Search Results (3,833)

Background/Objectives: Pediatric and adolescent gynaecology addresses the distinct developmental needs of the reproductive systems of young patients. Diagnosing and treating gynaecological issues in this age group are challenging due to overlapping symptoms and the developmental stage. This study aimed to identify common gynecological issues based on retrospective analysis of medical documentation from the Developmental Gynecology and Sexology Laboratory of the Gynecology Clinic, Department of Gynecology, Poznan University of Medical Sciences (UMP) from the years 2012–2023. Methods: The study involved 4942 patients under 18 years old. Medical records from the years 2012–2023 were analyzed, focusing on the most frequent diagnoses. Statistical analyses were performed using StatSoft STATISTICA PL 10 software, with a significance threshold of p < 0.05. Results: The most frequent diagnosis was pelvic pain syndrome (77.8%), followed by androgenization syndromes (13.2%). While the number of admissions remained stable over the years (r = 0.131, p > 0.05), there was a significant increase in the percentage of androgenization syndromes (p = 0.0040) and a decrease in pelvic pain syndrome cases (p = 0.0018). Other conditions such as eating disorders and psychosexual issues were also prevalent, highlighting the need for a multidisciplinary approach. Conclusions: The analysis indicates a shift in adolescent gynaecological diagnoses over time, with pelvic pain syndrome decreasing and androgenization syndromes increasing. The findings underline the importance of specialised, multidisciplinary care and further research to adapt diagnostic and therapeutic strategies to the changing landscape of pediatric gynaecology. Full article

Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder with several sensory, autonomic, motor, and trophic symptoms. Diagnosis is based on clinical criteria like the Budapest Criteria, but there are limitations to those criteria, especially for pediatric cases and different clinical presentations. Technical testing—including laboratory tests, electrophysiological studies, sensory and autonomic function tests, and more advanced imaging—provides supportive, but not definitive, evidence. Biomarkers such as certain microRNAs, inflammatory mediators, and autoantibodies may offer the potential for improved diagnostic accuracy, although they have not yet been adequately validated. New imaging techniques, including ultrasound elastography and neuroimaging, have identified both peripheral and central pathophysiological changes in CRPS. We can improve our diagnosis of CRPS by integrating standardized clinical criteria with technical evaluations and biomarker improvements; this should serve to make diagnosis earlier, reduce diagnostic delay, and promote individualized treatment. Full article

A 2-year-old male neutered domestic shorthair cat was presented with a 12-month history of anorexia, weight loss, vomiting, polyuria, and polydipsia. Physical examination revealed a responsive but debilitated cat with icteric mucous membranes and a low body-condition score. Laboratory tests showed mild macrocytic anemia, elevated liver enzymes, hyperproteinemia with hypoalbuminemia, hyperbilirubinaemia, and a decreased vitamin B12 level. Abdominal ultrasound revealed marked dilation of the common bile duct (CBD) and gallbladder, consistent with suspected extrahepatic biliary tract obstruction, as well as secondary pancreatic and intrahepatic duct distension. Cytological and bacteriological analyses confirmed bacterial cholangiohepatitis due to a mixed infection with Escherichia coli and Peptostreptococcus canis. Despite initial conservative management, the cat’s clinical condition remained unchanged, prompting exploratory laparotomy. Intraoperative findings confirmed the ultrasonographic suspicions and revealed severe pancreatitis. Based these findings, a cholecystectomy, choledochoenterostomy, and placement of a cholecystostomy tube as well as an abdominal drain and jejunal feeding tube were performed. Postoperatively, the cat initially showed improvement but subsequently developed signs of sepsis requiring intensive care. Although temporary stabilization was achieved, the cat died suddenly ten days after surgery due to unknown causes. This case report highlights the diagnostic and therapeutic challenges associated with bacterial cholangiohepatitis secondary to biliary obstruction in cats and documents the first clinical application of choledochoenterostomy—a surgical procedure previously only described hypothetically in this species. Full article

Risk prediction models are increasingly used in the management of coronary artery disease (CAD), with applications ranging from diagnostic stratification to prognostic assessment and therapeutic guidance. In the context of CAD and percutaneous coronary intervention, clinical decision-making often relies on risk scores to estimate the likelihood of ischemic and bleeding events and to tailor antithrombotic strategies accordingly. Traditional scores are derived from clinical, anatomical, procedural, and laboratory variables, and their performance is evaluated based on discrimination and calibration metrics. While many established models are simple, interpretable, and externally validated, their predictive ability is often moderate and may be limited by outdated derivation cohorts, overfitting, or lack of generalizability. Recent advances have introduced artificial intelligence and machine learning models that can process large, high-dimensional datasets and identify patterns not apparent through conventional methods, with the aim to incorporate complex data; however, they are not exempt from limitations and struggle with integration into clinical practice. Notably, ethical issues, such as equity in model application, over-stratification, and real-world implementation, are of critical importance. The ideal predictive model should be accurate, generalizable, and clinically actionable. This review aims at providing an overview of the main predictive models used in the field of CAD and to discuss methodological challenges, with a focus on strengths, limitations and areas of applicability of predictive models. Full article

Rapid and non-destructive acquisition of soil nutrient information is crucial for precision fertilization and soil quality monitoring. This study aims to establish a Raman spectroscopy-based framework for predicting key soil fertility indicators, including alkali-hydrolyzable nitrogen (AN), total nitrogen (TN), total phosphorus (TP), and organic matter (OM). The framework systematically integrates three typical spectral preprocessing methods (Standard Normal Variate transformation (SNV), Savitzky–Golay first derivative (SG_D1), and wavelet transform (Wavelet)), three feature selection strategies (Recursive Feature Elimination, XGBoost importance, and Random Forest importance), and 14 mainstream regression models to construct a multi-combination modeling system. Model performance was evaluated using five-fold cross-validation, with 80% of samples used for training and 20% for validation in each fold. Preprocessed Raman spectral features served as input variables, while the corresponding nutrient contents were used as outputs. Results showed significant differences in prediction performance across various combinations of preprocessing methods and regression algorithms for the four soil nutrient indicators. For AN prediction, the combination of Raw_SNV preprocessing with ElasticNet and BayesianRidge models achieved the best performance, with Test R² values of 0.713 and 0.721, and corresponding Test NRMSE as low as 0.092. For OM prediction, the same Raw_SNV preprocessing with ElasticNet and BayesianRidge also performed well, yielding Test R² values of 0.825 and 0.832, and Test NRMSE of 0.100 and 0.098, respectively. In TN prediction, both ElasticNet and BayesianRidge under Raw_SNV preprocessing achieved consistent Test R² of 0.74 and Test NRMSE around 0.20, indicating stable reliability. For TP prediction, the BayesianRidge model with Raw_SNV preprocessing outperformed all others with a Test R² of 0.71 and Test NRMSE of just 0.089, followed closely by ElasticNet (Test R² = 0.70, Test NRMSE = 0.092). Overall, the Raw_SNV preprocessing method demonstrated superior performance compared to SG_D1_SNV and Wavelet_SNV. Both BayesianRidge and ElasticNet consistently achieved high R² and low NRMSE across multiple targets, showcasing strong generalization and robustness, making them optimal model choices for Raman spectroscopy-based soil nutrient prediction. This study demonstrates that Raman spectroscopy, when combined with appropriate preprocessing and modeling techniques, can effectively predict soil organic matter and nitrogen in specific soil types under laboratory conditions. These results provide initial methodological insights for future development of intelligent soil nutrient diagnostics. Full article

Background: Ambatoboeny District in northern Madagascar faces significant health challenges due to widespread poverty, poor access to healthcare, and limited diagnostic capabilities. Despite high disease burden, data on morbidity patterns in the region are scarce. This study aims to identify the most prevalent diseases and most affected demographic groups, thus providing valuable insight into the region’s health profile. Methods: A retrospective analysis was conducted on medical records from 3678 patients who were admitted at Clinique Médicale BEYZYM, a secondary-level referral facility in Manerinerina, Boeny Region between January and December 2024. Diagnoses were retrieved from physician registration ledgers, hospitalization records, monthly laboratory reports, monthly general hospital activity reports and monthly reports from Centre de Traitement et de Diagnostic de la Tuberculose, which were cross-referenced and verified by trained clinical staff. Records were included if they contained identifiable demographic data and at least one clinical diagnosis. Diagnoses were coded using ICD-11 and were classified into 15 major categories. Results: The median patient age was 19.5 years (IQR: 7–42), with females accounting for 54% of the cohort. Most patients (87.2%) resided in Ambatoboeny. The most common reasons for admission were infectious and parasitic diseases (35.75%, 95% CI: 34.20–37.30), respiratory diseases (22.73%, 95% CI: 21.38–24.08), and diseases of the genitourinary system (13.95%, 95% CI: 12.83–15.07), collectively accounting for 72.43% of all recorded cases. Statistically significant differences in morbidity patterns were observed across age and sex groups. Conclusions: The findings underscore the multifaceted burden of disease in the Ambatoboeny District, where both infectious and chronic conditions coexist in a resource-limited setting. Delayed healthcare-seeking behavior, cultural beliefs, and diagnostic limitations further complicate care delivery. This study provides foundational data to inform targeted health policies, humanitarian medical missions, and diagnostic capacity-building tailored to local needs. Full article

Infection with Burkholderia pseudomallei, the causative agent of melioidosis, is uncommon in the United States (U.S.), leading to delays in pathogen identification and clinical diagnosis which can often lead to laboratory exposures. The indirect hemagglutination assay (IHA) is the primary serological test for confirming exposure to B. pseudomallei. In the U.S., a titer of ≥1:40 suggests exposure to B. pseudomallei or a closely related species, and a 4-fold rise in IHA titer ≥1:40 with clinically compatible illness is considered diagnostically probable. A retrospective analysis of 160 voluntarily reported laboratory exposure events to B. pseudomallei across 29 U.S. jurisdictions and 5 countries between 2008–2024 was conducted. This analysis included post-exposure management data and IHA results for 855 exposed laboratory personnel who had serological monitoring performed at the U.S. Centers for Disease Control and Prevention (CDC). Among exposed laboratory personnel, 105 (12%) had a seropositive titer. Of these, ninety-one (87%) laboratory personnel remained seropositive (≥1:40) at their last IHA test. Five (1%) people had a 4-fold rise in titers, though none developed melioidosis. This report underscores the need for prospective studies to evaluate seropositive laboratory personnel and to update risk guidance for laboratory exposures in non-endemic areas. Full article

Time- and space-resolved radiation emitted by the plasma produced by a 0.8 ns duration at full width half maximum, ~600 MW maximum power microwave (~9.6 GHz) pulse traversing a hydrogen-, helium-, or air-filled circular waveguide, is studied. Gas ionization by microwaves is an old subject but the regime investigated in the present experimental research, of very high-power microwaves and very short pulses using modern diagnostic tools, is new and follows a series of new studies performed so far only in our laboratory, revealing non-linear phenomena never observed before. In the present research, plasma radiation is observed along a slit made in a circular waveguide wall by either an intensified fast frame camera or a streak camera. Using calibrated input and output couplers, the transmission and reflection coefficients of the high-power microwaves were determined over a broad range of gas pressures, 0.1 kPa < P < 90 kPa. It was found that the intensity of the plasma light emission increases significantly after the high-power microwave pulse has left the waveguide. Depending on pressure, the radiation is either uniform along the slit, while the front of the emitted light follows the microwave pulse at a velocity close to its group velocity, or it remains in the vicinity of the input window, indicating that the plasma density is above critical density. It was also found that the radial distribution of radiation depends on pressure. At pressures <10 kPa, when the electron oscillatory energy reaches 20 keV close to the waveguide axis, light emission forms faster near the waveguide walls, where the ionization rate is maximal. Otherwise, when pressure is >80 kPa, light emission is most intense on the axis where the electron oscillatory energy is ~100 eV and the ionization rate is maximal. We also studied the UV radiation from the plasma, the duration of which was found to be longer than the duration of visible light emission. This indicates the existence of energetic electrons for tens of ns after the high-power microwave pulse has left the observation region. Considering that the emitted light intensity depends on the plasma density and temperature, the observed data may be used for a comparison with the results of collisional radiative models if the electron time and spatial energy distribution is known. Full article

Background: The Enterobacteriaceae family is the most heterogeneous group of Gram-negative bacilli, with both environmental and clinical relevance. Although many of these species are part of the normal intestinal microbiota, species such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis are among the most common opportunistic pathogens, frequently responsible for nosocomial infections, including urinary tract infections, bacteraemia, and pneumonia. Based on these concerns, these species are increasingly being studied for their ability to develop antimicrobial resistance, often mediated by extended spectrum β-lactamase or carbapenemase production. The present study aims to analyse the antimicrobial resistance profiles of Enterobacteriaceae isolated from a southern Italian hospital focusing on the species of major clinical importance. Methods: A retrospective analysis was carried out on biological samples collected between 2019 and 2023 at the Microbiology Laboratory of the San Pio Hospital, Vasto (Italy). Eight hundred ninety patients were included, with an average age of 73 years. Bacterial identification was carried out using bacterial culture and biochemical methods, while antimicrobial sensitivity was assessed by using the automated Walk Away System. Results: The most frequently isolated species were Escherichia coli (63.2%), Klebsiella spp. (21.9%), and Proteus spp. (8.8%). All isolates showed resistance to at least one antimicrobial and most to more than four. The highest resistance rates were observed for Cefotaxime (16.0%), followed by Ampicillin (15.6%) and Ciprofloxacin (13.2%). Conclusions: The high prevalence of antimicrobial resistance among clinically relevant Enterobacteriaceae species is a growing clinical challenge. The results of this study, which describe the trend of resistance among Enterobacteriaceae in a local hospital, could help to raise awareness highlighting the urgent need for more advanced diagnostic tools and new therapeutic strategies to treat infections caused by multi-resistant microorganisms. Full article

Background/Objectives: Dermatophytosis is a widespread superficial fungal infection affecting skin, hair, and nails. Its diagnosis is often based on conventional methods such as microscopy and fungal culture. Laboratory confirmation is essential for guiding appropriate treatment and preventing the misuse of antifungal agents, which can contribute to the emergence of antifungal resistance. We retrospectively assessed the burden and species distribution of dermatophytosis in individuals attending a public dermatology institute in Italy over a 3-year period (2019–2021). Methods: We analyzed 3208 samples from 3037 individuals with clinical suspicion of superficial mycosis. All samples underwent direct microscopic examination and fungal culture. Data were stratified by demographics, body site, and fungal species. Agreement between diagnostic methods was assessed using raw concordance and Cohen’s Kappa statistic. Results: Dermatophytes were confirmed in 667 samples (20.8%). Buttocks and genitals showed the highest positivity rates (37.5% and 36.4%, respectively). T. rubrum (56.8%) and T. mentagrophytes (30.7%) were the predominant species among the dermatophyte-positive specimens. Agreement between microscopy and culture was good (raw concordance: 91.6%, Cohen’s Kappa: 0.77, 95% CI: 0.74–0.79). Younger age and male gender were significantly associated with dermatophyte positivity. Conclusions: Our data provide updated epidemiological insights into dermatophytosis in Italy and support appropriate antifungal stewardship. Laboratory confirmation remains essential for an accurate diagnosis and species identification, thus avoiding other non-dermatophytic or non-infectious conditions being treated as dermatophytosis. Full article

This study provides an in-depth structural analysis of UNESCO World Heritage Apulian trulli, considering the three-layer dry-stone structure of their characteristic conical roofs. An integrated approach involving laser scanning, ground-penetrating radar, endoscopic investigation, and laboratory materials testing is used to identify and characterize the multi-wythe masonry system. A detailed finite element model is created in ANSYS to analyze seismic performance on Italian building codes. The model is validated through ambient vibration testing using accelerometric measurements. The diagnostic survey identified a three-layer system including exterior stone wythe, interior wythe, and rubble core, with compressive strength of stone averaging 2.5 MPa and mortar strength of 0.8 MPa. The seismic assessment will allow the examination of displacement patterns and stress distribution under design load conditions (ag = 0.15 g). The structural analysis demonstrates adequate performance under design loading conditions, with maximum stress levels remaining within acceptable limits for historic masonry construction. The experimental validation confirmed the finite element model predictions, with good correlation between numerical and experimental frequencies. The improvement of the overall seismic performance with the multi-wythe configuration and the role of wall thickness and geometric proportions will be taken into account. The methodology aims to provide technical evidence supporting the continued use of vernacular buildings while contributing to scientifically informed conservation practices throughout the region. Full article

Sweden has one neonatal screening laboratory and two centers conducting diagnostic workup for inborn errors of metabolism (IEM). Next-generation sequencing (NGS) has been gradually introduced as a confirmatory diagnostic test in the Swedish newborn screening program. Here, we describe the use of NGS in the diagnostic workup of IEM in screening-detected babies in Sweden between 2015 and 2023. During this period, 1,023,344 newborn children were screened, and 81 of 290 IEM cases were genetically confirmed using NGS. Planned improvements to the program are to perform genetic validation directly on the initial dried blood spot (DBS). As whole-genome sequencing (WGS) is superior in detecting causative genetic variants compared to Sanger sequencing, targeted NGS, and whole-exome sequencing (WES), it will likely become the method of choice more broadly in the future. A strong focus is to consolidate the nationally coordinated DBS newborn screening program, with all its individual components, including screening, targeted diagnostics, individualized treatment, and follow-up. This challenges the current regionalized organization of Swedish healthcare, which hinders close national collaboration between experts and sharing of data, as well as equal access to advanced treatments for identified patients, regardless of their place of birth. Full article

Background and Objectives: Pyogenic spondylodiscitis (SD) is a severe spinal infection involving the intervertebral disc and adjacent vertebrae and is often associated with significant morbidity. Identifying the causative microorganism is crucial for targeted treatment; however, the microbiological yield from blood or tissue cultures varies widely due to factors such as prior antibiotic use and biopsy technique. In this study, we aimed to investigate the clinical, laboratory, and radiological predictors of microbiological yield, particularly from tissue biopsy specimens. Materials and Methods: This retrospective cohort study included adult patients diagnosed with pyogenic SD between January 2023 and July 2025 at a tertiary care hospital. Demographics, comorbidities, laboratory markers (CRP, ESR, ALP, albumin), radiological findings (abscess presence, anatomical location, claw sign), prior antibiotic use, and microbiological results were analyzed. Tissue specimens were obtained through either surgical sampling or needle biopsy. Univariable and multivariable logistic regression were performed to determine the predictors of positive tissue cultures. Results: Of the 159 patients screened, 55 met our inclusion criteria. The mean age was 63.9 ± 13.5 years, 80% had lumbar involvement, and 58.2% had abscesses, primarily paravertebral or psoas in location. Microorganisms were isolated in 65.5% of the cases, with Staphylococcus aureus being the most common (41.7%). The blood culture positivity was 55.5%, while tissue culture positivity was 40.4%. Logistic regression revealed that lower albumin (p = 0.046) and higher ALP levels (p = 0.045) were independent predictors of a positive microbial yield from tissue biopsies. Conclusions: Serum albumin and ALP levels may aid clinical decision-making regarding invasive sampling in SD. When blood cultures are negative and albumin is low while ALP is elevated, clinicians should consider prioritizing tissue biopsy. These findings may help optimize diagnostic strategies and should be validated in larger, prospective studies. Full article

Acute pulmonary embolism can range from being completely asymptomatic to causing life-threatening events, which underscores the importance of effective risk stratification. Intermediate-risk patients represent a distinct subgroup characterized by specific clinical, laboratory, and imaging features. Although the majority have favorable outcomes, a significant proportion may still experience adverse events, presenting an ongoing challenge in determining the optimal therapeutic approach. This comprehensive review explores the characteristics of intermediate-risk pulmonary embolism patients, focusing on key diagnostic and prognostic factors, current treatment practices, and the evolving role of novel, specifically catheter-directed interventions. We also provide an overview of current guideline recommendations and discuss recent advancements in the field. Full article

Background: Undifferentiated arthritis is characterized by synovitis that does not meet the criteria for any specific rheumatic disease. However, a subset of chronic occult infectious arthritis, owing to atypical or overlapping clinical features, is often misclassified as undifferentiated oligoarthritis, potentially leading to diagnostic delays and suboptimal management. This study aimed to compare the clinical, laboratory, and imaging characteristics of these two types of oligoarthritis and to evaluate potential discriminatory markers. Methods: Patients older than 16 years with synovitis involving ≤2 joints at Beijing Jishuitan Hospital from September 2023 to December 2024 were included. Ultrasound-guided joint aspiration or synovial biopsy samples were analyzed by culture and next-generation sequencing, classifying patients as pathogen-positive or -negative. Clinical, laboratory, and imaging data (ultrasound, MRI, CT, X-ray) were compared, and multivariable logistic regression and ROC analyses were performed to identify predictors of infectious arthritis. Results: A total of 57 patients were included, with 20 (35.1%) categorized as pathogen-positive and 37 (64.9%) as pathogen-negative. The mean age was 41.7 ± 14.3 years, and 61.4% of the patients were female, with no significant demographic differences between groups. Monoarthritis was more common in pathogen-positive patients, accounting for 95% of cases (p = 0.02). Although the distribution of affected joints was similar between groups, ultrasound revealed a significantly higher bone erosion grade in pathogen-positive patients (p = 0.02), and CT/X-ray demonstrated articular surface destruction in 58.8% of infectious cases compared to 6.2% in pathogen-negative cases (p < 0.001). Serum albumin levels were significantly lower in the pathogen-negative group (20.7 ± 8.5 g/L vs. 41.1 ± 3.9 g/L, p < 0.001). ROC analysis determined that an albumin threshold >35.4 g/L predicted microbiological positivity with 100% sensitivity and 69.7% specificity. Multivariable logistic regression identified normal serum albumin levels, severe ultrasound-detected bone erosion, and imaging evidence of joint surface destruction as significant predictors of chronic occult infectious arthritis. Conclusions: Our findings suggest that, despite overlapping clinical and laboratory features, serum albumin levels, severe bone erosion on ultrasound and articular surface destruction on CT/X-ray may help differentiate chronic occult infectious arthritis from undifferentiated oligoarthritis. Further studies with larger cohorts are needed to confirm these preliminary results. Full article