Chronic viral hepatitis infections (hepatitis B (HBV), C (HCV) and D viruses (HDV)) are responsible for over 1 million deaths annually, due to cirrhosis and liver cancer. Mongolia has a high prevalence of all these infections, resulting in the highest incidence and mortality from liver cancer in the world. Other factors, such as metabolic dysfunction-associated steatotic liver disease (MASLD) can impact viral hepatitis, although the interaction is not fully understood. Several successful viral hepatitis screening programmes have been carried out among Mongolians living in Spain, USA, and Sweden. We describe a community-informed protocol for the implementation of liver health screening among Mongolians living in London (UK), designed by a multi-disciplinary team. This observational, mixed-methods study ('Hep-MoLo') has three domains. (i) In the clinical domain, liver screening events will be held in London, in collaboration with the Mongolian Community Organisation. An awareness-raising educational component will precede point-of-care screening for blood-borne infections (HBV, HCV, HIV), liver fibrosis and steatosis, and screening for cardiometabolic risk factors (obesity, hypertension, dyslipidaemia, diabetes); (ii) Laboratory studies will focus on the interaction between HBV and MASLD; (iii) A qualitative approach will be used to explore community views on liver health screening, access and engaging in care. This protocol provides a framework for a public health intervention targeting a high-risk population, combined with laboratory and qualitative research to give a multi-dimensional insight into viral hepatitis and liver health in the London Mongolian community. This is a community-academic-clinical partnership, fostering collaboration to generate data to inform clinical and public health interventions. Liver disease is the 11th leading cause of death worldwide, due to liver scarring (cirrhosis) and liver cancer. Two major liver disease causes are long-term viral hepatitis infections (caused by hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV)), and liver stress caused by conditions such as too much liver fat, high blood pressure, diabetes, obesity and/or abnormal blood fats. The exact relationship between all these factors on liver disease is not yet fully understood. This protocol describes a liver health study among Mongolians living in London, since Mongolia has very high rates of viral hepatitis and liver disease. Clinical outreach teams have joined a Mongolian Charity and Community Organisation to plan community-based liver screening events. Researchers will use clinical information and blood samples to explore the interaction between factors that cause liver disease. They will measure fats (lipids), immune markers (cytokines) and sequence the genetic code of both the human and hepatitis B virus. Researchers will also talk with people from the Mongolian community to understand community views on viral hepatitis screening and access to healthcare. This study will develop a clinical-academic-community partnership, set the scene for future studies, and improve access to healthcare and liver-health awareness.
ObjectivesSinonasal metastases are far rarer than primary sinonasal malignancies, hence seldom reported or analyzed in existing literature. To address these gaps, we have retrospectively analyzed 35 patients with sinonasal metastasis in a single university hospital in South Korea, over a 24-year period.MethodsFrom 1998 to 2022, among 11,814 pathology reports of sinonasal tissues, 35 (0.3%) were identified with sinonasal metastasis from solid organ cancers. Patients' clinical characteristics, presentation, primary tumor profiles, treatment modalities for the sinonasal metastasis, and overall survival (OS) were retrospectively reviewed and analyzed, in addition to the literature review.ResultsHepatocellular carcinoma (HCC) was the most common primary cancer (37.1%), followed by lung (14.3%), breast (11.4%), and thyroid (8.6%). The most common presentation was epistaxis (20%), however, 20% were identified incidentally. The nasal cavity (37.1%), sphenoid and maxillary sinus (31.4%), and skull base (34.3%) were the most prevalent metastatic locations. Although the median OS following a sinonasal metastatic diagnosis was 7.0 months, patients with isolated sinonasal metastasis, thyroid cancer- metastases, or definitive therapy for sinonasal metastasis had significant longer OS (p=0.037, 0.035, and p-trend=0.003, respectively).ConclusionIn our study, HCC was the most common primary cancer for sinonasal metastasis, contrasting with renal cell carcinoma prevalence in Western literature, suggesting that regional cancer incidence variations may influence sinonasal metastasis epidemiology. Despite the poor prognosis in general, in selected patients with thyroid cancer or solitary sinonasal metastases, the definitive treatment for the sinonasal metastasis may aid in an increased duration of survival.
This retrospective descriptive epidemiological study aimed to investigate the incidence of burns during the cold season compared to other times of the year and to identify associated risk factors and clinical characteristics among hospitalized patients. A total of 402 medical records of patients admitted to the burn unit at the Department of Surgery, Udon Thani Hospital, between January 1, 2022, and December 31, 2024, were reviewed. Descriptive statistics were used to analyze demographic characteristics and incidence. Comparisons between the cold season and other seasons were conducted, and associations between risk factors and clinical outcomes were tested using the Chi-square test. The incidence of burns increased over the three-year period. Incidence during the cold season was 1.65 times higher than in other seasons (OR=1.65). Most patients were elderly females, and the majority of burns occurred due to domestic accidents. Adults were significantly more likely to sustain severe burns than other age groups (χ2=28.45, df=15, p=0.019). Complications were significantly associated with burn severity (χ2=45.78, df=3, p<0.001) and treatment costs (χ2=89.34, df=2, p<0.001). These findings indicate a higher burden of burn injuries during the winter, particularly among the elderly and women. Targeted prevention efforts, such as public safety education and improved first-aid training, are needed. Enhancing treatment protocols and referral systems could further reduce complications and the economic impact of burn injuries. Cette étude épidémiologique rétrospective a pour but de comparer la saison hivernale aux autres. Quatre cent deux dossiers de patients hospitalisés dans le service de chirurgie de l’hôpital Udon Thani entre le 1er janvier 2022 et le 31 décembre 2024 ont été analysés. La statistique descriptive s’est penchée sur l’incidence et les caractéristiques démographiques. En utilisant le test de x2, nous avons comparé les données des brûlures survenues en hiver ou pendant une autre saison. L’incidence des brûlures a augmenté durant la période d’étude, et elle est 1,65 fois supérieure en hiver. La majorité des patients étaient des femmes âgées brûlées au domicile. Les adultes avaient des brûlures plus graves (p=0,019). La sévérité des brûlure affectait les complications (p<0,001) et le coût de prise en charge (p<0,001). Le risque de brûlure s’élève en hiver, en particulier chez les femmes âgées. Des efforts de prévention comme l’éducation du public, et une amélioration du secourisme sont nécessaires. L’amélioration des protocoles thérapeutiques et des critères de transfert pourraient diminuer les complications et les coûts.
Sodium thiosulfate (STS) has recently been approved as an otoprotectant for systemic use in pediatric cancer patients receiving cisplatin treatment for localized, nonmetastatic solid tumors by the Food and Drug Administration, European Medicines Agency, and Medicines and Healthcare Products Regulatory Agency. While incorporating STS into the current standard of care pediatric practice, questions about uniform, timely, and safe administration are raised that may benefit from additional guidance. Recognizing that advancing clinical practice presents multiple challenges, an international onco-ototoxicity prevention task force, including experts in pediatric oncology, audiology, and pharmacology, was established to identify potential barriers to the implementation of otoprotection and to offer practical solutions for clinical services for children exposed to cisplatin, based on available evidence, as well as consensus where data are less robust. This task force held several online meetings and a working group session at the annual SIOPE meeting in Milan in May 2024, where the challenges for implementing STS were outlined and addressed. Nine key challenges were identified, including, for example, the timing of both cisplatin infusion and STS administration, the optimal integration of STS into existing treatment protocols, potential drug interactions, and relevant economic considerations. In this article, we propose practical steps to address these challenges, informed by the existing literature and expert opinion, incorporating recommendation statements from the international onco-ototoxicity prevention task force on behalf of the SIOP Supportive Care Network, to facilitate the implementation of STS in children with localized, nonmetastatic disease.
Acinetobacter baumannii is a Gram-negative opportunistic pathogen increasingly implicated in severe hospital and community-acquired infections. In Nigeria, widespread antibiotic use across human, animal and environmental sectors contributes to antibiotic selection pressures that drive the emergence and spread of high-risk multidrug-resistant lineages. This One Health genomic surveillance study investigated the prevalence, resistance mechanisms, genomic characteristics and reservoirs of A. baumannii across multiple sources in Kano, Nigeria. A total of 3,235 samples were collected from clinical samples, hospital environments, non-hospital environments and poultry droppings. A. baumannii isolates were identified by growth on MacConkey/CHROMagar and confirmed by bla OXA-51-like amplification. Antimicrobial susceptibility was assessed using the Kirby-Bauer disc diffusion method. Of all samples, 62 isolates were confirmed as A. baumannii, originating from clinical samples (n=24), hospital environments (n=33), non-hospital environments (n=2) and poultry droppings (n=3). Whole-genome sequencing of 27 select isolates was performed to characterize resistance and virulence genes, sequence types (STs), mobile genetic elements, genomic islands and SNP-based relatedness. Thirteen bla OXA-51-like and one bla OXA-58-like variants were detected. MLST revealed 21 STs using the Pasteur scheme and 14 using the Oxford scheme, many of which were susceptible to most antibiotics tested. In contrast, isolates N9, N13 and N16 (ST821) and N19 (ST625) were resistant to all tested antibiotics, including carbapenems. The highly resistant ST821 clones were isolated from a municipal dumpsite, hospital floors and a hospital bedside surface and separated by only 5-17 SNPs, indicating close relatedness and clonality. Previously reported ST821 strains from the UK, Pakistan, Germany and Nigeria were highly susceptible to antimicrobials. Although no plasmids were detected, complementary genomic islands were identified in N9, N13 and N16 containing blaNDM-1, tetA/tetR, folP, aac, aphA, dinB, cueR and trxC and therefore likely to confer resistance to antimicrobials. In conclusion, this study provides the first broad One Health genomic overview of A. baumannii circulating across human, environmental and poultry sources in northern Nigeria, revealing substantial genomic diversity and the identification of a closely related extreme drug-resistant ST821 lineage spanning hospital and community environments.
Fracture-related infection (FRI) remains a serious complication in orthopedic trauma surgery, with microbiological confirmation based on positive cultures from deep tissue samples. However, the clinical interpretation of positive microbiological findings in asymptomatic patients remains unclear. This prospective study aimed to evaluate the incidence and characteristics of peri-implant soft tissue colonization in patients undergoing routine removal of osteosynthetic material without clinical or radiological signs of FRI. Indications for implant removal surgery included routine removal, prominence of osteosynthetic material, discomfort, removal prior to prosthetic joint implantation or patient request. It is a single-center prospective study. A total of 137 adult patients undergoing implant removal between 01/09/2023 and 30/11/2025 were included. For each patient, five deep tissue samples and the removed implant were collected for microbiological analysis, including sonication fluid culture. Histological evaluation was performed in a subset of cases. Peri-implant colonization was defined as the presence of identical pathogens in at least two tissue samples. All patients underwent routine postoperative clinical follow-up after implant removal surgery. Wound healing and local clinical status were assessed at the time of suture removal, typically 12-14 days postoperatively. In addition, all patients were instructed to return for further clinical evaluation in the event of any wound healing problems, local inflammatory signs or other symptoms involving the operated region. Peri-implant soft tissue colonization was detected in 32.8% of patients, while overall microbiological positivity (including sonication) reached 38.7%. Sonication and tissue cultures demonstrated comparable detection rates, with isolated positivity observed in 5.8% of cases. Histological positivity was rare (2.75%) and showed limited concordance with microbiological findings. Colonization rates varied significantly by anatomical location, with markedly higher prevalence in the shoulder region compared to other sites (70.0 vs. 20.7%, p < 0.001). In multivariable logistic regression analysis, shoulder region location was a strong independent predictor of culture positivity (OR 25.45, 95% CI 8.00-80.65), while male sex was also independently associated with positive cultures (adjusted OR 6.42, 95% Cl 2.11-19.51, p = 0.001). The microbiological spectrum was dominated by low virulence, predominantly polymicrobial flora, with Cutibacterium acnes as the most frequently identified organism. These findings demonstrate that peri-implant colonization is common in clinically asymptomatic patients, particularly in the shoulder region. Shoulder region localization and male sex were independently associated with microbiological positivity. Positive microbiological results should therefore be interpreted with caution and in the context of clinical, radiological and histopathological findings to avoid overdiagnosis of FRI and unnecessary treatment.
The optimal mean arterial pressure (MAP) target in high-risk hypertensive patients undergoing major abdominal surgery remains unclear. The HISTAP trial evaluated whether targeting an intraoperative MAP ≥ 80 compared with ≥ 65 mmHg reduces postoperative organ dysfunction and 30-day mortality, in this population. HISTAP was a multicenter, randomized trial conducted at 18 Italian centers between March 2023 and April 2025. The study included patients aged ≥ 60 years with chronic hypertension requiring home therapy, undergoing elective major abdominal surgery and having at least one additional high-risk criterion. The intraoperative MAP was targeted to ≥ 80 mmHg (Treatment group) or ≥ 65 mmHg (Control group). The primary outcome was a composite endpoint including postoperative mortality and at least one major organ dysfunction. Of 636 randomized patients, 6 were excluded since surgery was canceled after randomization, 630 completed the trial and were included in the intention-to-treat analysis (median age, 74 years [IQR, 69-79]). Mean intraoperative MAP was 77 ± 7 mmHg in the Control group and 88 ± 9 mmHg in the Treatment group. The primary composite outcome occurred in 48.9% of patients in the Control group versus 38.1% of patients in the Treatment group (relative risk, 0.78; 95% CI 0.65-0.93; P = 0.006). Acute kidney injury was significantly less frequent in the Treatment group (23.5 vs. 33.7%; P = 0.005). Among hypertensive patients receiving continuous hemodynamic monitoring and protocolized fluid therapy at increased postoperative risk undergoing major abdominal surgery, targeting an intraoperative MAP ≥ 80 mmHg, compared with ≥ 65 mmHg, reduced major organ dysfunction, primarily due to fewer mild-to-moderate acute kidney injuries. The HISTAP trial has been registered at ClinicalTrials.gov, NCT05637606 (Date of registration: 24 November 2022).
To evaluate the safety and feasibility of robotic natural orifice specimen extraction surgery (NOSES) for right colon cancer. Twenty-two female patients undergoing this procedure between January 1, 2022 and January 31, 2025 were enrolled. Safety and feasibility were assessed by analyzing operative time, intraoperative blood loss, conversion rate to open surgery, postoperative complications, 30-day mortality, and 30-day unplanned surgery-related readmission rate. All procedures were completed successfully. The median operative time was 158 min (152-169 min), and the median blood loss was 53 mL (43-75 mL). No conversions to open surgery occurred. The first postoperative flatus occurred at a median of 53.00 h (49.25-57.50 h), and the median postoperative hospital stay was 9.00 d (8.00-11.00 d). Postoperative complications included one case of intestinal obstruction. No anastomotic leakage, anastomotic bleeding, vaginal hemorrhage, vaginal infection, or abdominal infection was observed. There were no deaths within 30 days and no unplanned surgery-related readmissions. Robotic NOSES for right colon cancer is safe and feasible.
We aimed to characterize encephalitis, myositis, and myocarditis, in hospitalized children during the 2023 - 2024 dengue epidemic in Argentina. This case series included patients younger than 16 years with laboratory-confirmed dengue hospitalized for atypical manifestations across ten centers from Argentina between July 2023 and July 2024. Data was collected via a REDCap form version 12.4.1 (Vanderbilt University). Statistical analysis was performed by RStudio. We enrolled 47 patients; median age was 7 years [IQR 2 - 11], 64% were male, and 62% had no underlying conditions. Encephalitis was the most frequent clinical manifestation (60%), followed by myositis (38%) and myocarditis (4%). One patient had concurrent myositis and myocarditis. DENV-2 and DENV-1 were the identified serotypes. The 32% of patients required PICU admission, primarily those with encephalitis (n = 13) and myocarditis (n = 2). Thirteen patients required inotropic support and mechanical ventilation. Empirical antibiotics were administered in 32% of cases; no bacterial co-infections were identified. Median hospital stay was 5 days [IQR 3 - 8]. In 4 patients residual sequelae at discharge (persistent muscle weakness, myocardial fibrosis, and seizures) were detected. No deaths occurred. Encephalitis, myositis, and myocarditis are uncommon but clinically significant dengue complications in children.  Encephalitis and myositis were the most frequent atypical manifestations of dengue in this multicenter registry. Encephalitis and myocarditis were associated with a higher rate of PICU admission. • Atypical dengue manifestations in children such as encephalitis, myocarditis, and myositis, affect males predominantly, and may be associated with greater severity. • These clinical pictures are frequent in endemic countries, with a high burden of cases annually. • Argentina has become an endemic country with a cyclic epidemic pattern. • This was the largest epidemic in the country with a high burden of cases of dengue. • The cases had mild evolution in this new endemic scenario, with adequate clinical support.
Migraine operates as a systemic disorder of multisensory sensitization. Within this spectrum, auditory manifestations, including sensorineural hearing loss, tinnitus, and hyperacusis, represent prevalent yet frequently overlooked otologic phenotypes. Epidemiological data show that 15%-49% of migraine patients present with comorbid auditory symptoms, and nearly two-thirds exhibit auditory electrophysiological abnormalities. However, optimal clinical management remains constrained by an incomplete understanding of pathogenic mechanisms, variable audiological assessment protocols, and dispersed therapeutic data. This review synthesizes epidemiological, audiological, and pathophysiological data linking migraine to auditory dysfunction. The underlying pathology involves a peripheral-to-central continuum across three interacting axes. Anatomical and hydrodynamic vulnerabilities drive localized microvascular ischemia and aberrant brain-ear fluid exchange. Localized neurochemical imbalances, involving glutamate excitotoxicity, neuropeptide signaling, and innate immune activation, disrupt inner ear homeostasis. Concurrently, central sensitization facilitates neural network plasticity, characterized by impaired efferent gating and thalamocortical dysrhythmia. Drawing upon these underlying pathways, current and emerging therapeutic strategies are categorized by specific clinical objectives: blocking upstream migraine pathways, protecting the cochlear microenvironment, and correcting central hypersensitivity. This framework aims to catalyze future translational research to rigorously validate these mechanistic links, promote early identification, precise clinical phenotyping, and cross-disciplinary management of affected patients.
Nagashima-type palmoplantar keratoderma (NPPK) is a common inherited palmoplantar keratoderma predominantly affecting East Asian populations and caused by biallelic loss-of-function variants in the SERPINB7 gene. Clinically, NPPK is characterized by diffuse, non-progressive hyperkeratoderma of the palms and soles with erythema extending beyond the palmoplantar margins, frequently accompanied by hyperhidrosis and malodor. Although the disease course is generally benign, these features may lead to a considerable psychosocial burden. Advances in next-generation sequencing have expanded the mutational spectrum of SERPINB7 and clarified founder effects in different populations, while mechanistic studies have highlighted the essential role of SERPINB7 in maintaining epidermal protease-antiprotease balance and barrier homeostasis. These insights have enabled the development of mutation-targeted therapeutic approaches, most notably topical gentamicin-induced readthrough therapy for nonsense mutations. This review summarizes current knowledge and recent advances in the epidemiology, genetics, pathogenesis, clinical features, and management of NPPK, with particular emphasis on emerging precision treatment strategies.
Prostate cancer (PCa) remains one of the most common malignancies among men worldwide, with lymph node invasion (LNI) serving as a critical prognostic factor influencing treatment decisions and outcomes. This study aimed to evaluate the prevalence of LNI and investigate associated risk factors in a cohort of intermediate-risk PCa patients. This retrospective cross-sectional study included intermediate-risk PCa patients treated at Imam Khomeini Hospital, Tehran, Iran, from 2019 to 2024, who underwent radical prostatectomy with pelvic lymph node dissection (PLND). Data were extracted from hospital clinical documents and compared between patients with and without LNI. The primary outcome was the prevalence of LNI, while the secondary outcome aimed to identify associated demographic, clinical, and pathological risk factors. Statistical tests such as univariate logistic regression and ROC curve analysis were used. This study found a 12.10% prevalence of LNI. Univariate analysis revealed significant associations between LNI and advanced clinical stage, higher Gleason score, greater core involvement, and elevated total prostate-specific antigen (PSA) (OR=1.33), with all P<0.05. In multiple logistic regression analysis, adjusting for confounders, only PSA remained an independent predictor. The receiver operating characteristic (ROC) analysis confirmed PSA's moderate diagnostic accuracy for LNI (area under the curve [AUC]=0.685, P<0.001), with an optimal cut-off of 16.52 ng/mL, 65% sensitivity, and 68% specificity. The results indicated that only total PSA remained an independent predictor. This finding highlighted total PSA as a key biomarker for assessing LNI risk in intermediate-risk PCa patients. Additionally, total PSA demonstrated moderate diagnostic accuracy in predicting LNI, supporting its clinical utility in risk stratification and decision-making.
Aim: Network meta-analyses (NMAs) of seasonal vaccines face distinct challenges that can compromise the validity and relevance of findings. While established frameworks offer guidance for evaluating the feasibility of NMAs, they do not address factors specific to seasonal vaccines. This study aims to highlight unique methodological challenges related to conducting NMA feasibility assessments of seasonal vaccines. The considerations are framed to be compatible with existing guidance and recommendations for the conduct and reporting of NMAs. Materials & methods: We developed a set of key considerations that should be applied when assessing the feasibility and/or validity of NMAs comparing seasonal vaccines. The considerations were based on systematic reviews and critical appraisals of published NMAs of seasonal vaccines, hands-on experience performing feasibility assessments of seasonal vaccines, and input from consultations with vaccine experts. Results: Unique considerations for evaluating comparability across seasonal vaccine studies include: whether vaccines should be compared by platform, formulation, dose, and/or valence; the impact of seasonality, strain evolution and definitions of placebo/unvaccinated controls on network connectivity; target population characteristics including history and recency of prior vaccination and/or infection(s), and baseline infection/severe disease risk; antigenic match (i.e., the degree of concordance between vaccine composition and circulating viral strains), which directly influences effectiveness and outcome measurement approaches that consider time varying epidemiology and assay and measure discrepancy. Comprehensively integrating these elements into existing guidance frameworks ensures transparent assessment of the key assumptions underlying NMA (i.e., transitivity and homogeneity) within the context of unique study design and methodological features of seasonal vaccine studies. Conclusion: The concepts highlighted in this paper address important gaps in the feasibility assessment process for NMAs of seasonal vaccines, which are crucial for informing public health decisions and guiding vaccine policy and implementation. What is this article about? Existing network meta-analysis (NMA) frameworks were expanded to highlight considerations for NMAs of seasonal vaccines, such as those for COVID-19 and influenza, which require annual updates and evaluation across multiple formulations, platforms and populations. What methodology is described? Specific considerations related to challenges that are unique to NMAs of seasonal vaccine studies, including strain evolution, antigenic match, time varying epidemiology, assays and measures discrepancy, are considered alongside the potential need to rely on real-world evidence for an up-to-date understanding of vaccine efficacy/effectiveness. Why is this important? Currently, there is no existing guidance addressing the specific methodological challenges of conducting NMAs for seasonal vaccines. This paper provides researchers with key considerations to ensure their methodological approaches are robust, their analytical decisions are transparent, and their NMAs produce valid comparative evidence for informing vaccine policy and clinical practice.
This systematic review and meta-analysis evaluated the motor-sparing pericapsular nerve group (PENG) block's effect on early mobilisation and functional recovery outcomes following total hip arthroplasty (THA). We searched MEDLINE, Web of Science, EMBASE, the Cochrane Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP) up to 31 May 2025 for randomised controlled trials (RCTs) comparing PENG block with non-PENG analgesic strategies in adult THA patients. The primary outcome was time to first mobilisation. Secondary outcomes included Quality of Recovery (QoR) scores, quadriceps strength, hip range of motion, dynamic pain scores, patient satisfaction, and length of hospital stay. Risk of bias was assessed using the RoB 2 tool. Evidence certainty was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Meta-analyses were conducted using random-effects models. Twenty-six RCTs involving 2208 patients were included. PENG block reduced time to first mobilisation [mean difference (MD), -2.68 h; 95% confidence interval (CI) -3.84 to -1.53; P < 0.001] and improved quadriceps strength on post-operative day (POD) 1 [standardised mean difference (SMD), 0.35; 95% CI 0.05 to 0.64; P = 0.02], hip range of motion (MD 12.69°; 95% CI 1.05 to 24.33; P = 0.03), patient satisfaction (SMD 0.48; 95% CI 0.11 to 0.85; P = 0.01), and length of hospital stay (MD, -0.41 days; 95% CI -0.67 to -0.15; P = 0.002). No significant effects were found for QoR scores, quadriceps strength on POD 2, or dynamic pain scores. No major block-related complications were reported. In this synthesis of RCTs through May 2025, compared with non-PENG analgesic strategies, the PENG block was associated with earlier time to first mobilisation after THA and improvements in some early recovery outcomes, including quadriceps strength on POD 1, hip range of motion, patient satisfaction, and length of stay. Further large, standardised trials are needed to validate these findings and define their clinical significance.
Italian Cystic Fibrosis Registry (ICFR) collects data of people with cystic fibrosis through the collaboration with Italian CF referral and support Centres (Italian law 548/93). It aims at analysing medium and long-term clinical and epidemiological trends, identifying healthcare needs at regional and national levels, contributing to healthcare programs and resource allocation (sharing the population of FC centres with the Ministry of Health). Finally, the RIFC shares some of its data with the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) to better define the number of people with cystic fibrosis with early access to specific treatments with innovative therapies. Moreover, ICFR data are shared with the European CF Patients' Registry (ECFSPs' Registry) to contribute to the estimation of the European incidence of the pathology and to bridge knowledge gaps on specific topics as well as to the adoption of common strategies for the standardized collection of data on people with cystic fibrosis. The objective of this report is to provide updated data from ICFR for the years 2023 and 2024. It is essential to consider that the analyses and specific studies carried out refer to a limited number of variables collected in the Registry, and that the selection of the topics covered in the chapters of this report was agreed by the scientific committee of the ICFR. The analyses and results presented in this report pertain to people with cystic fibrosis currently under care Italian National Referral Centres (CRR) and Support Centres (SS) for Cystic Fibrosis and Paediatric Hospital 'Bambino Gesù' (OPBG). Data are collected using web-based software adopted by almost all participating centres, except for the centres in Verona (which also includes the data from Treviso and Rovereto) and Messina, where data collection is carried out using a different software. The submitted data are then subject to both quantitative and qualitative quality control (QC) procedures, aimed at verifying the consistency and continuity of the information previously transmitted and shared with the European CF Registry. In the two-year period 2023-2024, 28 and 27 CF Centres, respectively, submitted their data to ICFR. However, the information from the two CF centres in Sardinia is still partial, since the data provided is limited to a small number of people with cystic fibrosis from 2023. The results section provides a comprehensive overview of various aspects of CF epidemiology and people with cystic fibrosis characteristics. 1. Demography: in 2023 and 2024, 6,127 and 6,182 people with cystic fibrosis were, respectively, included in the ICFR (median ages of 24.1 and 24.9 years). On average, 52.2% of people with cystic fibrosis are male, and most of the population (65.3%) is older than 18 years. This reflects the growth of the adult population, the number of paediatric people with cystic fibrosis remains almost unchanged compared to previous years. 2. in 2024, 66.5% of the Italian CF population received a diagnosis before reaching two years of age, 61.8% within the first year of life, while 15.5% of diagnoses were made in adulthood (>18 years). New diagnoses were 103 in 2023 and 134 in 2024, with an incidence of 1 in 5,587 live births in 2023 and 1 in 8,808 in 2024. 3. the genetic analysis of people with cystic fibrosis was performed in 99.9% of cases. The results allowed the characterization of at least one of the two alleles in 6,040 individuals (97.7%). The most frequent variant in Italy, consistent with previous years, is F508del, present in 43.6% of cases. A higher frequency, compared with other European countries, is also confirmed for the genetic variants N1303K, G542X, and 2789+5G>A. Only 1.3% of alleles carry a CFTR gene variant that has not yet been identified (unknown). 4. Lung function: lung function, measured by percent predicted FEV1%p, declined progressively before adulthood. In detail, 96.4% (in 2023) and 95.5% (in 2024) of paediatric people with cystic fibrosis aged between 6 and 17 maintain a FEV1%p>=70%. On the other hand, the percentage of paediatric people with cystic fibrosis with severely impaired respiratory function (FEV1%p<40%) is 0.2% (2023) and 0.1% (2024). In the adult population, FEV1%p values are encouraging, with an increasing proportion of people with cystic fibrosis showing preserved lung function (85.7% in 2023 and 87.1% in 2024). This report introduces a brief focus on pulmonary exacerbations, which decreased between 2023 and 2024 (from 19.8% to 15.4%; recurrent forms from 8.6% to 4.9%), with reductions across all age groups, though less marked in those over 40. The most affected remain children (1-6 years) and those over 55; the 4.9% with recurrent episodes represent the priority for therapeutic optimization. Overall, trends in respiratory function suggest a progressive improvement in health status among the adult population, likely associated with the increasing use of new targeted pharmacological therapies. 5. Nutrition: ICFR data confirm the critical nature of the first months of life, which usually precede the definitive diagnosis of CF and the subsequent initiation of specialized care. In the 12-17 years age group, the median body max index (BMI) z-score is close to zero, documenting an adequate nutritional status in half of the subjects. The proportion of malnourished males was 6.2% and 5%, while among females it was 2.3% and 2.6%, respectively, in 2023 and 2024. In the >=18 years age group, a higher percentage of underweight BMI is observed among females (9% in 2023 and 8% in 2024) compared with males (4.2% and 4.4% in 2023 and 2024, respectively). 6. in 2024, in both paediatric and adult people with cystic fibrosis, the most frequent complications were the same, but occurred at different rates, such as CF-related liver disease (24.1% and 49.4%, respectively), diabetes (3.8% and 26%), and osteoporosis (4.2% and 18.7%). A total of 50 people with cystic fibrosis with cancer were recorded in 2023 and 2024, of whom 4 were of paediatric age. 7. Transplantation: over the two-year period, 21 people with cystic fibrosis underwent double-lung transplantation, with median ages of 36.2 e 36.8 years in 2023 and 2024, respectively, with ages ranging from 15.1 to 64.7 years across the two years. 8. Microbiology: in 2024, the prevalence of adult people with cystic fibrosis with chronic Pseudomonas aeruginosa infection is 30.1%, while in paediatric people with cystic fibrosis is 5.5%. The prevalence of Staphylococcus aureus infections is 28.7% and 26.4%, respectively, in adults and paediatric people with cystic fibrosis; prevalence of infections of Burkholderia cepacia is 1.6% and 0.2%. 9. in the two-year period, ICFR data show that 36 people with cystic fibrosis died (16 males and 20 females), with median ages at death of 48.3 years in 2023 and 57.2 years in 2024 (excluding transplanted people with cystic fibrosis). The crude mortality rate ranged from 3.1‰ in 2023 to 2.8‰ in 2024; excluding transplant recipients, the crude rate was 1.6‰ and 1.0‰ in the respective years. 10. Motherhood and fatherhood: over the two-year period, 80 pregnancies were recorded, of which 62 were successfully completed (77.5%). Additionally, 22 pregnancies were still ongoing as of 31.12.2024. In 2024, 25 people with cystic fibrosis became fathers. The present report updates data published in previous years thus summarizing 2023 and 2024 results. The number of registered people with cystic fibrosis was 6,127 in 2023 and 6,182 in 2024. Population coverage estimates for 2024 to be around 98%. Over the two-year period 2023-2024, the number and percentage of people with cystic fibrosis aged over 18 years increased. In detail, the ICFR recorded 3,927 adult people with cystic fibrosis (64.1%) in 2023 and 4,034 (65.3%) in 2024. An increase in the median age of Italian people with cystic fibrosis has been observed over time, reaching 24.9 years in 2024. The absolute number of new diagnoses per year is comparable with that of the previous biennium (237 vs 234); the percentage of new diagnosis in adulthood was 39.6% in 2024. In 2024, the median age at diagnosis was 3.9 months; 61.8% of subjects are diagnosed within the first year of life; 95.1% of them were identified through neonatal screening. Analysis of different CFTR genotypes in the Italian CF population confirms the high allelic variability observed in Italy, with a substantial proportion of subjects not eligible for CFTR modulator therapy. Regarding respiratory function, findings are consistent with previous reports, showing an increasing percentage of subjects under the age of 18 with a normal respiratory function. This marked improvement observed in the adult population seems to be mainly due to the introduction of highly effective CFTR modulator therapies in Italy from 2021. In 2024, a reduction in the percentage of chronic Pseudomonas aeruginosa infection was observed in both adults (30.1% vs 38.8% in 2020) and paediatric people with cystic fibrosis (5.5% vs 7.6% in 2020). Liver disease remains the most frequent complication in both paediatric and adult populations, affecting 24.1% and 49.4% of people with cystic fibrosis, respectively. During the two-year period, 36 people with cystic fibrosis died with a median age at death between 48.3 and 57.2 years (transplant people with cystic fibrosis excluded). Only one transplanted people with cystic fibrosis under the age of 18 died in the period 2023 and 2024, confirming once again that mortality in paediatric age is a rare event. Finally, for the first time, this report introduces data related to maternity and paternity, highlighting that in more than 77% of cases pregnancies were successful; as well as estimates of tumour and pulmonary exacerbations incidence as possible complications.
Gastroesophageal reflux disease (GERD) is a common condition influenced by lifestyle, clinical, and psychosocial factors. This study examined the relationship between GERD symptoms and perceived stress among Lebanese adults, while accounting for key demographic, dietary, and clinical variables. A cross-sectional study was conducted among Lebanese adults between January and September 2024 using an online self-administered questionnaire. GERD symptoms and perceived stress were assessed using the GERDQ and PSS-10 scales. Bivariate analyses followed by multivariable logistic regression were performed to identify factors independently associated with GERD symptoms. A total of 440 participants were included (mean age of 36.4 ± 16.96 years), of whom 28.4% had probable GERD symptoms. Most participants (83.2%) reported moderate stress levels with a mean PSS score of 19.74±5.05. Higher perceived stress was independently associated with increased odds of GERD symptoms (ORa=1.110). Additional correlates included dietary factors (frequent intake of fatty/fried foods, carbonated beverages, and caffeinated drinks), medication-related factors (NSAIDs, bisphosphonates, and iron supplements), former smoking, and a personal or family history of gastrointestinal disease. Being married was associated with lower odds of GERD symptoms. Probable GERD symptoms were independently associated with perceived stress, dietary habits, smoking history, medication use, and gastrointestinal disease history. These findings support a biopsychosocial understanding of GERD symptom burden and provide further evidence that psychosocial factors should be considered when investigating gastrointestinal health in vulnerable populations.
This study evaluates the epidemiological, clinical, and autopsy findings of 6 rabies-related deaths occurring in the Şanlıurfa province of southeast Türkiye between 2012 and 2023. The primary objective was to identify region-specific risk factors and preventable causes through a retrospective, descriptive analysis. The study group comprised 5 males and 1 female, with a mean age of 18.4 years. All cases involved animal contact, categorized as either scratches (n=3) or bites (n=3). A critical finding regarding postexposure prophylaxis was that only one case received both the vaccine and immunoglobulin, while the remaining five received the vaccine alone. Clinically, hypersalivation and aggressiveness were the most frequently observed symptoms, each occurring in 50% of the cases. The mean survival time following the onset of symptoms was 24.3 days. Among the cases undergoing autopsy and histopathologic evaluation, encephalitic changes and, in selected cases, Negri bodies were identified. Although rabies is a preventable public health threat, these findings suggest that fatalities in the region are closely associated with insufficient prophylaxis and unequal access to health care services. To mitigate future risks, it is of vital importance to strengthen preventative health care in high-risk areas, ensure the control of stray animal populations, and provide comprehensive training for health care personnel on current prophylaxis guidelines.
Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea-hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e' ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m2; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005-1.033) and ODI (OR 1.030, 95% CI 1.010-1.050) were significant predictors. HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors. The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige-Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).
Vaccine hesitancy is a significant public health concern. This study evaluated medical students' confidence in counseling parents on childhood vaccines before and after completing the pediatrics clerkship. A cross-sectional survey of 59 Penn State College of Medicine students compared pre- and post-clerkship confidence in vaccine communication. Quantitative data were descriptively analyzed; qualitative responses explored hesitancy contributors and training suggestions. The reporting of his study followed the STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) guideline for cross-sectional studies. Post-clerkship students reported higher confidence in discussing vaccines (79% vs. 33%), explaining schedules (62% vs. 20%), addressing risks/benefits (7% 2vs. 43%), and countering misinformation (59% vs. 37%) compared with pre-clerkship students. Several of these differences reached statistical significance. Comfort discussing vaccine safety remained low (∼44%). Students identified misinformation, politics, and social media as key hesitancy drivers and recommended standardized patient practice and formal teaching to improve preparedness. Pediatrics clerkship clinical exposure boosts medical student confidence in vaccine counseling. Targeted skills training is needed to address safety discussions and parental persuasion challenges.
To analyze the microbiological characteristics of extrapulmonary nontuberculous mycobacterial (ENTM) infections in a tertiary hospital and to provide data to support clinical diagnosis and treatment of ENTM infections. A retrospective analysis was conducted on mycobacterial culture results from West China Hospital, Sichuan University from 2020 to 2023. A total of 68 confirmed cases of ENTM infection were enrolled, with all of which meeting the diagnostic criteria for extrapulmonary infection outlined in the Guidelines for the Diagnosis and Treatment of Nontuberculous Mycobacterial Disease (2020). Demographic data, strain distribution, and drug susceptibility test results were analyzed. Microbial species identification was performed using mass spectrometry, and drug susceptibility was assessed using the microbroth microdilution method. Among the 68 ENTM cases, the male-to-female ratio was 1 to 1.2, with individuals aged 40-59 years being the main affected group population. The most common sites of infection were the skin and soft tissues. The primary specimen source was pus (33.8%, 23 cases), followed by pathological tissues (26.5%, 18 cases). The Department of Infectious Diseases was the main source of confirmed cases (29.4%, 20 cases). Among the 68 EMTM cases, rapid-growing mycobacteria (RGM) accounted for 32.4% (22 cases), with Mycobacterium abscessus being the predominant species, while slowly-growing mycobacteria (SGM) accounted for 67.6% (46 cases), with Mycobacterium intracellulare and Mycobacterium marinum being the predominant species. RRGM exhibited higher minimum inhibitory concentration (MICs) for rifampicin and rifabutin but lower MICs for clarithromycin and amikacin. In contrast, SGM demonstrated low MICs for most antibiotics tested. In this study, ENTM infections most commonly involve the skin and soft tissues, with SGM being the predominant pathogens and Mycobacterium intracellulare being the dominant species. RGM shows susceptibility to clarithromycin and amikacin, which provides a basis for empirical anti-infective therapy. Although SGM exhibits low MICs to most tested antimicrobial agents, combination regimens remain necessary in clinical practice, and the risk of treatment failure should be thoroughly evaluated.