Search Results (2,794)

Background: Pregnancy and lactation-associated osteoporosis is a rare cause of severe skeletal fragility in young women typically presenting with vertebral compression fractures during late pregnancy or postpartum. Its rarity and lack of risk factors often delay diagnosis. Case presentation: The patient was a 34-year-old pregnant Italian woman, presenting with severe osteoporosis related to pregnancy and lactation. The patient presented for the first time at the Outpatient clinic of the Rehabilitation Unit in the Department of Public Health at the University of Federico II, Naples in March 2024, exhibiting severe symptoms indicative of osteoporosis, along with acute lower back pain. During the anamnesis, it was revealed that the patient was unable to bend forward, with reduced flexion and extension movements. The symptoms began during the third trimester. Management and diagnosis: In terms of diagnosis, clinical exams were conducted to confirm the disease. The MRI exam showed fractures and vertebral variations, with significant findings including calcification. Additionally, DXA indicated lower values compared to normal Treatment included: breastfeeding cessation, correction of calcium and vitamin D deficiencies, and bisphosphonate injection therapy. It is noteworthy that the rehabilitative approach has been recommended throughout pharmacological treatment and especially upon its suspension. Ultimately, the primary cause of this condition was pregnancy as bone resorption increases during pregnancy. Outcome: Following clodronate treatment completion, the patient showed full clinical recovery and significant radiological improvement. Follow-up DXA one year after diagnosis revealed normalized bone density and the patient had gained autonomy in activities of daily living with no further symptoms. Full article

Background/Objectives: To evaluate the predictive role of anti-compensatory saccades in diagnosing mild acute unilateral vestibular loss. Methods: Consecutive patients with vertigo who underwent a bedside vestibular evaluation and video head impulse testing of the horizontal semicircular canal at the San Bernardino Outpatient Clinic in Salò, Italy, between 1 January and 30 June 2024 were examined (Group 1). Two control groups were considered: patients with severe unilateral acute vestibular loss (Group 2) and healthy subjects (Group 3). The video head impulse testing patterns of anti-compensatory saccades (amplitude, scattered pattern, and latency) using the suppression head impulse paradigm were analyzed to evaluate their predictive role in identifying horizontal canal dysfunction, even when borderline gain values of the canal’s vestibulo-ocular reflex were present. Results: Group 1 included 74 patients, Group 2 included 20 patients, and Group 3 included 20 healthy, voluntary subjects. The anti-compensatory saccades revealed significant differences in the amplitudes and scattered patterns between the two ears, exclusively in Groups 1 and 2. Conclusions: The anti-compensatory saccades alterations using the suppression head impulse paradigm can predict mild acute unilateral vestibular loss, even when the horizontal semicircular canal’s vestibulo-ocular reflex gain values are mild (lower borderline). Conversely, a borderline asymmetry of the horizontal semicircular canal’s vestibulo-ocular reflex using the classic head impulse paradigm should not be considered a marker of mild acute unilateral vestibular loss when the saccadic pattern is symmetrical using the suppression head impulse paradigm. Further meticulous differential diagnostic investigations are necessary in such cases to effectively diagnose horizontal semicircular canal dysfunction. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70–85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands. Full article

Zenker’s diverticulum (ZD) is an esophageal condition that results in an outpouching of the mucosal layer through a weakened area in the hypopharyngeal wall. This condition can cause symptoms like dysphagia, regurgitation, and aspiration, impacting patients’ quality of life. Historically, open surgery was the primary treatment. Although effective, this method is associated with longer recovery times and risks such as infections, nerve damage, and prolonged hospitalization. Rigid endoscopic stapling emerged as a less invasive alternative, offering high success rates for patients with favorable anatomy. Zenker’s peroral endoscopic myotomy (Z-POEM), adapted from treatments for achalasia, represents the latest advancement in ZD management. It involves creating a submucosal tunnel and precisely dividing the cricopharyngeus muscle. Z-POEM is minimally invasive and often provides quick relief with a high success rate of around 92%, while enabling outpatient treatment or brief hospital stays. However, it requires specialized expertise, and long-term data on recurrence rates are still emerging. This review discusses the evolution of these treatment modalities through comprehensive searches of PubMed, MEDLINE, and ScienceDirect databases. Studies reporting on treatment outcomes, complication rates, operative times, and clinical success associated with open surgery, rigid endoscopic stapling, and Z-POEM were included, with emphasis on meta-analyses, multicenter studies, and large case series highlighting Z-POEM’s comparable success to open surgery and increased patient tolerance. Open surgery achieves long-term symptom resolution rates of 90–95% but is associated with higher complication rates (up to 30%) and prolonged recovery times. Rigid endoscopic stapling offers symptom relief in approximately 90% of cases, with lower morbidity and shorter hospital stays (1–2 days), though anatomical limitations restrict its use. Z-POEM has demonstrated clinical success rates of 85.5–93%, with major complications reported in 4.8–5% of cases and recurrence rates as low as 1.4% at one-year follow-up in larger diverticula. Z-POEM’s minimally invasive nature and suitability for high-risk patients make it increasingly preferred in specialized centers. Management of Zenker’s diverticulum has evolved significantly, with endoscopic techniques, particularly Z-POEM, offering comparable success to open surgery but with fewer complications and faster recovery. Ongoing advances in endoscopic equipment and technique, along with emerging data on long-term outcomes, are likely to further refine treatment algorithms for ZD, especially for elderly and high-risk populations. Future directions in ZD management include ongoing research to enhance the safety and efficacy of endoscopic techniques, with new technologies on the horizon that could further improve outcomes and accessibility. Full article

Erectile dysfunction (ED) is a significant disorder commonly found in patients with cardiovascular diseases and diabetes mellitus. Recent updates have indicated that statins may also contribute to an increased risk of ED. This cross-sectional genetic study involved 246 cardiac patients attending normal visits at Hospital Universiti Sains Malaysia (USM) Kubang Kerian outpatient clinics. The patients were categorized into four groups: statins with ED (group 1), statins without ED (group 2), diabetes with statin without ED (group 3), and healthy patients without diabetes mellitus and statin use (group 4). Six genes were hypothesized to influence ED: CYP19A1, CYP17A1, SIM1, TP53, NR2F2, and NOS3, with different polymorphisms and variants investigated in this study. Overall, statin therapy was found to have a negative impact on ED by affecting NR2F2-AS1 and NOS3. However, atorvastatin showed varying effects on ED for all genes, with the highest impact observed with CYP17A1 and the lowest with CYP19A1. In conclusion, this study revealed novel findings related to genetic factors influencing ED in Malaysian males during statin use. Full article

Background: Hyperventilation Syndrome (HVS) is a well-recognized physiological consequence of acute anxiety, often resulting in respiratory alkalosis and subsequent electrolyte imbalances. Among these, a reduction in ionized calcium levels can lead to neuromuscular irritability and electrocardiographic abnormalities such as QTc prolongation. Although well-documented in specific settings, including autism spectrum disorders and drug-induced crises, such complications are rarely described in otherwise healthy pediatric patients presenting with isolated anxiety episodes. This report aims to raise awareness of anxiety-driven somatic manifestations, particularly in the context of the rising prevalence of mental health disorders among children and adolescents. Methods: We report the case of a previously healthy 10-year-old girl presenting to the emergency department with acute agitation and hyperventilation. Clinical examination revealed neuromuscular symptoms, including Trousseau’s sign and flexion posture. Initial laboratory testing and arterial blood gas analysis indicated respiratory alkalosis with decreased ionized calcium levels, and a resting ECG showed QTc prolongation (510 ms). Treatment included intravenous midazolam, a balanced electrolyte solution, and oral bromazepam during intensive observation with cardiac monitoring. Results: The patient’s symptoms progressively improved following anxiolytic and supportive therapy. Electrolyte abnormalities normalized within 48 h, with complete resolution of the prolonged QTc (430 ms). No arrhythmias or other complications occurred. Outpatient psychological follow-up was arranged upon discharge. Conclusions: This case underscores the importance of considering anxiety as a primary etiology in pediatric patients with apparent metabolic or cardiac abnormalities. Early psychiatric recognition and targeted supportive care can prevent overtreatment and reduce the burden on emergency and cardiologic resources. Full article

Background: Outpatient operative hysteroscopy is a minimally invasive procedure widely used for the diagnosis and treatment of intrauterine pathologies, including intrauterine adhesions (IUAs), which significantly affect fertility. Despite its therapeutic potential, the procedure itself may predispose patients to de novo adhesion formation. This review evaluates the effectiveness of anti-adhesion gels, particularly hyaluronic-acid-based formulations, in preventing IUAs and improving reproductive outcomes after outpatient operative hysteroscopy. Materials and Methods: A systematic search was performed in PubMed, CINAHL, Embase, and Web of Science for studies published between January 2020 and May 2025. Inclusion and exclusion criteria were defined using PICO guidelines. Relevant studies were screened and selected by two independent reviewers. Results: Anti-adhesion gels, especially hyaluronic acid and its derivatives, were associated with a lower recurrence of IUAs and improved reproductive outcomes. Combination therapies, such as hyaluronic acid gel with intrauterine devices (IUDs), showed better efficacy than monotherapy. Several studies also reported increased endometrial thickness, higher implantation rates, and improved pregnancy outcomes, although live birth rates remained inconsistent. Conclusions: Hyaluronic-acid-based anti-adhesion gels appear effective in reducing postoperative adhesion formation and enhancing reproductive outcomes in outpatient hysteroscopy. The best results are seen with multimodal preventive strategies. However, heterogeneity across studies highlights the need for standardized, prospective, randomized controlled trials to establish optimal clinical use. Full article

Background and Objectives: Suicide is one of the leading causes of death worldwide. Identifying psychopathological factors and personality traits associated with suicidal ideation is crucial for improving prevention. This study investigates the association between current suicidal ideation—measured by item 4 of the Brief Psychiatric Rating Scale-24 items (BPRS-24)—and personality traits assessed with the Personality Inventory for DSM-5 (PID-5) in a transdiagnostic outpatient psychiatric population. The association of BPRS-24 item 4 with early traumatic experiences, attachment styles, and dissociative phenomena is also explored as a secondary objective. Materials and Methods: We propose a secondary analysis on a sample of 137 individuals receiving care at an academic community mental health center. Personality traits were assessed using the PID-5, while attachment styles were assessed with the Experiences in Close Relationships-Revised (ERC-R), childhood traumas with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and dissociative experiences with the Dissociative Experience Scale II (DES-II). Suicidal ideation was measured with item 4 of the BPRS-24. Associations were examined using Spearman’s correlation and ordinal logistic regression models, adjusted for age, sex assigned at birth, and global clinical severity (CGI-S). Results: We found statistically significant associations between suicidal ideation and the PID-5 trait of depressivity (OR = 1.80, 95 % CI 1.23–2.63, p = 0.002, p-value adjusted Holm’s method 0.012). However, this association lost significance after adjusting for depressive symptoms (BPRS-24 item 3), suggesting a mediating role of depression. We found no significant associations with childhood trauma, attachment styles, or dissociative experiences. Conclusions: Our findings suggest a potential link between specific personality traits and suicidal ideation, mediated by depressive symptomatology. We explore how future studies may evaluate PID-5 as a clinical tool to support the identification of individuals at long-term risk of suicidality or for targeting specific populations for tailored interventions. Full article

Background: Differentiating between bacterial and viral infections in pediatric emergency care is challenging, often leading to unnecessary antibiotic use. The MeMed BV (MMBV) test is a host-response assay designed to differentiate bacterial from viral infections, but real-world data in pediatric settings remain limited. Methods: We conducted a pragmatic, single-center, prospective cohort study to assess the clinical utility of MMBV in children with acute respiratory infections or fever without source. Patients were assigned to standard of care (SOC) or MMBV testing (SOC+MMBV) based on time of presentation to the emergency department. The primary outcome was antibiotic prescribing. Secondary outcomes included diagnostic test utilization, hospitalization rates, and length of stay. Analyses were stratified by hospitalization status, clinical severity [National Institute for Health and Care Excellence (NICE) traffic light system], and patient age. Results: From July 2023 to April 2024, 343 patients were enrolled (171 SOC, 172 SOC+MMBV). In the SOC+MMBV arm, reduced antibiotic prescribing was observed among outpatients and those with non-severe signs and symptoms. Antibiotic prescribing was significantly reduced in children under five years with a low-risk profile, according to the NICE traffic light system (26.3% vs. 7.5%; p = 0.034). Multiplex PCR testing was significantly reduced in the SOC+MMBV group (28.7% vs. 16.3%; p = 0.006) compared to SOC for both inpatients and outpatients. No significant differences were observed in overall diagnostic test use or length of stay. Conclusions: MMBV improved antibiotic and diagnostic stewardship in a real-world pediatric ED setting, significantly reducing unnecessary antibiotic use among low-risk children under five and minimizing unnecessary multiplex PCR testing across the cohort. Full article

Background: Dubai’s healthcare system is designed to meet the growing needs of its population while maintaining high standards of accessibility, quality, equity, and responsiveness. The Dubai Health Authority (DHA) uses planning tools to assess residents’ health requirements and implement effective regulatory strategies. This study compares trend data from the 2018 and 2022 Dubai Clinical Services Capacity Plan (DCSCP) reports to understand how population changes have impacted healthcare demand and to identify service gaps addressed over four years with particular focus on key medical specialties in high demand. Methodology: This study retained the methodologies used in the 2018 and 2022 Dubai Clinical Services Capacity Plan (DCSCP) reports, capturing healthcare supply through a census of licensed facilities in Dubai and estimating demand using a need-based approach aligned with diagnosis-related groups (IR-DGRs). The data is categorized into eight key health-planning units (KPUs) to highlight gaps across major service categories and assess whether these gaps have been resolved in a rapidly evolving healthcare system. Results: Between 2018 and 2022, there were clear improvements across several key planning units. The shortage of acute overnight beds was resolved, moving from a deficit of 239 beds to a surplus of 1728 beds, an overall gain of 1967 beds. Outpatient consultation rooms also saw major growth, shifting from a gap of 1769 rooms in 2018 to a surplus of 4707 rooms in 2022, a net increase to 6476 rooms. In addition, emergency department capacity increased, and the number of ICU beds also rose from 484 to 691, an overall growth of 43%. These changes represent measurable improvements in acute care and outpatient service capacity. However, despite the addition of 76 beds, long-term care continues to show a shortfall of 138 beds, indicating that this remains a significant gap in Dubai’s healthcare system. Conclusions: Dubai has made significant progress in expanding its healthcare infrastructure between 2018 and 2022, addressing many capacity shortfalls, particularly in critical care and outpatient services. However, challenges in non-acute and long-term care remain, requiring ongoing strategic planning to meet future healthcare needs. Full article

Background and Clinical Significance: Cervical ectopic pregnancy (CEP) is a rare and potentially serious condition, in which the embryo implants within the cervical canal rather than the uterine cavity and is present in less than 1% of all ectopic pregnancies. There are different treatment options depending on the particular situation and the woman’s reproductive desire but conservative approaches as the first line of treatment is preferred in all cases and hysteroscopic resection of the fetus is one of these options. Several types of laser systems are available for use in hysteroscopic surgery, including neodymium:YAG (Nd:YAG) lasers, KTP and Argon lasers, as well as diode lasers. The holmium:YAG (Ho:YAG) laser, although more commonly used in urology due to its ability to cut, coagulate, and vaporize tissue, has gained interest in gynecologic procedures because of its precision and favorable safety profile. Case Presentation: We present the case of a 32-year-old woman, pregnant for the first time, who was diagnosed with CEP and successfully treated using a Ho:YAG laser during an outpatient hysteroscopic procedure. As far as we know, this is the first published case using this approach. Conclusions: The Ho:YAG laser is a proven tool for outpatient hysteroscopic procedures like septum and adhesion removal. Its ability to both cut and coagulate offers a minimally invasive, fertility-sparing option for managing cervical ectopic pregnancy. With the right patient and proper backup plans in place, this approach could be a promising alternative to more aggressive treatments. Full article

Objective: We aimed to investigate the relationship between camouflaging and lifetime depression among autistic people, along with the role of sex in this relationship. Methods: Sixty-five autistic subjects with no intellectual or language disability (34 females, 31 males), presenting to an outpatient service for the treatment of concurrent mental disorders, were administered module A of the Structured Clinical Interview for DSM-5 Disorders, the Autism Spectrum Quotient (AQ), and the Camouflaging Autistic Traits Questionnaire (CAT-Q). Results: No differences were found in CAT-Q total or domain scores across sexes. Subjects with lifetime depression reported significantly higher scores than those without for all CAT-Q scores, with depressed women often reporting the highest scores among the groups. The difference between depressed and non-depressed women was significant for all but the CAT-Q assimilation score. The CAT-Q total score significantly predicted lifetime depression (B = 0.053, p = 0.003) when controlling for age, sex, and the AQ total score. Conclusions: Our study expands the extant knowledge about the role of camouflaging in the mental wellbeing of autistic people by showing a correlation between camouflaging and depressive disorders throughout the lifetime among both males and females. Full article

Background/Objectives: There is growing evidence to support ambient artificial intelligence (AI) scribes in healthcare to improve medical documentation by generating timely and comprehensive notes. Using the Plan–Do–Study–Act (PDSA) methodology, this study evaluated the utility and potential time savings of an ambient AI scribe, Scribeberry, (V2), in a palliative medicine outpatient setting, comparing it to the standard practice of dictation. Methods: This prospective quality improvement study was conducted at an academic medical center by two palliative medicine resident physicians. Residents documented patient visits using a freely available ambient AI scribe software program, Scribeberry, as well as using standard dictation software. Primary outcome measures included the editing time for the AI scribe and the dictating and editing times for a dictated manuscript, as well as subjective assessments of the accuracy, organization, and overall usefulness of the AI-generated clinical letters. Results: A heterogenous response was seen with the implementation of an AI scribe. One resident saw a statistically significant reduction (p < 0.025) in the time spent on clinical documentation, while a second resident saw essentially no improvement. The resident who experienced time savings with the ambient AI scribe also demonstrated a significant improvement in the graded organization and usefulness of the AI outputs over time, while the other resident did not demonstrate significant improvements in any of the metrics assessed over the course of this project. Conclusions: This pilot study describes the use of an ambient AI scribe software program, Scribeberry, in the community palliative medicine context. Our results showed a mixed response with respect to time savings and improvements in the organization, accuracy, and overall clinical usefulness of the AI-generated notes over time. Given the small sample size and short study duration, this study is insufficiently powered to draw conclusions with respect to AI scribe benefits in real-world contexts. Full article

Background: The emergence of multidrug-resistant Gram-negative bacteria, particularly extended-spectrum β-lactamase (ESBL) and AmpC-producing Enterobacterales, has brought renewed interest in temocillin, a narrow-spectrum β-lactam antibiotic first introduced in the 1980s. Objectives: We aimed to provide a comprehensive overview of the microbiological, pharmacological, and clinical profile of temocillin. Methods: We conducted a narrative review of the literature using the PubMed database to identify relevant studies concerning the microbiology, pharmacokinetics, pharmacodynamics, clinical applications, and safety of temocillin. Results: Temocillin shows strong in vitro activity against ESBL- and AmpC-producing organisms, and partial efficacy against certain Klebsiella pneumoniae carbapenemase (KPC)-producing strains. Its pharmacokinetic and pharmacodynamic characteristics, including β-lactamase stability and low ecological impact, support its use in urinary tract infections, bloodstream infections, intra-abdominal infections, pneumonia, and central nervous system infections. Additionally, evidence supports its utility in outpatient parenteral antimicrobial therapy (OPAT), including subcutaneous administration, and in vulnerable populations such as pediatric, elderly, and immunocompromised patients. Temocillin demonstrates a favorable safety profile, minimal disruption of gut microbiota, and cost-effectiveness. It also exhibits synergistic activity with agents like fosfomycin, further enhancing its clinical value. Most of the current evidence is derived from retrospective and observational studies. Conclusions: Temocillin emerges as a promising carbapenem-sparing option for the treatment of challenging infections caused by multidrug-resistant Gram-negative bacteria. Full article