Search Results (4,653)

Background/Objectives: Delayed umbilical cord clamping (DCC) is widely recommended for neonatal benefit; however, concerns persist among professionals that DCC may increase the risk of postpartum hemorrhage. There is a higher risk of postpartum hemorrhage in women with hypertensive disorders of pregnancy (HDP). We aimed to evaluate the association between umbilical cord clamping timing and maternal blood loss in term pregnancies, including those complicated by HDP. Methods: We conducted a cross-sectional study of women delivering at three major hospitals in Almaty, Kazakhstan (August 2020–March 2021). The primary outcome was maternal blood loss. Secondary outcomes included hemoglobin (Hb) and red blood cell (RBC) change from pre-delivery to discharge. Multivariable models were adjusted for maternal age, parity and hypertension category. Results: Two hundred and seven women were analyzed (early cord clamping ≤ 60 (ECC) n = 21; delayed cord clamping 60–119 s (DCC60s) n = 161; delayed cord clamping ≥ 120 s (DCC120s) n = 25). Baseline characteristics were similar across groups except for hypertension distribution. Median blood loss did not differ significantly (255–260 mL; p = 0.9128). Adjusted models confirmed no association between clamping category and blood loss (RoM: ECC vs. DCC60s 0.97; 95% CI 0.93–1.01; DCC120s vs. DCC60s 1.01; 95% CI 0.96–1.07). Conclusions: Among term births in Almaty, including HDP-affected pregnancies, delayed umbilical cord clamping was not associated with increased maternal blood loss or hematologic decline. These findings indicate that DCC does not appear to increase maternal bleeding risk in high-risk obstetric populations and are broadly in line with current international recommendations. Further prospective research is warranted to evaluate specific subgroups, including severe preeclampsia. Full article

Background/Objectives: Childhood-onset Sjögren disease (cSjD) is a rare autoimmune disorder with heterogeneous manifestations and ongoing diagnostic challenges, as there are no validated paediatric criteria. Our study aims to characterise the clinical, laboratory, and imaging features of children diagnosed with cSjD at a single Romanian paediatric rheumatology centre between 2015 and 2025 and contextualise these findings within the most recent literature. Methods: A retrospective review of 15 consecutive cSjD patients was conducted, including clinical features, autoantibodies, imaging, biopsy findings, treatment, and outcomes. Results: Our cohort showed a significant female predominance (80%) and a broad age range at disease onset (3–15 years). Extraglandular manifestations were more common at presentation than glandular phenotypes (53.3% vs. 40%). Lupus-like extraglandular presentations frequently led to initial misdiagnosis as childhood-onset systemic lupus erythematosus (SLE) in our cohort. Sicca symptoms were present at diagnosis in only 3 of 15 patients (20%) and developed later during follow-up in an additional 4 patients (26.7%). Notably, the cohort included novel findings, such as an unprecedented presentation with acute exudative pericarditis complicated by cardiac tamponade. Anti-SSA antibodies and salivary gland ultrasound abnormalities were highly prevalent (86.7% and 100%, respectively). Anti-SSB antibodies were detected in seven patients (46.7%), with titres showing more variability than those of anti-SSA, ranging from just above the positivity threshold to mildly elevated levels. The association with macro-creatine kinase type I was another distinctive feature of this series. Chronic musculoskeletal pain and dryness were our patients’ most frequently reported symptoms at the last assessment, affecting up to 5/15 (33.3%) in each domain. One patient showed irreversible ocular damage during our study. Conclusions: Extraglandular presentations of cSjD are highly heterogeneous and diagnostically challenging, often occurring without glandular symptoms. Lupus-like systemic features—including facial vasculitic purpura, with or without arthralgia, and occasional pericarditis, as observed in our cohort—may contribute to frequent initial diagnostic misattribution to SLE. Early salivary gland ultrasonography, targeted autoantibody testing, and selective biopsy are essential for timely diagnosis, underscoring the urgent need for paediatric-specific validated classification criteria. Full article

Chemotherapy has significantly improved survival in breast cancer and, in the neoadjuvant setting, contributes to tumor downstaging and increased rates of breast-conserving surgery while enabling in vivo assessment of tumor biology and chemosensitivity. Pathological complete response (pCR) is a key endpoint associated with favorable outcomes; however, tumor heterogeneity highlights the need for reliable predictive biomarkers. This study evaluated the mRNA expression of 13 candidate genes in relation to molecular subtypes and pathological response to neoadjuvant chemotherapy (NAC) to identify potential predictive and prognostic markers. Pretreatment core biopsies from 92 patients receiving NAC were analyzed by quantitative RT-PCR. Molecular subtypes were determined by immunohistochemistry (ER, PR, HER2, Ki67), and pathological response was classified using the Miller–Payne scale as good (MP 4/5) or poor (MP 1–3). Multivariate logistic regression assessed associations between gene expression, subtype, and pCR. Hormone receptor-positive tumors showed significantly higher expression of AXL, FGFR1, RAP80, GAS6, BTRCP, and ZNF217. Significant associations with pCR were observed for AXL, FGFR1, YAP, and BRCA1. Low AXL and BRCA1 expression levels were independently associated with pCR. In addition, their combined low expression was associated most strongly with breast pCR in this cohort. These findings should be interpreted as exploratory and require validation in independent cohorts. Full article

Multi-class and multi-label classification of medical dialogues remains a challenging task due to high linguistic variability and transcription noise. This study proposes an ensemble approach based on three fine-tuned Polish T5 (Text-to-Text Transfer Transformer) models trained on partially overlapping clinical dialogue datasets. The models are evaluated exclusively on low-quality, highly noisy, automatically transcribed conversations to assess real-world robustness. The results demonstrate that the ensemble of models improves classification stability and outperforms the best single model, increasing the F1-score by 21.8% for internal medicine dialogues and by 44.9% for paediatric interviews. The proposed method shows potential for practical deployment in clinical decision support and automated medical documentation systems. Full article

Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: We conducted a multicenter, cross-sectional observational study of 152 adults with end-stage kidney disease undergoing hemodialysis in public and private dialysis units in the Attica region, Greece (January–May 2022). Data were collected using a demographic/clinical questionnaire, the 36-Item Short Form Health Survey (SF-36), the Dialysis Patient Satisfaction Questionnaire (SDIALOR), and the Missoula VITAS Quality of Life Index (MVQOLI). Multivariable linear regression models were fitted for SF-36 and MVQOLI domain scores. Results: Most participants reported being very (40.8%) or quite (53.3%) satisfied with their current vascular access, and 69.5% considered an arteriovenous fistula (AVF) the most appropriate option. SF-36 scores were generally lower than those reported for the general population, except for the mental health domain. Compared with AVF, permanent catheter use was associated with lower SF-36 physical functioning scores, and graft use was associated with lower vitality scores. Lower vascular access satisfaction was consistently associated with lower HRQoL: compared with being “very” satisfied, being “quite” satisfied was associated with lower general health, vitality, social functioning, mental health, and lower PCS/MCS scores, while being “a little/not at all” satisfied was associated with lower general health and worse bodily pain scores. On MVQOLI, living alone and lower access satisfaction were associated with lower interpersonal relationships, transcendence/spirituality, and overall quality-of-life scores, while obesity was associated with lower function scores. Conclusions: Vascular access type, particularly AVF versus catheter, is associated with meaningful differences in quality of life among hemodialysis patients. Patient satisfaction with access and sociodemographic characteristics should be considered in patient-centered access planning and follow-up. Full article

Background/Objectives: Liver function is difficult to estimate accurately. Conventional liver function tests can be normal, even in severe diseases. Dynamic liver function tests, including indocyanine green (ICG) clearance and hepatobiliary scintigraphy (HBS), are useful in adults. We aimed to evaluate the association between ICG clearance and HBS in children with liver disease and to identify liver disease markers associated with liver function measured with ICG clearance and HBS. Methods: Children aged 0–18 years followed at Copenhagen University Hospital, Rigshospitalet between November 2015 and August 2024 were eligible for inclusion if they had acute or chronic liver disease, suspected liver disease, or previous liver transplantation (LTx). All underwent ICG clearance and HBS. Results: We included 131 children with a total of 200 visits. The median visit age was 11.4 [6.6; 15.6] years. The ICG-plasma disappearance rate had the strongest correlation with the hepatic extraction fraction (ρ = 0.64, p < 0.001). ICG clearance and HBS were associated with liver injury, reduced synthetic function, cholestasis, cirrhosis, and portal hypertension, while only ICG clearance was associated with the portal blood flow. LTx was associated with increased HBS parameters, but not with ICG clearance. Conclusions: ICG clearance and HBS are correlated, and both are associated with most conventional liver function markers. This suggests their usefulness in evaluating children with liver disease. However, further evaluation of the predictive and clinical value of ICG clearance and HBS in disease progression is needed. Full article

Background: The risk of morbidity and mortality increases in newborns requiring postpartum transport. Various scoring systems have been developed to determine mortality risk, such as the Transport Risk Index of Physiologic Stability (TRIPS) and Mortality Index for Neonatal Transportation (MINT) scores. This study aimed to evaluate the efficiency of MINT and TRIPS scores by comparing them with the Score for Neonatal Acute Physiology-Perinatal Extension (SNAPPE-II) scoring system in preterm and term infants transported within the first 24 h after birth. Methods: This retrospective study included neonates transported within the first 24 h of life to the NICU of Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between 2016 and 2021, following ethics approval. Perinatal data, admission clinical and laboratory parameters, and TRIPS, MINT, and SNAPPE-II scores calculated within the were recorded. Mortality and short-term morbidities were analysed. Group comparisons were conducted using Mann–Whitney U and chi-square tests. Predictive performance and optimal cut-off values were determined by receiver operating characteristic curve analysis using the Youden index. p value <0.05 was considered significant. Results: A total of 137 newborns were included in the study. Seventy-two cases (52.6%) were preterm, and 65 cases (47.4%) were term newborns. The median gestational age and birthweight were 35.6 weeks and 2485 g, respectively. A total of 10 patients died. For mortality prediction, the areas under the curve for TRIPS, MINT, and SNAPPE-II were 0.919, 0.907, and 0.973, respectively (p < 0.001). The determined cut-off values for TRIPS, MINT, and SNAPPE-II were >19, >4, and >35, respectively. The TRIPS score showed the best accuracy for prediction of mortality in preterm infants. Conclusions: Our data show that MINT and TRIPS scores are efficient beyond SNAPPE-II. They demonstrated high diagnostic effectiveness in predicting mortality in preterm and term infants. The TRIPS score exhibits superior mortality prediction in preterm infants. Full article

Metabolic control is poor in East Africa for youth with type1 diabetes (T1D). Self-monitoring of blood glucose (SMBG) by fingerstick 2–3 times daily is routine care. This randomized controlled trial (RCT) will test the hypothesis that providing continuous glucose monitoring (CGM) to Ugandan youth with T1D will improve glucose time-in-range (TIR glucose 3.9–10.0 mmol/L) and be cost effective in this setting. Ugandan youth with T1D (n = 180, age 4–26 years) will be divided into four 12-month cohorts (August 2022–August 2027). Half will receive unblinded Freestyle Libre 2 Flash CGM for 12 months. For six months, control subjects received sufficient test strips for SMBG three times daily while wearing blinded Freestyle Libre Pro CGM (for endpoint assessment), and then they switch to unblinded CGM for six months. Everyone receives monthly diabetes education. The primary endpoints are as follows: (1) the six-month change from baseline in glucose TIR, unblinded CGM versus SMBG; (2) a cost analysis of CGM versus SMBG. The TIR hypothesis will be tested by linear mixed effects models. Cost analysis assumptions include direct material and indirect costs like hospitalizations, missed school/work, and diabetes complications. The study will inform T1D management guidelines in a low resource setting using evidence-based recommendations. Full article

Background: Fetal Growth Retardation (FGR) is considered a risk factor for atherosclerosis and coronary artery disease in adulthood. Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, is reported to be elevated in atherosclerosis. Objectives: In this case-control study, we investigated whether FGR affects postnatal OPG serum concentrations and the possible association between OPG levels and aortic intima–media thickness (aIMT), an index of preclinical atherosclerosis. Methods: We studied 30 infants with FGR and 30 appropriate for gestational age (AGA) infants matched for gestational age and sex. Quantitative determination of plasma OPG was performed via enzyme immunoassay on the second (DOL2) and fifth (DOL5) day of life. aIMT was measured in the distal abdominal aorta and adjusted for aortic lumen diameter. Results: Infants with FGR had significantly higher OPG levels on both DOL2 and DOL5 as compared to controls (DOL2: 5.4 ± 1.0 pmol/L vs. 4.6 ± 1.0 pmol/L, p = 0.002 and DOL5: 5.1 ± 0.8 pmol/L vs. 3.9 ± 0.7 pmol/L, p < 0.001). Between DOL2 and DOL5, OPG concentrations did not change significantly in infants with FGR (difference 0.3 ± 0.2 pmol/L, p = 0.087) but decreased slightly in controls (difference 0.7 ± 0.3 pmol/L, p = 0.003). FGR was also associated with increased aIMT (0.11 ± 0.03 vs. 0.06 ± 0.02, p < 0.001). There was a positive correlation between OPG and aIMT on DOL2 (r = 0.494, p < 0.001), which became stronger on DOL5 (r = 0.791, p < 0.001). Conclusions: We report significantly increased concentrations of OPG in infants with FGR and a positive correlation with aIMT. Follow-up studies with repeat OPG and aIMT measurements may be indicated to evaluate whether these findings represent a permanent effect of FGR on the offspring. Full article

Pulmonary hypertension (PH) is a complex condition in which early diagnosis remains challenging, particularly in patients with exertional symptoms and normal or borderline resting haemodynamics. Although right heart catheterisation is the diagnostic gold standard, transthoracic echocardiography is the recommended first-line non-invasive test. However, resting echocardiography provides only a static assessment and may underestimate disease severity in early or latent pulmonary vascular disease due to preserved pulmonary vascular compliance and adaptive right ventricular responses. Because pulmonary haemodynamics are intrinsically flow-dependent, pathological abnormalities may only emerge during increased cardiac output. Stress echocardiography, performed using exercise or pharmacological stress, enables dynamic evaluation of pulmonary pressure responses, cardiac output augmentation, right ventricular contractile reserve, and ventricular interaction. Increasing evidence indicates that stress echocardiography can unmask abnormal pulmonary pressure–flow relationships, impaired pulmonary vascular reserve, and reduced right ventricular–pulmonary arterial coupling that are not apparent at rest, thereby improving functional and haemodynamic characterisation in selected patients. This Diagnostic Review outlines the physiological basis for stress echocardiographic assessment of pulmonary circulation, proposes practical recommendations for patient selection and testing protocols, and provides a framework for interpretation centered on pressure–flow relationships rather than absolute pulmonary pressure thresholds. Particular attention is given to clinical scenarios with high diagnostic yield, including unexplained exertional dyspnoea, systemic sclerosis, suspected heart failure with preserved ejection fraction, at-risk relatives of patients with pulmonary arterial hypertension, selected athletes, and paediatric populations. Stress echocardiography should not be considered a standalone diagnostic test for PH but, when performed in experienced centers and integrated within structured diagnostic pathways, it represents a valuable non-invasive adjunct to guide referral for invasive haemodynamic confirmation. Full article

Elizabethkingia species are rare but increasingly recognised Gram-negative pathogens linked to healthcare-associated transmission, intrinsic multidrug resistance, and severe infection in vulnerable hosts. We performed a comprehensive review of human Elizabethkingia infections by systematically searching PubMed on 18 October 2025 and included English-language case reports, case series, and outbreak investigations; species were analysed as reported (legacy nomenclature retained), and adults were defined as ≥18 years. In total, 374 studies were included (300 case reports, 41 case series, 33 outbreak investigations). Adult infections were predominantly healthcare-related, affected older adults with substantial comorbidities and most often presented as bacteraemia or sepsis and pneumonia; crude mortality in adult case reports was 32.8%. Paediatric disease was concentrated in neonates and Neonatal Intensive Care Unit (NICU) settings, with meningitis and bloodstream infection predominating; crude mortality in paediatric case reports was 23.3%, and neurological sequelae were frequently reported among survivors. Across studies, isolates showed broad resistance to β-lactams and near-universal resistance to carbapenems, with variable activity to fluoroquinolones and trimethoprim–sulfamethoxazole and more consistent in vitro activity to minocycline. Species misidentification (notably Elizabethkingia anophelis as Elizabethkingia meningoseptica) and heterogeneous susceptibility testing limited comparability. Outbreak investigations repeatedly implicated water-associated reservoirs and reusable equipment, underscoring the need for improved diagnostics, susceptibility-guided therapy and water-focused infection prevention. Full article

Background/Objectives: Children with acute lymphoblastic leukemia (ALL) often experience treatment-related side effects. Physical therapy (PT) surveillance programs are helpful in identifying impairments; however, they do not typically incorporate assessments for peripheral neuropathy, motor proficiency, and foot drop. Our aim is to explore the feasibility of conducting additional functional tests to an existing surveillance program to improve the identification of impairments and characterize the prevalence of treatment-related deficits in children with ALL. Methods: A prospective, longitudinal descriptive study, embedded into a quality improvement initiative, was conducted. The surveillance program included standard assessments for ankle range of motion, activity level, balance, functional capacity, pain, gait, and kneeling to standing. Additional tests included motor and sensory function, foot posture, motor performance, quality of life, feasibility (recruitment and completion rates), service provision, and self-reported symptoms. Data were collected over 3 months. Results: Twenty children completed the study and 19 completed all assessments. Nineteen children presented deficits in at least two physical function tests. The most prevalent deficit identified from standard PT tests included decreased ankle range of motion (n = 19; 95%), and the most common deficit seen in the additional tests was impaired motor and sensory function (n = 14/19; 74%). Pain was the most common self-reported symptom in the checklist and the second worst subscale score in the pain dimension of the quality of life questionnaire (p < 0.001). Conclusions: Several treatment-related deficits were identified in children with ALL. Further research is warranted to explore the use of a standardized symptom checklist for the timely identification of functional limitations and impairments. Full article

Introduction: Fever is one of the most common reasons for Paediatric Emergency Department (PED) visits, often driven by parental anxiety and misconceptions about fever management. This study aimed to evaluate the knowledge, attitudes, and practices of parents regarding childhood fever to identify gaps and guide targeted educational interventions. Understanding parental behaviors is crucial for improving care outcomes and reducing unnecessary PED utilization. Methods: This study is a descriptive cross-sectional study. The sample of this study consists of a total of 440 parents of children admitted to the Paediatric Emergency Department (PED) with complaints of fever. Convenience sampling was used to select the participants. Data were collected using a questionnaire covering sociodemographics, a form surveying the parents’ fever knowledge and attitude, and the validated parents’ fever management scale (Turkish version). The data were analyzed using the SPSS 22.0 statistical program. Results: Most parents (95.5%) reported prior experience with childhood fever, yet 54.1% lacked a regular physician. Common fever detection methods included tactile assessment (56.4%) and thermometers (27.3%). Parental concern arose at 39 °C (48.6%). Cold applications (41.6%) and antipyretics (21.1%) were frequent interventions. The mean PFMS-TR score was high (34.97 ± 4.27), indicating elevated caregiver burden. Scores varied significantly by the child’s age (higher for infants, p = 0.044) and maternal education (higher for educated mothers, p = 0.008). Satisfaction with healthcare staff correlated with higher scores (p = 0.024). Negative correlations emerged between parental age, number of children, and fever management scores (p < 0.05). Conclusions: Parents exhibited high interventionist behaviors and persistent knowledge gaps, underscoring the need for targeted education programs. Educational programs targeting fever management, tailored to parental demographics and misconceptions, are essential. Healthcare providers, particularly pediatric nurses, should prioritize clear communication and evidence-based guidance to empower parents and reduce unnecessary healthcare burdens. Future research should expand to diverse geographic and cultural settings to enhance generalizability. Full article

Cefepime combined with late-generation β-lactamase inhibitors—enmetazobactam, zidebactam, and taniborbactam—represents a promising strategy to treat multidrug-resistant Gram-negative infections. These combinations expand the therapeutic armamentarium beyond established β-lactam/β-lactamase inhibitor regimens, offering targeted activity against ESBL-, AmpC-, and carbapenemase-producing Enterobacterales, as well as multidrug-resistant Pseudomonas aeruginosa. In vitro studies highlight potent and broad activity, with mechanisms including β-lactamase inhibition and, in the case of zidebactam, dual β-lactam enhancement through PBP2 binding. Clinical evidence demonstrates efficacy in complicated urinary tract infections and suggests potential for treating extensively drug-resistant infections, including those unresponsive to conventional β-lactam/β-lactamase inhibitors. Emerging resistance mechanisms—such as PBP alterations, porin loss, efflux pump overexpression, and evolving KPC or NDM variants—underscore the need for ongoing surveillance and robust susceptibility testing. This review provides a comprehensive overview of the mechanisms of action, in vitro activity, pharmacokinetic/pharmacodynamic properties, clinical outcomes, and resistance patterns of these cefepime-based combinations. It also highlights future directions, including the establishment of clinical breakpoints, evaluation in severe infections, and exploration of combination strategies to counteract complex resistance. Overall, these agents exemplify a strategic evolution in β-lactam therapy, offering versatile options to reduce carbapenem reliance while maintaining high efficacy against multidrug-resistant Gram-negative pathogens. Full article