Search Results (4,281)

A correlation between the near-surface ozone concentration in the urban atmosphere and hospitalizations of community-acquired pneumonia patients has been analyzed based on a long-term (five years) series of observations in the warm season in Moscow, Russia. The study included hospitalization records for patients over 15 years old. One of the main goals was to reveal vulnerable groups of the urban population that react most strongly to increased ozone concentrations. It has been shown that increased near-surface ozone concentrations lead to increased hospitalizations. Older people (over 60 years old) are most sensitive to the negative impact of air pollution. Women in this age group are more sensitive to the effects of ozone air pollution than men. In the middle-aged group (31–60 years), the highest correlation between the number of community-acquired pneumonia cases and the ozone level in the atmospheric surface layer, conversely, was in men, but it was still lower than the rate in older people. The young people (15–30 years old) group turned out to be insensitive to the near-surface air pollution. Full article

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

Background/Objectives: Within the last decade, there has been a 19% increase in stroke-related mortality among individuals aged 45–64. Understanding stroke characteristics is crucial, particularly in the younger age groups. This study describes the key demographics and clinical and anthropometric characteristics based on age categories in young adults admitted to the stroke unit in Abu Dhabi. Methods: This retrospective observational study had data between October 2024 and March 2025. Data were analyzed descriptively using SPSS, with a more detailed analysis conducted across two age-based groups. Results: A total of 51 patients were included, with the median age of 40 (IQR: 37–48) and 44 (86.3%) being males. The median hospital length of stay was 4 days (2–9 days). Most of the patients, 47 (92.2%), had ischemic stroke, with 24 (45.1%) presenting with right-side weakness, and bilateral weakness in 4 (7.8%). The median NIHSS score on admission was 4 (IQR 2–9). Prior to admission, 18 (35.3%) of the patients were known hypertensive, and 12 (23.5%) were diabetic. In terms of anthropometric measurements, the median waist-to-height ratio was 0.58 (0.5–0.69) and BMI was 25.7 (24.2–29.4), with 31 (60.8%) of the patients categorized as either obese or overweight. The statistical significance difference across the age groups was found in the gender distribution only (p = 0.034). Conclusions: In the UAE, more young men are experiencing Stroke due to lifestyle-related factors, many of which can be prevented. This growing trend calls for early screening, better prevention efforts, and tailored rehabilitation programs. Full article

Pulmonary embolism (PE) is one of the most serious complications of antiphospholipid syndrome (APS), a systemic autoimmune disorder defined by thrombotic events and persistent antiphospholipid antibodies (aPLA). PE occurs in 11–20% of patients and may constitute the initial clinical manifestation. Young and middle-aged women are most frequently affected, and triple-positive aPLA profiles markedly increase the risk of recurrence and long-term morbidity, including chronic thromboembolic pulmonary hypertension (CTEPH). This review article summarizes current evidence on the epidemiology, pathophysiology, diagnostic approach, and management of PE in APS. Key mechanisms include anti-β2-glycoprotein I-mediated endothelial and platelet activation, complement engagement, and neutrophil extracellular trap formation, resulting in immunothrombosis. Diagnostic pathways follow standard PE algorithms; however, chronically elevated D-dimer levels and lupus anticoagulant-related aPTT prolongation require careful interpretation and consideration. Long-term vitamin K antagonist therapy remains the standard of care, whereas direct oral anticoagulants are not recommended in high-risk APS. Future directions include improved risk stratification through detailed aPLA profiling and the use of emerging biomarkers, early screening for CTEPH, and the development of targeted therapies such as complement inhibition and anti-NETosis strategies. Full article

Background/Objectives: Chronic psychomotor and cognitive slowing after stroke can persist despite standard rehabilitation, especially in young adults with subcortical injuries. Innovative, integrated interventions are crucial for patients who have reached a plateau in their rehabilitation. We present a case of a 41-year-old male with chronic psychomotor and cognitive slowing following a left lenticulostriate infarction (NIHSS score = 5 at onset), who had plateaued after conventional rehabilitation. Methods: Over 4 weeks the patient underwent 20 sessions of a multimodal approach including high-frequency repetitive transcranial magnetic resonance stimulation over the supplementary motor area and bilateral temporo-parietal junctions and simultaneous computerized cognitive training targeting attention and executive function. Both motor and cognitive assessments, along with quantitative EEG (qEEG) evaluations, were conducted before and after the treatment. Results: At the end of treatment, the patient showed significant clinical improvement: speed and coordination in upper extremities (Finger Tapping Test) increased by 66% (dominant hand) and 74% (non-dominant hand), while finger dexterity (Nine-Hole Peg Test) increased by 25% (dominant hand) and 19% (non-dominant hand). Cognitive scores improved in alertness (58%), visual exploration (25%), and flexibility (24%), while divided attention remained stable. qEEG investigation showed increases in alpha (79%), gamma (33%), and beta (10%) power, with topographic shifts in the stimulated regions. Conclusions: These findings highlight the feasibility of combining targeted rTMS and cognitive training to enhance neuroplasticity in the chronic phase of stroke. Clinical recovery was accompanied by normalized cortical rhythms, suggesting qEEG biomarkers may be useful for tracking treatment response. Multimodal precision neurorehabilitation may offer a path forward for patients with persistent cognitive–motor deficits post-stroke. Full article

Background and Clinical Significance: Focal hemorrhagic severity associated with posterior convexity pial brain arteriovenous malformation (AVM) cases can be exacerbated by hemodynamic stress focusing on focal areas of architectural weakness and by superficial venous outflow being restricted by non-redundant superficial venous drainage. This clinical case report exemplifies how bedside neurologic localization and angioarchitectural characteristics can inform the selection of microsurgical approaches for the treatment of ruptured AVMs that are directed at reducing hemorrhage recurrence risk through corridors based on rupture location. Case Presentation: An otherwise healthy young adult male (modified Rankin scale [mRS] pre-morbid = 0) initially presented with a thunderclap headache, emesis, photophobia, decreased level of consciousness (admitted Glasgow Coma Score [GCS] = 11; E3V3M5), and subsequent deficits including left-sided pyramidal weakness, visual field loss, and visuo-spatial neglect. A non-contrast computed tomogram (CT) confirmed an intraparenchymal hemorrhage (ICH) located within the right hemisphere’s posterior lobe. Angiographic evaluation of this AVM with catheter injection and three-dimensional reconstruction revealed a compact right occipital posterior convexity pial AVM (nidus 8 × 3 mm) supplied by distal cortical branches of the right middle cerebral artery (MCA); all blood draining from the nidus was directed to a single cortical vein which then drained into the superior sagittal sinus; there were two additional intranidal saccular aneurysms (approximately 3 × 2 mm and 3 × 3 mm). Because of the acute worsening secondary to ICH and because all venous drainage was superficial-only, a single-stage approach was selected given the urgency: decompressive evacuation of the hematoma via a corridor to the site of the AVM, followed by microsurgical removal of the AVM. The removal of the AVM was accomplished in a feeder-first, vein-last sequence, and en-passage arteries and parasagittal bridging veins were preserved throughout the procedure. Additionally, the two intranidal aneurysms identified as potential weak points during progressive devascularization of the AVM were specifically treated during the removal procedure. Following the successful removal of the AVM, the patient experienced a rapid recovery and returned to a nearly premorbid state of functioning, excepting a persistent small area of quadrantanopia. Conclusions: Rupture of posterior convexity AVMs may result in increased hemorrhagic severity due to localized architectural weaknesses in addition to the overall size of the AVM nidus. By correlating neurological findings, the topography of the hemorrhage, and angioarchitectural features early after rupture, emergency decisions regarding management can be better informed. The application of a hematoma-corridor, feeder-first/vein-last microsurgical approach for the treatment of such AVMs can achieve definitive curative results while minimizing damage to posterior cortical regions. Full article

Monogenic diabetes (MD) is a rare and heterogeneous group of disorders caused by genetic variants in genes involved in glucose metabolism. Among many MD genes, the insulin gene (INS) deserves special attention, as its variants are responsible for both permanent neonatal diabetes mellitus (PNDM) and transient neonatal diabetes mellitus (TNDM), as well as a form of MODY (maturity-onset diabetes of the young)—INS-MODY. The aim of the study was to perform a clinical and molecular analysis of patients focused on the evaluation of INS gene variants identified during molecular testing in patients referred with suspected MD, and to assess the prediction of their impact on protein structure using in silico methods. Between 2017 and 2024, 1043 unrelated probands were tested using targeted next-generation sequencing (tNGS) panels. Three pathogenic or likely pathogenic variants in the INS gene were identified in three unrelated families, indicating that this gene accounts for 0.38% of MD cases. This allowed for the diagnosis of PNDM in two patients with diabetes diagnosed within the first four months of life and INS-MODY in a patient with diabetes since the age of 16. Moreover, in the patient with PNDM and the INS:c.T104C variant, additional disorders were identified in the form of intrauterine growth restriction (IUGR) and neurological disorders. Importantly, two of the identified genetic variants, c.C103G and c.G3C, have not previously been described in the literature. Furthermore, in silico analysis of the variants at the protein level, i.e., investigation of mutations at the 35th residue, indicated that symptom severity correlates with the extent of structural changes in insulin. The results obtained broaden the spectrum of causative variants of the INS gene, but also emphasize the clinical significance of these variants in patients with various forms of diabetes, pointing to the key role of comprehensive genetic testing in enabling accurate diagnosis and targeted treatment of patients. Full article

Background and Objectives: Psychomotor developmental delay is a frequent comorbidity in children with congenital heart defects (CHD), especially after surgical correction of the CHD and exposure to risk factors such as anesthesia, cardiopulmonary bypass and postoperative complications. Yet psychomotor delay is present in these patients before surgical correction but is under-recognized. Evidence focusing solely on unrepaired CHD remains limited. Materials and Methods: This prospective cross-sectional study evaluated 153 and included 77 children under 6 years of age with unrepaired CHD, stratified into cyanotic (n = 31) and non-cyanotic (n = 46) CHD, admitted to a pediatric cardiology department over a period of 5 years. Psychomotor development was assessed using the Denver Developmental Screening Test II (DDST-II), standardized for pediatric population. Associations with clinical, perinatal, and demographic factors were analyzed using univariate and multivariate methods. Results: Developmental delay was identified in 97% of cyanotic and 54% of non-cyanotic patients. Compared to healthy norms, CHD patients had significantly lower global developmental scores (p = 0.03). Gross motor and personal-social domains were most frequently affected. Prenatal CHD diagnosis correlated with better global developmental scores (p = 0.012), and breastfeeding was associated with improved outcomes compared with formula or mixed feeding (p = 0.008). Conclusions: Infants and young children with CHD are at increased risk of early psychomotor developmental delay, particularly in the gross motor and personal–social domains, even before exposure to surgical or intensive care damaging factors. Systematic psychomotor surveillance, integration of protective factors such as prenatal diagnosis and breastfeeding, and timely access to multidisciplinary interventions are essential to optimize long-term outcomes in this vulnerable population. Full article

Background: The Ross procedure provides excellent outcomes in young adults requiring aortic valve replacement, with lower rates of infective endocarditis (IE) compared to prosthetic valves. Early postoperative IE of the autograft is exceptionally rare, with only isolated cases reported in major registries. Case Summary: We report a 40-year-old man with bicuspid aortic valve and a history of two previous episodes of native valve endocarditis who underwent Ross procedure with Ozaki modification. Ten days postoperatively, he developed fever and was diagnosed with early autograft IE with perivalvular abscess formation. Despite negative blood cultures (due to prior antibiotic administration), clinical findings met modified Duke criteria for possible IE. Imaging revealed perivalvular abscess with subsequent pseudoaneurysm development, while the autograft leaflets remained functional. The patient was successfully treated with 6-week combination antibiotic therapy without requiring surgical reintervention. After one year of follow-up, he remains asymptomatic with stable pseudoaneurysm size and preserved valvular function. Conclusions: Early IE following Ross procedure, though rare, should be considered in patients presenting with postoperative fever. This case demonstrates that conservative management with appropriate antibiotic therapy can be successful even with perivalvular complications, provided there is hemodynamic stability and close multidisciplinary monitoring. Long-term surveillance remains essential given the persistent structural abnormalities. Full article

Background/Objectives: Cyclosporine A (CsA) is a key immunosuppressant in post-transplantation therapy protocol characterized by large interindividual and intraindividual pharmacokinetic (PK) variability and a narrow therapeutic range necessitating therapeutic drug monitoring (TDM) to prevent graft rejection and minimize side effects. TDM data can be used for developing PK models with the objective of identification and quantification of variability factors that contribute to the differences in CsA concentrations. Methods: Retrospectively collected data from medical records of 58 patients (children and young adults) regarding CsA blood concentrations, concomitant medications, and laboratory findings of significance were used for the population PK model development in NONMEM^® (version 7.5) with first-order conditional estimation method with interaction (FOCE-I). Simulation of the concentrations and area under the curve (AUC) was performed in the web application e-campsis^®. RStudio (version 4.5.0) was used for the purpose of descriptive statistics analysis and graphs plotting. Results: A one-compartment model with first-order absorption and elimination best described the data. Value of clearance (CL/F) was estimated to be 15 L/h, and volume of distribution (V/F) was 71.1 L for a typical patient weighing 40 kg. Interindividual variability (IIV) on CL/F and V/F was 34.91% and 43.05%, respectively. Interoccasional variability (IOV) was 12.25%. Body weight (WT) was introduced allometrically on CL/F and V/F, with the estimated exponent of 0.89 for CL/F and 1 (fixed) for V/F. According to the final model, CL/F decreases with increasing haemoglobin (HGB) value. A difference of almost 22.5% in CL/F was observed among patients’ HGB values reported in the study. Conclusions: Our findings indicate that HGB levels significantly influence CsA PK, particularly minimum concentration (C_min), highlighting the importance of regular HGB levels monitoring together with CsA levels. Full article

Melasma management is challenged by heterogeneity in patient presentation, particularly among individuals with darker skin tones. This study applied k-means clustering, an unsupervised machine learning algorithm that partitions data into k distinct clusters based on feature similarity, to identify patient subgroups that could provide a hypothesis-generating framework for future precision strategies. We analysed clinical and demographic data from 150 South African women with melasma using k-means clustering. The optimal number of clusters was determined using the Elbow Method and Bayesian Information Criterion (BIC), with t-distributed stochastic neighbour embedding (t-SNE) visualization for assessment. The k-Means algorithm identified seven exploratory patient clusters explaining 52.6% of the data variability (R² = 0.526), with model evaluation metrics including BIC = 951.630 indicating optimal model fit and a Silhouette Score of 0.200 suggesting limited separation between clusters consistent with overlapping clinical phenotypes, while the Calinski-Harabasz index of 26.422 confirmed relatively well-defined clusters that were characterized by distinct profiles including “The Moderately Sun Exposed Young Women”, “Elderly Women with Long-Term Melasma”, and “Younger Women with Severe Melasma”, with key differentiators being age distribution and menopausal status, melasma severity and duration patterns, sun exposure behaviours, and quality of life impact profiles that collectively define the unique clinical characteristics of each subgroup. This study demonstrates how machine learning can identify clinically relevant patient subgroups in melasma. Aligning interventions with the characteristics of specific clusters can potentially improve treatment efficacy. Full article

The classic triad of clinical findings in pigment dispersion syndrome was described decades ago. It consists of radial, spoke-like iris transillumination defects, pigment deposits on the corneal endothelium known as the Krukenberg spindle, and a densely and homogenously pigmented trabecular meshwork. PDS occurs approximately three times more frequently in young myopic men than in women and is most often identified between 30 and 50 years of age. The diagnostic evaluation does not differ from the standard examination performed in patients with suspected glaucomatous optic neuropathy. However, it must additionally incorporate examinations specific to PDS. The possible therapeutic approaches varying by disease stage will be discussed, including pharmacologic treatment, laser procedures (iridotomy and trabeculoplasty), and surgical approaches such as canaloplasty, trabeculectomy, and other glaucoma surgeries. In order to better identify patients requiring an optimal therapeutic strategy, we propose a division into five stages of PDS: (1) preclinical PDS, (2) visible PDS, (3) PDS converting to pigmentary glaucoma, (4) pigmentary glaucoma, and (5) inactive PDS. Therapeutic strategies of each stage are described below. Full article

Background/Objectives: The COVID-19 pandemic caused over seven million deaths globally as of July 2024. In an attempt to bring the pandemic under control, immunization was implemented as the main preventive strategy. This study aimed to investigate the knowledge, attitudes, and practices (KAP) of hospitalized patients and healthcare workers (HCWs) regarding COVID-19 vaccination, as well as the factors contributing to COVID-19 vaccination rates. Methods: This cross-sectional, survey-based KAP study was conducted between November 2024 and February 2025 in five hospitals across five cities of the Republic of Srpska, Bosnia and Herzegovina. Results: There were 571 respondents, 68% of whom were female, with an average age of 39.17 ± 14.74 years; one-third held a university degree. The study sample consisted of patients and healthcare workers (HCWs) (59% vs. 41%). During the pandemic period, 46.6% of respondents were diagnosed with COVID-19, with a higher prevalence among healthcare workers compared to patients (54.2% vs. 41.2%). Among the 55.2% of respondents who were vaccinated, HCWs were more often vaccinated than patients (70.9% vs. 44.2%) and more likely to know that vaccines protect against severe forms of disease and death (80.8% vs. 68.5%). Patients more often believed that vaccination against COVID-19 may lead to sterility in young patients (11.3% vs. 6%) and were more often afraid of vaccination compared to the occurrence of COVID-19 (35.6% vs. 24.8%). Regression analyses showed that independent predictors of COVID-19 vaccination were older age (p < 0.001), higher education level (p = 0.039), knowledge of vaccine production technology, and the belief that vaccinated individuals have milder symptoms of the disease (p = 0.002). Conversely, the belief that the COVID-19 situation was overblown was negatively associated with vaccination (p = 0.004). Conclusions: HCWs had better knowledge, more positive attitudes, and better vaccination practices against COVID-19 in comparison to patients. However, there are still certain dilemmas and hesitations among HCWs toward COVID-19 vaccination. Full article

Influenza-associated encephalitis/encephalopathy (IAE) is a severe neurological complication characterized by central nervous system dysfunction and structural damage following influenza virus infection. Predominantly affecting infants and young children, IAE exhibits its highest incidence in those under five years of age. Key clinical manifestations of IAE include acute seizures, sudden high fever, and impaired consciousness, frequently progressing to coma. Neuroimaging, particularly magnetic resonance imaging (MRI), often reveals multifocal brain lesions involving multiple brain regions, including the cerebellum, brainstem, and corpus callosum. The prognosis of IAE is poor, with a mortality rate reaching 30%. Current diagnosis relies heavily on clinical presentation and characteristic neuroimaging findings, as the precise pathogenesis of IAE remains elusive. While various research models, including cell lines, brain organoids, and animal models, have been developed to recapitulate IAE features, significant limitations persist in modeling the core clinical pathophysiology observed in pediatric patients, necessitating further model refinement. This review synthesizes the clinical spectrum of IAE, summarizes progress in understanding its pathogenesis, and critically evaluates existing research models. We aim to provide a foundation for utilizing experimental approaches to elucidate IAE mechanisms and identify potential therapeutic strategies. Full article

Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended. Full article