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Campylobacter and Salmonella are leading causes of bacterial gastroenteritis worldwide, yet their comparative impact on acute kidney injury (AKI) remains unexplored. We conducted a retrospective cohort study of adults (&#x2265;18 years) hospitalized with community-acquired bacterial gastroenteritis at a tertiary center in South Korea (2018-2025). The primary outcome was AKI incidence. Multivariable logistic regression assessed associations between pathogen type (Campylobacter, Salmonella, or Others, including Escherichia coli or Clostridium difficile) and AKI risk (reference: Campylobacter). Secondary outcomes included postdischarge kidney outcomes (acute kidney disease [AKD], incident chronic kidney disease [CKD], and CKD progression). Among 232 patients (Campylobacter n = 139, Salmonella n = 55, and Others n = 38), AKI incidence differed significantly across groups (26.6%, 70.9%, and 31.6%, respectively; P < .001), with 42% of Salmonella patients developing AKI stages 2 and 3. Salmonella enteritis was independently associated with higher AKI risk than Campylobacter (odds ratio 3.19, 95% confidence interval [CI] 1.23-8.30). Salmonella patients had 46% longer hospital stays (median 8 vs 5 days). In-hospital AKI was associated with postdischarge composite kidney outcome (hazard ratio 3.17, 95% CI 1.02-9.83), particularly during the AKD window (7-90 days postdischarge). Notably, 17% of patients who recovered from AKI before discharge subsequently developed AKD or CKD. In this retrospective study, hospitalized patients with Salmonella enteritis had a higher risk of AKI than those with Campylobacter; furthermore, those with in-hospital AKI from any cause were more likely to have adverse short-to-intermediate-term postdischarge kidney abnormalities. These findings support pathogen-specific risk stratification and the need for postdischarge monitoring of patients who develop in-hospital AKI.

Brown adipose tissue (BAT) activity has been suggested to play a role in cancer progression. Previous studies have shown that BAT activity is higher in patients with cancer, and that BAT volume is a predictor of tumour recurrence and mortality in patients with cancer, but the data on melanoma are limited. Here, we re-analysed 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (FDG-PET-CT) images from 135 patients with cutaneous melanoma treated at Turku University Hospital between 2012 and 2021 to assess associations among BAT, melanoma progression, patient survival, and patient weight. We applied a three-stage universal BAT threshold definition using predetermined standardised uptake value thresholds of 0.8, 1.0, and 1.2 g/ml, given the retrospective nature of our study. Of the 135 patients (81 men and 54 women; median age 61 years, interquartile range 54-71), 40 (29.6%), 24 (17.8%), and 19 (14.1%) were BAT-positive at the 0.8, 1.0, and 1.2 g/ml thresholds, respectively. Our results showed that patients with active melanoma on FDG-PET-CT imaging were more frequently BAT-positive at the 0.8 threshold (P = 0.026) and 1.0 threshold (P = 0.016). We also found a significantly higher BAT volume among patients who survived the observation period (0.8, 1.0, and 1.2 g/ml thresholds; P = 0.018, P = 0.038, and P = 0.571, respectively) and those who did not relapse (0.8, 1.0, and 1.2 g/ml thresholds; P = 0.631, P = 0.012, and P = 0.030, respectively). No association between BAT positivity and relapse-free survival or overall survival was observed at any threshold. Although higher BAT volumes were observed in subgroups of patients who survived or did not relapse, these findings were not supported by survival analyses and should be considered exploratory.

Orthodontic extraction decision-making remains difficult and highly subjective, particularly in marginal cases where the clinicalcues are ambiguous. Objectives: To design machine learning (ML) models for prediction of extraction vs. non-extraction decision-making and estimate the influenceof key clinical predictors on such decisions. Retrospective analysis was performed on 120 patients with extraction and 80 patients without extraction from asample of pretreatment records over 2 years. Five ML models including Logistic Regression (LR), Random Forest (RF), Support VectorMachine (SVM), Decision Tree (DT) and XGBoost are employed in this research by applying Python's Scikit-learn. The datasetwas divided in two parts for training and testing at a ratio of 70:30. The sensitivity, specificity, accuracy and AUC-ROCwere used to evaluate and compare the performance of the models. In order to rank the most important features for decision-making, feature importance was calculated. RF model provided the highest accuracy (93.5%) and AUC-ROC (0.95) values, whereas XGBoost was the second-bestmodel, with accuracy (90.2%) and AUC-ROC (0.92). Mandibular crowding (weight = 0.28) and IMPA (L1-MP angle,weight = 0.22) were the most influential predictors. Ensemble ML models, in particular RF, yield a promising objective methodology for clinical decision support in orthodontics topotentially lessen inter-clinician variation and enhance consistency in treatment planning.

A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to coronavirus disease 2019 (COVID-19), which is a global health problem that occurred in waves and resulted in high mortality globally. This is a single-center retrospective study conducted in a Medical College's dedicated COVID-19 hospital in India during the first wave (March-November 2020) and second wave (March-May 2021) of the COVID-19 pandemic on 104 children below 18 years of age to compare the clinical characteristics and outcome of COVID-19 patients during the first and second waves. During the first wave (n = 57, 54.8%), the majority of children (n = 36, 63.16%) were between 5-18 years, but during the second wave (n = 47, 62.09%), the majority of children (n = 29, 61.70%) were below 5 years. Neonates outnumbered during the second wave (n = 11, 23.4% vs. n = 1, 1.8%). Asymptomatic patients (n = 24, 42.1%) were common during the first wave, while severe-grade patients (n = 19, 40.4%) were common during the second wave. During both waves, fever and respiratory distress were the common symptoms followed by cough. Respiratory distress (p = 0.0003), C-reactive protein (p = 0.008), peripheral oxygen saturation <94% (p = 0.00002), and acidosis (p = 0.001) were significantly higher during the second wave. Use of steroids and low-molecular-weight heparin was similar in two waves, but intensive care unit (ICU) admission (p = 0.0031), oxygen via nasal prongs (p = 0.0003), use of CPAP/BIPAP (p = 0.031), blood and blood products (p = 0.044), comorbidity (p = 0.017), and mortality (p = 0.008) were significantly higher during second wave. ICU admission, use of blood and blood products, mechanical ventilation, comorbidity, and mortality were found to be higher during the second wave.

To explore the feasibility and preliminary behavior of the Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) tool in detecting radiologic differences in lung parenchyma of lung transplant recipients undergoing extracorporeal photopheresis (ECP) for chronic lung allograft dysfunction (CLAD). We performed a retrospective case review on a series of adult lung transplant recipients at Mayo Clinic who had a baseline CT following transplant, underwent ECP for CLAD, and had follow-up CT imaging. Our primary outcome was temporal change in lung parenchymal morphology exemplars assessed by CALIPER. Secondary outcomes included changes in distribution of vascular-related structures, calculated lung volumes, and spirometric indices. Data was analyzed using a linear mixed effects model. Of 91 eligible recipients with CLAD, 15 were treated with ECP. Following ECP we observed an increase in normal lung tissue (p&#x202f;=&#x202f;0.038) and a decrease in interstitial lung abnormalities (p&#x202f;=&#x202f;0.003). There was no significant difference in hyperlucent areas, distribution of pulmonary vascular-related structures, or calculated lung volumes. There was a slight increase in FVC (p&#x202f;<&#x202f;0.001) after initiation of ECP, but no significant change in FEV1. Initiation of ECP was associated with favorable parenchymal changes as calculated by CALIPER in this sample of patients.

This study describes the clinical and hematological characteristics of acute erythroblastopenia induced by Parvovirus B19 in patients with underlying hemoglobinopathies. We conducted a retrospective analysis of 53 patients with confirmed Parvovirus B19 infection, among whom 10 pediatric cases met the criteria for acute erythroblastopenia, defined by hemoglobin <6 g/dL and reticulocytopenia <20x109/L. Among 53 patients with confirmed Parvovirus B19 infection, 10 pediatric cases (18.9%) met the criteria for acute erythroblastopenia. All cases occurred in children with various hemoglobinopathies: sickle cell disease (3 cases), S/beta-thalassemia (1 case), hemoglobin C disease (2 cases), and hereditary spherocytosis (2 cases), while two patients had no identified hemoglobinopathy. The mean hemoglobin was 5.13 &#xb1; 1.66 g/dL, with profound reticulocytopenia. Multi-lineage involvement occurred in 20% (n=2/10) of cases. Bone marrow examination showed variable erythroblast percentages (1-47%). Recovery time ranged from 6 to 35 days, with the longest recovery observed in sickle cell patients. Parvovirus B19 causes severe erythroblastopenic crises in children with hemoglobinopathies, particularly in sickle cell disease, where the clinical impact is most pronounced.

Access block is defined as a delay in access to inpatient beds for patients from the Emergency Department (ED). It is a key contributor to ED overcrowding and is associated with worse patient outcomes. This study aimed to quantify access block within Chris Hani Baragwanath Academic Hospital's Trauma Emergency Unit (TEU) and identify associated factors. A retrospective review was conducted of all consecutive patients presenting to the TEU resuscitation room from January 1 to December 31, 2022. Patients aged <14 years (<10 for burns) and those managed by other services were excluded. Data on demographics, clinical characteristics, resuscitation length-of-stay, interventions, and disposition were analysed. Access block was defined as a >8 h delay for the purposes of this study. Univariable analyses were performed to identify associations with access block. During the study period, 2270 patients were admitted from the resuscitation room to the ward without first requiring the operating theatre, of whom 2091 had a recorded length-of-stay. Access block affected 61.3%. In unadjusted analysis, factors significantly associated with access block included a requirement for CT imaging (OR 4.17), intensive care unit (ICU) admission (OR 3.69), mechanical ventilation (OR 2.10), blunt mechanisms of injury (OR 2.19), presenting at night (OR 1.85), and an arrival shock index &#x2265;1 (OR 1.32). Conversely, presenting with penetrating trauma (OR 0.61), burns (OR 0.50), and undergoing intercostal catheter insertion (OR 0.53) were associated with significantly lower odds of access block. Time-to-CT was significantly longer in patients with access block (366 vs 165 min; P < 0.01). Patients requiring mechanical ventilation had significantly longer length-of-stay (834 vs 631 min; P < 0.01), even once time-to-CT was accounted for. Most admitted patients were affected by access block. Associated factors included CT imaging, ICU admission, mechanical ventilation, and presentation at night. This corroborates the international consensus that whole-of-system solutions are necessary to remedy it.

To assess the rate and timing of spontaneous regression of high-grade cervical intraepithelial lesions (CIN2/HSIL and CIN3/HSIL) in young women and to identify associated factors. This retrospective cohort study included patients aged&#x2009;&#x2264;&#x2009;30 years diagnosed with HSIL (CIN2 or CIN3) at the certified dysplasia unit of the Department of Gynecology, University Hospital Erlangen, between April 2014 and November 2025 who underwent observational management. Regression was defined as partial regression (low-grade squamous intraepithelial lesion; LSIL) or complete regression (less than LSIL), with histology as the reference standard. 45 patients with CIN3/HSIL and 38 with CIN2/HSIL were included. In the CIN3/HSIL cohort, regression was observed in 21 of 45 patients (46.7%), including regression to LSIL in 6 (13.3%) and complete regression in 15 (33.3%) cases. The median time to regression (&#x2264;&#x2009;LSIL) was 236 days (IQR, 126-308 days). The CIN2/HSIL cohort showed even higher regression rates, with partial or complete regression in 24 of 38 cases (63.2%). Regression was associated with HPV clearance in both groups and with HPV16 negativity and HPV vaccination in the CIN2/HSIL cohort. No cases of progression to (micro)invasive disease were observed in either group. The probability of regression did not differ between patients aged&#x2009;&#x2264;&#x2009;24 and >&#x2009;24 years. In this selected cohort of women aged&#x2009;&#x2264;&#x2009;30 years managed conservatively, spontaneous regression of CIN2/HSIL and CIN3/HSIL occurred frequently, particularly during the first year of follow-up, without progression to invasive disease. HPV clearance, HPV16 and vaccination status may help guide patient selection for observational management.

Triage is a cornerstone of modern emergency medicine. This study aimed to evaluate the predictive validity of the five-level Prehospital Taiwan Triage and Acuity Scale (TTAS-PH) for emergency department (ED) patient outcomes-specifically hospital admission, mortality, and ED length of stay (LOS)-compared to the former two-level system. This retrospective cohort study included 9,698 adult patients transported by Emergency Medical Services (EMS) to a tertiary academic medical center in Taoyuan City, Taiwan, during 2023. Logistic and linear regression models were utilized to analyze the impact of variables on clinical outcomes and ED LOS. Furthermore, Receiver Operating Characteristic (ROC) curve analysis evaluated the predictive performance of the triage systems. Male gender, older age, and higher TTAS-PH acuity levels (Levels 1 and 2) were significantly associated with worse ED outcomes and longer ED LOS. TTAS-PH Level 1 patients faced drastically elevated risks of death (OR=83.9); while they represented only 10.72% of the cohort, they accounted for 79.59% of all ED deaths. Notably, a discrepancy was observed in high-acuity (Levels 1-2) classification between the prehospital TTAS-PH (43%) and the in-hospital TTAS (8.7%). In predicting mortality, TTAS-PH demonstrated superior accuracy (AUROC=0.8829) compared to the traditional TPTS (AUROC=0.8296). The TTAS-PH system offers robust prehospital risk stratification, demonstrating superior predictive performance compared to the traditional TPTS. By functioning as a critical early warning mechanism, TTAS-PH facilitates proactive resource mobilization, effectively shifting emergency care from a reactive to a preemptive model.

Introduction The use of health services expanded during the pandemic and became a regular part of healthcare. There is not a lot of information about how these services are used over the long term and how patients engage with them. This study examined how patients used telemental health services at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia, from 2019 to 2025. Objectives To evaluate how telemental health services were used and how patients engaged with them during the time before the pandemic, during the pandemic, and after the pandemic. The study also compared how many appointments were completed and the characteristics of patients who had virtual appointments versus in-person appointments. Methods This was a retrospective, repeated cross-sectional census study of electronic health record data on all scheduled mental health appointments, virtual and in-person, at KAMC from January 1, 2019, to December 31, 2025. All eligible encounters and unique patients across 12 facilities were included using total enumeration rather than sampling. Data were cleaned and analyzed in Python using Google Colab. Descriptive statistics were used to summarize appointment and patient characteristics. Chi-square tests were used to compare categorical variables, including appointment completion by encounter type, and the Mann-Whitney U test was used to compare patient age between virtual and in-person appointments. A binary logistic regression model was used to identify factors associated with appointment completion, including encounter type, pandemic period, and patient demographics. Results The study included 479,643 appointments with 51,323 patients at 12 facilities. Overall, 9% of the appointments were virtual. In 2019, there were no appointments, but their use increased during the pandemic and then stayed steady at around 11% to 12% per year after 2021. Overall, 55% of appointments were completed. Virtual appointments had a higher completion rate than in-person appointments, with 60% of virtual appointments being completed compared to 54% of in-person appointments. We also found that patients who had virtual appointments were substantially older and that virtual appointments were mostly used for follow-up visits rather than new patient appointments. &#xa0;Conclusion Telemental health services went from being an emergency solution during the pandemic to a part of mental health services at the facility. The study found that virtual appointments were associated with patient engagement, which means that patients were more likely to complete their appointments. These findings support the continued use of a hybrid of in-person and virtual mental health services. The findings provide information to support the planning and development of telemental health services. Telemental health services are a part of the healthcare system, and they can be an effective way to deliver the services.

Recent evidence suggests that low-dose methotrexate might have antipsychotic properties. However, it remains unknown whether low-dose methotrexate is associated with a reduced risk of incident recorded psychosis in real-world data, whether these associations extend to other putatively immune-related common psychiatric conditions, or whether similar associations are observed with other disease-modifying anti-rheumatic drugs (DMARDs). In this retrospective cohort study using electronic health records (TriNetX US Collaborative Network), we identified adults with rheumatoid arthritis (age &#x2264;45 years at treatment initiation; data extracted from 1 January 2000 to 21 December 2025). The 5-year risk of an incident recorded psychosis (primary outcome) and bipolar, depression, or anxiety disorders (secondary outcomes) were compared between low-dose methotrexate and each of 14 comparator drugs used in rheumatoid arthritis - three primary comparators (non-steroidal anti-inflammatory drugs; NSAIDs, naproxen, diclofenac and celecoxib) and 11 secondary and exploratory DMARDs comparators. Cumulative incidences and ratios of restricted mean time lost (rRMTL) are reported. Results were Bonferroni-corrected for multiple comparison. Comparator cohort sizes ranged from 1161 to 21,445 (mean ages 33.7-37.4 years). For the primary outcome of psychosis, initiation of low-dose methotrexate was associated with lower 5-year incidence of newly recorded psychosis than initiation of naproxen (rRMTL 0.69, 95% CI 0.55-0.87) or diclofenac (rRMTL 0.71, 0.56-0.89); no significant difference was observed versus celecoxib or biologic DMARDs. For the secondary outcomes, low-dose methotrexate was similarly associated with lower 5-year incidence of newly recorded bipolar disorder, depression, and anxiety compared with non-selective NSAIDs naproxen and diclofenac, with the mood and anxiety associations extending to the selective cyclo-oxygenase-2 inhibitor celecoxib. In a real-world rheumatoid arthritis cohort, initiation of low-dose methotrexate was associated with lower 5-year incidence of newly recorded psychosis, bipolar disorder, depression, and anxiety than initiation of non-selective NSAIDs. Given that extensive trials of broad anti-inflammatories have yielded limited psychiatric benefit, the differential profile of low-dose methotrexate is consistent with a mechanism beyond simple inflammation suppression. We hypothesise potentiation of regulatory T cell-mediated control of systemic inflammation and neuro-glial regulation. The active-comparator observational design cannot establish causation; these findings are hypothesis-generating and confirmatory inference will require interventional studies. UK Research and Innovation (UKRI) Medical Research Council [grant number UKRI4403] Mental Health Platform. The National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research.

Opioid-induced constipation is a practical bowel-management issue when opioids are started for cancer pain, but real-world naldemedine timing and subsequent laxative needs remain variable. To describe naldemedine initiation timing/context after oxycodone start and early additional laxative adjustment among adults with cancer. Single-center retrospective cohort study using routine clinical records. Adults with cancer pain in a single-center Japanese cancer-care setting who started oxycodone between June 1, 2017, and December 31, 2018, and subsequently received naldemedine. Concurrent initiation was naldemedine prescribed as part of the same oxycodone-start prescribing decision; reactive initiation was naldemedine added as a separate prescribing decision after physician-recognized constipation during ongoing oxycodone therapy. The primary outcome was prescription-record-based additional laxative initiation or dose escalation of existing laxatives within 7 days after naldemedine initiation. Secondary outcomes were oxycodone-to-naldemedine interval and diarrhea-related discontinuation within 28 days. Among 101 patients, the primary outcome occurred in 6/31 (19.4%) concurrent and 2/70 (2.9%) reactive cases (p = 0.010). The reactive group had a median oxycodone-to-naldemedine interval of 15 days (interquartile range, 5-83); diarrhea-related discontinuation occurred in 2/31 (6.5%) versus 6/70 (8.6%). Concurrent naldemedine at oxycodone start did not eliminate early additional laxative initiation or escalation. Naldemedine timing should be understood within individualized bowel-management planning, with conventional or rescue laxatives considered when clinically appropriate.

Daratumumab is widely used for relapsed or refractory multiple myeloma, yet outcomes from regional Australian centers remain underreported. This retrospective study evaluated real-world treatment patterns between 2018 and 2023 and survival outcomes among patients receiving daratumumab-based therapy in two regional tertiary centers. Fifty-two patients were included. Median age was 74 years, and 59% had high-risk cytogenetics. Most patients received a combination of daratumumab, bortezomib, and dexamethasone (60%, 32). The overall response rate was 35%, including 10% complete responses and 25% very good partial responses. Median progression-free survival (PFS) was 13 months. Patients who received daratumumab at greater than first relapse had significantly longer PFS (hazard ratio 4.29, 95% confidence interval 1.94-9.47, p < 0.001). Median overall survival (OS) was 27 months. Prior autologous stem cell transplantation was not associated with differences in PFS or OS. Daratumumab-based combinations were feasible in a regional setting and yielded meaningful clinical outcomes in an older cohort with a high proportion of adverse cytogenetics.

Objectives: This study aimed to examine the morphological and morphometric characteristics of the incisive foramen and incisive canal in dry human skulls. Materials and Methods: The sample consisted of 150 dry adult skulls, with no distinction regarding sex or ethnicity. The analysis included the number of incisive canals within the foramen, their dimensions (area and diameter), and their anatomical connections with the incisive fossa and the nasal cavity. Results: All incisive canals were found to communicate with the nasal cavity. The most frequently observed configuration was foramina containing two or more canals. Conclusion: Precise anatomical knowledge about the incisive canal and its foramen is essential for clinical procedures involving the anterior maxilla. Morphological variations in this region may affect surgical access, technique selection, and procedural outcomes.

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