Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was a global pandemic where infected individuals experienced mild or severe disease. Unfortunately, some patients who experienced severe disease also had lasting abnormalities. The lung microbiome of 38 adult coronavirus disease 2019 (COVID-19) patients with persistent respiratory symptoms and/or radiological abnormalities was analysed. The aim was to investigate whether the lasting radiological abnormalities reported in this cohort were associated with an altered airway. Thirty-six bronchoalveolar lavage fluid samples from patients underwent 16S rRNA gene amplicon sequencing and were compared to 28 non-fibrotic control samples from a previously published study. COVID-19 patients had statistically significantly greater number of genera but at uneven abundances, though not statistically significant compared to non-fibrotic controls. Permutational ANOVA (PERMANOVA) suggested that COVID-19 can influence the lung microbiome composition after accounting for multivariate dispersion. Further analysis showed differences in the relative abundances of Actinomyces, Neisseria, Haemophilus, Rothia and Gemella. Indicator species analysis showed that a COVID-19 lung microbiome profile could be driven in part by differences in Fusobacterium, Actinomyces, Catonella, Oribacterium and Mycobacterium. Associations with clinical parameters were lacking apart from CT lung opacification, which revealed a significant negative association with the number of genera. Differential abundance analysis with MaAsLin2 pointed towards Porphyromonas as a potential explaining genus, though this was not significant after post hoc corrections. DESeq2 revealed enriched oral taxa in the BAL samples, suggesting potential oral-translocation reflective of a disease state. Our findings suggest that individuals with persistent radiological abnormalities following SARS-CoV-2 infection have experienced subtle shifts in their microbiome profile, but these are not strongly associated with clinical phenotypes and, therefore, unlikely of significance.
HER2-positive (HER2+) breast cancer (BC) is associated with a high incidence of brain metastases (BMs), which negatively affect prognosis and quality of life. Local therapies, such as whole-brain radiotherapy (WBRT), stereotactic radiotherapy, stereotactic radiosurgery, and neurosurgery, allow temporary control of metastatic spread. Systemic treatments are limited by the blood-brain barrier (BBB), which restricts the passage of many therapeutic molecules. Research initially focused on small molecule tyrosine kinase inhibitors due to their low molecular weight. Recent evidence suggests that tumor-induced disruption of the BBB may increase its permeability, potentially allowing larger molecules, including antibody-drug conjugates, to cross. Although trastuzumab deruxtecan (T-DXd) has demonstrated intracranial activity, evidence of durable complete responses in heavily pretreated patients with active BMs remains limited. We report a case of a HER2+ BC patient with multiple (>20) active BMs, previously treated with WBRT and trastuzumab emtansine (T-DM1), who developed intracranial progression. Third-line treatment with T-DXd resulted in a complete radiological intracranial response, which has been maintained for more than 20 months under ongoing therapy, with associated improvement in neurological symptoms and quality of life. This case provides preliminary evidence that T-DXd may achieve deep and durable intracranial responses even in heavily pretreated patients with active BMs, including those previously treated with WBRT and T-DM1. The exceptional duration of response observed in this case appears to exceed historical expectations and warrants further investigation in this high-risk population.
Polycythemia is a condition with abnormal increase in red blood cell mass and number in circulation. Increased attenuation with diffuse involvement of Circle of Willis and cerebral venous sinuses mimicking a contrast enhanced study is one of the early noncontrast CT findings in polycythemia. It can mimic venous sinus thrombosis which is its complication and thus warrants further imaging studies. Further imaging studies are needed for the dense vessel appearance in NCCT where the CT number is above a threshold value.
Gastric varices represent a challenging clinical scenario due to the severity of consequences when bleeding occurs, the cohort of patients in which it occurs and a paucity of high-quality prospective data to guide treatment decisions. Whilst a range of endoscopic and radiologic management strategies are now available, ambiguity exists about when to utilize each of these therapies. This study comprehensively reviewed current management considerations and the positioning of available treatment modalities for gastric varices. A literature search was performed using PubMed to identify peer-reviewed articles published until December 2025. Whilst a lack of large, randomized trials limits the ability to provide definitive guidance for the management of gastric varices, individualized patient care and a multidisciplinary approach with close collaboration between hepatologists, interventional endoscopists and radiologists is vital. Prompt endoscopic assessment remains important and allows initial management with either direct endoscopic injection (cyanoacrylate glue or thrombin) or if available, EUS-guided therapy. Further follow up endoscopic or EUS-guided therapies appear to be safe and effective, but definitive management with radiologic procedures such as transjugular intrahepatic portosystemic shunt to address global portal hypertension or retrograde transvenous obliteration procedures are highly successful and should also be considered.
Laminectomy fusion fixation (LF) and single open-door laminoplasty (LP) are common posterior surgeries for central cord syndrome without fracture/dislocation (CCSWOFD), yet a comprehensive comparison is lacking. This study compared outcomes of LF vs. LP for multi-segmental cervical canal stenosis with CCSWOFD. A retrospective analysis was conducted on 112 patients (LF group, n = 59; LP group, n = 53). Clinical and radiological outcomes were assessed. A post-hoc power analysis was performed, and multivariate logistic regression was used to identify factors associated with favorable outcomes, adjusting for key confounders. The LF group demonstrated significantly better final Japanese Orthopaedic Association (JOA) scores, recovery rates (RR), intrinsic hand muscle strength (IHMS), and Brain and Spinal Injury Center (BASIC) scores compared to the LP group (P < 0.05). LF also achieved superior postoperative C2-7 Cobb angles despite reduced range of motion (ROM). The sagittal vertical axis (SVA) decreased significantly in the LF group but increased in the LP group. Notably, LF showed superior IHMS and RR outcomes in K-line (-) patients. Complication rates did not differ significantly between groups. Multivariate analysis identified higher preoperative JOA and IHMS as independent protective factors for favorable recovery, while LF was associated with non-significantly greater odds of good outcomes after adjusting for confounders. Both LF and LP effectively improved neurological function, alleviated pain, enhanced motor ability, and reduced spinal cord edema in CCSWOFD patients with multi-segment stenosis. In this retrospective cohort, laminectomy fusion fixation was associated with superior neurological and radiological outcomes compared to laminoplasty for multi-segment CCSWOFD, particularly for patients with coexisting ossification of the posterior longitudinal ligament and K-line (-).
Mandibular buccal bifurcation cyst (MBBC) is an inflammatory cyst that typically manifests during early childhood and is positioned buccal to the furcation area of the mandibular first molars. Clinically, it manifests as a buccal inclination of the crown without associated symptoms or dental vitality loss. The diagnosis is confirmed through a combination of clinical, radiological, surgical, and histological findings. A case of a 9-year-old boy with MBBC is presented. Molar 4.6 exhibits a buccal inclination of the crown and a palpable, nonpainful hard swelling on the vestibular side of the tooth. Radiographic and cone-beam computed tomography (CBCT) imaging revealed a lack of bone structure. A minimally invasive surgical procedure involving a micro-osteotomy was performed, which enabled the en bloc excision of the cyst. A collagen membrane was used to reconstruct the tissues through complete regeneration, in accordance with the principles of guided tissue regeneration (GTR). After a 1-year follow-up period, complete restoration of the cortical bone and the lesion area is observed on a CBCT, with a completely asymptomatic tooth. A precise diagnosis of MBBC lesions is paramount for effective treatment, and this diagnosis must be made through clinical signs, radiographic imaging, and histology. Furthermore, it is imperative to ensure that surgical interventions are performed in a meticulous manner. A case is presented in which the lesion was treated by generating a bony microwindow to access the cyst and enucleate it in a single piece. Additionally, a collagen membrane was used to achieve complete regeneration of the lesion without interference from the soft tissues. The subsequent year of observation revealed a favorable evolution of the case, with complete regeneration of all lost tissues, including the buccal cortical.
Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) are widely used in the treatment of metastatic renal cell carcinoma (RCC). Although hemorrhagic events are recognized adverse effects of these agents, intracranial hemorrhage is rare, and the safety of re-administration of VEGFR TKIs after central nervous system (CNS) hemorrhage remains unclear. We report a 52-year-old man with metastatic clear cell RCC who initially received first-line immunotherapy with ipilimumab and nivolumab, resulting in disease progression, followed by second-line sunitinib, which achieved a partial response. However, he subsequently developed sudden neurological deterioration, and brain imaging revealed multifocal cerebellar hemorrhages without evidence of brain metastasis; the absence of metastasis was confirmed by surgical and histopathological examination. After surgical management, complete radiologic resolution of the hemorrhage was confirmed 4 weeks postoperatively. Pazopanib was subsequently initiated based on the prior favorable response to VEGFR TKI therapy; however, recurrent cerebellar hemorrhage occurred within 4 weeks of rechallenge, leading to rapid clinical deterioration and death despite supportive care. This case highlights that VEGFR TKI-associated intracranial hemorrhage can occur even in the absence of brain metastases and may recur with fatal consequences upon rechallenge. These findings suggest that early VEGFR TKI rechallenge (<1-2 months) after CNS hemorrhage may be unsafe, and that careful risk-benefit assessment with an adequate waiting period is essential when considering re-administration.
Retrograde jejunojejunal intussusception is a rare but recognized late complication of Roux-en-Y gastric bypass (RYGB). Clinical presentation is often nonspecific and overlaps with other postoperative complications, making imaging crucial for diagnosis. Contrast-enhanced computed tomography (CT) plays a central role by demonstrating characteristic morphological features, defining the level and direction of obstruction, and assessing bowel viability. We present a case of retrograde jejunojejunal intussusception causing high-grade mechanical small bowel obstruction several years after RYGB, highlighting radiological findings and their impact on surgical management.
Alzheimer's disease (AD) is a neurodegenerative condition marked by the accumulation of beta-amyloid plaques and neurofibrillary tangles, leading to neuronal death and cognitive decline. Acetylcholinesterase inhibitors (AChEIs) such as donepezil, galantamine, and rivastigmine are commonly used to enhance cognitive function by increasing acetylcholine levels, but they can cause side effects like nausea, bradycardia, and headaches. NMDA receptor antagonists, like memantine, reduce glutamatergic activity and are used to manage symptoms, yet are also associated with adverse effects including dizziness and agitation. Recently, monoclonal antibodies such as aducanumab have been developed to target amyloid-beta aggregates, though they are associated with amyloid-related imaging abnormalities (ARIA). This article aims to summarize current pharmacological approaches to AD and to highlight the emerging role of Donanemab-azbt, an FDA-approved monoclonal antibody for early symptomatic AD, in reducing amyloid plaques and slowing cognitive decline. This overview synthesizes data from clinical trials and therapeutic experience with acetylcholinesterase inhibitors, NMDA receptor antagonists, and monoclonal antibodies, with a particular focus on Donanemab-azbt, its mechanism of targeting amyloid-beta aggregates, and its efficacy and safety profile in early symptomatic AD. Donanemab-azbt has demonstrated efficacy in clinical trials, significantly reducing amyloid plaque burden and slowing cognitive decline in patients with early symptomatic AD. However, its use may result in ARIA and other adverse effects, necessitating careful clinical and radiological monitoring during treatment. Despite the risks of ARIA and other adverse events, Donanemab-azbt represents a promising addition to AD therapy, offering the potential for improved outcomes in patients with early symptomatic disease and expanding the therapeutic options beyond traditional symptomatic treatments.
An 80-year-old woman from rural Guangxi with post-tuberculosis lung disease (PTLD) (hereinafter referred to as PTLD)presented with one month of cough and fever. One month prior, she had ingested raw rodent meat-a known exposure for Talaromyces marneffei. Chest HRCT showed bilateral tree-in-bud opacities superimposed on prior left lung destruction. Conventional microbiological tests, including acid-fast bacilli smears, were negative. A nasopharyngeal swab was positive for SARS-CoV-2 (cycle threshold 17). Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid identified both T. marneffei and SARS-CoV-2. Her CD4+ count was 344/μL and HIV serology was negative. She received nirmatrelvir-ritonavir and sequential amphotericin B followed by voriconazole, with clinical and radiological improvement. This case illustrates that PTLD may serve as a local anatomical risk factor for talaromycosis even without systemic immunodeficiency.
Angiomatous epulis, also known as vascular epulis or gingival pyogenic granuloma, is a benign reactive gingival lesion characterized by marked capillary proliferation. It typically develops in response to chronic local irritation, trauma, inflammatory stimuli, or hormonal influences. Clinically, it presents as a rapidly growing erythematous to violaceous gingival mass with a marked tendency to bleed, which may mimic malignant gingival tumors and raise diagnostic concern. Although the diagnosis is primarily based on clinicopathological correlation, imaging plays an important complementary role. Radiological evaluation, particularly computed tomography (CT), is useful to assess lesion extent, confirm its superficial localization, and exclude aggressive features such as bone erosion or deep tissue invasion. Imaging also contributes to the differential diagnosis by helping distinguish angiomatous epulis from other gingival lesions, including peripheral giant cell granuloma, peripheral ossifying fibroma, vascular malformations, and malignant tumors. We report the case of a 15-year-old patient presenting with a rapidly progressive gingival mass evolving over two months. Periapical radiography demonstrated preserved alveolar bone architecture, while CT imaging confirmed a well-circumscribed soft-tissue lesion confined to the gingiva, without cortical bone destruction, periodontal ligament alteration, or extension to adjacent structures. Given the rapid growth and bleeding tendency, imaging was essential to exclude malignancy and guide management. Complete surgical excision was performed, and histopathological examination confirmed the diagnosis of angiomatous epulis. This case highlights the added value of imaging in the diagnostic workup of vascular gingival lesions, particularly in differentiating benign entities from malignant conditions and in supporting appropriate therapeutic decision-making.
Ileo-ileal knotting is an exceptionally rare cause of small bowel obstruction in which two ileal loops twist around each other, resulting in vascular compromise and bowel strangulation. Preoperative diagnosis is difficult because of non-specific clinical and radiological findings, and most cases are diagnosed intraoperatively. Delay in treatment may rapidly progress to bowel ischemia and gangrene. We report the case of a 78-year-old male patient who presented with acute intestinal obstruction. Contrast-enhanced computed tomography suggested closed-loop small bowel obstruction without definitive evidence of intestinal knotting. Emergency exploratory laparotomy revealed ileo-ileal knotting with gangrene involving approximately three feet of terminal ileum. Resection of the gangrenous bowel with double-barrel ileostomy was performed successfully. This case highlights the importance of early surgical exploration in rapidly progressive bowel obstruction and emphasizes intestinal knotting as a rare but important differential diagnosis of strangulated obstruction.
Pulmonary mucormycosis is a rare but rapidly progressive fungal infection commonly associated with diabetes mellitus, hematologic malignancies, and solid-organ transplants. Prompt diagnosis is essential given the infection's invasive nature and the likelihood of dissemination. The standard treatment typically involves surgical resection and systemic antifungal therapy, specifically liposomal amphotericin B, along with correction of the underlying risk factors. We present a 53-year-old male with diabetes, hypertension, end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) and chronic graft rejection following renal transplantation who presented with progressive respiratory symptoms. Initially treated as community-acquired pneumonia, his clinical condition progressively worsened despite appropriate antimicrobial therapy. Subsequent fibre-optic bronchoscopy (FOB) revealed a friable endobronchial mass with a spongiform appearance completely occluding the left mainstem bronchus and extending into the segmental bronchi, including upper, middle, and lower lobes. Complete resection of the endobronchial lesion was achieved using bronchoscopy-guided techniques, including cryoablation, argon plasma coagulation, and snare-forceps excision, thereby avoiding high-risk surgical intervention. Histopathological examination was consistent with invasive pulmonary mucormycosis. Following bronchoscopy, treatment with liposomal amphotericin B and oral posaconazole for parenchymal disease resulted in significant clinical and radiological improvement. This case highlights the promising role of advanced bronchoscopy-guided interventions as an adjunct to both diagnostic and therapeutic modalities in high-risk cases of pulmonary mucormycosis with an endobronchial component, particularly when conventional surgical approaches are not feasible due to life-threatening post-surgical complications and comorbidities.
Venous fat emboli are uncommon but important radiological findings in patients with long-bone fractures, and direct visualization on computed tomography (CT) is rarely reported. We report the case of a 34-year-old man with polytrauma, reported to be hemodynamically stable, admitted after a motorcycle road traffic accident. Initial radiography demonstrated a complete, displaced fracture of the proximal third of the left femoral shaft. Whole-body trauma CT revealed a fat-attenuation intravascular lesion within the distal left external iliac vein extending into the proximal left common femoral vein, with an attenuation value of approximately -81 Hounsfield units, consistent with a venous fat embolus. The lesion persisted in the same venous location across the available non-contrast, arterial-phase, and portal venous-phase images. Thoracic CT angiography showed no pulmonary arterial filling defect or acute pulmonary parenchymal abnormality on the available images. Abdominopelvic CT also demonstrated a superior polar splenic laceration measuring more than 3 cm in depth, associated with perisplenic hemoperitoneum, consistent with grade III splenic injury according to the American Association for the Surgery of Trauma classification. No definite active contrast extravasation was identified on the available arterial, portal venous, and delayed-phase images. Orthopedic fixation of the femoral fracture was subsequently performed; however, detailed follow-up data, including respiratory evolution, neurological status, laboratory data, splenic injury management, and discharge outcome, were not documented in the available medical record. This case highlights the importance of systematic venous assessment on whole-body trauma CT in patients with long-bone fractures and emphasizes the distinction between a CT-visible venous fat embolus and fat embolism syndrome, which remains a clinical diagnosis requiring appropriate clinical correlation.
This study explores the clinical efficacy of ultrasound-assisted minimally invasive treatment for Jakob Type II humeral lateral condyle fractures in children. A retrospective analysis was conducted on children with Jakob Type II humeral lateral condyle fractures who received treatment at our hospital between January 2021 and December 2024. Based on the surgical procedure, the patients were divided into two groups: the Ultrasound combined with x-ray arthrography-guided closed reduction and percutaneous pin fixation group (UA-CRPP) and the Open reduction percutaneous pin fixation group (ORPP). The UA-CRPP group underwent ultrasound-assisted closed reduction and internal fixation for Jakob Type II humeral lateral condyle fractures, with arthrography to assess the articular cartilage surface. The ORPP group underwent open reduction and Kirschner wire fixation for Jakob Type II humeral lateral condyle fractures. Demographic data, surgical time, clinical outcomes, complications, and radiographic data were recorded. A total of 57 patients were included in both groups, with 37 males and 20 females. There were no significant differences between the two groups in terms of gender, age, weight, time from injury to surgery, follow-up time, injury side, or complications such as pin tract infection, deep infection, or intraoperative blood loss(P > 0.05). No cases of nonunion, refracture, or nerve injury were observed in either group. The surgical time and hospital stay were shorter in the UA-CRPP group compared to the ORPP group (P < 0.05), and the radiological union time of fracture was shorter in the UA-CRPP group (P < 0.05). Ultrasound-assisted closed reduction and internal fixation is a feasible and effective treatment option for children with Jakob Type II humeral lateral condyle fractures. Compared with ORPP, it has similar functional effects, but its advantages lie in less invasive, shorter surgical time, and lower complication rate.
Intestinal tuberculosis (ITB) most commonly involves the ileocecal region. Isolated sigmoid colonic tuberculosis complicated by a colovesical fistula is extremely rare and may closely mimic colorectal malignancy or Crohn's disease (CD). A 73-year-old man presented with subacute diarrhea, fever, and lower urinary tract symptoms. Laboratory tests showed markedly elevated inflammatory markers and anemia. Cross-sectional imaging demonstrated segmental thickening of the sigmoid colon, pericolic lymphadenopathy, multiple serous effusions, and findings consistent with a colovesical fistula, including bladder wall disruption and intravesical gas. Colonoscopy revealed a circumferential stenosing lesion with irregular ulceration, raising strong suspicion for colorectal malignancy or CD. Initial histopathology showed only mixed inflammatory cell infiltration without granulomas or malignant cells, and empirical antimicrobial therapy failed to control the fever. Given the positive immunological testing for tuberculosis and persistent clinical suspicion, acid-fast bacilli staining and metagenomic next-generation sequencing (mNGS) were performed on colonic biopsy tissue. Acid-fast bacilli were detected, and mNGS identified Mycobacterium tuberculosis complex, confirming ITB. Standard anti-tuberculosis therapy was initiated, leading to rapid clinical improvement, complete endoscopic mucosal healing, and radiological resolution of the colovesical fistula. This case highlights that ITB can present as an isolated tumor-like sigmoid lesion complicated by fistula formation. When routine histology is nondiagnostic, especially in the absence of granulomas, integration of imaging, immunological testing, special staining, and molecular diagnostics may be crucial for early diagnosis, avoidance of misdiagnosis, and timely targeted treatment.
Osteoporotic vertebral compression fractures (OVCFs) cause significant morbidity in aging populations. Hounsfield unit (HU) from CT and the vertebral bone quality (VBQ) from MRI show promise in assessing bone quality and fracture risk. This study aims to directly compare the predictive efficacy of HU and VBQ for OVCFs and develop a nomogram model integrating HU and VBQ. A retrospective study was conducted involving 385 patients (127 with OVCFs, 258 controls) who were hospitalized at our hospitals between September, 2020 and September, 2024. HU and VBQ were derived from picture archiving and communication system (PACS). Other variables included demographic, clinical, and radiological data. Statistical analyses included t-tests, chi-square tests, multivariable logistic regression, the least absolute shrinkage and selection operator method (LASSO) regression, and receiver operating characteristic (ROC) curve analysis. Then, a nomogram model was established. The calibration, discrimination and clinical practicability of the nomogram model were also evaluated. The OVCF group had significantly higher VBQ and lower HU compared to controls. ROC analysis showed higher diagnostic accuracy for HU than VBQ.A nomogram model for predicting the risk of OVCF occurrence in patients has been developed based on three independent predictors, namely BMI, HU and VBQ. The AUC was 0.84 in the training set and 0.87 in the test set. The model has good practicability for clinics according to the decision curve analysis (DCA) and clinical impact curve (CIC). Both HU and VBQ are effective predictors of OVCFs. The nomogram model showed good internal discrimination and calibration in our study. These findings suggest potential utility for opportunistic screening of OVCF risk in patients undergoing routine spinal CT and MRI. However, external validation in prospective and multi-center cohorts is needed before clinical implementation.
Klebsiella pneumoniae invasive liver abscess syndrome (ILAS) is an emerging disease characterized by liver abscess without biliary disease, often with multiorgan metastatic infection. It can cause severe critical illness with significant morbidity and disability. There remains limited literature and understanding of this syndrome in the United States. This article aims to describe the clinical characteristics of hospitalized and critically ill patients with ILAS and providing management considerations for critical care clinicians. Adult patients admitted to Scripps Health from Janurary 1, 2018 to April 1, 2024 were reviewed. Inclusion criteria required radiographic evidence of a liver abscess and cultures (blood or abscess) positive for K. pneumoniae. Data collected included demographics, symptoms and signs, laboratory and radiologic data, metastatic infection characteristics, treatment, mortality, and morbidity. Patient cases were described, and a narrative review describing clinical, therapeutic, and prognostic characteristics was conducted. Six patients had ILAS. Mean age was 54.8 years, no immunosuppression (defined as underlying malignancy, drug-induced, or chronic infection), 83% had diabetes, 50% were male, and 50% were of Asian ethnicity. Liver abscesses were multilocular (50%), and all had percutaneous catheter drainage. Fifty percent of patients developed distant metastatic infections: emphysematous cystitis, pulmonary septic emboli, complicated parapneumonic pleural effusions, meningitis, ventriculitis, cerebral septic emboli, and endophthalmitis. These patients were younger, male, and had a higher rate of intensive care unit (ICU) admission and mechanical ventilation. Two patients required ICU admission with septic shock, diabetic ketoacidosis, respiratory failure, severe thrombocytopenia, and altered mental status. K. pneumoniae isolates were pansensitive except to ampicillin. There was no in-hospital mortality. The patient with meningitis and ventriculitis had full neurological recovery, and the patient with endophthalmitis had very poor residual visual acuity. ILAS is an emerging disease that can cause severe critical illness with multiorgan involvement. Early identification of the disease and metastatic infection is essential to provide appropriate treatment. Additionally, ILAS patients require screening for endophthalmitis.
Mongolia faces rising rates of obesity, diabetes, and cardiovascular disease, yet little is known about their relationship with thyroid nodules. This study aimed to assess the prevalence of thyroid nodules and their association with cardiometabolic outcomes in the Mongolian population. A nationwide retrospective analysis was conducted among 36,395 adults who underwent thyroid ultrasound during routine health checkups. Demographic, anthropometric, and metabolic parameters were recorded, including body mass index (BMI), central obesity, blood pressure, diabetes, and cardiovascular risk based on WHO criteria. Thyroid nodules were identified in 40.3% (n = 14,651) of participants. Age-adjusted prevalence was 32.1% overall, 19.8% in men, and 39.2% in women, with higher rates in Ulaanbaatar (43.9%) than in rural areas (35.4%). Participants with nodules had higher BMI, central obesity, diabetes, and cardiovascular risk compared to those without nodules. Prevalence was greatest in the very high CVD risk category (60.0% in women, 33.1% in men). Multivariate models confirmed independent associations between thyroid nodules and age, female sex, obesity, and cardiovascular risk. Thyroid nodules are highly prevalent in Mongolia and cluster with adverse cardiometabolic outcomes. Nodules may serve as a clinical marker of elevated cardiovascular risk. Future longitudinal studies should explore potential bidirectional pathways between obesity, thyroid nodules, and cardiometabolic disease.
There is a large spectrum of acute decompensated heart failure presentations resulting from the interaction between an acute precipitant and the patient's underlying cardiac and non-cardiac conditions. A robust classification scheme at admission is crucial for appropriate triage and targeted treatment of high-risk populations. Such a scheme should incorporate timely actionable items to generate immediate management decisions, including characteristics that suggest life-threatening clinical presentations, the factors that could be favourably modified by in-hospital interventions, such as correctable aetiologies and congestion/hypoperfusion status, and in-hospital trajectories determined by patient responses to inpatient treatment. In-hospital trajectories determine the intensity of escalation therapies and timing for initiation/up-titration of guideline-directed medical treatment. In the long term, some patients experience a progressive downsloping course culminating in advanced heart failure, while others maintain a relatively stable remitting-relapsing trajectory. For future clinical trials, a comprehensive classification scheme integrating in-hospital and long-term trajectories could profoundly affect study design by ensuring interventions are tested in more homogeneous patient populations and facilitating nuanced patient stratification.