anemia. Metastatic ATC carries a poor prognosis; thus, physicians need to keep a high index of suspicion in approaching similar cases. A multidisciplinary approach for the management is of utmost importance for appropriate treatment. This disease’s pathology, behavior, and targeted new treatment modalities must be explored further. Full article

Cardiogenic shock (CS) is the most lethal complication of acute myocardial infarction (AMI), with a 30-day mortality of approximately 40–50% despite early revascularization. Temporary mechanical circulatory support (tMCS) devices, including the intra-aortic balloon pump (IABP), microaxial flow pumps (MAFP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), are used as adjunctive therapy in refractory shock, but evidence of a survival benefit is limited and often conflicting. The IABP-SHOCK II trial found no 30-day mortality reduction with IABP, supporting a Class III (no benefit) recommendation, whereas the DanGer Shock trial reported a 12.7% absolute mortality reduction at 180 days with the MAFP Impella CP in highly selected patients. In contrast, the ECLS-SHOCK and ECMO-CS trials showed no improvement in survival with early VA-ECMO and noted high complication rates. Real-world data reveal significant disparities between trial populations and clinical practice, highlighting limitations of current evidence, since many AMI-CS patients are older, in more advanced shock or have multiple comorbidities and would not meet typical randomized controlled trial (RCT) inclusion criteria. In clinical practice, in-hospital mortality with IABP or VA-ECMO often exceeds 50–60%. Given the heterogeneity of AMI-CS, rapid identification of appropriate tMCS candidates and personalized therapy are essential. Management guided by individual patient profile, hemodynamic stage and neurological status, supported by multidisciplinary shock teams, may improve timely triage, device selection and outcomes. This review emphasizes the need for individualized, protocol-driven care within structured shock systems to optimize tMCS use in AMI-CS. Full article

Introduction: Epidermolysis Bullosa (EB) is a rare genetic condition with skin and mucosal fragility. Patients with EB present extra- and intraoral manifestations that can limit their access to dental treatment, including orthodontic treatment. This research aims to determine the barriers, benefits and complications of orthodontic treatment reported by a group of patients living with EB. Materials and Methods: This observational study included n = 101 patients with a genetic diagnosis of EB. After their regular dental consultation, they were interviewed about factors they considered barriers to accessing orthodontic treatment. Those who underwent orthodontic treatment (n = 24) reflected about their perceived benefits and complications from the therapy. Data were analysed with descriptive statistics and multiple Fisher’s exact tests with false discovery rate (FDR) correction. Results: The most prevalent barrier was that most patients with EB had never been evaluated by an orthodontist (74.3%), even if the teams had an orthodontist. Other barriers included distance to the treatment centre (42.6%), poor oral hygiene (27.7%) and poor oral health status (26.7%). Patients with limited mouth opening perceived greater treatment benefit compared to those without this limitation (φ = −0.28, p = 0.0242), while an increasing age was associated with a reduced perception of treatment benefit (Cramér’s V = 0.29, p = 0.0404). Among those who underwent orthodontic treatment, the most prevalent benefits of orthodontic treatment were aesthetic improvement (62.5%), oral hygiene improvement (20.8%) and occlusal stability (12.5%), while the most prevalent complications were wounds and ulcers (75.0%), gingivitis (54.1%), poor oral hygiene (41.6%) and caries (33.3%). Discussion: People living with EB reported different barriers to orthodontic treatment relating to psychosocial and professional aspects, which vary according to the EB type and severity. The involvement of orthodontists in multidisciplinary special care teams and the reduction in access barriers to dental specialities can be facilitated by a more comprehensive understanding of conditions such as EB. Full article

Background/Objectives: Permanent pacemaker implantation (PPI) remains one of the most common complications following transcatheter aortic valve replacement (TAVR). Identifying patients at increased risk for post-procedural conduction disturbances is clinically important for procedural planning and patient management. The aim of this study was to develop and evaluate a machine learning-based model for predicting the risk of PPI after TAVR. Methods: This prospective study was conducted between 2019 and 2025, and included 179 patients with severe aortic stenosis who underwent TAVR. Patient eligibility was determined by a multidisciplinary Heart Team based on clinical, echocardiographic, and imaging criteria. The primary endpoint was PPI occurring during hospitalization or within 30 days after the procedure. Statistical analyses were performed using RStudio (v. 2024.09.1+394)and Python (v.3.12.3), including comparative tests for continuous and categorical variables, receiver operating characteristic analysis to assess model performance, and SHapley Additive exPlanations (SHAP) to evaluate feature importance and model interpretability. Results: A total of 179 patients undergoing TAVR were included in the analysis. PPI occurred in 17 patients (9.5%) within 30 days after the procedure. A machine learning model was developed to predict post-TAVR PPI. The model demonstrated good predictive performance, with an overall accuracy of 0.944 and a weighted F1-score of 0.947. The confusion matrix showed that the model correctly classified 155 patients without PPI and 14 patients with PPI, with only a small number of false predictions. Explainability analyses using SHAP and permutation feature importance revealed that anatomical and procedural variables had the greatest impact on model predictions. The most influential predictors included valve size, right coronary sinus diameter, prosthetic valve diameter, and mean aortic annulus diameter. In contrast, baseline clinical variables such as left ventricular ejection fraction, previous myocardial infarction, and mean transaortic gradient showed a comparatively lower contribution to the prediction of PPI after TAVR. Conclusions: This study demonstrates that machine learning models can effectively predict the risk of PPI after TAVR. Anatomical characteristics of the aortic root and prosthesis-related parameters were the main determinants of PPI, whereas baseline clinical variables had a lower impact. The use of explainable artificial intelligence methods, such as SHAP analysis, may improve risk stratification and support procedural planning in patients undergoing TAVR. Full article

Background/Objectives: Large language models (LLMs) are increasingly consulted for information about cleft lip and palate (CLP), yet the reliability of their outputs across clinical domains has not been evaluated. This study aimed to compare the quality of CLP-related information generated by GPT-4o and Gemini 2.5 Pro across multiple thematic domains using a validated quality instrument and a reliability-first analytic framework. Methods: Fifty-four standardized CLP questions across six domains were submitted to GPT-4o (OpenAI) and Gemini 2.5 Pro (Google DeepMind) on 25 September 2024 via their public interfaces, using new, history-free sessions and default settings, yielding 108 responses. Three independent, CLP-experienced raters scored each response using the Global Quality Score (GQS; 1–5 scale assessing accuracy, completeness, and clinical usefulness). Before comparing models, we applied a reliability-first filter: only domains where all three raters showed substantial agreement (Fleiss’ kappa [κ] ≥ 0.60) were included in statistical comparisons. Domains that failed this threshold were analyzed qualitatively to identify the source of disagreement. A descriptive taxonomy of errors was developed for low-scoring responses. Results: Three domains met the reliability threshold (General Care Information, General Cleft Information, and Pre-Treatment Information; 30 paired questions). Both models performed at a high and practically equivalent level: GPT-4o median GQS 4.33 (IQR 4.00–5.00) versus Gemini 2.5 Pro 5.00 (IQR 4.00–5.00); the difference was not statistically significant (Wilcoxon V = 139.00, p = 0.691; Hodges–Lehmann median difference 0.00, 95% CI −0.33 to 0.67). Three domains were excluded because rater agreement was insufficient; qualitative review showed this reflected genuine clinical practice variation rather than clear model errors. The most common inaccuracies were overgeneralization of outcomes, outdated surgical timing, and omission of multidisciplinary team roles. Conclusions: Both models provided high-quality CLP information in domains supported by clinical consensus, indicating they may serve as useful adjuncts for general patient and family counseling. Clinicians should, however, verify any treatment-specific content against current institutional protocols before relaying it to patients. Future research should assess readability, alignment with health literacy, and patient comprehension of AI-generated CLP information. Full article

Background: Acute neurosurgical emergencies during pregnancy are rare but pose significant challenges due to the need for simultaneous management of two interdependent patients. Evidence remains limited, and standardized multidisciplinary protocols are lacking. Case Presentation: A 38-year-old woman at 32 + 4 weeks of gestation presented with acute left hemiparesis secondary to right capsulo-insular intracerebral hemorrhage with mass effect. Following initial conservative management, neurological deterioration and hematoma expansion necessitated emergency craniotomy. A structured multidisciplinary approach was implemented involving neurosurgery, anesthesiology, obstetrics, and neonatology, with predefined roles, continuous intraoperative fetal monitoring, and readiness for emergency cesarean delivery. Anesthetic management balanced maternal neuroprotection with preservation of uteroplacental perfusion. Surgery was completed without fetal compromise. The patient demonstrated neurological improvement and was transferred on postoperative day 13. Elective cesarean delivery was performed at 36 weeks. Conclusions: This case illustrates that emergency neurosurgery during pregnancy may be feasible in selected settings when supported by structured multidisciplinary coordination. Key practical elements included continuous fetal monitoring, predefined team roles, and immediate availability of obstetric and neonatal support. In this individual case, these components facilitated intraoperative decision-making and were associated with favorable maternal and fetal outcomes; however, their individual contribution cannot be determined from a single clinical experience. Further evidence is needed to assess the applicability of this approach across different clinical scenarios. Full article

Background: Differentiation therapy is a cornerstone in treating hematologic malignancies, particularly acute myeloid leukemia (AML). Differentiation agents target molecular defects blocking myeloid differentiation. However, rapid differentiation can precipitate a life-threatening complication, differentiation syndrome (DS). DS manifests with fever, pulmonary infiltrates, pleural or pericardial effusions, hypotension, and organ dysfunction, often mimicking sepsis or infection. Early recognition in the emergency department (ED) is critical to mitigate morbidity and mortality. This review aims to provide emergency clinicians with practical strategies for the timely identification and management of DS in patients undergoing differentiation therapy. Discussion: Suspicion for DS should be heightened in patients with acute promyelocytic leukemia (M3 AML) who recently started induction chemotherapy, including all-trans retinoic acid or arsenic trioxide, and in those with non-M3 AML receiving differentiation agents (i.e., isocitrate dehydrogenase inhibitors, menin inhibitors, FMS-like tyrosine kinase 3 inhibitors). Imaging can identify pulmonary infiltrates, effusions, and other cardiopulmonary manifestations. Laboratory workups should include complete blood counts with differentials, serum chemistries, cardiac biomarkers, and sepsis panels to exclude infection. Electrocardiography is advised for patients on QT-prolonging agents. Management emphasizes prompt initiation of high-dose corticosteroids and supportive measures such as blood pressure support, intravascular volume optimization, and oxygen therapy or ventilatory support. Multidisciplinary coordination with oncology, hematology, and critical care teams is important to tailor plans and monitor complications. Conclusions: DS represents a diagnostic challenge in the ED due to its nonspecific presentation and mimicry of infection. A high index of suspicion, combined with targeted imaging, laboratory evaluation, and early corticosteroid therapy, can improve outcomes. Full article

The global food system faces high pressure to sustain a growing population amid climate constraints and shifting consumer demands, making the traditional trial-and-error development methodologies inadequate. Artificial Intelligence (AI) has transitioned from a simple optimization tool into a structural enabler across the entire food chain. This review examines the integration and evolution of computational architectures in food technology between 2006 and 2026, tracing the paradigm shift from the early fuzzy logic and rule-based systems to modern deep learning and generative frameworks. This review highlights breakthroughs achieved over the last five years, demonstrating how Graph Neural Networks, Transformers, and Variational Autoencoders and other architectures are accelerating the in silico discovery of bioactive ingredients, predicting complex molecular flavors, and autonomously synthesizing optimal culinary formulations. The transition to Industry 5.0 is also explored, emphasizing the integration of collaborative robotics, process-level digital twins, and federated learning to enable autonomous manufacturing and privacy-preserving precision nutrition. Finally, this review addresses critical barriers to commercialization, including severe data fragmentation, the “Innovation Paradox” in fundamental academic research, and the urgent need for multidisciplinary teams capable of translating digital predictions into physically stable, strictly regulated food matrices. Full article

Soccer support staff operate under demanding schedules and high-performance environments while guiding players’ movement, sleep, and nutrition; however, their own lifestyle behaviours remain under-researched. This exploratory study assessed adherence to the Canadian 24-Hour Movement (24HM) guidelines and its association with diet quality (DQ) in professional and semi-professional soccer support staff. Methods: A cross-sectional survey collected data from 236 staff in the United Kingdom and Spain. Movement behaviours were measured using the Whole Day Matters Toolkit and DQ using the validated Mini-EAT questionnaire. A graded 24HM score (0–8) summed binary adherence across four general (MVPA, LPA, sedentary time, sleep) and four secondary (muscle-strengthening, sedentary interruptions, screen time, sleep–wake time) behaviours. Associations with DQ were estimated using adjusted multiple linear regression. Results: Only 7.6% of participants met all eight guidelines. Each one-point increase in the graded score was associated with 0.89-point higher DQ (95% CI 0.29–1.49, p = 0.004), with stronger associations observed for secondary behaviours (β = 1.27, p = 0.006) than for general behaviours (β = 0.38, p = 0.50). Conclusions: A graded 24HM scoring approach showed a graded association with DQ in soccer staff, with secondary movement behaviours showing a stronger association. All findings should be interpreted as exploratory and hypothesis-generating. ClinicalTrials.gov: NCT06771752. Full article

Background/Objectives: Health systems in many countries are increasingly turning to task shifting, task sharing and broader skill-mix solutions to address staff shortages and unequal access to care, particularly in rural regions. This article summarizes how different healthcare systems introduce intersecting competencies through new professional roles, the expansion of the scope of existing professions, and the transfer of selected tasks between them. The aim was also to indicate which strategies may be relevant for the Polish context. Methods: A literature review was carried out using PubMed and Embase (14 February–9 March 2025). Publications from 2010 to 2024 in English or Polish were included. The study was designed as a narrative review supported by a structured literature search. Publications and policy documents relevant to skill-mix strategies were identified through a concept-driven process and incorporated into a thematic synthesis. Results: Countries that introduced new professional roles reported better access to care and more continuity for patients. Expanding the scope of nurses, physiotherapists and pharmacists often helped reduce the workload of doctors and, in some places, also supported better treatment results or smoother work in facilities. At the same time, there were clear challenges: unclear role boundaries, gaps in training, extra workload and limited organizational support. These issues were particularly visible in rural areas, where staff shortages are the most severe. Conclusions: Skill-mix strategies can support healthcare systems by improving access and the overall quality of care. However, their success depends on clear regulations, adequate preparation and acceptance among health workers. Although many solutions are promising, further research is needed to better assess their long-term effects and usefulness in medical deserts. Full article

The rapid evolution of structural heart interventions, particularly transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), and hybrid procedures, has significantly expanded treatment options for elderly, frail, and multimorbid patients previously considered high risk or inoperable. However, perioperative risk stratification in this population remains challenging. Traditional risk scores such as EuroSCORE, EuroSCORE II, STS-PROM, CHA₂DS₂-VASc, and HAS-BLED were developed and validated primarily in cohorts undergoing conventional open-heart surgery (CABG and surgical valve replacement) more than 15–25 years ago. This narrative review critically evaluates the performance and limitations of these classical models in contemporary populations undergoing modern structural cardiac interventions. Evidence from registries and meta-analyses indicates only moderate discriminatory ability and systematic calibration errors. EuroSCORE II and STS-PROM frequently overestimate risk in low- and intermediate-risk patients while underestimating it in high-risk and frail individuals, particularly regarding neurological, renal complications, and prolonged hospitalization. Similar limitations apply to CHA₂DS₂-VASc and HAS-BLED when used beyond their original scope in the peri-procedural setting of TAVI/TEER. The review highlights the growing role of frailty assessment, procedure-specific variables, and machine learning algorithms, which demonstrate superior predictive performance compared to conventional scores. Until dedicated, regularly updated risk models based on large TAVI/TEER registries become available, traditional scores should be used only as supportive tools within multidisciplinary Heart Team discussions that incorporate individual frailty, quality of life, and patient preferences. Full article

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the availability of effective medications and lifestyle interventions, blood pressure control rates remain poor globally, and the prevalence of hypertension continues to rise. In 2023, the US Food and Drug Administration approved renal denervation—a catheter-based procedure that ablates the renal sympathetic nerves—as an adjunctive treatment for patients with uncontrolled or resistant hypertension, defined as blood pressure above goal despite the use of at least three antihypertensive medications, including a diuretic at maximally tolerated doses. Both radiofrequency and ultrasound-based devices are approved for this procedure. However, individual patient responses vary, and further research is needed to clarify long-term efficacy, safety, and optimal patient selection. The number of trained proceduralists and access to facilities is increasing, but multidisciplinary teams and shared decision-making are recommended to ensure appropriate referrals and patient education. In this review, we discuss the pathophysiology of hypertension and approaches to treatment, review the history of renal denervation and the data on which FDA approval was based, detail the safety profile of commercially available devices, and provide a practical, team-based approach to appropriate patient selection. Full article

Background: Thoracic paravertebral catheters are increasingly used in neonates to avoid neuraxial techniques during thoracoscopic tracheoesophageal fistula (TEF) repair. Catheter fracture and retention are exceedingly rare in this population, and optimal management remains undefined. Learning Objectives: Recognize this complication risk in neonatal paravertebral placement; identify appropriate imaging when retention is suspected; discuss conservative and surgical approaches; and understand the importance of early transparent communication with caregivers. Case: A 2-day-old term neonate weighing 2.90 kg underwent thoracoscopic repair of type C tracheoesophageal fistula with intraoperative placement of an ultrasound-guided right paravertebral catheter for continuous analgesia. The catheter was placed at the T5 vertebral level using a 20 G, 2-inch Tuohy needle with an in-plane lateral-to-medial approach. Saline hydrodissection was used to confirm entry into the paravertebral space. A 24 G radiopaque Perifix One catheter was initially inserted but proved difficult to advance. During attempted removal, some resistance was encountered, and both the needle and catheter were withdrawn together. Subsequent inspection suggested possible catheter shortening, raising concern for a retained fragment. A second catheter of size 20 G advanced via an 18 G needle was then successfully placed at the same level and was removed without complications on postoperative day 3. Comparison with an intact reference catheter revealed that the first-placed 24 G catheter was approximately 1.5 cm shorter, although the tip appeared intact. The pain physician promptly notified both the clinical teams and the family. One month later, during routine imaging for respiratory distress, a curvilinear opacity was noted at the T9 vertebral level. Dedicated thoracic spine films confirmed a 7 mm retained paravertebral catheter fragment. Multidisciplinary consensus (pain team, anesthesia, NICU, and surgery) determined that the fragment was small, non-metallic, and remote from critical structures. Conservative management with long-term follow-up was chosen. The family was informed early during initial suspicion and again upon confirmation. At 17-month follow-up, the child remained asymptomatic. Discussion: Retained catheter fragments are rare in pediatric regional anesthesia and may be radiographically occult early. In neonates, re-operation for a tiny, inert foreign body may cause more morbidity than observation. Prevention depends on appropriate equipment selection, catheter integrity checks pre- and post-placement, careful technique, and attention to resistance or difficulty during advancement or removal. Clear and timely communication with caregivers preserves trust when complications or iatrogenic uncertainty arise. Conclusions: In this neonate, a small retained paravertebral catheter fragment was identified incidentally and was safely managed with conservative observation. When such fragments are non-metallic, stable, and located away from critical structures, non-operative management with close follow-up may be an appropriate and safe approach. Full article

Introduction: During an excavation in 2022 of a mass grave within a cemetery in Castilla-La Mancha containing the remains of executed victims of the Spanish Civil War and Francoist dictatorship, the scientific team discovered a medallion with a name and a date inscribed on it. The medallion was associated with an individual recovered from a grave containing 12 other individuals in 5 separate stratigraphic layers. This paper aims to outline the identification process of the deceased from the skeletal remains and associated medallion. Methods: This process included archival research, gathering witness testimonies, archaeological evidence, osteological examination and DNA analysis. Results: After restoration, the medallion revealed the words “VIVA LA FIJL. VIVA LA FAI.” on one face and “MUERO POR LA LIBERTAD.” on the other. The human skeletal remains associated with the medallion showed male morphological characteristics and were estimated to be between 21 and 30 years old at the time of death, with a height between 1.64 and 1.67 m. There was skeletal evidence of ballistic trauma on the right mandible and the right scapula. Genetic analysis confirmed an mtDNA match with his maternal niece. Discussion/Conclusions: This study demonstrates the importance of a multidisciplinary approach to the identification of human remains from the Spanish Civil War and the Dictatorship which followed, and how the objects found within a mass grave can be useful in aiding a positive identification. Full article