Search Results (5,322)

Background: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. Objective: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children’s Hospital before and after COVID-19. Methods: We conducted a retrospective study including all patients aged 0–16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017–28 February 2020; COVID-19: 1 March 2020–31 December 2021; and post-COVID-19: 1 January 2022–31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. Results: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1–177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. Conclusions: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates. Full article

Objective: This study aims to examine the relationship between atopic dermatitis (AD), one of the most common dermatological conditions in children, and environmental factors, including meteorological variables and air pollution. Methods: This retrospective cross-sectional study analyzed the medical records of 21,407 pediatric patients aged 0 to 18 years who presented to the city hospital in Agri, Turkey, between 2020 and 2024. Admission dates were matched with meteorological data (wind speed, atmospheric pressure, humidity, temperature) and air pollution indicators (PM₁₀, SO₂, NO₂, NOx, NO, O₃). Statistical analyses included t-tests, correlation analyses, binary logistic regression, and a CHAID decision tree model. Results: AD accounted for 10.1% of all dermatology-related visits. AD admissions increased particularly during the first half of the year and were significantly associated with higher O₃ levels, whereas increased PM₁₀ levels were associated with a lower likelihood of AD admissions. Logistic regression showed that age, sex, semiannual period, atmospheric pressure, PM₁₀, and O₃ were significant predictors of AD. The decision tree model identified age, period, and O₃ as the strongest discriminating variables for AD. Conclusion: AD was found to be more sensitive to environmental and seasonal variations compared with other dermatitis types. In particular, elevated ozone levels and temporal factors played a notable role in increasing AD presentations. These findings may inform environmental risk management and preventive strategies for children with AD. Full article

Background: Efficient and accurate clinical data management is crucial for stroke care and research; however, for complex stroke cohorts, manual data entry is often complicated by high human error rates and significant inefficiency. This study addressed this gap by developing and evaluating an automated system for constructing high-quality stroke cohorts from electronic health records (EHRs). Methods: This retrospective cohort study was conducted at a single specialty hospital, comparing manual data entry (January–June 2022) with an automated system (January–June 2024). The system uses C# and secure SQL protocols for direct EHR integration. We developed an automated system using the C# programming language to extract 133 items covering the full hospitalization period (from admission to discharge) from EHRs, aligning with the Korean Stroke Registry, the Registry of Stroke Care Quality, and national quality assessment programs. The system’s effectiveness was evaluated by assessing the data entry time, data error rate, and medical record completion rate and comparing the automated method’s performance against conventional data entry. Results: The automated system significantly reduced the data entry time from 35 min to 19 s per patient. Furthermore, the data error rate decreased from 2.32% to 0.15% (p < 0.001), and the rate of missing medical records decreased from 28.9% to 16.2% (p < 0.001). Conclusions: The proposed clinical data collection and cohort construction system effectively improved data quality and efficiency compared to the manual method. This system provides a reliable and scalable data infrastructure that could facilitate research on stroke and quality improvement initiatives. Full article

Introduction: In recent decades, the burden of mental disorders has become a major determinant of population health in the European Union, generating profound clinical, socioeconomic, and institutional consequences. Despite political recognition of this silent crisis, substantial methodological challenges persist in the transnational monitoring of mental health and in linking disease burden with the resources allocated to address it. The present analysis develops a multivariate taxonomy of EU Member States from a psychosocial perspective, using an integrative quantitative approach. Methods: This cross-sectional, comparative study follows international standards for transparent and reproducible quantitative reporting and is based on 18 harmonized clinical, epidemiological, and institutional indicators collected for 27 EU Member States over the period 2014–2023. The indicators used in this study were grouped according to their position along the care continuum. Hospital-based indicators refer to inpatient activity and institutional capacity, including total hospital discharges, psychiatric admissions (affective disorders, schizophrenia, dementia, alcohol- and drug-related disorders), and hospital bed availability. Outpatient and community-level indicators reflect the capacity of systems to provide non-hospital psychiatric care and consist primarily of psychiatrist density and total specialist medical workforce. Finally, subjective perception indicators capture population-level self-assessed health status, complementing clinical and institutional measures by integrating a psychosocial perspective. After harmonization and standardization, Principal Component Analysis (PCA) with Varimax rotation was applied to identify latent dimensions of mental health. Model adequacy was confirmed using the Kaiser–Meyer–Olkin coefficient (0.747) and Bartlett’s test of sphericity (p < 0.001). Results: Three latent dimensions explaining 77.7% of the total variance were identified: (1) institutionalized psychiatric burden, (2) functional capacity of the health care system, and (3) suicidal vulnerability associated with problematic substance use. Standardized factor scores allowed for the classification of Member States, revealing distinct patterns of psychosocial risk. For example, Germany and France display profiles marked by high levels of institutionalized psychiatric activity, while the Baltic and Southeast European countries exhibit elevated suicidal vulnerability in the context of limited medical resources. These results highlight the deep heterogeneity of psychiatric configurations in Europe and reveal persistent gaps between population needs and institutional response capacity. Conclusions: The analysis provides an empirical foundation for differentiated public policies aimed at prevention, early intervention, and stigma reduction. It also supports the case for institutionalizing a European mental health monitoring system based on harmonized indicators and common assessment standards. Overall, the findings clarify the underlying structure of mental health across the European Union and underscore the need for coherent, evidence-based strategies to reduce inequalities and strengthen system performance at the continental level. Full article

Background/Objectives: Drug hypersensitivity reactions (DHRs) are an important cause of morbidity in hospitalized patients, but their epidemiology and management in the inpatient setting are not well defined. Mislabeling of drug allergies may lead to inappropriate treatment and reduced antimicrobial stewardship. This study aimed to characterize the clinical profile, diagnostics, and management of inpatients referred for suspected drug allergy in a tertiary care hospital. Methods: We retrospectively reviewed all adult inpatients (≥18 years) at Luigi Sacco Hospital (Milan, Italy) who received allergology consultation between 1 June 2022 and 31 May 2025. Data on demographics, reaction type, culprit drugs, investigations, and management were collected. Immediate reaction severity was graded using the United States Drug Allergy Registry (USDAR) scale; delayed reactions were classified as severe cutaneous adverse reactions (SCARs) or non-SCARs. Logistic regression identified predictors of severity. Results: Among 35,438 admissions, 334 patients (0.9%) were evaluated; median age was 65 years, 51.2% were female, 67.4% had atopic comorbidities, and 55.1% reported prior drug allergy. Immediate reactions occurred in 49.1%, delayed in 43.7%. Cutaneous involvement was present in 86.8%, anaphylaxis in 6.6%, and SCARs in 3.9%. Antibiotics—particularly β-lactams—were most often implicated. In multivariate analysis, antibiotic exposure and older age were linked to more severe immediate reactions, while the absence of atopy predicted SCARs. Desensitization was successfully performed in 16.2% of patients. Conclusions: DHRs in inpatients are frequent and often involve high-risk drugs. Structured inpatient allergology services and an “allergy stewardship” approach may reduce DHR-related risks, support optimal therapy, and improve antimicrobial use strategies in tertiary care settings. Full article

Background/objectives: Diabetes mellitus (DM) increases susceptibility to both cardiovascular and renal complications. Acute kidney injury (AKI) in the setting of acute coronary syndrome (ACS) is a frequent manifestation of acute cardiorenal syndrome (type 1); however, the impact of diabetes on the condition remains incompletely characterised. This study aimed to evaluate the real-world incidence, severity, and recurrence of AKI in individuals with ACS, focusing on the additional risk conferred by DM, and to assess the adequacy of post-discharge renal monitoring. Methods: We conducted a single-centre, retrospective observational study of 990 ACS admissions between July 2020 and June 2021 at the United Lincolnshire Hospitals NHS Trust. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes criteria and stratified by severity. Outcome measures included incidence of AKI during admission, recurrence of AKI, and renal function monitoring within 12 months post-discharge. Results: Of 990 individuals recruited, 315 (31.8%) had DM. Overall, 14.2% individuals developed AKI during admission, being more frequently observed in those with DM (20.0% vs. 11.6%; RR 1.7, p < 0.001). Severe AKI (stage 3) was higher in those with diabetes (2.9% vs. 0.7%, p = 0.017). Recurrent AKI within 12 months occurred in 9.7%, with a higher incidence in those with DM (15.8% vs. 6.9%, p < 0.001). Post-discharge renal follow-up was performed in 88.7% of persons with AKI and similar in those with and without DM. Conclusions: Acute kidney injury is a common and serious complication of ACS, with DM substantially increasing the risk and severity of the condition during acute events and post-discharge. Despite this, individuals with DM receive similar monitoring in the post-discharge period. Improved systems for post-discharge renal monitoring and early initiation of protective therapies are required to mitigate long-term risk. Full article

Seasonal influenza is a major cause of morbidity and hospitalization in children, with the potential for severe complications and considerable socioeconomic impact. We conducted a retrospective observational study including 1046 children aged 0–14 years with laboratory-confirmed influenza who accessed the Paediatric Emergency Department of a tertiary center in Bologna, Italy, across three consecutive epidemic seasons (2022–2025). While the entire cohort was analysed, particular attention was given to children with severe complications requiring hospitalization, for whom more detailed clinical and laboratory data were available. Overall, 12.3% of patients required hospitalization, and 6.1% experienced complications, most frequently influenza-associated encephalopathy, lower respiratory tract infections and myositis. Influenza A predominated overall (82.0%), except for in the last season, which saw a predominance of influenza B (57.4%), closely associated with myositis and elevated creatine phosphokinase levels. Younger age was consistently associated with increased severity and hospitalization. Intensive care admissions were rare (0.8%), and no deaths were recorded. Our findings suggest that, although influenza is generally self-limiting, younger children are at higher risk of complications. These results highlight the importance of active surveillance, careful monitoring of clinical manifestations and targeted paediatric vaccination strategies to reduce the burden of seasonal influenza. Full article

Although COVID-19 is associated with significant thrombo-inflammatory complications, reliable biomarkers to guide antithrombotic therapy remain limited. Immature platelet fraction (IPF) reflects platelet turnover and may indicate heightened thrombotic risk. We retrospectively analyzed 133 hospitalized COVID-19 patients (median age 68 years) at a single center. IPF and inflammatory markers (WBC, ANC, D-dimer, LDH, CRP) were measured on admission. Correlations between IPF and these biomarkers were assessed overall and in clinical subgroups (age, sex, disease severity, comorbidities, and treatment). We found that IPF was positively correlated with WBC and ANC in patients less than 70 years old (r = 0.36 and 0.33, respectively; p < 0.05), males, and those with moderate-to-severe disease. Among patients with congestive heart failure, IPF correlated strongly with D-dimer (r = 0.78, p = 0.013). Similar associations were observed in patients requiring enoxaparin or antiplatelet therapy. No significant correlations were found in patients age 70 or older. Based on these findings, we conclude that elevated IPF is associated with increased inflammatory and thrombotic activity in hospitalized COVID-19 patients, especially in younger, male, and more severe cases. These findings suggest IPF may serve as a dynamic marker for thrombo-inflammation and help identify patients who might benefit from more intensive antithrombotic therapy. Larger studies are warranted to validate IPF as a biomarker for personalized management of COVID-19. Full article

Objectives: The aim was to evaluate the clinical features, management and 1-year outcomes in patients with heart failure (HF) and advanced chronic kidney disease (CKD) who were followed in specialized HF units in Spain. Methods: Data from the registry of the SEC-Excellent-HF quality program of the Spanish Society of Cardiology were analyzed. This registry included 1567 patients between 2019 and 2022 followed by 45 specialized HF units. Clinical features, treatment and 1-year rate of events (death and HF hospitalizations) were compared between the groups of advanced CKD (glomerular filtration rate <30 mL/minute/m²) and GFR ≥ 30 mL/min/m². Results: 11.1% of patients had a GFR < 30 and 88.9% ≥ 30 mL/min/m². The median LVEF was similar in groups with GFR < 30 and ≥30 mL/min/m²: 42% (IQR 30–58) versus 38% (IQR 29–54). Advanced CKD patients were older, had more severe HF (previous HF admissions in the last year, worse NYHA functional class and longer evolution time) and had higher prevalence of ischemic heart disease, diabetes mellitus, systemic hypertension, iron deficiency, anemia and hyponatremia. All drugs for HF, except for diuretics and potassium binders, were used in a lower proportion in patients with GFR < 30 mL/min/m² (p < 0.001). One-year overall mortality (49.2 versus 13.7/100 patients-year; p < 0.001) and one-year HF hospitalizations rate (83.2 versus 30.7/100 patients-year; p < 0.001) were higher in the group of advanced CKD. Conclusions: In our study, patients with advanced CKD had different clinical characteristics, received indicated treatment in a lower proportion and had higher 1-year rates of death and HF admissions. Full article

Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus (DM) associated with significant morbidity, mortality, and healthcare burden worldwide. This study aimed to investigate population descriptors and clinical outcomes among adult and pediatric patients admitted with DKA at two tertiary medical centers in Riyadh, Saudi Arabia. Methods: We conducted a retrospective observational study that included adult and pediatric (≤15 years) patients admitted to emergency departments (EDs) and received care for DKA between 2018 and 2021. DKA severity was defined according to the American Diabetes Association (ADA) criteria, which rely on arterial/venous pH and serum bicarbonate (with anion gap supportive), as follows: mild (pH 7.25–7.30; HCO₃⁻ 15–18 mmol/L), moderate (pH 7.00–7.24; HCO₃⁻ 10–15 mmol/L), and severe (pH < 7.00; HCO₃⁻ < 10 mmol/L). Data were extracted from electronic medical records and analyzed descriptively. Results: A total of 373 patients were admitted to the EDs and received treatment for DKA throughout the study period. Adults constituted 71.6% (267/373), while children represented 28.4% (106/373) of the patients; the majority of adults (74.2%) had Type 1 DM (T1DM), while all pediatric patients had T1DM. More than half of the adult presentations met the criteria for severe DKA (55.8%; 149/267), whereas pediatric cases were most commonly moderate in severity (41.5%; 44/106). The most common precipitating factors across both age groups of patients with diabetes before the index DKA event were non-compliance with therapy and infection. Both groups demonstrated typical biochemical features of DKA, although pediatric patients presented with slightly lower bicarbonate and higher anion gaps (slightly greater metabolic acidosis) but with similar hydration status. Regarding patients’ outcomes, hyperkalemia was identified in 23.6% of adults and 24.5% of pediatric patients, while hypokalemia was documented in 20.2% of adults and 24.5% of pediatric patients, and adult patients experienced more acute kidney injuries than the other cohort (5.2% vs. 1.9%). In-hospital mortality was 0.8% (3/373) among all adults. Although pediatric patients experienced faster DKA resolution (median = 16.5 h; IQR, 11.7–25.8) compared to adult patients (23.7 h; 16.2–36.9), they had a longer hospital stay compared to adult patients, and a significant majority required ICU care (50.9%) at some point during their care. Conclusions: The increasing prevalence of DM in Saudi Arabia, especially among the youth, would lead to an increase in DKA burden unless effective preventive measures are taken. This study demonstrated that preventable causes, such as non-compliance with therapy and infection, were responsible for the high admission rates. Thus, comprehensive outpatient care can help strengthen care continuity and help decrease the burden on emergency and inpatient services. Full article

Introduction: Cardiac sarcoidosis (CS) is a rare but potentially life-threatening manifestation of systemic sarcoidosis, often leading to arrhythmias, conduction abnormalities, or heart failure. Diagnosis is challenging due to nonspecific symptoms and the need for advanced imaging or biopsy. Case Presentation: We describe a 49-year-old man admitted with severe decompensated heart failure (NYHA IV). He had a history of complete heart block treated with pacemaker implantation and subsequent CRT-D upgrade. On admission, echocardiography revealed biventricular dysfunction with severe mitral and tricuspid regurgitation. Cardiac MRI demonstrated extensive non-ischemic late gadolinium enhancement. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA) and intravenous antibiotics were initiated. Despite diuretics and inotropes, his condition deteriorated. Corticosteroid therapy was started due to high suspicion of sarcoidosis. Endomyocardial biopsy confirmed CS. The patient developed neuropsychiatric complications and, despite urgent listing for heart transplantation, died during hospitalization. Conclusions: This case highlights the diagnostic and therapeutic challenges of CS, the limitations of corticosteroid therapy in advanced disease, and the importance of early recognition with advanced imaging modalities. Full article

Background/Objectives: Hip fracture patients commonly exhibit impaired nutritional status, including low serum albumin levels related to sarcopenia, which may affect recovery. This study evaluated the effect of branched-chain amino acid (BCAA) supplementation on serum albumin levels in hip fracture patients. Methods: This retrospective analysis was conducted at a single tertiary referral center on a cohort of patients with hip fractures including femoral neck and intertrochanteric fractures who visited the emergency department between January 2022 and November 2023. After propensity score matching, 106 patients were analyzed (BCAA: n = 53; control: n = 53); prior to matching, 67 treated and 110 control patients were eligible. Patients receiving BCAA supplementation were administered three times daily for six weeks postoperatively and they were matched with controls based on clinical and demographic variables. Controls received standard perioperative care without BCAA supplementation, and no placebo was administered. Serum albumin levels were measured before the surgery and 6 weeks postoperatively. After propensity score matching, 53 patients from each cohort were analyzed. The primary outcome was the difference in serum albumin levels; secondary outcomes were the length of hospital stay (LOS), blood transfusions (Tf), and the incidence of delirium. Results: The matched cohorts exhibited comparable baseline characteristics. Analysis revealed a significant increase in serum albumin levels among patients who received BCAA supplementation compared to the matched control group. No differences were found in terms of LOS, Tf, and the incidence of delirium during the index admission. Conclusions: This preliminary study suggests a potential positive effect of BCAA supplementation on serum albumin levels in patients with hip fractures. Further prospective investigations with larger sample sizes are warranted to validate these findings and elucidate the clinical implications for nutritional support in this population. Full article

Background/Objectives: Postoperative pneumonia (PP) is a significant complication following thoracic surgery, increasing morbidity, mortality, and hospital length of stay. Identifying risk factors is crucial for optimizing perioperative management. This study analyses predictors for PP in patients undergoing anatomical lung resections in a single center setting. Methods: A prospective cohort study was conducted using data from the German Thoracic Registry (GTR). Patients who underwent anatomical lung resection were included in the study, while non-anatomical resections and cases with missing data were excluded. The primary outcome measure was the incidence of PP, which was analyzed using chi-square tests and Fisher’s exact test. Results: PP was observed in 15.2% of the 381 patients. Significant preoperative predictors included American Society of Anesthesiologists (ASA) classification ≥ 3 (p = 0.021), C-reactive protein (CRP) ≥ 20 mg/L (p = 0.004), white blood cell count (WBC) ≥ 15,000/µL (p = 0.003) and forced expiratory volume in 1 s (FEV1) < 50% (p = 0.004). Intraoperative risk factors included thoracotomy (THT) (p = 0.001) and duration of operation > 180 min (p = 0.002). Postoperative predictors included Intensive Care Unit (ICU) admission (p < 0.001) and mechanical ventilation > 24 h (p < 0.001). PP was associated with a higher perioperative mortality rate (10.3% vs. 1.2%, p = 0.01) and prolonged hospital stay. Conclusions: A number of risk factors for the development of PP have been identified, which may help to reduce the incidence of the condition. For further validation, multicenter studies are required. Full article

Thoracic aortic aneurysms (TAAs) carry a high risk of fatal rupture, necessitating improved preoperative risk stratification. This study evaluates the predictive value of systemic risk scores—specifically the Model for End-Stage Liver Disease (MELD) and the Charlson Comorbidity Index (CCI)—for in-hospital mortality, length of stay, and one-year mortality in patients undergoing elective ascending aortic surgery. The study further compares MELD variants (MELD-Na and MELD-XI) for their prognostic performance in this context. This retrospective single-center study analyzed digital medical records of 500 patients undergoing elective surgery for ascending thoracic aortic disease between 2003 and 2023. MELD, MELD-Na (incorporating sodium), and MELD-XI (excluding INR for anticoagulated patients) were calculated from preoperative laboratory data. The CCI was derived from documented comorbidities. Outcomes included in-hospital mortality, length of stay (from admission to discharge), and one-year mortality assessed via outpatient follow-up. The study excluded patients undergoing emergency surgery for Stanford type A aortic dissection. MELD-Na incorporates serum sodium, while MELD-XI is a variant that excludes INR for patients with anticoagulation. The Charlson Comorbidity Index (CCI) was derived from patients’ medical histories prior to surgery. Length of stay was defined as total inpatient days between admission and discharge. One-year mortality was assessed via outpatient follow-up data. Loss to follow-up did not exceed 30%. Of 500 patients (median age 64 years, 72.8% male), the MELD-Na score showed the strongest ability to predict in-hospital mortality (AUC = 0.698), outperforming both the standard MELD (AUC = 0.690) and the age-adjusted CCI (AUC = 0.631). For one-year mortality (N = 355), MELD-Na again performed best (AUC = 0.732), while the unadjusted CCI showed minimal predictive value (AUC = 0.509). Predictive power for hospital length of stay was limited across all scores; the age-adjusted CCI achieved the highest, though modest, discrimination (AUC = 0.627). 1-year mortality was assessed in 355 patients with available follow-up data (29.0% lost to follow-up). Among these, non-survivors had significantly higher MELD scores (p < 0.001). MELD-Na demonstrated the strongest predictive performance (AUC = 0.732). The MELD score, particularly MELD-Na, demonstrated strong predictive ability for in-hospital and 1-year mortality, but showed limited value in estimating hospital stay duration. MELD-Na and the age-adjusted CCI provide valuable preoperative prognostic information for patients undergoing elective ascending aortic surgery. While not intended to replace established risk models, their simplicity and reliance on routine clinical data make them attractive tools for early triage, especially in older or multimorbid patients. Their integration into preoperative planning may enhance individualized risk assessment and resource allocation. Full article