Search Results (1,404)

Caffeine is widely consumed and generally considered safe at customary doses. How-ever, high-dose preparations available online pose a risk of severe and potentially fatal intoxication. Although uncommon, lethal caffeine poisoning is associated with profound cardiovascular and neurological toxicity. A rare case of intentional acute caffeine intoxication with fatal outcome is presented. A 25-year-old woman ingested an estimated 60 tablets containing 200 mg of caffeine each, purchased online. She was admitted to hospital shortly after ingestion of the caffeine tablets with palpitations, agitation, dizziness, and repeated vomiting. On examination, she presented with arterial hypotension (90/60 mmHg) and marked sinus tachycardia (150 beats/min), accompanied by psychomotor agitation. Her blood caffeine concentration measured by means of high-performance liquid chromatography (HPLC) was 177 µg/mL. The patient’s condition rapidly deteriorated, with the development of convulsive syndrome progressing to coma, extreme ventricular tachycardia, exotoxic shock, and toxic cardiomyopathy. Despite intensive care management, including mechanical ventilation and advanced cardiopulmonary resuscitation, the patient died several hours after admission. In conclusion, this case underscores the life-threatening potential of acute high-dose caffeine ingestion and highlights the risk associated with unrestricted access to concentrated caffeine products. Early recognition and aggressive management are crucial, yet may be insufficient in cases of massive overdose. Full article

Background and Clinical Significance: Peptic ulcer perforation is a severe complication of peptic ulcer disease, resulting from erosion of the upper gastrointestinal mucosa. While uncommon in post-cesarean patients, its symptoms can resemble post-operative complications, risking delayed diagnosis and adverse outcomes. This case highlights the need for an expanded diagnostic approach in post-cesarean patients with atypical abdominal symptoms. Case Presentation: A 27-year-old West African woman presented to Ain Shams University Hospital in Cairo, Egypt, with worsening abdominal pain, vomiting, fever, and tachycardia three weeks post-cesarean. Initially misdiagnosed with gastroenteritis, she underwent emergency laparotomy due to persistent symptoms, which revealed a 3 cm perforated peptic ulcer. An omental patch repair was performed, and she was discharged in stable condition seven days later. Peptic ulcer perforation, although rare post-cesarean, can mimic common post-operative symptoms, leading to diagnostic delays. A thorough evaluation of abdominal symptoms unresponsive to standard post-operative care is essential, as misdiagnosis increases risks of morbidity. Non-gynecologic causes should be considered, particularly with persistent symptoms. Conclusions: Physicians should consider peptic ulcer perforation in post-cesarean patients presenting with sustained abdominal pain, fever, or gastrointestinal distress. Recognizing atypical complications early allows timely intervention, improving outcomes and reducing mortality. This case underscores the value of broad differential diagnoses in post-operative care. Full article

Incretin-based pharmacotherapy has rapidly transformed obesity management. However, despite its efficacy, gastrointestinal (GI) adverse events (AEs) are common and represent a major driver of treatment discontinuation. Symptoms such as nausea, vomiting, acid reflux, diarrhea, and constipation, not only impair the quality of life, but also compromise adherence, thereby limiting the real-world effectiveness of these agents. Targeted nutritional strategies may play a pivotal role in mitigating these symptoms and supporting sustained treatment. However, most clinical trials have relied on generalized lifestyle advice combined with hypocaloric dietary prescriptions, with limited integration of structured, mechanism-based nutritional counseling tailored to the physiological actions of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs. Consequently, practical guidance for clinicians and dietitians remains fragmented. The present review synthesizes the available evidence on GI AEs associated with incretin-based therapies and examines whether structured, targeted nutritional management can meaningfully reduce symptom burden. We also outline key monitoring strategies and focus on important clinical aspects for physicians and dietitians, aiming to optimize patient outcomes. In addition, we provide detailed information on the spectrum of GI AEs to guide effective management and limit intolerance. By bridging pharmacology with applied clinical nutrition, we aim to provide a pragmatic framework for improving tolerability, sustaining adherence, and translating trial efficacy into durable real-world effectiveness. Full article

Objective: The objective of this study was to choose the optimal anesthesia method for gastric cancer patients undergoing surgery with lymph node dissection. Materials and Methods: The study included 53 patients with stage T1-4aN0-3M0 gastric cancer, who underwent radical surgery with xenon and dexmedetomidine (DMM) anesthesia in combination with epidural analgesia (main group, 27 patients) or with sevorflurane anesthesia in combination with epidural analgesia (comparison group, 26 patients). All patients underwent monitoring of hemodynamic parameters, blood coagulation system, thromboelastometry, and inflammation and metabolic parameters (interleukins, hormones and glucose levels), with an assessment of complications according to the Clavien-Dindo classification and the intensity of postoperative pain. Results: Awakening and extubation times, narcotic analgesic consumption, and Numeric Rating Scale pain scores were lower in the xenon + DMM group than in the sevoflurane group (p < 0.05). The overall number of patients experiencing complications did not differ significantly between anesthesia types; however, significant differences were found in the total number of complications (p = 0.003), the number of complications according to Clavien-Dindo I (p = 0.043) and II (p = 0.019), and the incidence of postoperative nausea and vomiting (p = 0.042). Conclusions: The BIS monitoring data obtained showed a sufficient level of anesthesia depth during surgery in both groups; however, post-anesthesia depression persisted longer in patients in sevoflurane group. Mathematical models for predicting Clavien-Dindo IIIb-V complications and severe postoperative pain syndrome are characterized by high sensitivity and specificity. They include simple clinical and laboratory parameters as well as type of anesthesia as predictors. The limitations of predictive models are also discussed in the article. Full article

Background: Tuberculous meningitis (TBM) is the most severe manifestation of tuberculosis in children, with high mortality rates and long-term neurological sequelae. Early diagnosis is challenging due to its nonspecific symptoms and insidious onset. Case Presentation: An 8-year-old previously healthy male, fully vaccinated, presented with a two-week history of fever, headache, vomiting, and abdominal pain. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, elevated protein, and low glucose levels, while multiplex polymerase chain reaction (PCR) testing for bacteria and viruses yielded negative results. Brain computed tomography (CT) revealed mild ventricular dilation and pansinusitis. Empirical antibacterial and antiviral therapy were initiated; however, the patient subsequently experienced neurological deterioration, including cranial nerve deficits and hemiparesis. Brain magnetic resonance imaging (MRI) demonstrated acute infarctions of the basal ganglia, raising suspicion for TBM. Repeated CSF sampling and Xpert MTB/RIF assay confirmed infection with Mycobacterium tuberculosis. Anti-tuberculosis treatment was initiated in combination with adjunctive corticosteroids, anticonvulsant and anticoagulant therapies, and supportive care, including neurosurgical intervention for hydrocephalus. After 16 months of treatment, the patient showed clinical improvement but sustained left-sided hemiparesis, visual impairment, and cognitive deficits. Conclusions: This case highlights the diagnostic challenges of pediatric TBM in immunocompetent and Bacillus Calmette–Guérin (BCG)-vaccinated children, particularly in the presence of initially negative microbiological findings. It emphasizes the importance of maintaining a high index of clinical suspicion and the crucial supportive role of neuroimaging findings, as well as the earlier initiation of empirical TB therapy especially when epidemiological plausibility exists. Early recognition and intervention remain critical to reducing morbidity and mortality associated with this devastating disease. Full article

Background: Anatomical variations in visceral arteries are not so uncommon (up to 20% of cases in general population), with splenic and hepatic artery anomalies being the most frequently reported. Aberrant arteries may be affected with aneurysmal lesions that are rare but potentially fatal conditions. In their treatment, a comprehensive understanding and knowledge of the underlining anatomical variation are pivotal to prevent potential ischemic complications for the end organ. Methods: A comprehensive literature search on the PubMed, Cochrane and Scopus databases was done using the terms: “anomalous visceral artery aneurysm”, “Aberrant visceral arteries”, and “anomalous origin visceral vessels”. Eligible studies published from inception to 30 June 2024 were identified. Only those that had included the adopted treatment strategies (open, endovascular or hybrid repair) and the related outcomes (mortality, bleeding, end-organ ischemia, lesions of the surrounding organ, need for reintervention) were analyzed to evaluate the safety and efficacy of each approach. A narrative analysis of the indications informing the selection of each interventional treatment, based on individual procedural risks, was also presented. Results: A total of 30 publications describing 36 patients (mean age 48.9 ± 12.8 years, range 22–73 years) with aneurysms involving aberrant visceral arteries were included. Most patients were female (25/36, 69.4%). True aneurysms predominated (with a mean size of 30.5 ± 11.5 mm, range 6–60 mm), being reported in 33/36 (91.7%) patients. Most lesions involved a splenic artery arising from the superior mesenteric artery (27/36, 75.0%). Overall, 26/36 (72.2%) patients were symptomatic upon presentation, most commonly with abdominal or epigastric pain, often associated with nausea or vomiting, back pain or shortness of breath. All patients underwent preoperative Computed angiotomography or subtraction angiography to define the operative strategy. Most cases were managed electively (31/36, 86.1%), but 11.1% (4/36) of cases required urgent intervention (in one case the urgency status was not specified). Overall, 19/36 (52.8%) patients underwent purely endovascular repair, 15/36 (41.7%) were treated with open surgery, and 2/36 (5.6%) had hybrid procedures combining endovascular coiling with laparoscopic splenic artery ligation. Indication for treatment was based on vessel tortuosity, landing zones, and the presence of side branches supplying end organs. Early outcomes were favorable regardless of treatment strategies. A single organ-related complication was reported (1/36, 2.8%) following open/endovascular repair, consisting of mild pancreatitis, which resolved with conservative management. No perioperative or aneurysm-related deaths were reported in any of the included cases. No recurrent aneurysms or late aneurysm-related complications were described during the reported follow-up intervals (mean ≈ 10.5 months, range 1.5–42 months). Conclusions: Aneurysms arising from aberrant visceral arteries present unique challenges because their origin, course, and collateral networks deviate from standard anatomy. Patient selection and detailed anatomic mapping preoperatively are decisive as inadequate imaging or failure to recognize an aberrant origin can lead to the incomplete exclusion or inadvertent sacrifice of critical branches. Understanding the anatomy of visceral arteries and their variations is paramount in clinical practice, particularly when planning interventions for minimizing procedural risks, optimizing outcomes, and preventing potential complications. Contemporary practice favors endovascular repair due to lower perioperative morbidity, but success depends on vessel tortuosity, landing zones, and the presence of important side branches that supply end organs. Full article

Background/Objectives: Post-cholecystectomy syndrome (PCS) remains diagnostically challenging due to overlapping biliary and non-biliary causes. This study aimed to evaluate whether common bile duct (CBD) diameter measured by MRCP can serve as a practical triage parameter in symptomatic PCS patients and to define a data-supported threshold for predicting clinically relevant biliary pathology. Secondary objectives included assessing correlations between MRCP findings and upper endoscopic features. Methods: In this retrospective single-center study, symptomatic adults undergoing upper endoscopy and MRCP were analyzed. Demographic, clinical, biochemical, radiologic, and endoscopic variables were recorded. Diagnostic performance was assessed using ROC analysis, and independent predictors of biliary dilatation were evaluated with multivariable logistic regression. Results: We analyzed 141 symptomatic post-cholecystectomy patients (mean age 58.2 ± 16.3 years; 67.4% female; median time since surgery 18 [9–36] months). Major symptoms: abdominal pain 84.9%, dyspepsia/bloating 47.5%, nausea/vomiting 22.3%, diarrhea 15.1%. CBD diameter measurements were available in the MRCP subgroup (n = 45); ERCP was performed selectively (n = 12). MRCP findings: CBD ≥ 7 mm 31.9%, biliary dilatation 14.9%, stricture 2.8%, suspected Oddi dysfunction 11.3%, postoperative complications 39.7%. Endoscopy: mucosal inflammation 91.5%; normal 8.5%. Significant correlations included CBD diameter vs. mucosal inflammation (r = 0.32, p = 0.001), dilatation vs. bile reflux (r = 0.28, p = 0.004), and Oddi dysfunction vs. papillary edema (r = 0.41, p = 0.001). CBD diameter showed the best diagnostic performance (AUC 0.82, 95% CI 0.74–0.90; cut-off ≥ 8.0 mm; sensitivity 78.3%; specificity 81.5%; p < 0.001). In multivariable analysis, age independently predicted biliary dilatation (OR 1.05 per year; 95% CI 1.01–1.09; p = 0.007). Conclusions: In symptomatic post-cholecystectomy patients, MRCP-measured CBD diameter provides a useful metric for risk stratification, with a threshold of ≥8 mm identifying patients more likely to harbor biliary pathology. These findings support a structured diagnostic approach that prioritizes noninvasive imaging while reserving ERCP for selected cases. Further prospective validation is warranted. Full article

Background: Effective pain control after lumbar disc surgery is a key determinant of recovery. Therefore, we aimed to compare the effects of modified thoracolumbar interfascial plane block (M-TLIP) and erector spinae plane block (ESP) on postoperative pain control and opioid consumption. Methods: This prospective observational comparative cohort study included 96 patients aged 18–70 years with American Society of Anesthesiologists (ASA) physical status I–III who underwent elective single-level lumbar discectomy. Patients received either an M-TLIP block (Group M-TLIP, n = 49) or an ESP block (Group ESP, n = 47). Postoperative pain was assessed using visual analog scale (VAS) scores at 1, 2, 4, 8, and 24 h as the primary outcome. Secondary outcomes included opioid consumption, postoperative nausea and vomiting, Riker’s Agitation Sedation Scale (RSAS) scores, and patient satisfaction. Repeated pain measurements were analyzed using a linear mixed-effects model. Results: Postoperative pain scores were lower in the M-TLIP group compared with the ESP group, particularly during the early postoperative period. Linear mixed-effects modeling demonstrated a significant main effect of group and time, with the analgesic advantage of M-TLIP being most pronounced in the early postoperative hours and diminishing by 24 h. Total tramadol consumption within the first 24 h was significantly lower in the M-TLIP group (p = 0.039). Postoperative agitation, nausea and vomiting, and patient satisfaction scores were comparable between groups. Conclusions: These findings suggest that M-TLIP block may represent a clinically useful alternative to ESP block for postoperative analgesia in lumbar discectomy. Full article

Background and Clinical Significance: Deep thalamic and periventricular lesions are uncommon in adults but can result in significant loss of function because of their convergence on three interdependent processes: thalamocortical state regulation, throughput of periventricular long association systems, and ventricular compartmental compliance. The resulting combination of executive control collapse, retrieval-weighted language fragility, and load-sensitive gait instability may occur early after a lesion forms an atrial/posterior horn interface, and pressure-linked autonomic symptoms may be late to develop. Screening deficits will likely be minimal and therefore underreported. Objective/Aim: To present a thalamic–atrial/posterior horn tumor case with quantified load-sensitive cognitive–language–gait dysfunction and to detail a physiology-guided, sequence-driven decompression approach emphasizing ventricular relaxation and perforator-preserving, interface-limited thalamic resection. Case Presentation: A 56-year-old female patient experienced a 3-month, rapidly progressive decline in her cognitive and language abilities. The clinical progression was not stepwise or punctuated by a single “sentinel” event. She had a moderate level of cognitive impairment consistent with both Broca’s and Wernicke’s aphasias (MoCA: 22/30) and suffered from significant interference effects and increased cost of task-switching. Her ability to generate novel responses and name objects was significantly impaired; however, she was able to repeat words and phrases appropriately. In addition, she exhibited a severe sustained attention signature and a high error rate during dual-task performance, indicating severe gait instability, although her overall global anchors were nearly neutral (GCS 15; FOUR 15/16; NIHSS 2). Nausea and vomiting occurred simultaneously with the cognitive and language decline, suggesting decreased intracranial compliance. MRI revealed a heterogeneous left-sided thalamic tumor extending into the posterior horn of the lateral ventricle. The tumor caused deformation of the lateral ventricle and midline displacement. The patient underwent microsurgical intervention using a physiology-conscious sequence of graded cerebrospinal fluid (CSF) equilibration and primary mechanical removal of the tumor from the ventricular system. Additionally, decompression of the thalamus was performed in a manner that was cognizant of the boundaries formed by the perforating arteries of the thalamus. Early resolution of pressure symptoms was noted postoperatively. Objective measures demonstrated significant improvement in the patient’s executive functioning, language skills, attentional errors, and dual-task performance stability. The patient remained functionally independent at discharge and at subsequent follow-up visits. Surveillance imaging did not demonstrate any evidence of tumor recurrence. Conclusions: The clinical presentation described above is supportive of a model in which the synergy between deep network damage and distortion of the posterior ventricular compartment amplifies network dysfunction. Additionally, the use of quantitative stress-phenotyping makes it possible to identify deep network pathology early in its course. Finally, the physiology-guided decompression approach that was used in this case has the potential to increase functional reserve in patients with pathology that requires millimeter transitions. Full article

Background/Objectives: Cancer and their treatments could impact physical, nutritional, and psychological health, negatively influencing overall well-being. Accordingly, Health-Related Quality of Life (HRQoL) could be influenced by lifestyle habits, such as physical activity. This study aimed to assess physical activity levels in patients with a primary cancer diagnosis and their association with HRQoL at the first nutritional assessment. Methods: Data from the NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), were analyzed. Nutritional and sarcopenia risk, anthropometry and body composition parameters were collected. HRQoL and physical activity (as MET levels) were assessed through validated questionnaires. Descriptive statistics summarized categorical and continuous variables, and multivariable ordinal logistic regression models were performed. Results: Nutritional and sarcopenia risk decreased progressively with higher MET levels (p = 0.005 and p < 0.001, respectively). Adjusted multivariable models showed that HRQoL functional scores improved with increasing MET levels, with significant positive trends for physical (p < 0.001), role (p < 0.001), emotional (p = 0.003), and social functioning (p = 0.001), and global health status (p < 0.001). Conversely, symptom burden, including fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, and constipation, decreased across MET quartiles (all p < 0.05). Conclusions: Overall, our findings suggest that physical activity may positively influence HRQoL among cancer patients. Early assessment helps to identify patients at risk of inactivity and support tailored rehabilitation programs to promote active lifestyles, preserve muscle mass, improve outcomes and overall health status. Full article

Background: Total neoadjuvant therapy (TNT) is increasingly administered in rectal cancer, but compared with concurrent chemoradiotherapy (CRT), data regarding the gastrointestinal (GI) toxicity profile and clinical predictors remain limited. Objectives: To evaluate GI toxicity associated with TNT compared with CRT and to explore clinical predictors of these adverse events (AEs). Methods: This retrospective study included 201 patients with rectal cancer treated with TNT (n = 157) and CRT (n = 44). GI AEs (nausea, vomiting, diarrhea) were graded according to CTCAE v5.0. In the analysis of factors associated with GI AEs, multiple clinical and pathological variables were included using multivariable logistic regression. Results: The composite endpoint “any GI AEs grade ≥ 1” was more frequent in the TNT group compared with the CRT group (33.1% vs. 15.9%; RR = 2.08; 95% CI 1.02–4.25; p = 0.038). Nausea was significantly more frequent in the TNT group (28.7% vs. 9.1%; RR = 3.15; 95% CI 1.20–8.30; p = 0.012), whereas vomiting (9.6% vs. 2.3%; p = 0.203) and diarrhea (17.8% vs. 9.1%; p = 0.242) did not reach statistical significance. In multivariable logistic regression, TNT (OR = 2.65; 95% CI 1.08–6.53; p = 0.032) and female sex (OR = 2.03; 95% CI 1.05–3.77; p = 0.033) were identified as independent predictors of grade ≥ 1 GI AEs. For nausea, TNT remained significant (OR = 4.37; 95% CI 1.45–13.20; p = 0.0089). Upper rectal tumor location was significantly associated with vomiting (p = 0.0054). No grade 3–4 GI AEs were observed in either treatment group. Conclusions: TNT was associated with a higher incidence of mild GI AEs, predominantly driven by nausea, without an increase in severe toxicities. TNT and female sex were identified as independent clinical predictors of an increased risk of GI AEs, while tumor location in the upper third of the rectum was associated with a higher occurrence of vomiting. Full article

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care. Full article

While typical benign paroxysmal positional vertigo (BPPV) presents with reproducible patterns of nystagmus and vertigo during positional testing, atypical variants often deviate from typical patterns, making diagnosis more complex. Recognizing atypical BPPV is crucial to avoid misdiagnosis and inappropriate management. This study aims to describe the clinical spectrum of atypical BPPV, differentiate it from central positional vertigo, and provide practical diagnostic guidance for clinicians. A narrative review was conducted to explore the clinical spectrum of atypical BPPV. Findings indicate that it may present with vertigo without nystagmus, conflicting torsional components in bilateral cases, or persistent symptoms despite repositioning maneuvers. Canal switch and pseudo-spontaneous nystagmus have also been described. Although these variants may mimic central etiologies, the absence of consistent neurological signs supports a peripheral mechanism. Diagnosis relies on detailed assessment of nystagmus characteristics—such as latency, /duration, and direction—as well as the exclusion of red flags, like direction-changing nystagmus without head movement, vomiting, or non-positional ocular motor abnormalities. Atypical BPPV remains a diagnostic challenge and requires careful bedside assessment and clinical testing. Understanding these variants is essential for timely and appropriate treatment. When doubt persists and resolution with treatment does not occur, neuroimaging should be considered to exclude central pathology. Full article

Objective: Nausea and vomiting in pregnancy (NVP) have a negative impact on quality of life and nutritional status and may progress to hyperemesis gravidarum (HG). We explored the incidence, severity, clinical evolution, and management of NVP. Methods: In accordance with the Italian Society of Gynecology and Obstetrics (SIGO), we conducted a multicentric prospective cohort study at eighteen Italian hospitals, from October 2022 to November 2024. We enrolled pregnant women before 13 weeks of gestation. The severity of NVP and its management were assessed during pregnancy. Results: A total 890 pregnant participants completed the follow-up. NVP prevalence was 70.0% and was classified as 54.4% mild, 42.3% moderate, and 3.2% severe according to the PUQE score; 2.4% required hospitalization. Severe NVP was more frequent in multiparous women (90.0%; p < 0.001); NVP history was independently associated with NVP recurrence, OR 3.20 (2.12–4.83; p < 0.001). NVP cases showed a low rate of smoking (3.9% vs. 7.1%; p = 0.04). After the first consultation, pharmacological treatment, primarily doxylamine–pyridoxine, was prescribed to 50.7% of mild, 67.0% of moderate, and 50.0% of severe PUQE scores. Dosages of ≥3 capsules/day were common in moderate (51.0%) and severe (70.0%) NVP cases (p < 0.001). By the second visit, continuation of therapy did not differ among PUQE classes, although reasons for discontinuation varied (p < 0.001). By the third visit, therapy continuation dropped to 32.1% in moderate cases (p = 0.03). Conclusions: NVP is a common disorder in pregnancy, with a predominance of mild and moderate symptoms. Prior NVP increases the recurrence risk threefold. Despite the high prevalence of NVP, the therapy remains inconsistent and delayed. Full article

Backgroud/Objectives: Pediatric central nervous system (CNS) tumors represent the second most common oncological disease in children. The purpose of this research was to analyze the course of surgical treatment for these tumors at the University Medical Centre Ljubljana between October 2018 and December 2025. Methods: A retrospective analysis of 110 patients was conducted, focusing on diagnostic accuracy and its correlation with surgical and neurological outcomes. Results: Over a seven-year period, 110 children were surgically treated, undergoing a total of 130 operative procedures. A calculated annual incidence of 3.8 cases per 100,000 was identified. The most common initial symptoms were headache (36.3%), vomiting (20%), and ataxia (17.2%). Tumors were localized supratentorially in 52.7% of cases, infratentorially in 30%, and along the spinal canal in 13.6%. The most frequent histopathological types were pilocytic astrocytomas/paediatric-type diffuse low-grade gliomas (18.1%), medulloblastomas (14.5%), and craniopharyngiomas (7.2%). Gross total resection was achieved in 60% of all procedures. Surgical complications occurred in 10.6% of cases, with a surgical mortality rate of 0.9%. Neurological deterioration occurred in 27.2% of cases, most commonly in the form of cerebellar mutism (8.1%). Diagnostic histology of medulloblastoma and infratentorial anatomical location were confirmed as critical prognostic markers for cerebellar mutism (p < 0.011) and shunt dependency (p = 0.0121). Conlcusions: This study confirms that treatment outcomes in the Slovenian tertiary center are comparable to international standards. Integrative diagnostic strategies significantly refine surgical planning and prognostic assessment, optimizing long-term morbidity management. Full article