Search Results (152)

Background: Burn injuries remain a major health problem in low- and middle-income countries. Contemporary data from Jordan are scarce, and the last report from Jordan University Hospital (JUH) was published more than four decades ago. This study describes the epidemiology, characteristics, management, and outcomes of burn admissions to JUH during 2016–2020 and compares them with historical and regional data. Methods: We conducted a retrospective cohort study of all consecutive patients admitted to the JUH burn unit with acute burn injury between 1 January 2016 and 31 December 2020. Demographic and clinical variables were abstracted from electronic and paper records using a standardised case-report form. Descriptive statistics summarised injury patterns, while bivariate tests and multivariable linear regression were used to identify factors associated with hospital length of stay (LOS). Results: A total of 575 patients were included (50.3% male; median age 19 years). Children constituted 43.5% of admissions. Median TBSA was 7%, and partial-thickness burns predominated (73.9%). Scalds were the leading aetiology (60.7%), followed by flame burns (19.5%). Most injuries occurred at home (92.5%). The median LOS was 6 days, and 2.1% of patients died. Burn degree, aetiology, TBSA, surgical grafting, and adverse clinical events were independently associated with longer LOS, whereas escharectomy shortened hospitalisation. Conclusions: Domestic scald injuries in children remain the dominant burn pattern in Jordan, although mortality has fallen markedly compared with the 1980 JUH cohort. Prevention efforts should prioritise household safety and child supervision, while continued investment in specialised burn care is likely to further improve outcomes. Full article

Background/Objectives: Hospitalisations in systemic lupus erythematosus (SLE) reflect disease severity, accumulated damage, and the burden of comorbidity, remaining a major determinant of healthcare utilisation. Recent evidence suggests a shift from flare-driven admissions toward complications related to infections, comorbidities, and long-term treatment effects. We aimed to analyse the causes, characteristics, and outcomes of hospital admissions in patients with systemic lupus erythematosus (SLE) over a 30-year period in a tertiary referral centre in Catalonia (Spain) and to evaluate changes over time and prognostic factors associated with adverse outcomes. Methods: A retrospective observational study was conducted including all SLE patients admitted to the Department of Autoimmune Diseases at Hospital Clínic de Barcelona between June 1995 and December 2024. Admissions lasting less than 48 h or lacking clinical documentation were excluded. Variables analysed included demographics, disease duration, comorbidities, cause of admission, treatments, and outcomes. A composite outcome was defined as intensive care unit (ICU) admission, 30-day readmission, or prolonged hospital stay. Statistical analyses included univariate and multivariate regression models. Results: Among the 1216 hospital admissions, SLE flares and infections were the most frequent causes. Over the study period, admissions due to infections increased significantly and, in the last five years, exceeded those related to disease flares (33.7% vs. 26.1%). Patients hospitalized for flares were younger and had a shorter disease duration, whereas infection-related admissions were more common among older patients, those with overlap syndromes, and those with higher damage scores. Vascular events and SLE flares were independently associated with poorer outcomes. Although antimalarial use increased over time, it remained suboptimal, largely due to drug toxicity and newly diagnosed cases (from 45.2% to 69.7%; p < 0.001). Treatment strategies also evolved, with a shift toward lower glucocorticoid doses (from 14.5% to 38.3%; p < 0.001), and mycophenolate mofetil replacing cyclophosphamide as the preferred immunosuppressive agent. Conclusions: Hospitalisation patterns in SLE have shifted over time, with infections emerging as the leading cause of admission. This trend reflects an evolving patient profile characterized by older age, greater accumulated damage, comorbidities, and increased exposure to immunosuppressive therapies. These findings underscore the need for optimized infection prevention strategies and individualized treatment approaches to improve outcomes in contemporary SLE care. Full article

Background: In the paediatric intensive care unit (PICU), certain drugs should be avoided or administered with strict precautions and close monitoring. This is due to their potential for toxicity or adverse effects or a lack of safety data, especially for critically ill children with organ failure. Additionally, practitioners must assess the unique pharmacokinetic and pharmacodynamic properties of drugs when treating critically ill children. In this narrative review, we highlight the risks, advantages, and disadvantages of three exemplary cases of drugs for paediatric patients hospitalised in the PICU: chloramphenicol, acetylsalicylic acid, and propofol. Methods: Apart from key papers on these drugs, a retrospective analysis of the English literature on chloramphenicol, acetylsalicylic acid (ASA), and propofol was performed on PubMed for papers from January 2014 to December 2025. Results: Chloramphenicol should be avoided in neonates due to the risk of grey baby syndrome. Acetylsalicylic acid (ASA) is contraindicated in children ≤18 years with suspected viral illness because of the risk of Reye’s syndrome, but remains essential for Kawasaki disease and post-cardiac surgery antiplatelet therapy. Propofol should be avoided when used for a longer period at high doses. With proper dosing and monitoring, propofol-related infusion syndrome (PRIS) is preventable, but high-risk patients should receive alternative treatment. Conclusions: This narrative review highlights the significant risks associated with the use of chloramphenicol, ASA, and propofol in paediatric intensive care settings. Their potential for life-threatening and severe adverse reactions emphasises the need for cautious and informed use. Clinicians must carefully consider the risks and benefits of these drugs. To minimise adverse events, strict monitoring, dose adjustments, and the use of safer alternatives are essential. However, it appears that their use in well-defined circumstances in acute illness in children is still warranted. The findings of this narrative review underscore the need for further research to focus on identifying high-risk biomarkers, genetic predispositions, and safer alternatives to improve evidence-based guidelines and reduce morbidity and mortality in paediatric intensive care. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of emergency department (ED) presentation, hospitalisation, and preventable healthcare utilisation worldwide. Although guidelines advocate coordinated, preventative, and community-based management, care within ED settings often remains reactive and crisis-driven. Nurses occupy a central role in COPD management; however, the experiential dimensions of nursing practice and its contribution to improving patient outcomes are insufficiently understood. Objectives: To explore the lived experiences of patients, nurses and medical officers regarding COPD presentations to the ED, with particular focus on the nursing role in assessment, coordination, education, and identification of unmet and comorbid care needs. Methods: A qualitative phenomenological approach was undertaken across three regional Australian EDs. Purposive sampling recruited patients presenting with acute exacerbations of COPD and nursing and medical officers involved in their care. Semi-structured interviews were conducted and transcribed verbatim. Data were analysed using Braun and Clarke’s thematic analysis framework, supported by reflexive discussion and audit trails to enhance rigour. Results: Six interrelated themes were identified: (1) nursing within a “crisis first” model of care; (2) holistic assessment and translation of complexity; (3) education and care coordination as preventative nursing work; (4) relational care and therapeutic connection; (5) nurses as sentinels for undiagnosed comorbidities, particularly obstructive sleep apnoea; and (6) system pressures constraining optimal nursing practice. Participants consistently described nurses as the clinicians who stabilised acute episodes, interpreted contextual risks, coordinated services, and provided relational and educational support, yet whose preventative contributions were limited by time and organisational demands. Conclusions: ED nurses function as critical integrators between acute stabilisation and chronic disease management for patients with COPD. Formalising nurse-led assessment, education, coordination, and sleep-disordered breathing screening may reduce avoidable ED presentations and enhance patient-centred outcomes. Investment in structured nursing models represents a key opportunity for improving COPD care delivery. Full article

Food fraud has emerged as a significant and under-recognised public health threat, with documented global incidents resulting in severe illness, hospitalisations, and fatalities. International estimates suggest that up to 9% of the global food trade is adulterated. In South Africa, evidence of mislabelling, substitution, counterfeit products, illicit trade, and the use of unauthorised additives continues to surface, yet the national burden and regulatory response remain insufficiently characterised. This review synthesised peer-reviewed literature and articles from reputable South African media sources published from 2015 to December 2025, focusing on food fraud within the South African context. Searches were conducted across Web of Science (WoS), Scopus, and PubMed, supplemented by Google Scholar and the EU Food Fraud Database, with emphasis on studies reporting fraud associated with South African food products. Standard PRISMA procedures guided the final selection of fifteen (14) eligible articles. These studies reveal widespread food fraud driven mainly by economic gain. Common practices include substituting high-value products, mislabelling meat and seafood, altering dates on expired goods, and producing counterfeits with unauthorised additives and packaging. Collectively, these factors compromise consumer health, undermine industry integrity, and impede effective surveillance. Strengthening South Africa’s food fraud prevention ecosystem will require coordinated multisectoral engagement, targeted investment in detection technologies, and robust regulatory reforms. Full article

Tasmania has some of Australia’s worst potentially preventable hospitalisation (PPH) rates linked to chronic illness. This means that people are living with increasing pain and incapacity. PPHs are also an unnecessary social and financial cost and signal a failure to address the drivers of chronic illness, disproportionally experienced by people with poor access to the social determinants of health. Systems thinking (ST) is increasingly being applied to understanding such problems and designing solutions from a whole system perspective. This case study describes a novel, exploratory application of ST tools in four communities with high chronic disease risk to better understand and develop place-based interventions in the prevention approach known as ‘Anticipatory Care’ (AC). With community members, recruited through four community bodies, we used causal loop diagrams (CLDs) to implement three of the WHO’s recommended steps to ST in health systems: collectively brainstorm, conceptualise effects, and adapt and redesign. Community stakeholders developed CLDs to understand the locally relevant AC system, determine boundaries and priorities, and identify barriers to and opportunities for change. Opportunities focused on the relationship between safe access, place, belonging, relationships and culture, health information, and health services. At the project’s end, a second set of CLDs identified indicators of changes to local AC systems. Given a ‘blank slate’ for chronic disease prevention, communities developed unique, place-based responses orientated towards strengthening resources, connections, and collaboration. We argue that ST can be used to support community understanding of the behaviour of the local chronic disease prevention system, surface the interdependence of system parts, and identify formerly unrecognised opportunities for and consequences of intervention. The impact of place-based approaches is constrained by structural forces, including policies, norms, institutions, and resourcing. Full article

Salmonellosis in equine medicine is of clinical and public health significance. There are no published studies on nosocomial Salmonella outbreaks in South Africa. Electronic medical records of patients admitted to the equine veterinary academic hospital between October and December 2016 were reviewed. The SOPs for hospital infection, prevention and control measures pre-, during, and post-outbreak, and possible zoonotic transmission were collected using structured questionnaires. Salmonella was isolated from 25% of patients, including a white rhinoceros. Salmonella Typhimurium was the most common serotype isolated from patients (42%), stables (72.2%), and clinic areas (84%). Hospitalisation duration (p = 0.017) and repeated faecal samples (p = 0.011) were significantly associated with Salmonella infection, but there was no association between syndromic clinical presentation of salmonellosis and Salmonella infection. Four students reported symptoms of salmonellosis, and one was hospitalised with a positive faecal culture. The importance of heightened biosecurity around high-risk patients cannot be over-emphasised. A continuous surveillance programme of both patients and the environment is essential to identify early lapses in infection prevention and control measures, and patient care should be optimised to reduce the length of hospitalisation. Syndromic clinical signs of salmonellosis cannot always be used to identify Salmonella-positive patients as previously suggested, emphasising the importance of a surveillance programme. Full article

Nationwide hospital discharge databases are increasingly used in infectious disease research, yet their methodological strengths and limitations are rarely synthesised. In Spain, the Minimum Basic Data Set (Conjunto Mínimo Básico de Datos, CMBD) was implemented in 1987 and provides near-universal coverage of acute-care hospitalisations and has been widely applied in infectious disease epidemiology. However, its overall contribution and intrinsic constraints have not been comprehensively mapped. Given the breadth of infections, study designs, populations and outcome definitions in CMBD-based research, effect-size synthesis was not feasible; therefore, we conducted a scoping review with an evidence-mapping approach. We aimed to synthesise the scope, applications and methodological limitations of CMBD-based infectious disease research since its implementation. We conducted a scoping review following JBI guidance and reported according to PRISMA-ScR. PubMed, Embase, Web of Science and Scopus were searched from inception to 25 November 2024 for peer-reviewed journal articles in English or Spanish using CMBD data to investigate infectious diseases in Spain (no restrictions were applied by study design; grey literature was excluded). Screening, data charting and synthesis were completed during 2025. Four reviewers independently screened records and charted data. Studies were classified by infectious disease focus, syndromic category, study design and geographical scope. A total of 359 studies published between 1996 and 2024 were included, mostly retrospective observational analyses. Infectious diseases were the primary focus in 225 studies (62.7%), most commonly respiratory, gastrointestinal/liver and vaccine-preventable infections. Subnational analyses were concentrated in a limited number of regions. Over 80% of reported limitations reflected intrinsic CMBD features. Over three decades, the CMBD has become a cornerstone of hospital-based infectious disease research in Spain, enabling robust national analyses. However, limitations in clinical detail, microbiological confirmation and coding consistency constrain aetiological specificity and causal inference, highlighting the need for data validation and linkage with complementary sources. Full article

Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are high-burden healthcare-associated pathogens that increase mortality, prolong hospitalisation, and drive substantial healthcare costs worldwide. These infections are associated with high morbidity, increased mortality, prolonged hospital stays, and significant costs, particularly among immunocompromised patients or those with extended hospitalizations. This systematic review was conducted and reported in accordance with PRISMA 2020, aiming to synthesise existing data on the epidemiology, resistance mechanisms, clinical manifestations, and strategies for the diagnosis, treatment, and prevention of MRSA and VRE infections. Data were qualitatively synthesised. A total of 113 records published between 2020 and 2025 met the inclusion criteria and were identified through searches in multiple bibliographic databases and publisher platforms (e.g., PubMed, Scopus, Web of Science). MRSA and VRE are implicated in numerous severe infections, including ventilator-associated pneumonia, catheter-associated urinary tract infections, endocarditis, and bacteraemia. Antimicrobial resistance is driven by the mecA, vanA, and vanB genes, while biofilm formation further complicates therapeutic efforts. Biofilm formation can promote antibiotic tolerance (slower killing without an increase in MIC) and persistence (survival of ‘persister’ cells), distinct from genetic resistance, and may complicate therapy in selected infections. Effective strategies include appropriate anti-MRSA/anti-VRE agents (e.g., ceftaroline for MRSA; linezolid or daptomycin for VRE), active screening, stringent infection prevention and control measures, and antimicrobial stewardship programmes. Implementation is often hindered by institutional barriers, limited resources, and insufficient staff training. A multidisciplinary, evidence-based approach is essential for the effective management of these infections. Reducing this burden requires coordinated implementation of rapid diagnostics, stringent infection prevention and control, and antimicrobial stewardship, supported by sustained institutional and public health investment. Full article

Background/Objectives: Diabetic foot disease is one of the most severe and disabling complications of type 2 diabetes mellitus, resulting from the interaction between peripheral neuropathy, peripheral arterial disease, and infection. It is associated with a high risk of ulceration, lower-limb amputation, hospitalisation, and mortality, and is currently recognised as a marker of advanced systemic vascular disease. Although glucagon-like peptide-1 receptor agonists have demonstrated robust cardiometabolic benefits, their potential impact on diabetic foot disease outcomes remains insufficiently explored. Methods: This narrative review critically synthesises clinical, experimental, and translational evidence evaluating the association between glucagon-like peptide-1 receptor agonist therapy and diabetic foot disease-related outcomes. A comprehensive literature search was conducted in PubMed and related databases, focusing on studies published over the last decade that assessed diabetic peripheral neuropathy, foot ulceration, amputations, hospitalisations, and mechanistic pathways potentially linking glucagon-like peptide-1 receptor agonists to diabetic foot pathophysiology. Results: Available observational studies and population-based analyses suggest that glucagon-like peptide-1 receptor agonist treatment is associated with a reduced incidence of diabetic foot ulcers, lower-limb amputations, and related hospitalisations. Experimental and translational data provide biological plausibility for these findings, demonstrating neuroprotective effects, attenuation of neuroinflammation, and improvement of endothelial function and microvascular perfusion, as well as modulation of inflammatory and reparative pathways involved in wound healing. These pleiotropic actions extend beyond glycaemic control and may influence the natural history of diabetic foot disease. Conclusions: Glucagon-like peptide-1 receptor agonists emerge as promising therapeutic agents with potential benefits in the prevention and progression of diabetic foot disease. Their integrated neurovascular and immunometabolic effects may contribute to improved clinical outcomes and a reduced healthcare burden. Prospective studies and dedicated clinical trials are warranted to confirm these associations and to define the role of glucagon-like peptide-1 receptor agonists in the multidisciplinary management of diabetic foot disease. Full article

Background: While COVID-19 vaccination significantly reduces acute disease severity, its impact on the incidence of long COVID remains debated, with some observational studies paradoxically suggesting higher symptom rates among vaccinated individuals. This study aimed to resolve this controversy by distinguishing between the protective effects of prior immunity and the confounding influence of reverse causality. Methods: We conducted a retrospective cohort study of 627 adults hospitalised for COVID-19 in London. Participants were stratified into two analytical cohorts based on vaccination timing: a “prevention cohort” (vaccinated ≥14 days pre-infection) and a “post-acute cohort” (vaccinated post-infection). Multivariable Bayesian logistic regression was employed to estimate Adjusted Odds Ratios (aOR) for long COVID, controlling for age, gender, BMI, comorbidities, and acute length of hospital stay (LoS). Results: In the prevention cohort, prior vaccination demonstrated a non-significant protective trend against long COVID (aOR 0.81; 95% CI 0.45–1.42; p = 0.45), with no significant difference observed between homologous and heterologous regimens. The post-acute cohort exhibited a strong, significant positive association (aOR 3.41; 95% CI 2.23–5.52; p < 0.001), indicating substantial indication bias, with symptomatic individuals more likely to seek vaccination. The strongest independent predictors of long COVID were comorbidities (aOR 2.78) and prolonged acute hospitalisation (≥4 days; aOR 1.82). Conclusions: Vaccination administered prior to infection demonstrates a protective trend against long COVID, whereas the strong association observed with post-infection vaccination reflects indication bias, with symptomatic survivors being more likely to seek immunisation. Clinical strategies to mitigate post-acute sequelae should prioritise reducing acute disease severity and managing comorbidities, which were identified as the dominant independent predictors of risk in hospitalised patients. Full article

In Spain, Leishmania infantum causes both cutaneous (CL) and visceral leishmaniasis (VL). This study aimed to analyse trends in the clinical presentation, diagnosis, management, and epidemiology of leishmaniasis at Severo Ochoa University Hospital in Leganés, an endemic area in Southern Madrid affected by Europe’s largest outbreak (2009–2015). A retrospective study was conducted, including all confirmed cases from January 1992 to December 2024, using clinical records. Cases were stratified into pre-outbreak, outbreak, and post-outbreak periods. A total of 151 cases were identified, including 129 VL, 21 CL, and 1 simultaneous VL/CL. VL predominated among adults during the HIV epidemic, later shifting to elderly and non-HIV immunosuppressed patients, while paediatric cases remained stable. Diagnostic methods evolved from bone marrow microscopy, culture, and IFAT to molecular and chemiluminescence assays. VL treatment also evolved, with amphotericin B gradually replacing meglumine antimoniate as first-line VL treatment. Most patients required hospitalisation, with 8.5% mortality, mainly among immunocompromised or elderly individuals. A persistent concentration of cases near recently urbanised areas adjacent to the parks of Polvoranca and Bosquesur was observed. Despite advances in diagnosis and therapy, endemic transmission and underreporting continue, highlighting the need for ongoing surveillance and preventive measures. Hospital record review proved useful for monitoring compliance with mandatory VL notification, though its applicability to cutaneous cases remains limited. Full article

Background: The COVID-19 pandemic substantially altered the epidemiology of respiratory infections. Its impact on the clinical course of influenza in hospitalised children remains insufficiently characterised. Objectives: We aimed to compare the clinical course, complications, and selected laboratory parameters of influenza in children before, during, and after the COVID-19 pandemic. Methods: This single-centre retrospective study included 553 children hospitalised with laboratory-confirmed influenza between September 2017 and August 2025. Patients were divided into three groups: pre-pandemic, pandemic, and post-pandemic. Clinical complications and inflammatory markers (CRP, PCT, neutrophil counts) were analysed. Results: Influenza-related complications occurred in 59.5% of patients and were significantly more frequent after the pandemic compared to the pre-pandemic period (64.3% vs. 52.9%, p = 0.02). Pneumonia was the most common complication across all groups, but its incidence was lowest during the pandemic. Myositis occurred most frequently during the pandemic and appears to coincide with a higher proportion of influenza B infections. No significant differences were observed in CRP, PCT concentrations, or neutropenia rates between groups. Conclusions: The COVID-19 pandemic influenced the clinical presentation of influenza in children, with a post-pandemic increase in complications. These findings may reflect delayed access to healthcare and the phenomenon of immunity debt, highlighting the need for continued surveillance and preventive strategies. Full article

Background/Objectives: Cardiovascular diseases are the leading cause of death worldwide. The preventive efforts to reduce the burden are crucial. Primary causes of cardiovascular diseases include lipid disorders. The variety of available medications influences cardiovascular risk and allows for improvement. However, discontinuation or infrequent initiation of lipid-lowering therapies remains a problem. This study aimed to investigate predictors of lipid-lowering therapy escalation. Methods: 431 patients with known concentrations of Lipoprotein (a) (Lp (a)) acquired as part of routine cardiovascular risk assessment from the HELPE-R registry, hospitalised in the University Clinical Hospital in Białystok were included in this study. Escalation of treatment was defined as the initiation of any form of lowering therapy or an increase in the potency or dose of statins. The analysis of the influence of various factors on the decision about escalation was performed. Results: The median age was 69.00 years. The escalation of therapy occurred in 48.49% of patients. Not reaching the LDL-C goal was the strongest predictor of escalation (OR: 9.177). The other factors increasing the probability of escalation included acute coronary syndrome (OR: 3.913), prediabetes (OR: 2.372), chronic coronary syndrome (OR: 2.217), dyslipidemia (OR: 2.354), hypertension (OR: 1.734), carotid artery stenosis (OR: 1.625), and obesity (OR: 1.543). There was no effect of past MI and stroke on the escalation of lipid profile. Lp (a) did not affect the escalation. Conclusions: The decision about escalation of lipid-lowering therapy is mainly influenced by classical risk factors and established atherosclerotic disease. Lp (a) did not affect the escalation, despite growing interest among medical practitioners. Full article

Background: The COVID-19 pandemic exposed both the fragility and importance of long-term care facilities (LTCFs). In this context, seasonal influenza vaccination is more than a routine intervention, it is a measurable indicator of system readiness. Methods: We conducted a secondary analysis of the validated 2022 WHO–UNICEF Joint Reporting Form (JRF) on Immunization for all 194 Member States, extracting (i) policy inclusion of older adults and LTCF residents/staff and (ii) availability of numeric coverage data. Findings were interpreted alongside evidence on vaccine effectiveness and delivery in LTCFs as proxies for operational preparedness. Results: Of 194 countries, 128 (66%) reported a national influenza-vaccination policy. Among these, 109 (56%) recommended vaccination for older adults, while only 84 (43%) explicitly included LTCF residents (few countries explicitly named staff). Numeric coverage for older adults was reported by 54 countries (median 55%, range 0–103%), with 13 meeting the WHO ≥75% target. No country reported specific coverage for LTCF residents or staff. Evidence from trials and observational studies shows that vaccination reduces hospitalisation and mortality among residents and that higher staff uptake is associated with fewer resident infections and improved continuity of operations. Facilities achieving high joint coverage appear to reflect stronger governance, supply chains, data systems, and infection-prevention capacity, the same elements required for pandemic response. Conclusion: Influenza vaccination in LTCFs functions as both a barometer and a mechanism of preparedness. Three practical levers should be recognised as core readiness functions: explicit inclusion of LTCF residents and staff in national policy; routine, public reporting of resident and staff coverage; and timely, resourced on-site delivery before seasonal peaks. Embedding these features would better protect those at highest risk and strengthen overall health-system resilience. Full article