Search Results (7,555)

Background/Objectives: Multidrug-resistant (MDR) Escherichia coli is a critical One Health challenge, with rising resistance in both humans and animals. The present study aimed to compare antimicrobial resistance (AMR) profiles of E. coli isolates from hospitalized patients and food-producing animals in Satu Mare, a county located in northwestern Romania. Methods: Between 2022–2023, 701 samples were collected, leading to 571 non-duplicate E. coli isolates (420 human, 151 animal). Human strains were recovered from 21 hospital departments and originated from feces, urine, blood, sputum, ear secretions, cerebrospinal fluid, purulent wound secretions, and puncture fluids. Animal isolates were obtained from ceca collected at local slaughterhouses serving farms in north-west Romania, including samples from turkeys, broilers, and pigs. Antimicrobial susceptibility testing was performed against eight antimicrobials (amikacin, ampicillin, cefotaxime, ceftazidime, cefepime, ciprofloxacin, gentamicin, sulfamethoxazole/trimethoprim) using standardized methods. Resistance classification followed international definitions of MDR. Statistical associations between host species and resistance were assessed with chi-square tests. Results: Resistance levels were consistently higher in E. coli strains isolated from animals compared with those from humans (p < 0.05). Among human isolates, resistance to ampicillin (41.9%), ciprofloxacin (41.4%), and sulfamethoxazole/trimethoprim (45.7%) approached, but did not exceed 50%. In contrast, E. coli strains recovered from animals showed markedly higher resistance, exceeding 50% for ampicillin (78.8%), ciprofloxacin (65.6%), and cefotaxime (55.0%). Amikacin retained full activity against all animal isolates, whereas 2.8% of human strains were resistant. Overall, multidrug resistance (MDR) was observed in 70.0% of E. coli isolates from humans and 79.7% from animals, with the highest resistance burden in pig-derived isolates. Conclusions: The study underscores the veterinary sector as a key contributor to the maintenance and spread of MDR E. coli. Even in clinically healthy animals, resistance levels exceeded those observed in human isolates. These findings emphasize the need for coordinated One Health monitoring and stricter antimicrobial use policies in livestock to reduce transmission risks across human and animal populations. Full article

Background and Objectives: Familial clustering and autoimmune multimorbidity are frequently observed in vitiligo. However, the clinical implications of a positive family history across generations remain unclear. In this study, a positive family history was defined as having at least one affected parent or grandparent. Materials and Methods: We retrospectively reviewed the electronic medical records of 972 adults with vitiligo who attended the rheumatology division in a regional teaching hospital in southern Taiwan between 2006 and 2022. Demographic characteristics, family history, clinical features, and autoimmune comorbidities were extracted from electronic medical records. Associations between family history and clinical parameters were assessed using logistic regression analyses adjusted for age and sex. Results: A total of 157 patients (16.2%) reported a family history, more often through parents than grandparents; maternal history was more common than paternal. Compared with those without a family history, affected families showed significantly younger age at diagnosis and a higher prevalence of lower-limb involvement. In adjusted models, family history was associated with greater odds of lower-limb involvement (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI] 1.22–2.58) and lower odds of eyebrow/eyelash depigmentation (aOR 0.39, 95% CI 0.16–0.92). Hashimoto thyroiditis was more frequent among familial cases (aOR 7.56, 95% CI 1.23–46.65). In sex-stratified analyses, associations were stronger in females, notably for lower-limb involvement (aOR 1.87), axillary depigmentation (aOR 2.33), and Hashimoto thyroiditis (aOR 11.27). Conclusions: Familial vitiligo shows earlier onset, distinct anatomical patterns, and increased thyroid autoimmunity, supporting systematic family-history assessment and targeted thyroid screening. Full article

Background and Objectives: Intraoperative hypotension (IOH) is of great importance in preventing diseases such as postoperative myocardial infarction, acute kidney injury, and mortality. This study aimed to develop and validate machine learning and deep learning models that predict IOH using both biosignals and personalized clinical information for each patient. Materials and Methods: In this retrospective observational study, we used the VitalDB open dataset, which included intraoperative biosignals and clinical information from 6388 patients who underwent non-cardiac surgery between June 2016 and August 2017 at Seoul National University Hospital, Seoul, South Korea. The predictive performances of models trained with four waveforms (arterial blood pressure, electrocardiography, photoplethysmography, and capnography) and clinical information were evaluated and compared at time points at 5 min before the hypotensive event. To predict hypotensive events during surgery, we developed two predictive models: machine learning and deep learning. In total, 2611 patients were enrolled in this retrospective study. Machine and deep learning algorithms were developed and validated using raw waveforms and clinical information as inputs. Results: Gradient boosting machine showed predicted IOH with an AUROC and accuracy of 0.94 (0.93–0.95) and 0.88 (0.86–0.89). A hybrid CNN-RNN model also showed similar performance with an AUROC and accuracy of 0.94 (0.93–0.95) and 0.88 (0.87–0.89). Conclusions: This study developed and validated machine and deep learning models to predict IOH using waveform data and covariate values. In the future, we anticipate that the results of our study will contribute to predicting IOH in real time in the operating room and reducing the occurrence of IOH. Full article

Background/Objectives: Antimicrobial resistance (AMR) has increased significantly over the years, contributing to a real challenge in the intensive care unit (ICU). The emergence of metallo-beta-lactamases (MBLs) has contributed to the protection of pathogens against all current beta-lactam/beta-lactamase inhibitors (BL/BLIs), including the newer ceftazidime–avibactam (CAZ-AVI), meropenem–vaborbactam, and imipenem–relebactam. Treatment of such infections is challenging. In vitro and clinical data suggest that combinations of CAZ-AVI with aztreonam (ATM) and the use of two different carbapenems (double carbapenem therapy, DCT) may be an option for MBL-producing pathogens. The aim of our study was to evaluate the effectiveness of the combination CAZ-AVI + ATM and the effectiveness of DCT against MBL-producing K. pneumoniae infections in the critically ill, mechanically ventilated patients. Methods: This is a retrospective study conducted in the two ICUs of hospitals in central Greece. Mechanically ventilated patients admitted to the ICU were included in the study if they developed an infection by MBL-producing K. pneumoniae. Patients were divided into three groups: the first one consisted of patients who were treated with CAZ-AVI plus ATM (CAZ-AVI + ATM group), and the second group consisted of patients who received DCT (DCT group). The third group included patients who received appropriate antibiotic therapy other than CAZ-AVI + ATM and DCT (control group). The primary outcome of the study was the evolution of the sequential organ failure assessment (SOFA) score, and secondary outcomes were duration of mechanical ventilation (MV), ICU length of stay (LOS), and, finally, ICU mortality. Results: 108 patients were included in the study. 35 (32%) in the CAZ-AVI + ATM group, 31 (29%) in the DCT group, and the remaining 42 (39%) patients in the control group. The SOFA score was not statistically different on day 1, day 4, and day 7 of the infection among the three groups (p > 0.05). Duration of MV and ICU LOS were also similar. Finally, mortality did not differ between the groups [20 patients (57.1%) vs. 18 (58.1%) vs. 25 (59.5%) for CAZ-AVI + ATM, DCT and control group, respectively, p = 0.98]. Comparison between survivors and non-survivors revealed that independent risk factors for mortality were SOFA score at day 1 of infection and medical cause of admission (p < 0.05). Conclusions: Treatment with CAZ-AVI + ATM or DCT presented similar efficacy with appropriate antibiotic therapy for infections caused by MBL-producing K. pneumoniae strains. Larger studies are required to confirm the findings. Full article

Purpose: This study aimed to develop a precise predictive model to assess the risk of radiation pneumonitis (RP) and three-year survival in patients with non-small cell lung cancer (NSCLC) following volumetric modulated arc therapy (VMAT). Radiomics features, ensemble stacking, and explainable artificial intelligence (XAI) were integrated to enhance predictive performance and clinical interpretability. Materials and Methods: A retrospective cohort of 221 NSCLC patients treated with VMAT at Kaohsiung Veterans General Hospital between 2013 and 2023 was analyzed, including 168 patients for RP prediction (47 with ≥grade 2 RP) and 118 patients for survival prediction (34 deaths). Clinical variables, dose–volume histogram (DVH) parameters, and radiomic features (original, Laplacian of Gaussian [LoG], and wavelet filtered) were extracted. ANOVA was used for initial feature reduction, followed by LASSO and Boruta-SHAP for feature selection, which formed 10 feature subsets. The data were divided at an 8:2 ratio into training and testing sets, with SMOTE balancing and 10-fold cross-validation for parameter optimization. Six models—logistic regression (LR), random forest (RF), support vector machine (SVM), k-nearest neighbors (KNN), XGBoost, and Ensemble Stacking—were evaluated in terms of the AUC, accuracy (ACC), negative predictive value (NPV), precision, and F1 score. SHAP analysis was applied to interpret feature contributions. Results: For RP prediction, the LASSO-selected radiomic subset (FR) combined with Ensemble Stacking achieved optimal performance (AUC 0.91, ACC 0.89), with SHAP identifying V40 Firstorder_Min as the most influential feature. For survival prediction, the FR subset yielded an AUC of 0.97, an ACC of 0.92, and an NPV of 1.00, with V10 Wavelet Firstorder_Min as the top contributor. The multimodal subset (FC+R) also performed strongly, achieving an AUC of 0.91 for RP and 0.96 for survival. Conclusions: This study demonstrated the superior performance of radiomics combined with Ensemble Stacking and XAI for the prediction of RP and survival following VMAT in patients with NSCLC. SHAP-based interpretation enhances transparency and clinical trust, offering a robust foundation for personalized radiotherapy and precision medicine. Full article

Background and Objective: Gastric cancer (GC) is a serious public health problem in southeastern Mexico. Some cases go undiagnosed or are diagnosed at advanced stages of the tumors. Borrmann classification is the method used by endoscopists to classify gastric lesions and identify tumor stage. This study aimed to characterize GC patients treated at a specialized hospital in the Yucatan Peninsula, Mexico, according to the Borrmann endoscopic classification, with a focus on clinicopathological characteristics and survival differences. Materials and Methods: A retrospective cohort study was conducted among patients aged 18 years or older who underwent an endoscopic procedure at the hospital to confirm a diagnosis of GC between January 2019 and December 2024. Clinical data were collected, including medical history, blood type, non-communicable diseases, tumor type, tumor location (primary or metastatic), and details of medical and/or surgical treatment. Survival curves were generated for all patients and stratified by the Borrmann classification. Results: A total of 209 cases of GC were included, with 115 men with a mean age of 59.3 years and 94 women with a mean age of 52.2 years. Acid peptic disease (70.3%), followed by wasting syndrome (66.9%), was the most common medical condition in patients with GC. Blood type O with a positive Rh factor was the most frequent (66.5%). According to the Borrmann classification, localized tumors (p = 0.001) were observed at lower Borrmann levels, whereas Helicobacter pylori (p = 0.040) was more frequent at higher levels. The overall survival time was 18 months for all patients; specifically, 18 months at higher Borrmann levels and 20 months at lower levels. Conclusions: GC is a highly prevalent malignancy in southeastern Mexico. The Borrmann classification remains a valuable and practical tool for evaluating GC. The association between Borrmann endoscopic classification and the clinicopathological and survival characteristics may contribute to accurate diagnosis assessment and improved prognostic stratification in future GC cases. Full article

Background/Objectives: Major limb amputation is associated with high short-term mortality, yet practical preoperative risk models remain limited. This study aimed to identify easily obtainable preoperative predictors of in-hospital mortality after limb amputation and to develop a compact predictive model. Methods: We retrospectively analyzed 184 adult patients undergoing major or minor limb amputation between January 2021 and July 2025 at a tertiary referral hospital. Preoperative variables included demographics, comorbidities, urgency of surgery, hemoglobin, and complete blood count-derived inflammatory indices: neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was in-hospital mortality. Multivariable logistic regression was used to construct a compact preoperative model. Model performance was assessed by area under the receiver operating characteristic curve (AUC) and calibration plots. Results: In-hospital mortality occurred in 36 patients (19.6%). Independent predictors in the multivariable model were emergency surgery (OR 4.39, 95% CI 1.83–10.55), age (per 1 SD; OR 1.73, 95% CI 1.16–2.59), SIRI (per 1 SD; OR 1.77, 95% CI 1.19–2.65), and hemoglobin (per 1 SD decrease; OR 0.63, 95% CI 0.43–0.91). The model demonstrated good discrimination (AUC = 0.80) and acceptable calibration. Although not included in the model, intensive care unit and total hospital length of stay were higher among non-survivors. Conclusions: A compact preoperative model incorporating age, urgency of surgery, hemoglobin, and SIRI provides reliable risk stratification for in-hospital mortality after limb amputation. These variables are readily available before surgery, making the model practical for bedside clinical use. Prospective multicenter validation is warranted. Full article

Background/Objectives: Falls are a leading cause of hospitalization, injury, and healthcare spending among older adults. Surveillance data on local falls, especially for those associated with Alzheimer’s disease and related dementias (ADRD), are limited. We conducted a surveillance analysis to describe fall-related hospitalizations and their associations with ADRD in Los Angeles County (LAC). Methods: We analyzed countywide hospital discharge data for LAC residents aged 50+ from 2016–2022 (n = 3,520,927) to assess differences in fall-related hospitalizations by ADRD status and demographic characteristics. We used multivariable logistic regression to identify predictors of fall status and multinomial regression to examine associations between ADRD status and discharge disposition. Results: Of all hospitalizations, 6.8% were fall-related. Individuals hospitalized for falls had longer stays, higher charges, and were more frequently female, older, and White. Fall frequency peaks consistently occurred during winter months, with higher seasonal variation among those without ADRD. After adjustment, ADRD diagnosis was associated with increased odds of fall-related hospitalization (AOR = 1.14) and non-routine discharge, including transfer to a short-term hospital (AOR = 1.35), skilled nursing or other care facilities (AOR = 1.88), and home health care (AOR = 1.23). Conclusions: This study provides one of the most comprehensive local assessments of fall-related hospitalization among older adults in the United States. The findings highlight the increased risk and care complexity among patients with ADRD. As results are descriptive and reflect cross-sectional surveillance, temporality and causality cannot be inferred. Nevertheless, the findings underscore the need for better surveillance and integrated fall prevention, discharge planning, and post-hospital support strategies tailored to individuals with ADRD. Full article

Background: The COVID-19 pandemic profoundly affected healthcare delivery and antibiotic prescribing, raising concerns about increasing antimicrobial resistance. This study investigated seven-year trends in bacterial resistance, underlying resistance mechanisms, and antibiotic consumption in COVID-19 and non-COVID-19 units at a tertiary hospital in Slovakia. Methods: A retrospective cohort analysis (2018–2024) was conducted using clinical isolates of Klebsiella sp., Acinetobacter sp., and P. aeruginosa. Data on hospitalizations, resistance profiles, resistance mechanisms, and standardized antibiotic use were compared between COVID-19 and non-COVID-19 departments. Results: Hospitalizations markedly decreased in COVID-19 units, while pathogen occurrence—particularly of Acinetobacter sp.—was substantially higher compared with non-COVID-19 units. Resistance in Klebsiella sp. shifted from extended-spectrum beta-lactamase production to carbapenemase production. Acinetobacter sp. remained highly resistant, although some declines were observed in ceftazidime and gentamicin resistance. P. aeruginosa showed a gradual reduction in resistance, notably to piperacillin/tazobactam and imipenem. Antibiotic consumption was consistently higher in COVID-19 units, particularly for broad-spectrum beta-lactams and carbapenems, whereas fluoroquinolone use decreased over time. Clinically effective treatment options were considerably fewer in COVID-19 units, often limited to colistin. Conclusions: COVID-19 units experienced greater pathogen burden, higher broad-spectrum antibiotic exposure, and increased prevalence of critical resistance mechanisms. Tailored antimicrobial stewardship and infection prevention, and control are essential to reduce selective pressure and preserve last-line antibiotics. Full article

Trauma is a major cause of morbidity and mortality in dogs and cats. While prognostic tools are well-established in human medicine, few guidelines exist in veterinary trauma care. The Animal Trauma Triage (ATT) score and modified Glasgow Coma Scale (mGCS) are used to assess illness severity, but their clinical utility in veterinary patients remains undervalued. This study aimed to evaluate the prognostic value of ATT and mGCS scores and their association with organ dysfunction and survival in polytraumatized veterinary patients. We hypothesized that multi-organ failure (MOF) is more prevalent in non-survivors and correlates with higher ATT and lower mGCS scores. A prospective observational study was conducted for 30 patients (20 dogs and 10 cats) admitted to two veterinary hospitals. Clinical data, trauma scores, and outcomes were collected and analyzed. The overall survival rate was 83.3%; blunt trauma accounted for 80% of cases. Non-survivors (n = 5) had higher respiratory rates at admission (p = 0.01). The ATT score accurately predicted all fatalities, while the mGCS score showed limited prognostic value. MOF was the leading cause of death in 60% of non-survivors. ATT appears to be a more reliable tool for outcome prediction, enabling improved triage, resource allocation, and early intervention in veterinary trauma cases. Full article

Background/Objectives: Unpaid medical expenses incurred by foreign nationals represent a growing concern for healthcare systems amid increasing international mobility. Japan, which lacks mandatory public insurance coverage for non-resident visitors, faces particular vulnerability in terms of uncompensated hospital care. This study aims to identify factors contributing to unpaid medical charges among uninsured, non-resident foreign patients hospitalized at a tertiary care facility in Tokyo. Methods: This retrospective observational analysis was conducted using medical and administrative data from patients admitted between January 2023 and February 2025. Patients who received elective medical tourism care were excluded. Data on demographics, length of hospital stay, care intensity, payment status, and third-party financial assistance were analyzed. Logistic regression models were applied to assess predictors of nonpayment. Results: Among 153 eligible cases, 9 patients (5.9%) had outstanding hospital bills upon discharge. Compared with those with completed payments, the unpaid group experienced longer admissions, more intensive care utilization, and higher total charges. Notably, the absence of third-party financial support (primarily travel insurance) was significantly associated with unpaid charges. Multivariate analysis identified this factor as the main independent predictor (adjusted odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.02–0.915; p = 0.040). Total amount of billing was also statistically significant (adjusted odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00–1.01; p = 0.039). Conclusions: These findings highlight the importance of private insurance in mitigating financial risk in hospitals. Implementing policy measures to promote or require insurance enrollment, along with streamlined reimbursement systems, may contribute to sustainable care delivery for international patients. Full article

Background/Objectives: Thoracic trauma remains a leading cause of trauma-related illness and death. Despite advances in imaging, ventilation strategies, and surgical fixation, its management remains a topic of debate, with varying practices across hospitals. Current Gaps: Although surgical stabilization of rib fractures (SSRF) has shown a mortality benefit in cases of flail chest and in elderly patients, its indications for non-flail cases remain uncertain. Analgesia strategies are evolving, and epidural remains the gold standard; however, it is limited by contraindications. In contrast, regional blocks, such as the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB), are emerging as safer alternatives to opioid and thoracic epidural analgesia (TEA). Artificial intelligence (AI) is transforming imaging interpretation and risk stratification; however, its integration into daily trauma care is still in its early stages of development. Perspective: This article examines the integration of surgical innovation, regional anesthesia, and AI-powered diagnostics as integral components of future thoracic trauma care. We emphasize the importance of standardized surgical criteria, multimodal pain management approaches, and AI-assisted decision-making tools. Conclusions: Thoracic trauma care is shifting toward a personalized, multidisciplinary, and technology-enhanced approach. Incorporating evidence-based SSRF, advanced pain management techniques, and AI-supported imaging can help reduce mortality, enhance recovery, and optimize resource utilization. Full article

Early menarche has been recognized as an early-life marker of metabolic vulnerability, yet its link to gestational diabetes mellitus (GDM) remains unclear. We investigated this association in a retrospective case–control study of 71 cases and 355 controls from a tertiary hospital in Mexico City. Age at menarche was evaluated both in categories and using restricted cubic splines to capture potential non-linear trends. Mediation analysis explored the contribution of pregestational body mass index (BMI) to the relationship between variables. Women who experienced menarche before age 12 had more than twice the odds of developing GDM compared with those whose menarche occurred between 12 and 15 years (adjusted OR = 2.51, 95% CI 1.40–4.50). In contrast, late menarche showed a minor, non-significant increase in risk. The spline models revealed a subtle U-shaped pattern, suggesting that both very early and delayed pubertal timing may carry metabolic disadvantages. The mediation analysis showed that pregestational BMI accounted for only a minor share of this association. Overall, the findings indicate that early pubertal onset may influence glucose regulation during pregnancy through pathways beyond adiposity, highlighting early menarche as a valuable marker for identifying women at higher risk of GDM. Full article

Background and Objectives: Cardiac myxoma (CM) is the most common primary benign neoplasm of the heart. This study’s objective was to analyse diagnostic features of CM, surgical data and postoperative courses of patients over a 20-year period in a single institution. Materials and Methods: We conducted a retrospective analysis of patients with diagnosed and pathologically confirmed CM who underwent surgical resection in our hospital from 1 January 2004 to 1 January 2024. Data was assessed and analysed from medical records. Results: The study included 76 patients (mean age, 61.7 ± 12.6 years; 60.5% female). The majority of patients (93.7%) had symptoms, most commonly presenting with dyspnoea (64.5%), chest pain (39.5%) and arrhythmias (35.5%). Myxomas were found in the left atrium (89.5%), right atrium (9.2%) and left ventricle (1.3%). Isolated tumour extirpation surgery was performed in 50 patients (65.8%). During the early postoperative period, arrhythmias were the most common complication (n = 16, 21.1%). Early in-hospital mortality occurred in two patients due to cardiopulmonary failure. In the late postoperative period, 11 deaths (14.9%) were observed 4 to 17.5 years after surgery. No recurrence of CM was found in any patient during the follow-up period, yet tumours of other localisations were detected in nine patients. Conclusions: Surgery is the first-line treatment for CM, with a good prognosis. Although during the late postoperative period no cardiac tumour recurrence was observed in our study, 12.2% patients were newly diagnosed with non-cardiac neoplasms. Therefore, we suggest monitoring patients not only for cardiac disorders but also for the occurrence of extracardiac tumours. Full article

Multidrug-resistant (MDR) bloodstream infections (BSIs) constitute a major challenge in intensive care units, with the COVID-19 pandemic compromising infection control and potentially increasing MDR incidence. Comparative data between COVID and non-COVID ICU populations remain limited. The MARTINI study is a retrospective observational analysis held in a tertiary hospital during the COVID-19 pandemic (2020–2022) encompassing adult patients with MDR BSIs admitted to COVID and non-COVID ICUs. Demographics, comorbidities, severity scores, microbiology, resistance patterns, and outcomes were accessed and compared. A binary logistic regression model and multivariate regression was performed to identify independent predictors of ICU mortality. Among the study’s 156 patients (106 COVID-ICU, 50 non-COVID-ICU), COVID-ICU patients were significantly older with higher comorbidity and severity scores. Gram-negative pathogens predominated in both cohorts, mainly Acinetobacter baumannii and Klebsiella pneumoniae, with comparable resistance mechanisms. Timing of bacteremia onset and initiation of appropriate therapy did not differ between groups. However, ICU mortality was markedly higher in COVID-ICU patients (74.5% vs. 38%, p < 0.001). Age, SOFA score, the presence of systemic inflammation (SIRS) and COVID-19 infection were identified as independent predictors of mortality. Although pathogen distribution and resistance were similar across groups, COVID-ICU patients experienced significantly poorer outcomes. Strengthened infection control and timely and targeted antimicrobial therapy are essential to diminish MDR bacteremia risk in critically ill populations. Full article