Search Results (247)

Patients presenting with abdominal pain and/or distension require rapid diagnostics to narrow the differential diagnosis from a long list of obstructive gastrointestinal (GI) pathologies that may appear clinically similar but warrant distinct management. While the workup of abdominal distension currently centers around computed tomography (CT), this modality is costly, requires radiation exposure, and necessitates patient transport, potentially delaying care. In contrast, point-of-care ultrasound (POCUS) avoids ionizing radiation and the need for patient transport while providing some insight into the gastrointestinal size and function. While POCUS cannot currently replace CT in the definitive diagnosis of GI obstructive pathologies, it remains a promising tool to help with the initial triage and monitoring responses to therapy for several causes of functional and/or mechanical GI obstruction, such as gastric dilation, ileus, and small bowel obstruction. Because the obstruction severity and features can evolve over time, POCUS enables serial examinations to monitor the progression or resolution. This manuscript reviews characteristic sonographic findings that help distinguish obstructive GI conditions and highlights practical techniques for integrating gastric and intestinal POCUS to improve diagnostic accuracy and expedite treatment. Full article

Introduction: Evidence on steroid treatment for established bronchopulmonary dysplasia (BPD) is sparse. To our knowledge, a systematic review has never been conducted on this topic. This meta-analysis aims to synthesize available evidence for the use of postnatal steroids to treat established BPD. Methods: MEDLINE, Embase, Cochrane databases, and gray literature sources were searched without time or language restrictions until October 2024. We included randomized and non-randomized trials (analyzed separately) that evaluated postnatal steroids started from 28 days of life in preterm infants diagnosed with BPD. Certainty of evidence was assessed using the GRADE approach. Results: The search retrieved 9113 records, and 20 studies were included. Meta-analysis of the RCTs demonstrated that steroids significantly reduced oxygen requirement (daily mean difference of 1.6%, 95% CI 0.25–2.95), but the analysis did not identify significant differences in total duration of supplemental oxygen, length of stay, or mortality (moderate quality). From a safety perspective, steroids resulted in a transient increase in systemic blood pressure (mean difference of 6.8 mmHg, 95% CI 4.6–8.9) (moderate quality). Weight gain during treatment was lower in the systemic steroid group (−9.2 g/day, 95% CI −11.7 to −6.8) (moderate quality), although overall growth was reported as equal (2.4 g/day, 95% CI −0.3 to 6.3) (moderate quality). One retrospective study reported the incidence of steroid treatment among infants with established BPD (any definition) to be as high as 36%. Two single-arm studies reported a prolonged high-dose systemic steroid regimen as the routine treatment strategy for severe established BPD. Conclusions: Moderate quality of evidence suggests that steroid treatment cannot be recommended as standard of care for established BPD. However, corticosteroids are often used to this end. Large-scale RCTs designed to treat BPD are urgently needed. Furthermore, careful consideration for patient selection and compliance with GRADE methodology is essential. 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

Background: Cardiopulmonary resuscitation (CPR) is a highly effort-intensive intervention and, in cases of cardiac arrest, the ability to predict a return of spontaneous circulation (ROSC) is of great importance for the efficient use of resources. This real-time assessment approach offers a practical advantage by increasing the applicability of prognostic models during acute resuscitation in an emergency department. Method: In this study, the data of patients who underwent CPR in the emergency department of a tertiary care hospital between 1 June 2019 and 1 June 2024 and underwent cardiopulmonary resuscitation were retrospectively analyzed. The patients’ demographics, comorbidities, CPR characteristics, and laboratory findings were evaluated using logistic regression and ROC curve analysis to identify the predictors of ROSC. Result: Our study revealed that cases with shockable rhythms and a shorter CPR duration were more likely to achieve ROSC. Elevated levels of albumin, creatine kinase, glucose, hemoglobin, and white blood cells were significantly associated with ROSC, while higher levels of creatinine, base excess, and eosinophils were more common in non-survivors. Atrial fibrillation and neurodegenerative disease were associated with lower ROSC rates. Conclusions: Although the criteria for the termination of cardiac arrest resuscitation are not definitive, certain patient characteristics and laboratory findings may guide the prediction of ROSC or the identification of cases requiring prolonged CPR. The integration of these real-time predictors into clinical algorithms may support decision making in crowded emergency departments. Full article

Mucormycosis is a rare invasive fungal disease in pediatric patients with hematological malignancies and is associated with poor outcomes. We present a fulminant and ultimately fatal case of rhino-orbito-cerebral mucormycosis, addressing important issues including clinical signs and symptoms, diagnostic approaches and the challenges of timely diagnosis. The patient was an 11-year old girl undergoing re-induction chemotherapy for Central Nervous System relapse of B-cell precursor acute lymphoblastic leukemia. She presented six days into the second course of chemotherapy in profound neutropenia with aggravating headaches, painful abducens nerve palsy and anisocoria. At first (day −3), no significant radiological or ophthalmological correlations were found, and methyl–prednisolone was started due to suspected vasculitis following ICU admission. After further clinical deterioration, a second MRI scan (day 0) revealed a prolonged occlusion of the left carotid artery, which was successfully stented in a neuroradiological intervention (day +1). However, during the next day the child developed clinical signs indicating severe cerebral dysfunction. An emergency CT scan showed complete infarction of the left hemisphere including a progredient perfusion deficit and beginning brain edema. Based on the unfavorable prognosis, best supportive care was initiated, and the patient deceased on day +2. Pathological and microbiological workup identified thrombotic infarction in all major cerebral arteries. While microscopy was suspicious for mucormycosis, nested PCR from retained blood specimens confirmed the genus Lichtheimia. Final NGS on brain tissue led to the identification of Lichtheimia ramosa. This case illustrates the rapidity and severity of Mucorales infection. It shows the importance of early clinical suspicion and the need for an aggressive laboratory testing algorithms. The stratification of risk factors and definition of red flags may be a future task fighting these infections. Full article

The Internet of Things (IoT) has emerged as a transformative technology in managing Alzheimer’s Disease (AD), offering novel solutions for early diagnosis, continuous patient monitoring, and assistive care. This review presents a comprehensive analysis of IoT-enabled systems tailored to AD care, focusing on wearable biosensors, cognitive monitoring tools, smart home automation, and Artificial Intelligence (AI)-driven analytics. A systematic literature survey was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify, screen, and synthesize 236 relevant studies primarily published between 2020 and 2025 across IEEE Xplore, PubMed, Scopus and Web of Science. The inclusion criteria targeted peer-reviewed articles that proposed or evaluated IoT-based solutions for AD detection, progression monitoring, or patient assistance. Key findings highlight the effectiveness of the IoT in detecting behavioral and cognitive changes, enhancing safety through real-time alerts, and improving patient autonomy. The review also explores integration challenges such as data privacy, system interoperability, and clinical adoption. The study reveals critical gaps in real-world deployment, clinical validation, and ethical integration of IoT-based systems for Alzheimer’s care. This study aims to serve as a definitive reference for researchers, clinicians, and developers working at the intersection of the IoT and neurodegenerative healthcare. Full article

The optimal sequencing of chemotherapy in locally advanced gastric cancer (LAGC) remains controversial. This study aimed to compare survival outcomes between adjuvant (ACT) and neoadjuvant (NACT) chemotherapy and to identify clinicopathological factors associated with progression-free survival (PFS) and overall survival (OS) in a real-world setting. Methods: We retrospectively analyzed 103 patients with non-metastatic gastric cancer treated between 2014 and 2024. Patients were categorized into ACT (n = 56) and NACT (n = 47) groups. Kaplan–Meier and Cox regression analyses were used to assess survival outcomes and prognostic factors. Results: The NACT group was younger and had more proximal tumors. Median OS was 48.7 months in the ACT group versus 17.7 months in the NACT group (p = 0.048). Median PFS was not reached in the ACT group and was 15.6 months in the NACT group (p = 0.008). Negative surgical margin status was independently associated with improved survival, whereas age was an independent negative prognostic factor for OS. No significant associations were found between OS or PFS and histologic subtype, lymphovascular invasion, perineural invasion, gender, D2 dissection, or type of surgery. Notably, 21% of NACT patients did not proceed to surgery due to progression, treatment intolerance, or refusal. Conclusion: Although ACT was associated with longer PFS and OS in this cohort, these differences are most likely explained by baseline imbalances, patient selection factors, and survivorship bias rather than the timing of chemotherapy itself. These findings highlight the importance of careful patient selection for NACT and underscore the need for prospective, randomized studies to define optimal sequencing strategies in LAGC. Our study contributes descriptive, real-world data rather than definitive evidence of treatment superiority. Full article

Background: Myasthenia gravis (MG), a chronic autoimmune disorder with variable disease trajectories, presents considerable challenges for clinical stratification and acute care management. This systematic review evaluated machine learning models developed for prognostic assessment in patients with MG. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Scopus for relevant articles published from January 2010 to May 2025. Studies using machine learning techniques to predict MG-related outcomes based on structured or semi-structured clinical variables were included. We extracted data on model targets, algorithmic strategies, input features, validation design, performance metrics, and interpretability methods. The risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool. Results: Eleven studies were included, targeting ICU admission (n = 2), myasthenic crisis (n = 1), treatment response (n = 2), prolonged mechanical ventilation (n = 1), hospitalization duration (n = 1), symptom subtype clustering (n = 1), and artificial intelligence (AI)-assisted examination scoring (n = 3). Commonly used algorithms included extreme gradient boosting, random forests, decision trees, multivariate adaptive regression splines, and logistic regression. Reported AUC values ranged from 0.765 to 0.944. Only two studies employed external validation using independent cohorts; others relied on internal cross-validation or repeated holdout. Of the seven prognostic modeling studies, four were rated as having high risk of bias, primarily due to participant selection, predictor handling, and analytical design issues. The remaining four studies focused on unsupervised symptom clustering or AI-assisted examination scoring without predictive modeling components. Conclusions: Despite promising performance metrics, constraints in generalizability, validation rigor, and measurement consistency limited their clinical application. Future research should prioritize prospective multicenter studies, dynamic data sharing strategies, standardized outcome definitions, and real-time clinical workflow integration to advance machine learning-based prognostic tools for MG and support improved patient care in acute settings. Full article

Background: Klebsiella pneumoniae represents a major cause of healthcare-associated infections in intensive care units, with resistance profiles ranging from multidrug-resistant to extensively drug-resistant and pandrug-resistant. Critically ill patients, who often require invasive devices and prolonged antibiotic therapy, are especially vulnerable to colonization and infection by these strains. Surveillance data on resistance trends and specimen-specific patterns in Romanian intensive care units (ICUs) remain limited. Methods: We conducted a four-year surveillance study (2021–2024) in a tertiary Romanian ICU, analyzing K. pneumoniae isolates collected from diverse clinical specimens. Resistance phenotypes were classified as MDR, XDR, PDR, or susceptible based on standard definitions. Trends over time were assessed using Cramér’s V and correspondence analysis, while stratification by specimen type evaluated associations between anatomical site and resistance profiles. Results: A total of 254 K. pneumoniae isolates were analyzed. MDR strains predominated in 2021 and 2022 but sharply declined by 2024 (from 80% to 8.3%). In parallel, XDR and PDR phenotypes increased substantially, indicating a shift toward more complex resistance profiles. A significant temporal association was found (Cramér’s V = 0.43), with 2024 marked by a sharp decline in MDR isolates and a predominance of XDR and PDR phenotypes, reflecting an advanced resistance profile. Specimen-type analysis showed tracheal aspirates as the main reservoir for resistant strains, followed by urine and blood cultures, with a weaker but meaningful association (Cramér’s V = 0.24). Conclusions: These findings reveal a change in resistance patterns in ICU-acquired K. pneumoniae infections, with MDR strains being displaced by XDR and PDR phenotypes. These findings highlight the urgent need for time- and specimen-informed resistance monitoring and adaptive antimicrobial stewardship. Without targeted interventions, gains made in controlling MDR strains risk being rapidly eclipsed by the spread of highly resistant organisms. Full article

Objectives: The objective of this study was to investigate the relationship between the simultaneous 75 g Oral glucose tolerance test (OGTT), gestational diabetes mellitus (GDM), and fetal pancreatic circumference at 24–28 weeks of gestation. Methods: This prospective case–control study was conducted between September 2024 and February 2025 at our perinatology clinic, which provides tertiary health care services. The correlation between the 75 g OGTT, GDM, and pancreatic circumference was assessed by comparing fetal pancreatic circumference between the groups with and without GDM at the time of diagnosis. Results: A total of 130 pregnant patients were recruited for this` study, with 64 patients forming the GDM group and 66 patients forming the control group. Fetal pancreas circumference (7.0 cm vs. 6.4 cm, p < 0.001), fetal pancreas circumference percentile (88.5 vs. 52, p < 0.001), and the rate of fetal pancreas size >90th percentile (15.6% vs. 3%, p < 0.001) were significantly higher in the GDM group compared to the control group. Conclusions: Although our findings demonstrate a statistically significant correlation between fetal pancreatic circumference and GDM, diagnostic performance remains modest. Therefore, fetal pancreatic circumference should be interpreted as a supportive marker, such as family history, rather than a definitive marker for identifying individuals at risk for GDM. Full article

Background: The development of brain metastases (BM) is a relatively uncommon but significantly adverse event in the spread of colorectal cancer (CRC). Although management of CRC BM has improved with advances in imaging and systemic therapies, clinical outcomes remain poor. Methods: This retrospective cohort study used the U.S. National Cancer Database to evaluate survival outcomes, treatment patterns, and prognostic factors in CRC patients diagnosed with BM between 2010 and 2020. Patients with isolated brain-only metastases formed the primary analytic cohort, while those with additional extracranial metastases were included for descriptive comparison. Multivariable Cox proportional hazards and logistic regression models were used to assess factors associated with of survival. Proportional hazards assumptions were tested using Schoenfeld residuals. Accelerated failure time models were also employed. Results: From a cohort of 1,040,877 individuals with CRC, 795 had metastatic disease present along with relevant data, of which 296 had isolated BM. Median overall survival (mOS) in BM-only metastatic disease group was 7.82 months (95% CI: 5.82–9.66). The longest survival was observed among patients treated with stereotactic radiosurgery combined with systemic therapy (SRS+Sys), with a median OS of 23.26 months (95% CI: 17.51–41.95) and a 3-year survival rate of 35.8%. In adjusted Cox models, SRS, systemic therapy, and definitive surgery of the primary site were each independently associated with reduced hazard of death. Rectal cancer patients had longer survival than those with colon primaries (mOS: 10.35 vs. 6.08 months). Age, comorbidity burden, and insurance status were not associated with survival in adjusted analyses. Conclusions: SRS+Sys was associated with longer survival compared to other treatment strategies. However, treatment selection is highly dependent on individual clinical factors such as performance status, comorbidities, and disease extent; therefore, these findings must be interpreted with caution Future prospective studies incorporating molecular and biomarker data are warranted to better guide care in this rare and high-risk group. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Spinal muscular atrophy (SMA) is a severe autosomal recessive neuromuscular disorder and a leading genetic cause of infant mortality. Advances in disease-modifying therapies have significantly improved outcomes when treatment is initiated early, underscoring the importance of timely diagnosis. With the growing availability of prenatal genetic screening and high-resolution molecular diagnostics, opportunities for early detection, and potentially in utero intervention, are rapidly expanding. This narrative review synthesizes current evidence on the prenatal management of SMA, focusing on diagnostic strategies, the clinical application of fetal genetic testing, and the emerging potential of fetal therapy. We explore both invasive and non-invasive diagnostic approaches and evaluate experimental prenatal treatment modalities, while critically addressing the associated ethical, regulatory, and economic considerations. As the field progresses, integrating in utero strategies into clinical care may reshape perinatal medicine and offer transformative potential for genetic neurodegenerative disorders diagnosed before birth. The convergence of early diagnosis, fetal intervention, and personalized genetic counseling will be central to optimizing care pathways and outcomes in the era of precision medicine. Although significant challenges remain, the translation of fetal therapy into routine clinical practice is approaching feasibility. Future clinical trials, anchored in definitive prenatal diagnosis, will be essential, with benefits potentially outweighing the inherent procedural risks. Full article

Background: Hypotension following epidural labor analgesia (ELA) is its most common complication, affecting approximately 20% of patients and posing risks to both maternal and fetal health. As digital tools and predictive analytics increasingly shape perioperative and obstetric anesthesia practices, real-world implementation data are needed to guide their integration into clinical care. Current monitoring practices rely on intermittent non-invasive blood pressure (NIBP) measurements, which may delay recognition and treatment of hypotension. The Hypotension Prediction Index (HPI) algorithm uses continuous arterial waveform monitoring to predict hypotension for potentially earlier intervention. This clinical trial evaluated the feasibility, acceptability, and efficacy of continuous HPI-guided treatment in reducing time-to-treatment for ELA-associated hypotension and improving maternal hemodynamics. Methods: This was a prospective randomized controlled trial design involving healthy pregnant individuals receiving ELA. Participants were randomized into two groups: Group CM (conventional monitoring with NIBP) and Group HPI (continuous noninvasive blood pressure monitoring). In Group HPI, hypotension treatment was guided by HPI output; in Group CM, treatment was based on NIBP readings. Feasibility, appropriateness, and acceptability outcomes were assessed among subjects and their bedside nurse using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) instruments. The primary efficacy outcome was time-to-treatment of hypotension, defined as the duration between onset of hypotension and administration of a vasopressor or fluid therapy. This outcome was chosen to evaluate the clinical responsiveness enabled by HPI monitoring. Hypotension is defined as a mean arterial pressure (MAP) < 65 mmHg for more than 1 min in Group CM and an HPI threshold < 75 for more than 1 min in Group HPI. Secondary outcomes included total time in hypotension, vasopressor doses, and hemodynamic parameters. Results: There were 30 patients (Group HPI, n = 16; Group CM, n = 14) included in the final analysis. Subjects and clinicians alike rated the acceptability, appropriateness, and feasibility of the continuous monitoring device highly, with median scores ≥ 4 across all domains, indicating favorable perceptions of the intervention. The cumulative probability of time-to-treatment of hypotension was lower by 75 min after ELA initiation in Group HPI (65%) than Group CM (71%), although this difference was not statistically significant (log-rank p = 0.66). Mixed models indicated trends that Group HPI had higher cardiac output (β = 0.58, 95% confidence interval −0.18 to 1.34, p = 0.13) and lower systemic vascular resistance (β = −97.22, 95% confidence interval −200.84 to 6.40, p = 0.07) throughout the monitoring period. No differences were found in total vasopressor use or intravenous fluid administration. Conclusions: Continuous monitoring and precision hypotension treatment is feasible, appropriate, and acceptable to both patients and clinicians in a labor and delivery setting. These hypothesis-generating results support that HPI-guided treatment may be associated with hemodynamic trends that warrant further investigation to determine definitive efficacy in labor analgesia contexts. Full article

This paper is based on our engagement in a cross-sector network in Leeds, UK, taking local climate action. It draws on in-depth engagements with participants in this network, to explore how they negotiate being in, while at the same time wanting to push beyond, a climate emergency. We found three emergent trends: a reworked interpretation of the climate emergency through longer-term, holistic, historically grounded, and politicised definitions; novel forms of disruptive, collaborative place leadership that could help respond to this longer emergency; and a value-based focus on a reparative ethics of self-care, people-care, and Earth-care that foregrounds climate justice and accountability to frontline communities. We end by recommending that place-based actors can enhance the effectiveness of their collective action by broadening emergency definitions, developing politics and strategy, and supporting values-based climate justice and equity. Full article