Search Results (268)

Background: Intra-abdominal infection (IAI) is a challenging condition that needs both medical and surgical treatment and it is still associated with high morbidity and mortality rates. Fosfomycin is approved for use in combination therapy for IAIs. The aim of this study was to evaluate the impact of intravenous fosfomycin addition in a combination regimen for IAI treatment in an intensive care setting. Methods: We performed a retrospective, observational, monocentric study. We enrolled patients admitted to the ICU with IAIs from April 2022 to June 2024. Patients were divided into two groups: Group A, standard treatment; and Group B, combination therapy including fosfomycin. Primary endpoints were clinical response at 7 days and in-hospital mortality; moreover, a risk factor analysis for mortality was also performed. Results: In total, 104 patients were enrolled, 85 in Group A, and 19 in Group B. Groups were homogenous in regard to demographics, but clinical condition was slightly worst in Group B. Source control < 24 h was performed in 69.6% and 33.3% cases in Group A and Group B, respectively (p = 0.017). Clinical response on day 7 (81.2% vs. 73.7%, p = 0.675) and in-hospital mortality (27.1% vs. 47.2%, p = 0.145) were comparable. Univariate and multivariate analysis highlighted Charlson Comorbidity Index (CCI) (p = 0.04) and septic shock (p = 0.029) as risk factors, and effective empirical therapy (p = 0.04) as the protective factor; fosfomycin was not directly associated with outcome improvement. Conclusions: The outcome was comparable between groups; clinicians preferred to administer a combination regimen including fosfomycin in patients with statistically significant greater severity of illness and without early source control. Full article

Background: The recently proposed Staging of Airflow Obstruction by Ratio (STAR) system classifies severity based on the FEV₁/FVC ratio, potentially offering improved prognostic performance. This study aimed to evaluate the prognostic performance of STAR in patients hospitalized for COPD exacerbation. Methods: A retrospective observational single-center study was conducted including COPD patients who were discharged after hospitalization for a severe exacerbation at a university hospital. The clinical and spirometric data in a stable condition, GOLD classification, STAR system, and mortality outcomes were recorded. Results: A total of 197 patients (23% female) were included. The follow-up was performed for a minimum of 38 months or until death if it occurred earlier. During the study period, 91 patients died (46%). Patients were distributed according to the STAR classification as follows: 21% in STAR 1, 32% in STAR 2, 28% in STAR 3, and 19% in STAR 4. The agreement between STAR and GOLD was fair (Cohen’s kappa = 0.28), with a moderate correlation (Tau-b = 0.49, p < 0.001). STAR grades 2 to 4 demonstrated progressively increasing mortality, while STAR grade 1 showed a mortality similar to grade 2. STAR showed a trend toward a superior discrimination for mortality than GOLD (AUC 0.63 [95%CI 0.55–0.71] vs. 0.55 [0.47–0.63]; p = 0.055), although BODEx remained the most accurate predictor (AUC = 0.70 [0.63–0.77]). Conclusions: The STAR system effectively stratified the mortality risk among hospitalized COPD patients across grades 2 to 4. However, STAR grade 1 failed to differentiate patients with a lower risk. Although STAR may underestimate severity in individual patients with relatively preserved ratios, its integration into clinical evaluation could enhance prognostic assessments. Full article

Background: Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), is characterized by chronic intestinal inflammation with fluctuating clinical severity. Although fecal calprotectin (FC) and fecal occult blood (FOBT) are established noninvasive biomarkers of intestinal inflammation, their interplay with nutritional status and disease activity has not been fully elucidated. This study aimed to explore the relationship between FC, FOBT, and disease activity in IBD, and to assess the potential mediating role of nutritional status as measured by the prognostic nutritional index (PNI). Methods: This retrospective study includes 128 adult patients with confirmed IBD (50 UC and 78 CD) examined at a tertiary care center between December 2023 and August 2025. Disease activity was assessed using the Mayo score for UC and the Harvey–Bradshaw Index for CD. FC levels were quantitatively measured using an enzyme-linked immunosorbent assay (ELISA), and fecal occult blood testing was performed with an automated latex agglutination-based system. Multivariable linear regression models were conducted to identify independent predictors of disease activity. Results: UC patients had significantly higher FC levels (278.0 vs. 133.5 µg/g, p < 0.001), FOBT positivity rates (76.7% vs. 43.6%, p = 0.002), and lower PNI (49.2 ± 4.2 vs. 51.5 ± 4.6, p = 0.048) compared to CD patients. In both UC and CD, disease activity scores were positively correlated with FC, FOBT positivity, CRP, and duration of illness, and negatively correlated with PNI (p < 0.05). In multivariable regression, PNI lost predictive value when FC and FOBT were included; FC and FOBT remained strong independent predictors of disease activity. Conclusions: FC and fecal occult blood are independently associated with higher disease activity in IBD, and may mediate the observed relationship between poor nutritional status and inflammation severity. The loss of significance of PNI in adjusted models suggests that intestinal inflammation and bleeding may act as intermediaries linking malnutrition to disease activity. Full article

Objectives: This study aimed to assess the dynamics of liver tests (LT) and detect signs of liver fibrosis and steatosis 2.5 years after the first COVID-19 episode in patients without pre-existing liver-related conditions. Methods: The study included 65 adult patients hospitalized with COVID-19 (including 18 with severe or critical illness) in 2020. After 2.5 years, in addition to regular LT, liver health status was assessed by the FIB-4 index, hyaluronic acid, cytokeratin 18 fragment M30 (serum, ELISA), cardiometabolic risk factors, and the multiparametric ultrasound examination. Results: LT abnormalities in the acute COVID-19 period were observed more frequently (p = 0.036) in patients with severe or critical COVID-19 (83%) than in patients with non-severe COVID-19 (55%). LT dynamics in 2.5 years showed an improvement of liver health status in most patients (p = 0.006). Persistent LT abnormalities were associated with LT abnormalities during hospitalization (p = 0.021). After 2.5 years, the presence of cardiometabolic risk factors and signs of liver fibrosis were associated with the severity of the first COVID-19 episode. However, regression analyses did not support disease severity as a predictor for LT abnormalities and liver stiffness. The latter was predicted by cardiovascular diseases in the anamnesis. Conclusions: In most patients, LT normalized despite potential risk factors. Simultaneously, in some patients, signs of liver fibrosis after COVID-19 might be stimulated by COVID-19-related metabolic dysfunction and the presence of cardiovascular diseases. Full article

Background and Objectives: Although nutritional status is critical to the clinical outcomes of septic patients, studies on this topic are limited. We aim to assess the prognostic value of five nutritional screening tools (NSTs) for septic patients both at the time of admission to the intensive care unit (ICU) and five days later. Materials and Methods: This prospective observational study included adult septic patients in the ICU. Patients were divided into two groups: survivors and non-survivors. Clinical, laboratory characteristics, and NST values [The Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), Nutritional Risk Screening (NRS-2002), Geriatric Nutritional Risk Index (GNRI), and Nutrition Risk in the Critically Ill (NUTRIC)] were recorded at admission and on Day-5, and intergroup and intragroup comparisons were performed. Results: A total of 126 patients were included in this study: 97 in the survival group and 29 in the non-survival group. The non-survivors had higher CONUT and NUTRIC scores and lower PNI scores. Multivariate analysis found higher Day-5 NUTRIC scores independently associated with mortality. ROC analysis identified NUTRIC > 6 as a mortality predictor. Conclusions: Although several markers differed significantly between survivors and non-survivors, our findings show that a high Day-5 NUTRIC score was the only factor independently associated with mortality among NSTs. Full article

Background/Objectives: Accurate telephone triage of emergency medical cases plays a crucial role in improving outcomes for critically ill patients. Effective triage enables emergency medical dispatchers to provide appropriate pre-arrival instructions and to deploy operational units according to the patient’s severity level. This study aimed to develop and assess the content validity of the Emergency Medical Triage Protocol and Criteria-Based Dispatch Code (EMTP-CBDC) for Thailand. The objective was to ensure the tool’s content accuracy and applicability in prioritizing emergency responses in line with medical urgency, considering global changes and universal standards. Methods: A cross-sectional descriptive study was conducted from 15–30 April 2024. The content validity of the newly developed EMTP-CBDC, comprising 30 symptom groups, was evaluated by five emergency physician experts with at least 1 year of experience in emergency medical oversight. The assessment focused on four aspects: relevance, clarity, simplicity, and ambiguity. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and the scale level using the average index (S-CVI/Ave). To adjust for chance agreement, the probability of chance agreement (Pc) and the modified kappa coefficient (k*) were calculated for each item. Results: The content validation revealed I-CVI values ranging from 0.80 to 1.00 across all items. The S-CVI/Ave scores were 0.97 for relevance, 0.93 for clarity, 0.98 for simplicity, and 0.94 for ambiguity. These values surpassed the accepted thresholds for content validity. Conclusions: The EMTP-CBDC developed for Thailand demonstrated good content validity across relevance, clarity, simplicity, and ambiguity. Further studies are needed to establish its reliability and field performance before routine implementation. Full article

Background/Objectives: Depression accompanying hypertension increases the burden of illness and negatively affects patients’ lives. However, depression among elderly with cardiovascular diseases in general and hypertension in specific has not been paid proper attention, especially in the context of Vietnam. Therefore, we expected to examine the prevalence, characteristics, and related factors of depression on elderly patients with hypertension. Methods: A cross-sectional study at the Department of Geriatrics, Can Tho Central General Hospital (from April 2020 to February 2022), involving 414 patients aged ≥60 years with hypertension. Depression was assessed using ICD-10 diagnostic criteria; related factors were evaluated using the Pittsburgh Sleep Quality Index (PSQI), KATZ12 index, and UCLA-LS3-J11 scale. Results: 31.4% of participants were found to have depression (mild 17.7%, moderate 9.7%, severe 4.0%). Common characteristics of depression included sleep disturbances, decreased energy, and low mood. Poor sleep quality, being female, lower socioeconomic status, higher hypertension grade, and increased loneliness were found to be significantly associated with depression. Conclusions: The high prevalence of depression among elderly hypertensive patients highlights the need for effective screening and intervention strategies. Addressing factors such as sleep quality, gender, socioeconomic challenges, and social isolation may help mitigate the burden of depression in this vulnerable population. This research should be expanded to elderly patients with hypertension in society, outpatients, and individuals with other chronic diseases. Developing a predictive model for depression in elderly patients, particularly those with chronic diseases, can improve early detection, treatment effectiveness, and overall care quality. Full article

Acute kidney injury (AKI) is a frequent and severe complication in trauma patients, affecting up to 28% of intensive care unit (ICU) admissions and contributing significantly to morbidity, mortality, and long-term renal impairment. Trauma-related AKI (TRAKI) arises from diverse mechanisms, including hemorrhagic shock, ischemia–reperfusion injury, systemic inflammation, rhabdomyolysis, nephrotoxicity, and complex organ crosstalk involving the brain, lungs, and abdomen. Pathophysiologically, TRAKI involves early disruption of the glomerular filtration barrier, tubular epithelial injury, and renal microvascular dysfunction. Inflammatory cascades, oxidative stress, immune thrombosis, and maladaptive repair mechanisms mediate these injuries. Trauma-related rhabdomyolysis and exposure to contrast agents or nephrotoxic drugs further exacerbate renal stress, particularly in patients with pre-existing comorbidities. Traditional markers such as serum creatinine (sCr) are late indicators of kidney damage and lack specificity. Emerging structural and stress response biomarkers—such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), C-C motif chemokine ligand 14 (CCL14), Dickkopf-3 (DKK3), and the U.S. Food and Drug Administration (FDA)-approved tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein 7 (TIMP-2 × IGFBP-7)—allow earlier detection of subclinical AKI and better predict progression and the need for renal replacement therapy. Together, functional indices like urinary sodium and fractional potassium excretion reflect early microcirculatory stress and add clinical value. In parallel, risk stratification tools, including the Renal Angina Index (RAI), the McMahon score, and the Haines model, enable the early identification of high-risk patients and help tailor nephroprotective strategies. Together, these biomarkers and risk models shift from passive AKI recognition to proactive, personalized management. A new paradigm that integrates biomarker-guided diagnostics and dynamic clinical scoring into trauma care promises to reduce AKI burden and improve renal outcomes in this critically ill population. Full article

Background: Adults with developmental disabilities often experience accelerated aging, but the magnitude of this phenomenon is not well quantified. This study aimed to measure the disparity in functional ability and chronic illness prevalence between adults with developmental and other disabilities. Methods: A “functional age” was calculated for adults with developmental disabilities. This metric, designed as a statistical index of disparity, was derived from normative regression models of ADL and IADL based on a reference group of adults with other disabilities. Results: A profound gap was found between chronological and functional age. On average, a 44-year-old individual with a developmental disability exhibited a level of functional limitation equivalent to a person over 100 years older in the reference population for both ADL and IADL (p < 0.001). Conclusions: Accelerated aging in this population manifests as a severe, early onset functional disadvantage rather than an elevated burden of general chronic disease. Policies should shift toward function-based, not age-based, models of care to address these lifelong support needs. Full article

Background/Objectives: Malnutrition is common among patients with advanced chronic illnesses receiving palliative care, yet comparative data between diagnostic groups are limited. This study aimed to evaluate and compare the nutritional status of patients with end-stage chronic heart failure (CHF) and chronic respiratory disease (CRD), and to assess the clinical utility of the Controlling Nutritional Status (CONUT) score in this setting. Methods: We conducted a retrospective analysis of 80 patients (41 with CHF, 39 with CRD) enrolled in a palliative care program (mean age 77.8 ± 6.8 years, 65% male). Nutritional status was assessed using BMI (Body Mass Index), CONUT score, and routine biochemical markers. Functional and clinical variables, including the Palliative Performance Scale (PPS), were also collected. Results: Moderate-to-severe malnutrition (CONUT ≥ 5) was significantly more prevalent in patients with CHF patients (44%) than CRD patients (10%, p = 0.002). CHF patients exhibited lower BMI, cholesterol, lymphocyte counts, and prealbumin levels. Despite more frequent nutritional follow-up and protein supplementation in the CHF group, these interventions were not associated with improved nutritional classification. The CONUT score correlated more strongly with functional impairment (PPS) than with disease type alone. Conclusions: Patients with CHF receiving palliative care demonstrate higher rates of malnutrition than those with CRD. The CONUT score, derived from standard blood test, may be pragmatic screening tool for identifying nutritional vulnerability and guiding interventions. While it does not predict survival, it may help detect functional decline earlier and support care strategies aimed at maintaining quality of life in end-stage disease. Full article

Background: Older adults who are hospitalized in internal medicine wards often present with a challenging interplay of multimorbidity and geriatric syndromes. The timely identification of clinical and geriatric predictors of in-hospital mortality is crucial for guiding individualized care pathways and ensure appropriate resource allocation. In this study, we investigate the prognostic impact of frailty, delirium—including its motor subtypes—and global comorbidity burden on in-hospital mortality in patients aged 70 years and older. Methods: We conducted a retrospective observational study including 556 consecutive patients aged ≥ 70 years who were admitted to the Internal Medicine Unit of the University Hospital of Parma from January 2019 to July 2019. Demographic, clinical, and geriatric data were collected within 48 h of admission, including Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale (CIRS), and delirium diagnosis with the 4AT tool. Multivariate Cox and logistic regression analyses were performed, including sex-stratified models. Results: The median age was 85 years (IQR 80–89), 58% were female, and in-hospital mortality was 11% (n = 61). Non-survivors had higher rates of severe frailty (CFS ≥ 7: 39% vs. 16%, p < 0.001), prevalent delirium (20% vs. 4%, p < 0.001), hypokinetic delirium (20% vs. 5%, p < 0.001), liver disease (23% vs. 11%, p = 0.008), cancer (44% vs. 24%, p < 0.001), and dementia (43% vs. 29%, p = 0.026) and a higher CIRS severity index (≥3:55% vs. 31%, p < 0.001). In Cox regression, independent predictors of death were prevalent delirium (HR 4.66, 95% CI 2.42–8.96), CFS ≥ 7 (HR 2.26, 95% CI 1.32–3.87), CIRS-LIVER ≥ 2 (HR 2.05, 95% CI 1.18–3.56), and cancer (HR 1.83, 95% CI 1.07–3.14). Sex-stratified models showed that in males, prevalent delirium (HR 10.23) and cancer (HR 2.49) predicted mortality, whereas in females, hypokinetic delirium (HR 3.67) and CIRS-LIVER ≥ 2 (HR 2.75) were the strongest predictors. Logistic regression confirmed these associations and additionally identified anemia and CFS ≥ 7 in males and CIRS severity index ≥ 3 in females as significant risk factors. Conclusions: In elderly patients who are admitted to internal medicine wards, prevalent and hypokinetic delirium, severe frailty, and high comorbidity burden, particularly liver disease and cancer, are strong independent predictors of in-hospital mortality, with distinct sex-specific patterns. Early multidimensional geriatric assessment may improve risk stratification and guide targeted interventions. Full article

Background: Fibromyalgia syndrome (FS) is one of the most common causes of chronic generalised pain and often complicates the therapeutic management of inflammatory chronic arthritis (ICA), negatively impacting both the real assessment of disease activity and the perception of response. Our study aims to evaluate in a group of patients with ICA, multi-resistant to biologic/target synthetic disease-modifying antirheumatic drugs (b/ts-DMARDs), both the impact of FS on the possibility of achieving low disease activity (LDA) or remission (REM) and the possible improvement in the severity of FS symptoms, after starting b/ts-DMARDs with different a mechanism of action (MoA). Methods: A prospective study was conducted, from January 2023 to December 2024, on patients who fulfil the classification criteria for psoriatic arthritis (PsA) or fulfil the 2010 American College of Rheumatology criteria for RA. Results: Sixty-four Caucasian patients with ICA, of which 47 with FS, were enrolled in the study. At the baseline visit, FS patients had a significantly shorter ICA disease duration, worse fibromyalgia symptom-related indices (such as Fibromyalgia Severity Scale (FSS), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS)) and functional and disability scores (such as health assessment questionnaire (HAQ) and Functional Assessment of Chronic Illness Therapy (FACIT)), and a higher basal value of Disease Activity in Psoriatic Arthritis (DAPSA) score compared to patients without FS. After 6 months of starting b/ts-DMARDs, no differences in severity of arthritis clinimetric indices (disease activity score (DAS) 28 (erythrocyte sedimentation (ESR)) and DAPSA) and Visual Analogue Scale (VAS) pain were found between the patients with FS compared to those without. At the follow-up visit, 36% of the whole group of patients were in LDA (36% ICA patients with FS vs. 35% of ICA patients without FS; p = 0.080), while 17% of patients reached REM (11% ICA with FS vs. 35% ICA without FS patients; p = 0.031). The FS presence appeared to be a factor associated with failure to reach REM (OR 4.5 (95%CI: 1.1–17.8), p = 0.028), but not for achieving LDA (OR 2.7 (95%CI: 0.8–8.9), p = 0.099). The overall retention rate at 6 months was 79%; in particular, 11 patients discontinued treatment with b/ts-DMARD, 69% of whom belonged to the FS group (p = 0.489). Among the group of patients with ICA and FS, patients in LDA/REM presented an important improvement in FSS, SSS, and VAS pain, with the best percentage variation from the baseline of these indices compared to patients who did not achieve the LDA/REM. Of note, sixteen patients with FS at the baseline no longer met the diagnostic criteria for FS after 6 months of follow-up. Conclusions: The presence of FS seems to negatively impact the achievement of REM, but not LDA, in both RA and PsA patients, even in b/ts-DMARDs patients with multi-failure of at least two different MOAs. Only a cluster of patients with FS, presumably those with FS triggered and/or amplified by the chronic joint inflammatory process, appear to improve their perception of FS severity by achieving ICA LDA/REM. However, these findings require further supporting data for more accurate validation. Full article

Background: Childhood obesity is a pro-inflammatory state associated with poorer outcomes in chronic allergic diseases, such as asthma, and in adults, it is a recognized risk factor for more severe anaphylaxis. However, whether this association extends to the pediatric population remains unclear. Objectives: The aim of this study was to assess the association between nutritional status, as measured by Body Mass Index (BMI), and anaphylaxis severity and presentation in a cohort of hospitalized children. Methods: We retrospectively assessed the association between BMI categories (underweight, normal weight, overweight, and obese) and the severity (WAO grading) and clinical presentation of anaphylaxis in 199 hospitalized children (0–18 years). Results: No statistically significant association was found between BMI categories and anaphylaxis severity (χ² = 7.06, p = 0.861). Severe reactions (WAO grades 4–5) were rare across BMI categories, occurring in 0% of underweight, 3.8% of normal-weight, 9.1% of overweight, and 7.7% of obese children. In regression analyses adjusting for age, sex, asthma, and atopic dermatitis, BMI was not an independent predictor of anaphylaxis severity, whether considered as a categorical or continuous variable (all odds ratios non-significant, 95% CIs crossing 1). Similarly, organ system involvement did not differ between BMI groups (all p > 0.05). Conclusions: In this pediatric cohort, contrary to findings in adults, we did not find nutritional status to be a predictor of anaphylaxis severity or presentation. This suggests obesity’s role as a risk factor may be age-dependent and that adult data should be extrapolated to children with caution. Full article

Imaging through dynamic scattering media remains a fundamental challenge because of severe information loss and the ill-posed nature of the inversion problem. Conventional methods often struggle to strike a balance between reconstruction fidelity and efficiency in evolving environments. In this study, we present DynaFlowNet, a framework that leverages conditional flow matching theory to establish a continuous, invertible mapping from speckle patterns to target images via deterministic ordinary differential equation (ODE) integration. Central to this is the novel temporal–conditional residual attention block (TCResAttnBlock), which is designed to model spatiotemporal scattering dynamics. DynaFlowNet achieves real-time performance at 134.77 frames per second (FPS), which is 117 times faster than diffusion-based models, while maintaining state-of-the-art reconstruction quality (28.46 dB peak signal-to-noise ratio (PSNR), 0.9112 structural similarity index (SSIM), and 0.8832 Pearson correlation coefficient (PCC)). In addition, the proposed framework demonstrates exceptional geometric generalization, with only a 1.05 dB PSNR degradation across unseen geometries, significantly outperforming existing methods. This study establishes a new paradigm for real-time high-fidelity imaging using dynamic scattering media, with direct implications for biomedical imaging, remote sensing, and underwater exploration. Full article

Background/Objectives: Previous research has demonstrated that the lactate/albumin ratio (L/A) may predict mortality among critically ill patients. Based on pathophysiological rationale, L/A may also correlate with volume status, however such an association has not been investigated extensively. This retrospective cohort study aimed to confirm the prognostic value of L/A and to assess the prognostic value of L/A and its relationship with hypovolemia severity in intensive care unit (ICU) patients. Methods: We analyzed data from consecutive adult patients admitted to the ICU. Admission L/A was evaluated in relation to 30-day mortality and indirect markers of volume status (mean arterial pressure on admission, median dose of norepinephrine and fluid intake within the first 24 h of ICU stay). Results: A total of 1421 patients were included. L/A ≥ 0.06 (estimated on the basis of ROC curve using the Youden index) was an independent predictor of 30-day mortality (HR = 1.423; 95%CI 1.183–1.712; p < 0.001). L/A moderately correlated with markers of absolute or relative hypovolemia, i.e., lower mean arterial pressure (r = −0.353, p < 0.001) on admission, higher norepinephrine dose (r = 0.506, p < 0.001) and greater fluid intake (r = 0.233, p < 0.001) within the first 24 h of ICU stay. Furthermore, L/A ≥ 0.06 on admission was an independent risk factor for the implementation of continuous renal replacement therapy (OR = 2.134; 95%CI 1.652–2.757; p = 0.001). Conclusions: L/A is not only a predictor of poor prognosis but also may be a valuable indirect marker of the extent of hypovolemia in critically ill patients. Further prospective studies are necessary to assess if this parameter should incline a decision for more aggressive fluid management in hypovolemic patients. Full article