Search Results (438)

This narrative review integrates landmark studies, recent publications, and major clinical guidelines to highlight the current state of the art concerning acute pancreatitis, a well-known yet still challenging condition. We will focus on recent practice transitions and future perspectives arising from advances in diagnostic imaging and interventional endoscopy. Pathogenesis and etiology: We carry out an overview of the fundamental mechanisms underlying acute pancreatitis, followed by an analysis of both common and uncommon causes, along with emerging evidence regarding idiopathic forms. Diagnosis and risk stratification: We pursue two objectives: on one hand, to emphasize the enduring importance of clinical assessment in the diagnosis of acute pancreatitis; on the other, to analyze the increasingly central role that imaging has acquired over recent decades. Identification of patients at higher risk for complications or an unfavorable prognosis is crucial. Several scoring systems have been proposed over the past decades, but with limited impact on daily clinical practice. Treatment: Therapeutic approaches have undergone significant revisions over time. Our objective is to provide an overview of the current standards together with best evidence-based medical approaches, targeted and interventional therapies, with focus on the endoscopic ones. Furthermore, we want to clarify the importance of nutrition and its proper management. Conclusions: Acute pancreatitis continues to stimulate discoveries and improvements in clinical management. We will place emphasis on unmet needs and emerging innovations that may importantly influence future practice also promoting evidenced-based standards of care. Full article

Introduction/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice/family medicine; 14.7% cardiology; 14.7% internal medicine/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used “often” or “always” by 52.6%, with significant inter-specialty variation (p < 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (“always”) differed markedly across specialties (p < 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB/non–HDL-C/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care. Full article

Background: Early Childhood Caries (ECC) is a prevalent multifactorial disease strongly influenced by dietary and behavioral factors. Night-time feeding practices and sugar exposure have been implicated, yet the relative impact of feeding duration, feeding type, and oral hygiene remains debated. This study aimed to investigate the association between ECC and major dietary and behavioral risk factors, with particular emphasis on the presence and duration of night-time feeding, in a pediatric population from Southern Italy. Methods: A single-center retrospective observational study was conducted on medical records of children aged 1–6 years referred for a first dental visit to a pediatric dentistry unit. ECC and severe ECC (S-ECC) were diagnosed according to AAPD criteria. Data on night-time feeding (presence and duration), sugar-rich diet, number of daily meals, oral hygiene habits, and age at initiation of toothbrushing were collected through structured interviews. Associations were evaluated using chi-square tests and multivariable logistic regression analysis, with ECC/S-ECC as the dependent variable. Results: A total of 248 children were included. ECC/S-ECC prevalence was 62.5%. A sugar-rich diet was associated with increased ECC risk (OR = 4.14, p < 0.001). Prolonged night-time feeding showed a dose–response relationship with ECC, with risk increasing beyond 12 months and exceeding twelvefold for durations > 24 months. Multivariable analysis showed that night-time feeding duration > 12 months, high-sugar diet, >5 daily meals, and delayed initiation of toothbrushing were associated with ECC, whereas use of an electric toothbrush and fluoridated toothpaste showed a trend toward a protective effect. Feeding type was not independently associated with ECC after adjustment for duration. Conclusions: Duration of night-time feeding, rather than feeding type, represents a key modifiable determinant of ECC risk. Preventive strategies should prioritize early cessation of night-time feeding, reduction in sugar exposure, limitation of meal frequency, and early introduction of effective oral hygiene with fluoride. Full article

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality globally. While multi-modal artificial intelligence (AI) models offer significant predictive potential, their translation into routine clinical practice is delayed by the “black box” nature of complex algorithms and the fragmentation of heterogeneous data. We present LANTERN-XGB, a hierarchical machine learning workflow designed to bridge this gap by generating interpretable “digital human avatars” for precision oncology. The methodology employs a multi-stage scalable tree boosting system (XGBoost) architecture utilizing shapley additive explanations (SHAP) for rigorous hierarchical feature selection, missing value management, and patient-specific decision support. The workflow was developed and benchmarked using a retrospective cohort of 437 patients with clinical N0 NSCLC, followed by validation on a prospective dataset (n = 100) and an independent external dataset (n = 100). The pipeline integrates diverse data modalities to predict occult lymph node metastasis (OLM). LANTERN-XGB identified a robust consensus signature driven by non-linear interactions among CT textural fragmentation, PET metabolic heterogeneity, tumor density distribution, and systemic clinical modulators. Exploratory transcriptomic pathway analysis (GSVA) revealed that high-risk predictions strongly correlate with systemic molecular dysregulation, such as the enrichment of immune-inflammatory signaling and metabolic stress pathways. The model achieved robust discrimination in external validation (AUC ≈ 0.77), performing comparably to state-of-the-art nomogram benchmarks. Crucially, the LANTERN-XGB framework demonstrated superior utility in handling diagnostic ambiguity; local force plots allowed for the correct reclassification of “borderline” prediction by visualizing feature interactions that standard linear models fail to capture. LANTERN-XGB provides a validated, open-source framework that successfully balances predictive power with clinical transparency. By empowering clinicians to visualize and verify the logic behind AI predictions, this workflow offers a pragmatic path for integrating reliable multi-modal avatars into daily medical decision-making. Full article

Objectives: Design strategies to improve management, outcomes, and quality of life for people with heart failure (HF) in Spain through the identification of areas of improvement regarding diagnosis, treatment, comorbidities, progression of disease and healthcare coordination between specialists. Methods: IC-MMERSIVE project was developed by the Cardiology and Primary Care Integration Working Group of the Spanish Society of Cardiology. The project included a pre-session survey for participants, face-to-face sessions led by a clinical cardiologist, and post-session questionnaires for the moderator and for participants. A web platform was created to host program content and resources and electronic forms for data collection and analysis. Results: A total of 1186 physicians (80.5% cardiologists) participated in 144 face-to-face sessions throughout Spain. When patients are at risk for HF (HF stage B), 78.9% of respondents said they proactively search for HF. Only 38.0% were familiar with and applied the IC-BERG study questions designed to detect falsely stable patients. Specific protocols for optimizing and implementing the four pharmacologic pillars of treatment for HF were used by 51.6% of participants, 53.9% had protocols to reach the guideline-recommended target doses, and 25.6% reported no nursing involvement. Structured follow-up was conducted in 53.9% of cases. Even though 63.0% used shared single medical records, the connection between specialized HF consultations and healthcare centers was occasional in 72.1% of cases. Conclusions: There is marked room to improve HF management in daily clinical practice. These findings highlight specific actionable gaps in HF management and support the need for structured, multidisciplinary strategies to improve patient outcomes. Full article

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious sisters. Materials and Methods: An anonymous survey was conducted among 463 women from international, apostolic Catholic congregations in Poland and 33 other countries. The questionnaire included questions on lifestyle, physical health (including diet, physical activity, sleep, chronic conditions, and medication use), and perceptions of how community life influences health and encourages health-conscious behaviors. Results: Overall, 57% of participants reported following a healthy lifestyle, most commonly sisters aged 65 and older (73%). Non-Polish sisters and those living outside Poland were more likely to report healthy habits. Among sisters who saw their community as beneficial for health, 69% led a healthy lifestyle. Retreats, a sense of belonging, communal prayers, and vacations were consistently rated as having the most positive impact on well-being, particularly among older sisters and missionaries. Conclusions: Life in a religious community appears to support health both directly, through structured daily routines and shared responsibilities, and indirectly, by providing social support and fostering a sense of purpose. Spiritual practices, rest, and close interpersonal relationships emerge as the most influential factors for well-being, while formal obligations such as wearing religious attire or attending formation meetings were rated as less impactful. These findings highlight the important role of communal life in promoting both physical and spiritual health among religious sisters. Full article

Background: Chronic pain following thoracotomy remains a common and clinically significant complication that adversely affects functional recovery and quality of life. Despite advances in perioperative analgesic techniques, chronic post-thoracotomy pain continues to be under-recognized and insufficiently managed in routine clinical practice. In this study, we aimed to determine the incidence of chronic pain after thoracotomy and evaluate its impact on daily activities and postoperative pain management behaviors. Methods: This retrospective observational study was conducted after institutional ethics committee approval was received (approval no. 2023/61). Patients aged ≥15 years who underwent thoracotomy between 15 June 2022 and 15 June 2023 and had undergone an operation at least three months prior to the study were included. Patients who underwent video-assisted thoracoscopic surgery were excluded. Demographic, surgical, anesthetic, and postoperative analgesia data were obtained from medical records. Patients were contacted by telephone to assess pain intensity using a Numeric Rating Scale (NRS), functional impact on daily activities, and analgesic medication use. The primary outcome was the incidence of chronic post-thoracotomy pain, defined as pain persisting beyond three months and reported at the time of the interview. Results: A total of 56 patients were included in the analysis. Chronic pain was reported by 55.4% of the patients. Pain that interfered with daily activities and required medication use was reported by 51.5% of the patients. Thirty-three patients (57.9%) reported an NRS score > 3 during movement. Among patients with chronic pain, 64.7% reported self-medication without physician consultation, whereas only 11.8% sought medical advice for pain management. Conclusions: Chronic pain remains highly prevalent after thoracotomy and substantially interferes with daily functioning. A considerable proportion of patients self-manage their pain without medical supervision, underscoring the need for structured postoperative follow-up, early identification of high-risk patients, and individualized multimodal analgesic strategies to reduce the burden of chronic post-thoracotomy pain. Full article

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare iatrogenic reaction that may occur following parenteral drug administration, including inadvertent intra-arterial or periarterial injection. Its pathophysiology remains poorly understood; however, several mechanisms have been proposed, including vasospasm, embolization, cytotoxic inflammation, and secondary tissue necrosis. We report the case of a 22-year-old transgender woman who received intravenous benzathine penicillin in the left arm without a medical prescription following a reactive syphilis screening performed outside a formal healthcare setting. She subsequently developed severe pain, livedoid dermatitis, pallor, distal cyanosis, and blister formation. Radial and brachial pulses remained palpable, and Doppler ultrasonography revealed no evidence of arterial or venous thrombosis. Medical management included daily wound care, anticoagulation, corticosteroids, peripheral vasodilators, antibiotic therapy, and analgesia. The patient was hospitalized for nine days, with partial clinical improvement. However, persistent distal ischemic changes involving the second through fifth fingers raised concern for evolving necrosis and potential amputation. After counseling regarding these risks, the patient requested voluntary discharge. This case underscores the importance of safe medication administration and appropriate injection practices, particularly in low-resource settings. It also highlights the need for improved training of healthcare personnel to ensure early recognition and prompt management of Nicolau syndrome, as well as strengthened patient education to discourage self-medication and promote timely care by qualified healthcare professionals. Full article

This national survey examined factors influencing dentists’ prudent antibiotic prescribing, barriers to implementing evidence-based guidelines in dental practice, and solutions to promote prudent prescribing. A validated online survey assessed dentists across five domains: participant characteristics, antibiotic prescribing practices, knowledge of antimicrobial resistance, barriers and solutions for prudent antibiotic use, and knowledge and adherence to evidence-based guidelines. A total of 811 dentists completed the survey (55.2% female). Antibiotic prescribing was mainly influenced by patients’ clinical signs and symptoms (79.0%), immune status (73.0%), and medical/dental history (66.0%). Key contributors to antimicrobial resistance were frequent antibiotic prescribing (97.1%), patient self-medication with leftover antibiotics (95.1%), and use of broad-spectrum agents when narrower options were available (90.3%). Only 25% of participants were familiar with evidence-based guidelines. Regression analysis showed region and professional experience as significantly associated with compliance with prophylactic/therapeutic antibiotic prescribing to protect patients (OR = 1.7–1.5; p < 0.025). Awareness of the evidence-based guidelines, working ≤ 30 h/week, and receiving prescription feedback were significantly associated with compliance with therapeutic antibiotic prescribing to protect society (OR = 1.8–1.5; p < 0.030). Information technology support was perceived as a useful aid for prescribing. Antibiotics are still prescribed for inappropriate indications. Continued efforts are needed to raise awareness and strengthen antibiotic stewardship in daily practice. Full article

This study aims to examine eating practices during pregnancy as socially organized everyday labor (foodwork) embedded in daily life. Drawing on the sociology of food, it analyzes how pregnancy reshapes eating routines, food classifications, procurement practices, and care responsibilities. The research is based on in-depth qualitative interviews conducted with 38 pregnant women living in Türkiye. The findings demonstrate that eating during pregnancy becomes a multilayered social practice shaped by normative expectations, structural inequalities, and identity construction. First, eating routines emerge as a central site for the construction of maternal identity, as women regulate their food practices through expert advice, risk discourses, and norms of “good motherhood.” Second, body-related norms concerning aesthetics and weight control discipline eating practices under conditions of public surveillance and self-monitoring, shaping everyday eating arrangements. Third, pregnancy functions as a social lens that intensifies concerns related to food safety and food security; pesticides, additives, regulatory uncertainty, and economic access become central elements of everyday foodwork. By moving beyond medical and ideological approaches to pregnancy nutrition, this study foregrounds eating practices as foodwork and contributes to the sociology of food by linking motherhood, care labor, and food systems. Full article

Background and Objectives: The use of a standard chest X-ray has become a routine diagnostic method in daily clinical practice for the evaluation of a wide range of lung diseases. During the COVID-19 pandemic, significant challenges occurred in achieving accurate diagnostics and selecting appropriate therapies for patients with different symptoms of diseases. The aim was to cross-correlate radiological findings and clinical data and to develop models to predict hospitalization status, while evaluating the prognostic importance of the different variables. Materials and Methods: A set of variables including Brixia score, and clinical data: gender, age, hypertension, and diabetes was used to explore their association with patient hospitalization. Four different machine learning (ML) methods (Decision Tree—DT, Logistic Regression—LR, Random Forest—RF and Support Vector Machine—SVM) were used for hospitalization outcome prediction. Results: SVM appeared to be with the highest AUC (0.851), with low sensitivity, while DT was the most balanced in the context of AUC, accuracy, sensitivity, and specificity. Brixia score appeared to be the most important predictor for hospitalization within the group of predictors (gender, age, hypertension and diabetes). Conclusions: All four ML models that used in this study provided “good” prediction capabilities (AUC > 0.8), with the exception of SVM that had low sensitivity, emphasizing Brixia score as the strongest predictor of hospitalization. Application of ML methods have considerable potential in various aspects of medical clinical practice and future studies could potentially indicate the importance of applying the ML model in more precise diagnosis, therapy and prognosis of the patient’s clinical condition. Full article

Background: Electronic Medical Records improve decision-making but add administrative burdens for healthcare providers, such as physicians and nurses. While the rate of adoption is high in Saudi Arabia, the concrete temporary impact and reasoning behind their adoption are understudied. Objectives: This study is a Mixed-Methods Study designed to ascertain the number of hours of EMR use among physicians and nurses, the predictors of using EMRs for extended periods, perceived barriers and clinical impacts. Methods: A sequential mixed-methods study was performed in three hospitals in Riyadh, Dammam, and Makkah. Quantitative data from 503 clinicians were analyzed using inferential statistics, followed by thematic analysis of 10 semi-structured interviews. Results: A total of 503 professionals (162 physicians, 341 nurses) participated. The majority were females (67.2%), aged 30 to 40 years (44.9%), and non-Saudi (62%). Nurses reported a significantly higher daily EMR workload than physicians with 5.43 h (45.25%) versus 4.34 h (36.17%), with a mean difference of 1.09 h (t = −5.76, p = 0.001). Ordinal logistic regression identified female gender, non-Saudi nationality, nursing position, and lack of advanced education (Masters/Doctorate) as high-significance predictors of prolonged usage (all p < 0.005). Additionally, years of experience (p = 0.001) and EMR training (p = 0.003) were significant factors. Perceived barriers were moderate but significantly predicted by professional position (p = 0.004), work region (p = 0.017), and training duration (p = 0.001). Qualitatively, thematic analysis revealed four major barrier categories: system performance, infrastructure issues, lack of IT support, and increased workflow burdens. While EMRs improved professional practice and patient safety by solving handwriting issues and structuring data, they forced work routine adjustments that significantly reduced bedside patient interaction and assessment time. Full article

Background: Effective postoperative analgesia after laparoscopic cholecystectomy (LC) should facilitate rapid recovery while minimizing exposure to opioid-related adverse events, a central goal of enhanced recovery after surgery (ERAS). Although intravenous patient controlled analgesia (IV-PCA) remains widely used, its gastrointestinal and mobilization-impairing side effects may hinder early recovery. Methods: This retrospective cohort study included adult patients who underwent elective laparoscopic cholecystectomy, all performed using a standardized three-port technique, between January 2025 and December 2025. Patients with conversion to open surgery, concurrent procedures, incomplete medical records, or American Society of Anesthesiologists physical status ≥ IV were excluded. Patients received either a single-shot ultrasound-guided subcostal transversus abdominis plane (TAP) block with 0.19% ropivacaine or conventional fentanyl-based IV-PCA. Postoperative analgesic requirements, functional recovery outcomes, and safety profiles were evaluated. Results: All patients in the Group TAP (n = 60) required no rescue analgesia during the first 12 postoperative hours and did not require nonsteroidal anti-inflammatory drugs or IV-PCA within 24 h. Early recovery milestones were consistently achieved, including preserved early ambulation, prompt tolerance of oral intake, and smooth transition to oral acetaminophen 650 mg orally three times daily from postoperative day 1. All Group TAP patients met the discharge criteria by postoperative day 2 without opioid-related adverse events or signs of local anesthetic systemic toxicity. In contrast, the Group IV-PCA (n = 60) exhibited a high incidence of opioid-related adverse effects, frequent PCA interruption or discontinuation, delayed functional recovery, and prolonged hospitalization. Conclusions: A single-shot ultrasound-guided subcostal TAP block using low-concentration ropivacaine can function as a reliable, opioid-free primary analgesic strategy after laparoscopic cholecystectomy, effectively supporting ERAS-consistent early recovery. This approach represents a practical and clinically meaningful alternative to conventional IV-PCA in routine LC. Full article

Background/Objectives: Calcinosis cutis universalis is a rare and severe manifestation of dystrophic calcification, most associated with connective tissue diseases such as dermatomyositis, systemic sclerosis, and systemic lupus erythematosus. It is characterized by widespread deposition of calcium salts throughout the soft tissues, leading to pain, recurrent infections, restricted mobility, and significant impairment in daily functioning and quality of life. Management remains challenging due to the absence of standardized treatment guidelines with risks including delayed wound healing and recurrence. Adjunctive therapies may support symptom control in refractory cases. Conclusions: Management of calcinosis cutis universalis requires an individualized, multimodal strategy. Based on available evidence and expert opinion, a stepwise therapeutic decision-making algorithm integrating medical, minimally invasive, and surgical approaches is proposed to guide clinical practice and the variable efficacy of available therapies. This review aims to summarize current therapeutic strategies and to propose a pragmatic approach to clinical decision-making. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar. The review focused primarily on calcinosis cutis universalis and severe or extensive forms of calcinosis cutis, with particular emphasis on surgical management and its integration with medical and minimally invasive treatments. Results: Pharmacological treatments—including bisphosphonates, calcium-channel blockers, tetracyclines, phosphate binders, probenecid, immunomodulatory agents, biologics, colchicine, sodium thiosulfate and JAK inhibitors—show heterogeneous and often partial efficacy, with more favorable responses in early or localized disease. Surgical interventions such as excision, curettage, CO₂ laser ablation, and reconstructive procedures provide meaningful symptomatic relief in selected patients but are associated. Full article

Background and Objectives: Academic point-of-care (POC) manufacturing enables the in-hospital design and production of patient-specific medical devices within certified environments, integrating clinical practice, engineering, and translational research. This model represents a new academic ecosystem that accelerates innovation while maintaining compliance with medical device regulations. Gregorio Marañón University Hospital has established one of the first ISO 13485-certified academic manufacturing facilities in Spain, providing on-site production of anatomical models, surgical guides, and custom implants for oral and maxillofacial surgery. This study presents a retrospective review of all devices produced between April 2017 and September 2025, analyzing their typology, materials, production parameters, and clinical applications. Materials and Methods: A descriptive, retrospective study was conducted on 442 3D-printed medical devices fabricated for oral and maxillofacial surgical cases. Recorded variables included device classification, indication, printing technology, material type, sterilization method, working and printing times, and clinical utility. Image segmentation and design were performed using 3D Slicer and Meshmixer. Manufacturing used fused deposition modeling (FDM) and stereolithography (SLA) technologies with PLA and biocompatible resin (Biomed Clear V1). Data were analyzed descriptively. Results: During the eight-year period, 442 devices were manufactured. Biomodels constituted the majority (approximately 68%), followed by surgical guides (20%) and patient-specific implants (7%). Trauma and oncology were the leading clinical indications, representing 45% and 33% of all devices, respectively. The orbital region was the most frequent anatomical site. FDM accounted for 63% of the printing technologies used, and PLA was the predominant material. The mean working time per device was 3.4 h and mean printing time 12.6 h. Most devices were applied to preoperative planning (59%) or intraoperative use (35%). Conclusions: Academic POC manufacturing offers a sustainable, clinically integrated model for translating digital workflows and additive manufacturing into daily surgical practice. The eight-year experience of Gregorio Marañón University Hospital demonstrates how academic production units can enhance surgical precision, accelerate innovation, and ensure regulatory compliance while promoting education and translational research in healthcare. Full article