Search Results (33,992)

Objective: This study aimed to identify clinically modifiable and readily accessible predictors of 30-day mortality in a 10-year candidemia cohort and to assess temporal changes in Candida species distribution. Methods: We retrospectively evaluated 391 hospitalized adults with positive blood cultures for Candida spp. between January 2015 and March 2025. Only the first candidemia episode was included. Demographic characteristics, comorbidities, risk factors, laboratory parameters, antifungal therapy, and outcomes were recorded. Species identification was performed using conventional methods and the VITEK 2 system. Factors associated with 30-day mortality were analyzed using univariate and multivariate logistic regression models. Results: The mean age was 64.5 ± 17.7 years, and 56.3% of patients were male. Most patients (68.8%) were managed in the intensive care unit, and the 30-day mortality rate was 54%. Non-albicans Candida species accounted for 62.7% of isolates, with an increasing trend over time, particularly for Candida glabrata. Fluconazole susceptibility was 79%. In univariate analysis, advanced age, solid tumors, invasive mechanical ventilation, leukocytosis, thrombocytopenia, septic shock, intensive care unit admission, and failure to remove the central venous catheter were associated with mortality. Multivariate analysis identified advanced age, intensive care unit admission, septic shock, failure to remove the central venous catheter, leukocytosis, and thrombocytopenia as independent predictors of 30-day mortality. Conclusions: Candidemia remains a life-threatening infection with high mortality. Central venous catheter management and simple hematological parameters, particularly white blood cell and platelet counts, provide practical tools for early risk stratification. Although the rising prevalence of non-albicans Candida species may require updates in empirical therapy, prompt source control remains essential to improve survival. Full article

Background: Total knee arthroplasty (TKA) is a common procedure aimed at alleviating knee pain and restoring function in patients with degenerative joint diseases. Traditional implants are typically designed to restore mechanical knee alignment, but personalized implants have shown promise in improving clinical outcomes. The Origin^® individualized TKA system provides a tailored approach to knee reconstruction by utilizing preoperative 3D planning to create individualized implants and cutting guides based on each patient’s unique anatomy. Surgical Technique: The Origin^® system employs a preoperative computed tomography (CT) scan and Knee-Plan^® software to design individualized implants that optimize alignment and joint anatomy. The surgical technique involves the use of patient-specific cutting guides for precise bone resections and the insertion of either cruciate-retaining (CR) or posterior-stabilized (PS) implants, depending on individual patient needs. This process aims to replicate the pre-arthritic alignment and kinematics of the pre-arthritic knee. Postoperative Protocol: The postoperative protocol allows for immediate weight-bearing, and patients are guided through a structured rehabilitation program to ensure optimal recovery. Full range-of-motion exercises begin early to promote knee mobility and strength. Discussion: The individualized TKA system offers several advantages, including precise restoration of pre-arthritic anatomy, reduced bone resection, and improved implant fit. These benefits are particularly valuable in patients with unique anatomical challenges, such as deformities or previous surgeries. Despite the potential advantages, challenges remain, including the costs and time associated with individualized manufacturing, as well as increased radiation exposure from the required CT scans. Conclusions: The Origin^® individualized TKA system represents a significant advancement in knee arthroplasty by providing a tailored approach to patient care. Future studies are needed to further evaluate the long-term outcomes and cost-effectiveness of this personalized system compared to conventional TKA approaches. Full article

Hypospadias is a congenital malformation of the male external genitalia resulting from incomplete fusion of the urethral folds during embryonic development. The perineal form represents the most severe phenotype and is frequently associated with abnormalities such as cryptorchidism and penile hypoplasia. Although surgical correction is generally recommended in young dogs, the long-term clinical course of severe hypospadias under conservative management remains poorly documented. In this study, we describe an unusual canine case of severe perineal hypospadias that survived to geriatric age under conservative management and subsequently developed bilateral testicular tumors arising from cryptorchid testes. Despite recurrent urinary tract infections during early life, the patient maintained an acceptable quality of life with long-term supportive care, providing a rare clinical example of extended survival without surgical correction. Because no molecular material was available from the patient, publicly available mouse transcriptomic datasets related to genital tubercle development and Leydig cell differentiation were consulted only as contextual reference. These datasets illustrate established developmental regulators and steroidogenic pathways relevant to genital formation and testicular function but do not represent direct molecular findings from the reported case. This report primarily highlights the clinical course and management of severe hypospadias in a dog, while using existing transcriptomic knowledge solely to provide biological context. The findings should therefore be interpreted as descriptive and hypothesis-generating rather than as evidence of a direct mechanistic link between developmental abnormalities and endocrine tumorigenesis. Full article

Background/Objectives: Ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA) differ in terms of medical severity and prognosis; however, it remains unclear whether these differences are reflected in nursing complexity and nursing intensity when assessed using standardized nursing language. Methods: This retrospective study analyzed routinely collected nursing and administrative data from an acute care hospital. Hospitalizations were classified as ischemic stroke, hemorrhagic stroke, or TIA using ICD-9-CM codes. Nursing complexity was measured as the number of nursing diagnoses (NDs) documented within 24 h of admission, while nursing intensity was measured as the number of nursing actions (NAs) recorded during hospitalization. Group differences were tested using ANOVA and Kruskal–Wallis tests, as appropriate. Results: A total of 728 hospitalizations were included: 429 ischemic strokes, 236 hemorrhagic strokes, and 63 TIAs. Overall, 4136 NDs and 27,528 NAs were recorded. Distinct patterns emerged across stroke categories. ND counts differed significantly (F = 5.81, p = 0.003), with TIA showing lower counts than both ischemic and hemorrhagic stroke, while no significant difference was observed between ischemic and hemorrhagic stroke. NA counts also differed significantly (H = 16.73, p < 0.001), with the highest counts in hemorrhagic stroke, intermediate counts in ischemic stroke, and the lowest counts in TIA. In a sensitivity analysis standardized by length of stay, nursing intensity also differed significantly across stroke categories (H = 12.999, p = 0.002), although the pattern differed from that observed for cumulative counts. Conclusions: Nursing complexity and nursing intensity showed distinct patterns across stroke categories. While complexity was comparable between ischemic and hemorrhagic stroke and lower in TIA, intensity followed a clear gradient, highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA. Standardized nursing data may complement medical indicators by capturing additional dimensions of patient needs and care delivery in people with stroke. Full article

Background: Tranexamic acid (TXA) is an antifibrinolytic agent that helps prevent and manage bleeding events. In patients with trauma, TXA reduced bleeding-related deaths by one-third. Moreover, TXA showed a lower risk of mortality from bleeding in postpartum patients. Few studies have examined the appropriateness of TXA use for the management of bleeding in critically ill patients. This study aimed to describe the clinical outcomes and the safety of TXA use in critically ill patients with bleeding. Methods: This single-center, single-arm descriptive study was conducted at King Faisal Specialist Hospital & Research Center, Jeddah, between January 2018 and March 2023. The study included adult patients 18 years or older who were admitted to the medical intensive care unit (ICU) for ≥48 h and had documented bleeding that was treated with TXA for at least one dose. The primary outcome was the frequency of thrombotic events. Secondary outcomes included time from bleeding onset to bleeding resolution, rebleeding event at 30 days, time from bleeding onset to rebleeding event, ICU and hospital length of stay, and 30-day all-cause mortality. Results: A total of 129 patients were included in the study, 55% of whom were male. The median age was 60.9 years. The median APACHE II score was 22 (15–29). At baseline, 24.8% of patients had a history of bleeding. Major bleeding occurred in 86.1% of the patients. The frequency of thrombotic events was 2.3%. The median bleeding duration was 3.9 days (1.9–7.0). Rebleeding events at 30 days occurred in 24.8% of patients, with a median time of 11.7 days (8–14.8) from bleeding onset to rebleeding. The average ICU length was 12 days (6–24), and the average hospital length of stay was 25 days (15–50). The 30-day all-cause mortality rate was 55.8%. Multivariable analysis assessing factors contributing to mortality revealed that higher APACHE II score was strongly associated with increased mortality (adjusted OR 1.14 per point increase, 95% CI 1.07–1.21, p < 0.001), while higher platelet counts were independently protective, with each 10 × 10⁹/L increase associated with a 4% reduction in mortality odds (adjusted OR 0.96, 95% CI 0.93–0.99, p = 0.034). Conclusions: In this descriptive study, TXA use in critically ill patients was accompanied by low absolute rates of thrombotic and rebleeding events. Further studies with larger sample sizes and comparable groups are needed to examine the appropriateness of TXA use in managing bleeding events in the ICU. Full article

Background and aim: Chest CT is a major contributor to population radiation exposure. Conventional, pooled diagnostic reference levels (DRLs) do not account for inter-individual variability in body habitus and are typically used retrospectively. We evaluated dose behavior in adult chest CT, derived BMI-stratified local DRLs, and developed models to enable AI-assisted, prescan dose prediction. Methods: Consecutive adult chest CT examinations from a single center were analyzed. Dose indices (CTDIvol, DLP) and patient factors (BMI, weight, height, age, sex; scan length and planned technical parameters where available) were extracted. DRLs were defined as the 75th percentile overall and within BMI categories (underweight, normal, overweight, and obese). Group differences were assessed using non-parametric tests; associations were examined using correlation analysis. Supervised learning (e.g., Random Forest, Gradient Boosting) was trained to predict CTDIvol and DLP from routinely available variables. Results: BMI-stratified DRLs increased monotonically with habitus: underweight 444.95 mGy·cm/9.60 mGy; normal 513.00/11.55; overweight 756.08/14.65; obese 931.60/20.25 (DLP/CTDIvol). Differences across BMI groups were significant for DLP (H = 31.53, p < 0.001) and CTDIvol (H = 33.61, p < 0.001). DLP correlated moderately with weight and BMI (r ≈ 0.54–0.56, p < 0.001), with a weaker association for age; height was not a meaningful predictor. No sex-based differences in CTDIvol or DLP were observed. Predictive models estimated CTDIvol and DLP with high performance (R² up to ~0.79 and ~0.77, respectively), enabling comparison of predicted dose against BMI-matched DRLs before acquisition. Conclusions: Size-aware, BMI-stratified DRLs provide clinically interpretable investigation levels that avoid pitfalls of pooled benchmarks. Coupled with robust prediction of individualized dose from routine variables, this framework supports a shift from retrospective audit to prospective, point-of-care dose governance and protocol optimization in chest CT. Full article

Background: Understanding how demographic and clinical factors influence SARS-CoV-2 infection patterns, vaccination uptake and disease outcomes in community settings is essential for effective primary care-based public health planning. Objectives: This study aimed to investigate the distribution of SARS-CoV-2 infections among adults attending Primary Healthcare (PHC) facilities in Giannitsa, Greece, from 2020 to 2024, and to examine associations between demographic and clinical characteristics, vaccination category and disease outcomes. Methods: A retrospective analysis was conducted using data from the National Registry of Patients with COVID-19. The study included 1144 adults diagnosed with SARS-CoV-2 at PHC facilities from 19 November 2020 to 3 October 2024; all cases included in the present analysis had been confirmed by rapid antigen testing. Variables included age, gender, residence, registry-recorded underlying medical conditions, vaccination category, seasonality and clinical outcome. Results: Significant shifts in case distribution were observed across time, with younger adults predominating in 2020–2022 and older adults (61–90 years) in 2023–2024 (p < 0.001). Winter months showed higher case incidence overall (p < 0.001). Vaccination coverage increased annually, reaching 84.8% in 2024 (p < 0.001). Hospitalization/death occurred in 1.7% of patients and was strongly associated with age ≥61 years (6.0% vs. 0.3%), the presence of at least one registry-recorded underlying medical condition (9.2% vs. 0.9%) and vaccination category; specifically, hospitalization/death occurred in 10.4% of individuals diagnosed during the pre-vaccine period, 2.3% of unvaccinated individuals during the vaccination era and 0.9% of vaccinated individuals (all p < 0.001). Conclusions: Older age, underlying medical conditions and a lack of vaccination were key predictors of worse outcomes. The findings underscore the importance of strengthening vaccination outreach and targeted PHC interventions, particularly for high-risk and rural populations. Full article

Introduction: Asthma is a chronic inflammatory disease that impairs daily functioning and quality of life. Despite effective therapies, asthma control remains suboptimal and may improve through greater engagement of community pharmacists. This study assessed the knowledge, practices, and perceived barriers of community pharmacists regarding asthma management in the Aseer region, Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered online questionnaire covering demographics, asthma-related knowledge, practice, and perceived barriers. Results: A total of 290 community pharmacists participated. Overall, 64.8% showed high asthma-related knowledge, while 51.7% reported high asthma counseling practice. Pharmacists showed strong knowledge of asthma symptoms, triggers, determinants of poor control, and counseling on medication-related adverse effects, but moderate knowledge of asthma control assessment, guideline-based management, and treatment-related side effects. Commonly reported services included patient education on asthma and medications, identification of modifiable risk factors, and discussion of treatment side effects, whereas written asthma action plans, symptom control assessment, and follow-up visits were less common. In multivariable logistic regression, high knowledge (p = 0.002), interest in asthma training (p < 0.001), and greater work experience (p = 0.01) were associated with higher counseling practice, while patient volume showed a borderline association (p = 0.051). Conversely, higher practice (p = 0.002), working in independent community pharmacies (p < 0.001), and pharmacy location (p = 0.034) were associated with higher asthma knowledge. Conclusions: Community pharmacists demonstrated moderate-to-high knowledge of asthma management, but gaps remain in guideline-based practice and follow-up. Strengthening guideline-oriented training and pharmacist integration into asthma care may improve outcomes. Full article

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

Sexuality is a fundamental aspect of human well-being, yet it is often disrupted in women diagnosed with cervical cancer. Although healthcare providers play a crucial role in supporting patients’ sexual health, the topic remains largely unaddressed in oncology settings. This study aimed to explore how healthcare providers perceive and respond to sexual health concerns among women with cervical cancer. A qualitative approach was conducted between August and November 2024 at Dharmais Cancer Hospital, Indonesia. Eighteen healthcare workers experienced in cancer care were selected through purposive sampling. Semi-structured interviews were conducted and analyzed thematically using Braun and Clarke’s six-phase framework with Nvivo 12 Plus software. The analysis revealed three main themes: (1) diverse perceptions of sexuality; (2) unmet sexual health needs; and (3) challenges to address sexual health. This study highlights that healthcare providers acknowledge the importance of addressing sexuality in cancer care but face numerous challenges that hinder open discussions in Indonesia. Integrating sexual health into routine oncology care and enhancing provider training are essential steps toward delivering more holistic and patient-centered care. These findings can improve sexual health care in cancer patients. Full article

Inguinal hernia repair remains one of the most frequently performed surgical procedures, but the problem of early postoperative complications remains significant, particularly in the context of surgical technique selection and patient age. The aim of this study was to compare the incidence of early complications and the length of hospital stay in patients undergoing laparoscopic and open inguinal hernia repair. To achieve this goal, a retrospective study was conducted, analyzing data from 172 patients who underwent laparoscopic and open mesh repair. The results showed that no early complications occurred in patients undergoing laparoscopic repair, whereas complications were reported in 6.4% of patients undergoing open repair, primarily in older adults. The average hospital stay was also shorter with the laparoscopic approach. These data suggest advantages of laparoscopic surgery, especially for elective procedures, which may help reduce complication rates and accelerate recovery. The practical significance of the work is that the obtained results can be used to optimize the selection of surgical technique in the treatment of inguinal hernia, especially in the context of limited financial resources and the need to improve the quality of medical care in Polish medical facilities. Full article

Objectives: The aim of this study is to investigate the relationship between the lactate/albumin ratio (LAR) and 28-day mortality in gastric cancer patients undergoing monitoring in a postoperative intensive care unit due to reasons such as haemodynamic instability, need for vasopressor support, or intraoperative bleeding. Methods: This retrospective study included patients followed up at the tertiary surgical intensive care unit of Kastamonu University Faculty of Medicine between January 2020 and October 2025 who were diagnosed with histologically confirmed gastric adenocarcinoma and underwent total open surgery or subtotal gastrectomy + D2 lymphadenectomy. The patients were categorized into two groups: non-survivors within 28 days (n: 45) and survivors within 28 days (n: 139). Results: A total of 184 critically ill patients (110 males, 74 females) who underwent gastric adenocarcinoma surgery and were followed up in the surgical intensive care unit were included in this study. The mean age of the patients was 72.2 ± 11.3 years. Of these patients, 139 (75.5%) were survivors, and 45 (24.5%) were non-survivors. Albumin, the C-reactive protein (CRP)/albumin ratio, lactate, and the lactate/albumin ratio were associated with 28-day mortality. Receiver operating characteristic (ROC) analysis showed that the LAR (area under the curve (AUC): 0.839) was superior to the serum albumin (AUC: 0.736) and lactate levels (AUC: 0.796) for predicting 28-day mortality. The optimal cut-off value of the LAR was 0.82, and an LAR of ≥ 0.82 was shown to be a significant and independent prognostic factor for 28-day mortality in patients with stomach cancer in a critical postoperative condition (odds ratio (OR): 4.78, confidence interval (CI): 1.09–21.08, p = 0.0386). Conclusions: The lactate/albumin ratio is a prognostic parameter for 28-day mortality in critically ill postoperative gastric cancer patients. The optimal cut-off value for the lactate/albumin ratio is 0.82. Full article

Background/Objectives: Escherichia coli bacteremia is a major cause of morbidity, mortality, and healthcare expenditure. The increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) complicates management and resource utilization. This study aimed to identify clinical predictors of higher hospital costs in E. coli bacteremia. Methods: We conducted a cross-sectional study of hospitalized patients with E. coli bacteremia in Surabaya, Indonesia (2022–2024). Hospital costs were categorized into bed costs, diagnostic costs, pharmacy costs, antibiotic costs, total costs, and daily costs. Costs were compared between ESBL and non-ESBL cases. Predictors of higher hospital costs were analyzed using generalized linear models with a Gamma distribution and log-link. Results: Among 209 patients, 131 (62.7%) had ESBL-producing E. coli. ESBL E. coli bacteremia was associated with significantly higher bed, diagnostic, pharmacy, total, and daily hospital costs than non-ESBL cases, while antibiotic costs were similar. ESBL E. coli bacteremia was associated with higher diagnostic and daily costs. High-care/ICU stay was the strongest predictor of increased costs. Pneumonia and infection source influenced cost components. Longer hospitalization increased total cost but reduced daily cost. Conclusions: Hospital costs in Escherichia coli bacteremia are driven by antimicrobial resistance, disease severity, and healthcare utilization. Targeted strategies such as antimicrobial stewardship and optimized critical care use are essential to reduce the economic burden. Full article

Background: The ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) is central to the classification of acute respiratory distress syndrome (ARDS). However, its assessment requires arterial blood gas analysis, which may be limited by availability, cost, and invasiveness. Consequently, the ratio of peripheral oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂) has been proposed as a non-invasive surrogate for estimating the degree of oxygenation impairment. Methods: A retrospective cross-sectional study was conducted in adult patients with COVID-19 admitted to the intensive care unit at an altitude of 2600 m above sea level (m.a.s.l.). Spearman correlation coefficients were calculated to assess the association between the SpO₂/FiO₂ and PaO₂/FiO₂ ratios and their corresponding imputation models. A generalized linear model was applied, and the diagnostic performance of the SpO₂/FiO₂ ratio and the imputation models for detecting severe and non-severe hypoxemia (PaO₂/FiO₂ cutoff value of 150) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: A total of 473 patients receiving invasive mechanical ventilation were included, with a mean age of 62.4 years (SD 14.1), and a predominance of males (67.2%). An SpO₂/FiO₂ ratio cutoff value of ≥206 demonstrated excellent diagnostic performance, with an AUC of 0.983 (95% CI 0.97–0.99), high sensitivity (90.6%), high specificity (96.7%), and an overall correct classification rate of 93.9%. This performance remained consistent across multiple clinical scenarios. In patients with positive end-expiratory pressure > 10 cmH₂O, the AUC was 0.982, with a specificity of 97.7%. In the presence of hyperbilirubinemia (total bilirubin ≥ 3 mg/dL), the AUC was 0.951. Among patients with hemoglobin levels < 10 g/dL, sensitivity reached 100%, although specificity was reduced. In the subgroup with arterial partial pressure of carbon dioxide > 35 mmHg, an SpO₂/FiO₂ ratio ≥ 206 showed near-perfect specificity (99.4%) and a positive likelihood ratio of 120.9. Conclusions: The SpO₂/FiO₂ ratio is a reliable and non-invasive surrogate of the PaO₂/FiO₂ ratio in mechanically ventilated patients with COVID-19 living at high altitude, particularly for the identification of non-severe hypoxemia. Full article

Objectives: Management of unstable pelvic fractures during pregnancy presents a major therapeutic challenge, requiring careful multidisciplinary evaluation to balance maternal benefits and fetal radiation risks. Methods: We report the case of a 32-year-old patient who presented with a pelvic fracture due to a road traffic accident at three months of pregnancy. A left sacroiliac osteosynthesis was performed to treat a left sacroiliac diastasis with pelvic osteosynthesis using a trans-iliosacral approach under cone-beam CT (CBCT) guidance using a very-low-dose protocol. Radiation parameters and fetal dose estimates were calculated in advance in collaboration with a medical physicist. Tight beam collimation, a reduced field of view, and minimization of fluoroscopic checks were applied to keep fetal exposure as low as reasonably achievable. This article aims to demonstrate the feasibility of managing a complex pelvic fracture using interventional radiology and to review the literature on management options and gestational age-dependent fetal risks. Results: The estimated cumulative fetal dose from initial imaging, open surgery, and CBCT-guided osteosynthesis remained below 70 mGy using a pregnant phantom (Duke Organ Dose–Dosewatch–General Electric system), which is below thresholds associated with deterministic effects. The procedure achieved optimal screw positioning with less than 40 s of fluoroscopy. Maternal postoperative recovery was favorable, and follow-up revealed normal fetal development. Conclusions: This case demonstrates that CBCT-guided percutaneous iliosacral screw fixation can be safely performed during pregnancy with meticulous planning, dose-reduction strategies, and multidisciplinary collaboration, maintaining fetal radiation exposure below accepted safety thresholds. Full article