Search Results (403)

Background/Objectives: Cardiac implantable electronic device-related infective endocarditis (CIED-RIE) is a serious condition with significant morbidity and mortality. Although recent advances in imaging and therapeutic approaches have improved management, diagnosing and treating CIED-RIE continues to be challenging. This study aimed to identify factors associated with mortality in CIED-RIE patients. Methods: We conducted a retrospective, multicenter international study of adult patients diagnosed with CIED-RIE between January 2014 and June 2024. Data on demographics, clinical presentation, microbiological findings, imaging results, treatment modalities, and outcomes were collected and analyzed to determine predictors of short-term mortality. Results: A total of 197 patients (mean age: 65.3 ± 14.4 years; 75.1% male) were included. The most common device type was permanent pacemaker (48.2%). Staphylococcus species were the predominant pathogens (62.4%). Surgical intervention was performed in 67.5% of patients, and 90-day mortality occurred in 19.3%. Multivariable analysis identified higher Charlson comorbidity index (HR: 1.31), tricuspid valve involvement (HR: 2.35), vegetation size ≥ 10 mm (HR: 2.53), pulmonary embolism (HR: 3.92), and absence of surgical intervention (HR: 2.90) as independent predictors of increased 90-day mortality. Conclusions: Early identification of high-risk patients and prompt multidisciplinary management, including surgical intervention when indicated, are critical to improving outcomes in patients with CIED-RIE. Full article

Intraventricular hemorrhage (IVH) is a common complication of prematurity and continues to represent a considerable threat due to its association with significant short- and long-term morbidity and mortality. Despite the advances in neonatal care, the prevalence of IVH, particularly in the extremely preterm neonates, remains high. Therefore, it is imperative to recognize and implement in clinical practice preventive strategies, non-pharmacological or pharmacological, to reduce IVH effectively. The aim of this narrative review is to provide an overview of novel and debatable preventive measures for IVH that are promising for clinical use and could potentially improve outcomes for very preterm neonates. IVH prevention bundles (IVHPBs) consist of strategies that aim to minimize hemodynamic and cerebral perfusion fluctuations, which are a crucial component of IVH pathogenesis. Early postnatal prophylactic indomethacin, erythropoietin, and insulin-growth factor-1 administration have shown encouraging results on IVH prevention; however, the literature is still inconclusive. Stem-cell-based interventions represent novel and promising techniques with the potential to contribute to the prevention of IVH. The prevention of IVH remains a field of investigation, and there is a requirement for conclusive evidence and recommendations. The necessity for further large-scale prospective studies is therefore evident. Full article

Background and Objectives: Partial nephrectomy is the standard treatment for small renal tumors, balancing cancer control with renal function preservation. Robot-assisted partial nephrectomy (RAPN) has improved surgical precision and reduced morbidity. Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) improves intraoperative visualization of renal vasculature and tissue perfusion, potentially enabling selective arterial clamping to reduce ischemic injury. This study updates contemporary evidence on NIRF/ICG-guided RAPN, focusing on intraoperative, perioperative, and renal function outcomes. Materials and Methods: We systematically queried PubMed, Scopus, and Web of Science databases up to June 2025 for controlled prospective and retrospective studies comparing NIRF/ICG-guided RAPN (selective clamping or zero-ischemia) versus conventional RAPN with main artery clamping in adults with renal masses. Data were synthesized narratively, and random-effects meta-analyses were performed on warm ischemia time (WIT), operative time, estimated blood loss, transfusion rate, length of hospital stay, complication rate, positive surgical margins, and variation in renal function. Results: Eleven studies (10 full-text and one abstract), including two randomized controlled trials, encompassing a patient population of 893 patients (403 NIRF/ICG-guided RAPN and 490 conventional RAPN), were included. Ischemia strategies varied between no clamping, selective or super-selective clamping for NIRF/ICG, and main artery clamping for controls. ICG doses ranging from 3 to 7.5 mg or 0.5–7 mL. Most evidence was classified as level 2b or 3b, indicating a moderate to serious risk of bias. Meta-analysis showed that compared to conventional RAPN, NIRF/ICG-guided RAPN was associated with a shorter WIT (MD: −1.30 min, 95% CI: −2.51 to −0.09; p = 0.039), with no differences in other outcomes. Renal function favored NIRF/ICG at discharge and short-term follow-up, although the difference was not statistically significant. Conclusions: NIRF/ICG reduces WIT during RAPN without increasing perioperative risks. The technique shows promise for better preserving functional outcomes. However, further well-designed, large-scale trials with longer follow-up are needed to confirm these benefits and define clinical indications. Full article

(1) Background: In addition to its fatal outcomes, COVID-19 is associated with a spectrum of non-fatal complications that significantly influence clinical trajectories and quality of life. Cardiovascular complications, in particular, are of major clinical relevance and are recognized as key contributors to both short- and long-term morbidity and mortality. The aim of the present study was to evaluate the short-term and long-term effects of COVID-19 infection on patients with underlying cardiovascular diseases. (2) Methods: The prospective cohort study included a total of 99 consecutive subjects hospitalized due to moderate and severe forms of COVID-19 pneumonia in “Zvezdara”—University Medical Center in the period of 18 March–18 April 2021. (3) Results: During hospitalization, 47% of patients had some new cardiovascular events. A total of 10 patients died during hospital stay. The highest chance for the lethal outcome was seen in those with previously diagnosed coronary heart disease (B = 3.356, OR = 28.667 (95% CI 2.69–305.14), p = 0.005), heart failure (B = 3.056, OR = 21.250 (95% CI 3.36–134.56), p = 0.001) and increased potassium values (B = 2.639, OR = 14.000 (95% CI 2.65–73.88), p = 0.002). (4) Conclusions: Care strategies for patients who survived the acute episode of COVID-19 should include attention to cardiovascular disease. Our findings emphasize the need for continued optimization of strategies for primary prevention of SARS-CoV-2 infections as the best way to prevent long COVID and serious cardiovascular complications. Full article

Necrotizing pneumonia is a serious complication of pediatric pneumonia, characterized by liquefaction and cavitation of the lung parenchyma. Streptococcus pneumoniae and Staphylococcus aureus are the most implicated organisms. Mycoplasma pneumoniae has been an increasingly recognized pathogen, especially is Asian and Pseudomonas aeruginosa is mainly noted in a higher percentage of patients with complex chronic conditions. Clinical presentation typically includes fever, respiratory distress, and failure to respond to standard antibiotic therapy. These patients are more likely to have pleural involvement in the form of effusion or empyema and a higher need for respiratory support. Diagnosis is typically through a combination of chest radiographs, lung ultrasound, and chest computed tomography. Management is primarily via prolonged intravenous antibiotics that cover the above organisms, though pleural drainage with fibrinolytics is often required. Surgical intervention is often reserved for refractory cases that fail initial fibrinolytic therapy. Prognosis is usually favorable in the short and long term, though early recognition and appropriate management are imperative to reduce the duration of illness and morbidity. Full article

Introduction: Fetal Inflammatory Response Syndrome (FIRS) is widely acknowledged for its contribution to neonatal morbidity in premature infants. Being a systemic inflammatory process triggered by intrauterine infections or other stimuli, FIRS has gained significant attention due to its complex implications for neonatal adverse outcomes: preterm birth, early onset neonatal sepsis, death or long-term neurodevelopmental impairments. Fetal plasma Interleukin-6 (IL-6) levels above 11 pg/mL define FIRS and serve as an essential biomarker, providing insights into the complex mechanisms underlying this response. This study aims to evaluate the clinical, laboratory, and therapeutic differences between preterm neonates with and without FIRS. Methods: A prospective cohort study was conducted, involving 125 preterm neonates with gestational ages between 23 and 37 weeks, who were admitted to the Neonatal Intensive Care Unit (NICU) at the Emergency University Hospital Bucharest between April 2023 and April 2025. Infants were stratified into FIRS and non-FIRS groups based on the measurement of cord blood IL-6 levels greater than 11 pg/mL. Demographic, biochemical, and therapeutic parameters were compared across the two groups. Results: Preterm neonates with FIRS had significantly lower birth weight, length, and head circumference, and lower Apgar scores at 1 and 5 min (p = 0.001). FIRS was associated with a higher incidence of vaginal delivery, meconium-stained amniotic fluid, and neonatal metabolic imbalances, requiring more respiratory support, longer antibiotic treatment periods, and more blood transfusions (p < 0.05). Neonatal complications such as early-onset sepsis (EOS) and late-onset sepsis (LOS), respiratory distress, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP) were significantly more frequent in the FIRS group (p ≤ 0.01). Among maternal cervical screening, Chlamydia trachomatis was the only pathogen significantly associated with FIRS. Conclusions: FIRS in preterm neonates is linked to important perinatal inflammation, adverse short and long-term outcomes, and extensive medical intervention. These findings highlight the value of early identification of intrauterine inflammation and targeted neonatal monitoring strategies. Further studies are needed to explore long-term outcomes and improve diagnostic and therapeutic protocols. Full article

Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies. Results: A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis. Conclusions: Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery. Full article

(1) Background: Prematurity remains a leading contributor to neonatal morbidity and mortality, with long-term consequences that extend well beyond the neonatal period. This cross-sectional study aimed to identify key maternal, perinatal, and neonatal factors that influence the short- and long-term evolution of preterm infants. It also seeks to evaluate the level of post-discharge follow-up care, parental involvement during NICU hospitalization, access to supportive therapies such as physiotherapy and RSV prophylaxis, and the impact of breastfeeding practices. Additionally, the study explores parental awareness and use of recent national initiatives in Romania, such as the “Premature and Vulnerable Newborn’s Notebook”. (2) Methods: A total of 360 mothers of preterm infants born between 2001 and 2025 responded to a structured questionnaire assessing clinical characteristics, NICU care, parental involvement, and post-discharge support. (3) Results: The findings indicate that assisted reproduction and pregnancy plurality were associated with higher maternal age, while vaginal delivery was associated with lower gestational age at birth. Notably, only 25% of infants were enrolled in structured follow-up programs, and a large proportion of families relied on private services for physical therapy. Kangaroo mother care was reported by just 16.4% of mothers. While breastfeeding rates improved after discharge, access to multidisciplinary follow-up and public physiotherapy remains limited. Encouragingly, most mothers endorsed the proposed national initiative for a “Premature and Vulnerable Newborn’s Notebook.” (4) Conclusions: This study underscores the urgent need for a comprehensive national follow-up strategy to ensure equitable and continuous care for Romania’s vulnerable preterm population. Full article

Major surgical operations of the gastrointestinal tract, such as colorectal resections, lead to significant burden on the human body, which is expressed during the first postoperative hours with an intense inflammatory reaction and consumption of a large amount of energy, increasing patients’ nutritional requirements. Therefore, specific protocols have been implemented for the early initiation of oral feeding. However, not every patient could meet them due to old age and associated pathophysiological changes, the use of opioid drugs for the management of postoperative pain (which is associated with postoperative ileus or nausea), as well as open resections which might lead to gastrointestinal impairment during the first postoperative days. Therefore, a tailored nutritional approach after colorectal resections seems necessary under specific conditions. Parenteral nutrition could be part of this personalized treatment, as it might counterbalance the energy deficit occurring during the early postoperative period, which appears to be associated with adverse clinical outcomes. Nevertheless, the conventional way of administration through central venous lines is associated with significant complications. On the other hand, the alternative administration of parenteral nutrition through a peripheral venous catheter could avoid morbidity, maintaining patients’ energy balance even during the first postoperative hours. However, the efficacy of peripheral parenteral nutrition on the postoperative outcomes of patients undergoing colorectal resections needs to be investigated in prospective randomized trials. The aim of the present review is to present the current trends regarding administration of peripheral parenteral nutrition (PPN) after colorectal resections and highlight any potential correlations between PPN and postoperative inflammatory reaction, as well as short-term nutritional status. Full article

Background/Objectives: Umbilical cord pH is used as a predictor of risk for poor neurologic outcome in high-risk newborns. While data on neonates with severe acidemia show a strong association with birth asphyxia and long-term adverse outcomes, the significance of mild-to-moderate acidemia is less clear. This study aimed to investigate short-term outcomes of late preterm and term infants born with mild-to-moderate cord blood acidosis and to compare the predictive ability of pH and base excess. Methods: This was a retrospective cohort study, including term and late preterm (≥34 weeks) neonates with mild–moderate umbilical cord blood acidosis, defined as pH 7.0–7.2 or base excess between −12 and −16. Data including demographic, clinical, and laboratory measures were extracted. The cohort population was stratified based on the level of acidosis, mild or moderate, with separate analyses performed by definitions of pH and BE. Mild acidosis was defined as cord blood pH 7.13–7.20 and base excess > −12 and moderate acidosis was defined as cord blood pH 7.00–7.12 or base excess between −12 and −16. Results: The study included 337 newborns. Most had mild acidosis, but 90 infants had BE of −12 to −16 and 86 infants had pH 7.00–7.12. Rate of NICU admission was 12.8% (43/337), rising up to 27% among newborns with moderate acidosis. The leading cause for admission was respiratory distress, and there were no cases of moderate–severe HIE. Renal and hepatic dysfunction were more common in moderate compared to mild acidosis; however, most lab abnormalities were mild and transient. Using ROC curves, BE ≤ −12 was found to be a better predictor for renal and liver involvement than pH ≤ 7.12. Conclusions: Moderate acidosis in cord blood was associated with an increased incidence of short-term neonatal morbidities, NICU admissions and renal or liver dysfunction compared to mild cord blood acidemia. BE correlated with abnormal values better than pH. Infants with cord gas BE levels ≤ −12 may benefit from closer clinical monitoring and assessment of renal and liver function. Full article

Background: Rib fractures are among the most common thoracic injuries following blunt trauma and are associated with significant morbidity, particularly in elderly and polytrauma populations. Historically managed non-operatively, recent advances have redefined the role of surgical stabilization of rib fractures (SSRF) in improving patient outcomes. The objective of this narrative review is to evaluate current evidence surrounding the management of rib fractures, with a focus on indications for SSRF, surgical techniques, special populations, and future directions in care. Methods: A narrative review of the literature was conducted, incorporating relevant randomized controlled trials, cohort studies, clinical guidelines, and expert consensus statements. Emphasis was placed on patient selection criteria, surgical strategies, multimodal analgesia, and emerging technologies. Results: SSRF has demonstrated benefits in short- and long-term outcomes, including improved pain control, reduced ventilator dependence, shorter ICU and hospital stays, and better functional recovery. These outcomes are most evident in patients with flail chest, severe displacement, or failure of conservative therapy. Minimally invasive techniques and 3D-printed implants represent promising innovations. Despite growing evidence, SSRF remains underutilized due to variability in institutional protocols and access to trained personnel. Conclusions: The management of rib fractures continues to evolve with increasing support for surgical intervention in select patients. Wider implementation of SSRF, guided by standardized protocols and advanced technologies, may improve outcomes and reduce complications in this high-risk trauma population. Full article

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop a predictive score for postoperative AKI and assess the associations between AKI, chronic kidney disease (CKD), and 1-year mortality. Methods: This was a retrospective study in a cancer referral center in Marseille, France, from 2018 to 2022. Results: Among 169 patients, 55 (32.5%) experienced AKI. Multivariate analysis revealed several independent risk factors for postoperative AKI, including age, body mass index, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, time to liver resection, intraoperative shock, and bile duct reconstruction. Neoadjuvant chemotherapy was protective. The AKIMEBO score was developed, with a threshold of ≥15.6, demonstrating a sensitivity of 89.5%, specificity of 76.4%, positive predictive value of 61.8%, and negative predictive value of 94.4%. AKI was associated with increased postoperative morbidity and one-year mortality following major hepatectomy. Conclusion: AKI is a common complication post-hepatectomy. Factors such as time to liver resection and intraoperative shock management present potential clinical intervention points. The AKIMEBO score can provide a valuable tool for postoperative risk stratification. Full article

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients, evaluate the short-term and long-term results, including complications and functional outcomes, as well as to share some unique observations regarding the use of BTM in paediatric population. Patients and Methods: Patients undergoing reconstructive surgery and BTM application during the last three years were included. Data collected included patient demographics, primary diagnosis, previous surgical management, post-operative complications and final outcomes. BTM was used in 32 patients. The indications varied including epidermolysis bullosa (n = 6), burns (n = 4), trauma (n = 7), infection (n = 4), ischemia or necrosis (n = 11). Results: The results were satisfying with acceptable aesthetic and functional outcomes. Complications included haematoma underneath the BTM leading to BTM removal and re-application (n = 1), BTM infection (n = 1) and split-thickness skin graft failure on top of BTM requiring re-grafting (n = 2). Conclusions: BTM can be a good alternative to large skin grafts, locoregional flaps or even free flaps. The big advantages over other dermal substitutes or skin grafts are that BTM is less prone to infection and offers excellent scarring by preserving the normal skin architecture. Specifically in children, BTM might not require grafting, resulting in spontaneous healing with good scarring. In critically ill patients, BTM reduces the operation time and there is no donor site morbidity. BTM should be considered in the reconstructive ladder when discussing defect coverage options in children and young people. Full article

Osteoporosis is a chronic disease associated with significant morbidity and mortality and requires long-term therapy. Efficacious and well-tolerated treatments are available, but their effect is either short-lived or lost following their discontinuation. The exception is bisphosphonates that reduce bone resorption and turnover, can be administered in regimens ranging from once-daily to once-yearly, and have been shown in randomized clinical trials to reduce the incidence of all osteoporotic fractures, but their effect persists following their discontinuation. This is due to their property of being taken-up selectively by the skeleton and being slowly released following treatment arrest. This property allows the discontinuation of bisphosphonate treatment for different periods of time, the so-called drug holiday, which reduces the risk of rare adverse events while maintaining the effect; an action particularly important for patients at very high risk of fractures for whom sequential therapy with different agents is currently advised. Thus, bisphosphonates, apart from being the treatment of choice for certain groups of patients, are also indispensable for the consolidation and maintenance of the gains of all other treatments, providing, in addition, the opportunity of temporary treatment arrest. Most patients with postmenopausal osteoporosis will, therefore, receive bisphosphonate at some stage during therapy of their disease, regardless of their initial fracture risk. Full article