Search Results (36,509)

Background: Post-bariatric abdominoplasty is associated with a high risk of bleeding and wound complications due to extensive tissue resection and impaired tissue quality. Tranexamic acid (TXA) reduces perioperative bleeding in multiple surgical disciplines, but evidence in massive-weight-loss abdominoplasty is limited. The aim of our study was to evaluate the association between perioperative TXA use and bleeding-related and surgical outcomes in post-bariatric abdominoplasty. Methods: This retrospective cohort study included 97 patients undergoing post-bariatric abdominoplasty, of whom 49 received perioperative TXA and 48 did not. The primary outcome was a composite of bleeding-related complications within 30 days, including hematoma, clinically relevant bleeding, or reoperation. Secondary outcomes included overall and specific surgical site complications, drain output and duration, length of hospital stay, and perioperative hemoglobin changes. Multivariable regression analyses adjusted for body mass index, abdominoplasty type, and year of surgery. Results: Bleeding-related complications were significantly lower in the TXA group compared with controls (4.1% vs. 33.3%; unadjusted OR 0.09, 95% CI 0.02–0.40; p < 0.001). This association remained significant after adjustment (adjusted OR 0.13, 95% CI 0.03–0.68; p = 0.016). TXA use was associated with lower cumulative drain output (median 200 vs. 382.5 mL; p < 0.001) and shorter drainage duration (median 4 vs. 5 days; p < 0.001). Overall complications were reduced in the TXA group (42.9% vs. 66.7%; p = 0.025), driven by fewer wound healing disturbances. Hemoglobin changes, seroma, and infection rates were similar between groups. Conclusions: Perioperative TXA use in post-bariatric abdominoplasty is associated with significantly fewer bleeding-related and wound complications without increased adverse effects, supporting its use in this high-risk population. Full article

Purpose: Surgical resection has been the gold standard for colorectal liver metastases (CRLM) for decades. In recent years, thermal ablation has emerged as a first-line treatment option for small-size CRLM, while for intermediate-size lesions (3–5 cm), it is reserved for patients with unresectable disease. In this setting, thermal ablation has proven safe and effective, achieving durable local control (LC) in the majority of patients. This retrospective study compares oncological outcomes of thermal ablation versus surgical resection of intermediate-size (3–5 cm) CRLM. Material and methods: Patients treated with thermal ablation or surgical resection for intermediate-size CRLM between 2000 and 2025 were included. Baseline per-patient and per-procedure characteristics were compared across three groups: thermal ablation, surgical resection, and combined treatment. Per tumor characteristics were compared between thermal ablation and surgical resection. Primary outcomes included local tumor progression-free survival (LTPFS) and complication rates. Secondary outcomes were OS, distant progression-free survival (DPFS), LC, and length of hospital stay. Survival outcomes were analyzed using the Kaplan–Meier method; additionally, LTPFS was assessed using Cox proportional hazards regression models, with multivariable analyses performed to adjust for potential confounders. Results: A total of 320 patients with 448 metastases were included: 135 patients underwent thermal ablation, 156 underwent surgical resection, and 29 received combined treatment. LTPFS per tumor was significantly higher in the surgical resection group (HR 1.86, 95% CI 1.24–2.81, p = 0.0025), however, LC per tumor did not significantly differ amongst groups (HR 1.48, 95% CI 0.70–3.11, p = 0.307). Complication rates were significantly higher after resection (p < 0.001). OS and DPFS did not differ significantly between the three groups (p = 0.08 and p = 0.084). OS comparing only thermal ablation and resection was significantly lower in the thermal ablation group. Median hospital stay was 3, 5, and 7 days for the ablation, resection, and combined groups, respectively (p < 0.001). Conclusions: Thermal ablation offers a safe alternative to surgical resection for selected patients with intermediate-size (3–5 cm) CRLM, with higher treatment-site recurrence rates. With the option of repeat ablation, comparable local tumor control can be achieved. Improvements in local control with both modalities over time support the need for a prospective clinical trial. Full article

Background/Objectives: After several decades of using titrated paclitaxel infusions, our institution adopted non-titrated infusions in April 2023 to streamline infusion workflows. We aimed to evaluate whether this alteration in infusion was associated with a higher incidence of HSRs. Methods: This was a retrospective cohort study of patients receiving paclitaxel with titration versus non-titration from April 2022 through November 2023. Patients diagnosed with gynecologic cancers who presented for their first or second paclitaxel lifetime infusions were included. Results: A total of 150 patients were included in this study, each with one or two infusions, for a total of 282 infusion visits. There were 176 infusions performed with titrated paclitaxel (62.4%), and 106 infusions performed with non-titrated paclitaxel dose (37.6%). HSRs occurred in 20.8% of the non-titrated paclitaxel infusions and in 11.9% of titrated paclitaxel infusions (RR 1.73 (95% CI 1.006–3.006), p = 0.047). Additionally, when stratifying by first- or second-visit infusions, the HSR rate increased significantly for non-titrated infusions to 22.4% during the second visit, while there was a decrease to 8.4% for titrated infusions (RR 2.66 (95% CI 1.105–6.413), p = 0.029). Non-titrated infusion reactions were associated with higher grades of reaction. Conclusions: HSRs occurred more frequently with non-titrated infusions, particularly during the second administration, suggesting that eliminating titration may increase hypersensitivity risk. These findings support a prospective evaluation of titration rates to further refine paclitaxel administration. Full article

Background: Parents of school-age children with neurodevelopmental and conduct difficulties face elevated stress, reduced self-efficacy and relational strain, yet evidence for scalable, school-embedded support remains limited. Drawing on mentalization theory—which emphasises parents’ capacity to understand behaviour in terms of underlying mental states—this mixed-methods study evaluated a weekly parent learning group integrating psychoeducation, mentalization-based practice and peer support, delivered within an alternative provision school. Methods: A group of twelve parents who attended at least six sessions completed retrospective pretest–posttest questionnaires assessing parental reflective functioning (PRFQ) and parenting self-efficacy (PSOC). Semi-structured interviews explored parents’ subjective experiences and perceived changes in parent–child interactions and parent–school relationships. Quantitative outcomes were analysed using paired t-tests and effect sizes; qualitative data underwent reflexive thematic analysis. Results: Quantitative analyses revealed statistically significant improvements in parental reflective functioning and self-efficacy. Pre-mentalizing scores decreased substantially (d = 1.34), indicating reductions in non-mentalizing, while interest and curiosity about children’s mental states increased markedly (d = 1.83). Parenting self-efficacy improved significantly (d = 1.61). Although a reduction in excessive certainty about mental states approached significance (d = 0.63, p = 0.053), trends suggested greater epistemic balance. Qualitative analysis identified six themes elucidating mechanisms of change, including enhanced mentalizing capacity, reduced parental stress, transformed parent–child interactions and facilitation style as a critical active ingredient. Integration of findings suggests that psychoeducational content provided conceptual grounding for understanding behaviour, facilitator modelling scaffolded reflective practice, and relational safety within the group enabled authentic engagement with challenging experiences. Conclusions: These preliminary findings indicate that a school-based parent learning group combining psychoeducation, mentalization-based practice and peer support is feasible and associated with meaningful improvements in parental reflective functioning and self-efficacy. Parent narratives of transformed relational practices and shifts from reactive to reflective engagement echo broader literature demonstrating that group-delivered mentalization-oriented programmes can enhance reflective capacities and caregiving quality in diverse family contexts. The school setting may extend the reach of such interventions to families not engaged with clinical services and support collaborative parent–school partnerships. Future research should employ larger, controlled designs, incorporate observational and child outcome measures, and explore scalability across educational contexts. Full article

Background and Objectives: Müllerian duct anomalies (MDAs) are congenital malformations of the female genital tract for which several classification systems have been proposed. The objective of this study is to estimate the interrater reliability of the American Fertility Society (AFS), European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM) and Congenital Uterine Malformation by Experts (CUME) classification systems for Müllerian duct anomalies. Materials and Methods: This retrospective cohort study was conducted at a tertiary care hospital and included 71 patients aged up to 45 years who were assessed for a Müllerian duct anomaly between January 2000 and April 2023. Pelvic MRI images were independently evaluated by four readers, followed by a consensus meeting. The primary outcome was interrater reliability (Krippendorff’s α), and the secondary outcomes were the proportions of indeterminate and unclassifiable cases after consensus meeting. Results: The interrater reliability for MDA diagnosis was very low for all the classification systems (AFS α 0.63, 95% CI [0.57, 0.67]; ASRM α 0.46, 95% CI [0.41, 0.52]; ESHRE/ESGE α 0.33, 95% CI [0.29, 0.38]; CUME α 0.57, 95% CI [0.45, 0.72]). After consensus meeting, the ESHRE/ESGE system had more indeterminate cases (9.9%) and the ASRM system had more unclassifiable cases (20.6%). Conclusions: All the classification systems for Müllerian duct anomalies had a very low interrater reliability, with more indeterminate cases in the ESHRE/ESGE system and more unclassifiable cases in the ASRM system. We present our recommendations for the improvement of each classification system. The ultimate goal of future research should be the development of a single uniform system integrating the best features of these systems and with clinically relevant cut-off values, considering patients’ reproductive outcomes. Full article

Objectives: This study aimed to evaluate the setup accuracy and intrafractional geometric stability of surface-guided radiation therapy (SGRT) under frameless immobilization in lung cancer radiotherapy and to assess its clinical utility in a relatively large patient cohort. Materials and Methods: A total of 678 treatment fractions from 52 patients with primary non-small cell lung cancer (NSCLC), treated between October 2024 and November 2025, were retrospectively analyzed. Patient setup was performed using SGRT with the Identify system, and cone-beam computed tomography (CBCT) served as the reference for internal target localization Intrafractional setup displacements, center-of-mass (COM) shifts, residual setup errors, and intrafractional clinical target volume (CTV) variations were evaluated. Spatial agreement between planned and intrafractional tumor volumes was quantified using the Dice Similarity Coefficient (DSC). Results: The mean CBCT-based intrafractional shifts were −0.01 mm (vertical), 0.03 mm (longitudinal), and 0.01 mm (lateral), indicating negligible systematic errors. The greatest variability was observed in the longitudinal direction (standard deviation, 1.32 mm), with a maximum displacement of 4.58 mm. COM-based analysis demonstrated near-zero mean displacements in all directions, with standard deviations ranging from 0.01 to 0.02 mm. DSC values ranged from 0.91 to 0.98, with a mean of 0.96, indicating excellent spatial agreement between planned and intrafractional tumor volumes. Residual setup errors were predominantly within ±1 mm, and the mean intrafractional CTV volume change was minimal (0.27 cm³). Conclusions: SGRT-based frameless lung cancer radiotherapy demonstrated high setup accuracy and robust intrafractional geometric stability. Although slightly greater variability was observed in the longitudinal direction, overall positional deviations and volumetric changes remained within clinically acceptable limits. These findings support the feasibility of integrating SGRT with CBCT-guided radiotherapy and suggest potential benefits for workflow efficiency and planning target volume margin optimization. Full article

Background: Turner syndrome is a genotypic disorder in females characterized by the total or partial absence of an X chromosome. While cardiovascular issues and sensorineural hearing loss are well-documented, vestibular system involvement remains understudied. This study aims to examine vestibular system involvement in patients with Turner syndrome and assess if they exhibit a higher prevalence of peripheral vestibular pathology compared to the general population. Methods: A retrospective longitudinal study was conducted with 21 Turner syndrome patients and 21 age-matched controls. Evaluations included clinical history, otoscopy, pure tone audiometry, the Video Head Impulse Test (vHIT) to measure vestibulo-ocular reflex gain, and computerized dynamic posturography, specifically the Sensory Organization Test (SOT) and Stability Limits Analysis. Results: Turner syndrome patients showed significantly higher hearing thresholds across all frequencies compared to controls (p < 0.001). In the vHIT, 30% of the Turner group presented pathological results, with significant gain reductions in the right horizontal and left posterior semicircular canals. Posturography revealed a significant reduction in overall stability (p = 0.006) and a significantly lower vestibular index (p = 0.011) in the Turner group. Additionally, patients with Turner syndrome demonstrated significant impairments in directional control, reaction time, and excursion points during Stability Limits Analysis. Conclusions: Patients with Turner syndrome are more likely to experience vestibular disorders, a finding likely associated with estrogen deficiency and the loss of its protective effect on the inner ear. These results highlight the necessity of including vestibular and posturographic assessments in the routine clinical follow-up of these patients to facilitate early detection and rehabilitation, even in the absence of overt symptoms like vertigo. Full article

Background: The perioperative period in cancer surgery is characterized by transient metabolic and inflammatory perturbations that may influence early postoperative biochemical dynamics. Surgical stress induces insulin resistance, hyperglycemia, cytokine activation, and metabolic shifts that interact with tumor cell signaling pathways. Intravenous lidocaine has been associated with anti-inflammatory and systemic stabilizing effects beyond analgesia. We investigated whether perioperative lidocaine administration during robotic-assisted radical prostatectomy (RARP) is associated with early postoperative prostate-specific antigen (PSA) dynamics within the context of perioperative metabolic–inflammatory modulation. Methods: In this single-center retrospective cohort study, 180 patients undergoing RARP for localized or locally advanced prostate cancer were stratified according to perioperative intravenous lidocaine exposure. The primary endpoint was undetectable PSA (<0.1 ng/mL) at 6–12 weeks postoperatively. Secondary endpoints included PSA detectability at 3 and 6 months and time to first detectable PSA. Multivariable logistic and Cox regression models were adjusted for established oncologic risk factors. Perioperative glycemic variation, intraoperative lactate dynamics, and postoperative IL-6 levels were analyzed as indicators of stress-induced metabolic activation. Results: Lidocaine exposure was independently associated with higher odds of undetectable PSA at 6–12 weeks (OR 2.10, 95% CI 1.15–3.85) and at subsequent time points. In Cox analysis, lidocaine was associated with a reduced hazard of PSA detectability (HR 0.58, 95% CI 0.37–0.92). Patients receiving lidocaine demonstrated significantly attenuated perioperative hyperglycemia, lower lactate elevation, and reduced IL-6 response. Conclusions: Perioperative intravenous lidocaine administration during RARP was associated with more favorable early PSA dynamics and attenuation of perioperative metabolic–inflammatory activation. Given the retrospective and non-randomized design of the study, these findings should be interpreted as associative and hypothesis-generating, and warrant confirmation in prospective controlled investigations. Full article

Background and Objectives: To evaluate the impact of liver cirrhosis on pregnancy outcomes using a large-scale, propensity score-matched cohort, with adjustment for numerous confounding variables. Materials and Methods: From a total of 3,701,876 pregnancies (women aged 18–49) from 1 January 2010, to 31 December 2024, after propensity score matching, 2498 pregnancies with cirrhosis and 2498 pregnancies without cirrhosis in TrinetX database were included in our analysis. To adjust for potential confounding, pregnancies in the cirrhosis group were matched 1:1 to those without cirrhosis using propensity scores derived from demographic, lifestyle, comorbidity, and laboratory characteristics. Relative risks (RRs), risk differences (RDs), and corresponding 95% confidence intervals (CIs) were calculated for pregnancy-related outcomes. Subgroup analyses stratified by maternal age were further performed to assess potential effect modification. Main outcomes included Gestational diabetes mellitus, preeclampsia, premature rupture membranes, preterm birth, miscarriage, stillbirth, placental abruption, dystocia, postpartum hemorrhagia, and cesarean delivery. Results: After matching, 2485 women were included in each group, with well-balanced baseline characteristics. Compared with women without cirrhosis, those with cirrhosis had a higher risk of pregnancy-related outcomes, including gestational diabetes mellitus (15.5% vs. 11.9%; RR = 1.30; 95% CI, 1.13–1.50, p < 0.001), preeclampsia (8.6% vs. 5.7%; RR = 1.52; 95% CI, 1.24–1.87, p < 0.001), and preterm birth (9.0% vs. 4.9%; RR = 1.85; 95% CI, 1.49–2.29, p < 0.001). Cirrhosis during pregnancy was also associated with a higher risk of miscarriage (6.6% vs. 4.8%), stillbirth (1.3% vs. 0.5%), placental abruption (1.8% vs. 0.8%), postpartum hemorrhage (6.9% vs. 4.3%), and cesarean delivery (20% vs. 17.2%). The limitations include the lack of detailed data on cirrhosis severity. Conclusions: Pregnancy with liver cirrhosis is associated with increased risks of diverse maternal and neonatal complications. Our findings highlight the importance of multidisciplinary management and individualized care planning in order to reduce adverse outcomes. Full article

Salmonella enterica serotype Mbandaka has emerged as a significant foodborne pathogen in poultry, posing increasing public health risks through its zoonotic transmission from poultry sources to humans, yet critical gaps remain in understanding its transmission inter-host transmission and antimicrobial resistance (AMR) mechanisms within the poultry industry. In this study, we addressed these knowledge gaps by conducting a comprehensive genomic analysis of 1813 S. Mbandaka genomes, including genotyping, phylogenetic reconstruction, and pangenome analysis. The results revealed that S. Mbandaka exhibits a global distribution pattern, with sequence type 413 (ST413) representing the dominant lineage. Phylogenetic analysis revealed frequent close genomic relatedness between human and poultry-derived strains (SNP ≤ 10), suggesting poultry as a potential major zoonotic reservoir for human S. Mbandaka infection. Furthermore, close genetic relationship was also detected among the human-derived strains, suggesting the potential community spread. In addition, genomic analysis indicated an increase over time in the number of antimicrobial resistance genes (ARGs) detected per genome, frequently associated with plasmids and insertion sequences (ISs). Notably, the ARGs significantly enriched in Chinese strains were primarily associated with the Col(pHAD28) plasmid. Comparative analysis demonstrated that the ARG profiles of S. Mbandaka were similar to those of other Salmonella serovars, suggesting the potential for cross-species transmission. In conclusion, these findings represent a large-scale retrospective genomic analysis of publicly available whole-genome sequences and elucidate the transmission dynamics and AMR mechanisms of S. Mbandaka in poultry, providing insights into its risks to poultry production and public health while guiding the development of targeted prevention strategies for the poultry sector. Full article

Background/Objectives: Malaria remains a major cause of hospitalization in rural Madagascar, yet data on in-hospital clinical presentation, management, and patient outcomes remain limited. Methods: We conducted a three-year retrospective study (2023–2025) at a rural district hospital in Ambatoboeny, Madagascar, including patients of all ages hospitalized with malaria confirmed by rapid diagnostic testing and microscopy. Sociodemographic, clinical, laboratory, and treatment data were extracted from routine records. Length of hospital stay (LOS) was analyzed continuously and categorized as ≤2, 3–4, or ≥5 days. Seasonal admission patterns and factors associated with LOS were assessed using chi-square or Fisher’s exact tests, and associations with rainfall seasonality were explored using Spearman’s correlation. Results: Among 134 hospitalized patients, median age was 15 years (interquartile range (IQR) 7–25) and 52.2% were female. Plasmodium falciparum predominated (94.0%), while mixed-species infections were identified in 6.0% of cases; 20.1% of cases were classified as severe malaria, including 10.4% with cerebral malaria. Co-infections were frequent (52.2%), most commonly Schistosoma haematobium infection (14.2%) and typhoid fever (12.7%). Intravenous artesunate was initiated in 97.8% of patients; all received paracetamol and 94.8% received intravenous fluids. Median LOS was 2 days (IQR 2–3); 12.7% had prolonged hospitalization (≥5 days). Prolonged LOS was significantly associated with cerebral malaria, high parasitemia (≥5%), blood transfusion, and age < 15 years (all p ≤ 0.034), while co-infection and nutritional status were not. Conclusions: Hospitalized malaria in rural Madagascar presents with heterogeneous clinical phenotypes and a high burden of co-infections. Prolonged LOS is primarily driven by markers of severe disease and supportive care requirements, underscoring the need for early severity recognition and resource planning in low-resource hospitals. Full article

Background: Ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) have transformed the treatment landscape of relapsed/refractory multiple myeloma (RRMM). Given their recent regulatory approval and limited availability, mainly due to logistical issues, real-world data remain scarce. Methods: A retrospective study was conducted using the TriNetX database, identifying adult patients with RRMM treated with either cilta-cel or ide-cel. The clinical outcomes evaluated included overall survival (OS), progression-free survival (PFS), as well as the safety profile. Results: A total of 697 patients treated with cilta-cel and 575 with ide-cel were identified. The median age was 65 and 67 years, with ~16% being Black/African American. The 12-month OS was 89.6% for cilta-cel and 86.0% for ide-cel. In a descriptive subgroup analysis, renal impairment (eGFR < 60 mL/min/1.73 m²) seemed to be associated with significantly inferior OS in both cohorts (HR = 3.66, p < 0.001 for cilta-cel; HR = 1.73, p = 0.003 for ide-cel). Conversely, prior anti-CD38 exposure did not seem to impact survival in any of the two treatment groups. Any-grade CRS occurred in 45.9% (cilta-cel) and 41.8% (ide-cel), while any-grade ICANS was observed in 15.4% and 11.8%, respectively. Severe (grade ≥ 3) ICANS remained rare (<3%) in both cohorts. Hematologic toxicity was prevalent, with grade ≥ 3 neutropenia occurring in 76.0% (cilta-cel) and 68.0% (ide-cel). Notably, any-grade infections (28.5–40.1%) and hypogammaglobulinemia (41.1–43.1%) were frequent, highlighting a significant long-term immunosuppressive burden. Conclusions: In these real-world cohorts, both approved CAR T-cell therapies demonstrated favorable survival outcomes. While the incidence of severe hematologic and immune-related toxicities was high, these findings are compatible with published data from clinical trials and it seems that the clinical utility of these drugs overcomes the adverse safety profile. Full article

Background: Hospitalizations for hepatocellular carcinoma (HCC) increasingly reflect a complex interplay among chronic liver disease, cardiometabolic comorbidities, and systemic complications, which now exert greater influence on patient outcomes than tumor-specific factors alone. Despite this shift, contemporary data regarding the impact of the evolving comorbidity burden on inpatient resource utilization and procedural care remain limited. This study examines national trends in inpatient characteristics, procedural utilization, and outcomes among patients hospitalized with HCC between 2018 and 2022. Methods: A retrospective, cross-sectional analysis of adult hospitalizations was performed using the National Inpatient Sample (NIS) from 2018 to 2022. Hospitalizations involving HCC were identified through ICD-10 diagnosis codes, encompassing both principal and secondary diagnoses. Survey-weighted analyses were used to estimate national prevalence, in-hospital mortality, length of stay (LOS), and total hospital charges. Temporal trends were evaluated using survey-weighted logistic or linear regression, with calendar year as a continuous variable. Multivariable survey-weighted logistic regression models were constructed to identify adjusted predictors of inpatient mortality and procedural utilization, including liver transplantation, hepatic resection, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Results: During the study period, an estimated 275,000 HCC-related hospitalizations occurred nationwide. The prevalence of cardiometabolic comorbidities increased significantly over time (all p < 0.001), including MASLD (6.6% to 8.7%), obesity (10.6% to 13.7%), diabetes (36.0% to 38.9%), and dyslipidemia (26.4% to 34.4%). In-hospital mortality rose from 8.82% (95% CI, 8.40–9.24%) in 2018 to 9.23% (95% CI, 8.81–9.65%) in 2022, with the highest rate in 2020 (9.42%). In parallel, inpatient resource utilization rose, as reflected by longer lengths of stay and higher hospitalization charges. Utilization of diagnostic endoscopic procedures, such as esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography, increased, whereas rates of definitive inpatient oncologic and portal hypertension-directed interventions—including liver transplantation, hepatic resection, and TIPS—remained low and stable. In-hospital mortality was independently associated with markers of hepatic decompensation and systemic illness, including hepatic encephalopathy, acute kidney injury, sepsis, and hepatorenal syndrome. These associations were stronger than those observed for tumor-directed procedures, as reflected by inpatient procedural utilization patterns. Conclusions: Between 2018 and 2022, inpatient resource utilization among patients hospitalized with hepatocellular carcinoma increased in parallel with rising cardiometabolic comorbidity. It was primarily driven by management of hepatic decompensation and systemic illness rather than oncologic intervention. These findings characterize the evolving complexity of HCC hospitalizations in the contemporary inpatient setting. Full article

Preconception care is globally recognized as essential for optimizing pregnancy outcomes; however, in Japan, comprehensive data on medication-related potential exposure to pregnancy-contraindicated medications among women of reproductive age remain limited. We conducted a retrospective cross-sectional descriptive study using data from Japan’s National Database of Health Insurance Claims (fiscal year 2022) to assess the potential exposure to pregnancy-contraindicated medications among women of reproductive age. Outpatient prescriptions for oral medications dispensed to women aged 15–49 years were analyzed. In total, 270 medications classified as contraindicated during pregnancy were identified, of which 75 were also contraindicated for women planning pregnancy. Of these, 58 active ingredients were restricted in both phases. Notably, 212 medications were uniquely contraindicated during pregnancy, highlighting the broader contraindication profiles during fetal development than during the preconception period. Despite these contraindications, high prescription volumes were observed for medications such as loxoprofen sodium hydrate, sodium valproate, and metformin hydrochloride among women of reproductive age. These findings illustrate a high baseline utilization of pregnancy-contraindicated medications among women of reproductive age. As most women in this demographic are neither pregnant nor actively planning conception, these volumes primarily reflect standard care rather than inappropriate prescribing. In conclusion, pharmacists serve as an important supplementary safety net by routinely confirming pregnancy status to prevent inadvertent exposure. Full article

Background: Rapid diagnostic tests (RDTs) for bloodstream infections (BSIs) reduce time to pathogen identification, yet evidence on their real-world economic and clinical value remains inconsistent. This study aimed to compare clinical outcomes, antibiotic utilization, and hospital costs associated with different rapid microbiological identification methods versus standard culture. Methods: A retrospective observational study was conducted in a tertiary university hospital including 115 hospitalized patients with suspected or confirmed BSIs. Multiplex PCR (mPCR), fluorescence in situ hybridization (FISH), and MALDI-TOF MS were compared with conventional culture. Outcomes included mortality, length of stay, antibiotic-days, and direct and indirect hospital costs. Nonparametric and exploratory adjusted analyses were performed. Results: No significant differences were observed across diagnostic groups for age, sex, mortality, or length of stay. Patients tested with mPCR showed higher empirical and total antibiotic-days and increased antibiotic-related costs (p < 0.05). Median direct and indirect hospital costs were numerically lower with FISH and mPCR but did not reach statistical significance. Adjusted analyses confirmed that diagnostic modality was not independently associated with mortality or costs. Conclusions: Rapid diagnostics accelerate identification but demonstrate heterogeneous downstream clinical and economic effects. Their value appears to depend more on local implementation and antimicrobial stewardship integration than on diagnostic speed alone. Full article