Post-Infectious Syndromes in the Post-Pandemic Phase Among the German General Population

Abstract: Persistent symptoms after a respiratory infection can impair daily life, as has been shown, for example, for "long COVID." In this study, we determined the frequency and impact of symptoms that persisted for 12 weeks or more after a respiratory infection. A further endpoint was health care utilization for such symptoms in the general population. A cross-sectional study was conducted within the population-based digital cohort DigiHero in Germany (DRKS00025600). 39.3% of invited participants responded by completing an online questionnaire. 46 915 adults were included in the analysis. Participants were asked about symptoms that persisted 12 weeks or longer after a respiratory infection between September 2024 and August 2025. 48.3% of participants (95% confidence interval: [47.9; 48.8]) reported having had at least one respiratory infection during the study period. Among them, 18.8% [18.3; 19.3] stated that they still had symptoms 12 weeks or more afterward. The frequency of persistent symptoms was higher in older persons (13.1% for ages 20 to 29, 21.4% for ages 60 to 69). Most (86.8%) of those affected reported at least moderate functional impairment, and 57.9% consulted a physician. The pathogen causing the original infection was known for 24.3% of those reporting persistent symptoms: there were 483 cases of SARS-CoV-2 infection, 102 of influenza, and 36 of RSV. The symptom duration, functional impairment, and symptom pattern were similar after infection with SARS-CoV-2 and influenza. The most common symptoms in all pathogen groups were impaired physical performance, shortness of breath, rapid exhaustion, and fatigue. Persistent symptoms after respiratory infections are common and similar across pathogens in frequency and severity.


Clinicopathological Features and Outcomes of Metastatic Colorectal Cancers Treated at a Tertiary Care Hospital: A Bidirectional Observational Study

Abstract: Metastatic colorectal cancer (mCRC) remains a major contributor to cancer-related mortality worldwide. Real-world data from low- and middle-income countries remain limited. This bidirectional observational study included 60 patients with histologically confirmed mCRC treated at a tertiary care center between January 2019 and December 2025. Demographic, clinicopathological, molecular, treatment, and survival data were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify prognostic factors. The median age was 48.5 years, and 63.3% of patients were male. Extensive metastatic disease was present in 96.7% of patients. Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were detected in 20.7% of patients, whereas microsatellite instability-high (MSI-high) status was identified in one patient. Median PFS and OS were 10.6 and 22.3 months, respectively. On multivariable analysis, peritoneal metastasis independently predicted inferior PFS [hazard ratio (HR) 4.45, 95% confidence interval (CI) 2.16-9.19; p < 0.001] and OS (HR 2.83, 95% CI 1.13-7.07; p = 0.026). Poorly differentiated histology independently predicted worse OS (HR 3.05, 95% CI 1.03-9.06; p = 0.045). This study highlights the substantial burden of advanced disease in Indian patients with colorectal cancer. Peritoneal metastasis and poor differentiation were associated with adverse outcomes. Improved early detection and wider access to targeted therapies may improve survival outcomes in resource-limited settings.

The Journal of the Association of Physicians of India

Natti HS
Gumdal V
Koppaka D
Nuguri S
Potu SR
Rudra RS
Jaffer RM

Humans
Male
Colorectal Neoplasms
Middle Aged
Tertiary Care Centers
Female
Adult
Aged
India
Prognosis
Microsatellite Instability
Proto-Oncogene Proteins p21(ras)
Neoplasm Metastasis
Progression-Free Survival


Cardiac Magnetic Resonance Imaging Study on Cardiovascular Involvement >60 Days Post COVID-19 Recovery

Abstract: This study evaluates individuals who have recovered from coronavirus disease 2019 (COVID-19) for cardiac manifestations at least 60 days postrecovery, using cardiac magnetic resonance (CMR) imaging. Native T1, native T2, and late gadolinium enhancement (LGE) were used as parameters to detect potential cardiac pathologies. To study the incidence and nature of cardiac manifestations in long COVID using CMR. Prospective observational study. A total of 54 COVID-19-recovered patients and 50 healthy matched controls (age- and sex-based) underwent CMR using a 3 T scanner. Pathologies were assessed through native T1 and T2 mapping and LGE imaging. Data analysis was conducted using SPSS version 23. Only 1 patient (1.85%) showed midmyocardial LGE in the basal and midinferior segments, along with raised native T1 and T2 values. The remaining 53 recovered patients (98.15%) revealed no LGE or elevated T1/T2 values compared to controls. Native T1 and T2 values did not significantly differ between the post-COVID participants and healthy controls. Mild concentric hypertrophy was observed in six patients, which appeared incidental and unrelated to COVID-19. None of the patients exhibited elevated troponin T levels. In this study, CMR imaging did not find a significant increase in cardiac manifestations that may be attributed to long COVID in patients who had recovered from COVID-19 compared with uninfected controls. We believe the incidence of cardiovascular comorbidities related to long COVID syndrome is much lower in the Indian population than reported in Western literature. These findings are reassuring and may help alleviate concerns among the Indian population regarding long-term cardiovascular involvement of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Mehta N
Banerjee TS
Karnavat CO
Parikh RM
Kashikar R
Sinhasan S
Tandan-Pardasani S
Bindroo S
Bhabhor A
Raut I
Shah N
Desai SB
Kapadia M
Desai M
Kapoor A

Humans
Female
COVID-19
Male
Prospective Studies
Magnetic Resonance Imaging
Adult
Middle Aged
Post-Acute COVID-19 Syndrome
India
Cardiovascular Diseases
SARS-CoV-2
Heart Diseases
Time Factors


A Cross-sectional Study to Assess the Knowledge, Attitude, and Practice of Look-alike, Sound-alike Drugs among Healthcare Providers at a Tertiary Care Hospital

Abstract: Sometimes, drug names or their appearances create confusion among healthcare providers. These look-alike or sound-alike (LASA) drugs have the potential to cause medication errors leading to patient harm. Such errors can occur during prescribing, dispensing, and administration of drugs. Therefore, this study was conducted to assess the knowledge, attitudes, and practice of LASA drugs among healthcare providers at a tertiary care hospital in India. This cross-sectional, observational, single-center, questionnaire-based study was conducted among healthcare providers at a tertiary care hospital in India. The study was conducted over a duration of 2 months between November and December 2024. Out of the 400 participants, 81% were doctors, followed by 12.75% nurses, 3.25% pharmacists, and 3% interns. The majority of them were aware of the term LASA drugs. The majority of them were slightly concerned about the risks of LASA drugs. Whereas, only 10% of them had ever reported LASA errors, as the majority of them were unaware about medication error reporting form. This study suggests that lack of awareness about LASA drugs among healthcare providers contributes to medication errors. To address this, solutions can be implemented at different levels via a multidisciplinary approach.

Bansal N
Khobragade AAK
Bawne AR
Bavlecha A
Kohli BS

Humans
Cross-Sectional Studies
Tertiary Care Centers
Health Knowledge, Attitudes, Practice
India
Male
Medication Errors
Female
Adult
Surveys and Questionnaires
Health Personnel
Attitude of Health Personnel
Middle Aged


Spectrum and Clinical Burden of Drug-induced Ataxia in Low-resource Settings: An Observational Study

Abstract: The clinical manifestation of drug-induced ataxia (DIA) is well established clinically but often becomes unrecognized until actual ataxia occurs. DIA may include ataxia as its primary clinical symptom or may be one of multiple manifestations. This study aimed to characterize the development of DIA types and the timing of clinical resolution. Between January 2016 and March 2025, a prospective observational study of subjects diagnosed with DIA based on the development of ataxia after starting a drug and no prior history of ataxia was conducted. Collected data included the drug involved, timing to onset of symptoms, type of DIA (cerebellar vs sensory), and time required for resolution of symptoms. A total of 63 subjects met the criteria for inclusion in this analysis. Ataxia was most commonly attributed to antiepileptic drugs (AED) (44 subjects, 69.8%), with the remaining 19 subjects having ataxia after the use of chemotherapeutic or other drugs (30.2%). The most frequent drug associated with ataxia was phenytoin (22 subjects). The majority of ataxia experienced by the subjects was of the cerebellar variety (58.7%), whereas only 41.3% experienced a sensory form of ataxia. Symptoms of ataxia following the use of a drug were most commonly noted >72 hours after starting the drug (79.4%). In subjects with symptomatic improvement after intervention, 39.7% of subjects demonstrated improvement within 72 hours after intervention. DIA may typically be caused by AEDs and chemotherapeutic drugs, with symptoms commonly manifesting >72 hours after initiation of drug therapy. Early recognition and treatment of DIA may improve clinical outcomes for individuals diagnosed with DIA.

Saibaba J
Subramaniam MP
Thangavelu AP
Rennukaranjan KC

Humans
Ataxia
Female
Male
Prospective Studies
Anticonvulsants
Adult
Middle Aged
Resource-Limited Settings
India


Incidence of Infections in Renal Allograft Recipients and Their Outcomes in a Tertiary Care Center in Northeast India

Abstract: The advent of modern potent immunosuppression has significantly reduced the occurrence of rejection in renal allograft recipients but has increased the risk of infection, which remains the major cause of death in these patients. This single-center retrospective observational study was conducted at a tertiary care center in India. Data were collected from medical records of renal allograft recipients admitted for infection-related complications over a 10-year duration. Out of 238 admissions, 63 (26.47%) were due to infection-related complications involving 59 unique patients. The most common infections were urinary tract infections (UTIs) (n = 24) and pneumonia (n = 19). Of the two patients requiring multiple admissions, one patient had two episodes of pneumonia and one episode of UTI, and the other patient needed three admissions for diabetic foot. Six patients succumbed to their illness, resulting in a mortality rate of 10.16%, with sepsis due to UTI being the most common cause of death.

Hajong S
Sharma M
Hakmaosa A
Doley PK
Pegu G

Humans
Kidney Transplantation
India
Male
Tertiary Care Centers
Female
Retrospective Studies
Incidence
Adult
Urinary Tract Infections
Middle Aged
Pneumonia
Postoperative Complications


Clinical Characteristics Treatment Approaches and Survival Outcomes in Secondary Hemophagocytic Lymphohistiocytosis: A Retrospective Observational Study

Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal syndrome characterized by immune hyperactivation and a cytokine storm, leading to fever, cytopenia, organomegaly, and multiorgan dysfunction. Given its high morbidity and mortality, prompt diagnosis and treatment are essential. Currently, there are no established markers to predict outcomes in secondary hemophagocytic lymphohistiocytosis (sHLH). This retrospective study aimed to identify prognostic factors in patients with sHLH, specifically evaluating the prognostic role of absolute neutrophil count (ANC) and serum ferritin level. The study also examined the impact of dexamethasone and etoposide on the treatment of these patients. HLH remission was achieved in 64 patients (71.1%). Forty-seven out of those 64 patients survived and were discharged home, while 17 patients died in the hospital. HLH remission was not achieved in 26 patients (28.9%), of whom 25 patients died in the hospital. ANC at diagnosis and lower nadir ANC during the hospital stay significantly correlated with mortality (p = 0.001 and 0.017, respectively). Serum ferritin levels, however, were not a significant prognostic marker (p = 0.396). Treatment with dexamethasone was associated with better outcomes in patients with sHLH. sHLH should be considered in patients with treatment-resistant bicytopenia or pancytopenia. Lower ANC at diagnosis and nadir ANC during hospitalization are associated with increased mortality, suggesting that ANC is a potential indicator for early immunochemotherapy. Serum ferritin level is not a significant prognostic marker. Early diagnosis and dexamethasone treatment help achieve HLH remission, which improves outcomes in sHLH. These findings highlight the need for prospective studies to better understand sHLH prognostic markers and therapeutic strategies, especially in intensive care settings, where mortality remains high.

Varshney A
Phadke PS
Prabhakaran A
Patade D
Bhalani Y
Kumar A

Humans
Lymphohistiocytosis, Hemophagocytic
Female
Retrospective Studies
Male
Dexamethasone
Prognosis
Etoposide
Ferritins
Treatment Outcome
Adolescent
Child
Glucocorticoids
Child, Preschool
Adult
Neutrophils
Leukocyte Count
Remission Induction
Young Adult


Barriers to Timely Rheumatologic Care for Rheumatoid Arthritis: A Real-World Questionnaire-based Study from Karnataka Chapter of Indian Rheumatology Association (KRA)

Abstract: To assess referral timelines to rheumatologists in Karnataka, India, identify factors linked to delays, and to examine their impact on disease activity, functional disability, and economic burden. A multicenter, cross-sectional, observational questionnaire-based study was conducted across 17 rheumatology centers in Karnataka, India (June, 2023-July, 2024). Disease activity (DAS28, CDAI), disability (HAQ-DI), and healthcare expenditure prior to referral and during the past 1 year were analyzed in relation to self-reported referral time, categorized as early (≤3 months from symptom onset) and late (>24 months). Utilization of healthcare schemes available in Karnataka was captured. Among 2,141 participants with RA, the median referral time to a rheumatologist was 18 (6-36) months, early referral (≤3 months) in 17% (n = 365), and late referral (>24 months) in 31% (n = 662). Older age [AOR = 1.01 (1.005-1.02)], being married [AOR = 1.48 (1.03-2.12)], resident of non-Bengaluru regions [AOR = 2.26 (1.60-3.19)], academic treating facility [AOR = 2.32 (1.68-3.18)], and longer duration of illness >120 months [AOR =2.84 (2.14-3.76)] had higher odds of late referrals. This group had significantly higher expenditure prior to referral [β = 3.57 (3.05-4.19)], higher total annual medical expenditure [β = 1.20 (1.09-1.32)], and catastrophic expenditure [β = 1.56 (1.22-2.01)]. 52 % (n = 1120) of participants reported out-of-pocket healthcare expenditure. Delayed referral to a rheumatologist was associated with increased disability and financial strain, including a significantly higher risk of catastrophic health expenditure.

Shobha V
Subramanian R
Prakruthi J
Selvam S
Shaleni V
Haridas V
Mamadapur M
Kamath A
Arjun MN
Chebbi P
Vahaneyil JM
Vr SV
Patil A
Pinto B
Yathish GC
Jeevanagi SR
Baliga S
Harshini AS
Singhai S
Rao VK
Ramachandran V
Anusha MS
Chandrashekara S
Mahendranath KM

Humans
Arthritis, Rheumatoid
India
Female
Cross-Sectional Studies
Referral and Consultation
Male
Middle Aged
Treatment Delay
Surveys and Questionnaires
Rheumatology
Adult
Health Expenditures
Health Services Accessibility
Time-to-Treatment
Aged

Journal Article
Observational Study
Multicenter Study


Reliability of Arterial Blood Gas Analyzer for Electrolyte and Hemoglobin Measurement: A Method Comparison Study

Abstract: Rapid assessment of electrolytes and hemoglobin is crucial in emergency and critical care. Arterial blood gas (ABG) analyzers are widely used as point-of-care devices. However, their agreement with central laboratory measurements remains uncertain because of methodological differences. This study aimed to evaluate the reliability of sodium, potassium, chloride, and hemoglobin values obtained from an ABG analyzer compared with those from a central laboratory autoanalyzer and to assess analytical acceptability using US Clinical Laboratory Improvement Amendments (CLIA) 2025 allowable error limits. In this prospective observational study, 200 paired arterial and venous samples from patients in the Emergency Department were analyzed. Arterial samples were processed on an ABG analyzer using direct ion-selective electrode (ISE) methodology, and venous serum electrolytes were measured on a central laboratory autoanalyzer using indirect ISE methodology. Hemoglobin was measured on a hematology analyzer. Paired comparisons were performed using the Wilcoxon signed-rank test, correlation was assessed with Spearman's coefficient, agreement was assessed with Bland-Altman analysis, and total error was compared with CLIA limits. ABG-derived sodium and potassium values were significantly lower than venous laboratory values, whereas chloride and hemoglobin values were significantly higher (p < 0.001). All analytes showed strong positive correlations. Bland-Altman analysis demonstrated acceptable agreement for sodium (bias, -2.8 mmol/L) and potassium (bias, -0.2 mmol/L), both within CLIA allowable limits. Chloride showed a total error of 6.43%, and hemoglobin showed a total error of 15.15%, indicating unacceptable analytical error. ABG-derived sodium and potassium values demonstrated acceptable agreement with central laboratory measurements and can be used for rapid clinical decision-making in emergency settings. However, chloride and hemoglobin values should not be used interchangeably without institution-specific validation and correction equations.

Dhanapalan A
Murugiah V
Ramasamy J
Raja NK

Humans
Blood Gas Analysis
Reproducibility of Results
Hemoglobins
Prospective Studies
Electrolytes
Potassium
Chlorides
Point-of-Care Systems
Sodium

Journal Article
Comparative Study
Observational Study


A Study of the Clinicoetiological Profile of Hyponatremia in Patients in a Tertiary Care Hospital

Abstract: Hyponatremia is a common and important electrolyte imbalance seen both in isolation and more commonly, as a complication of other medical illnesses. With a wide spectrum of presentations, the prognostic implications are grave and far-reaching if not addressed meticulously. Despite the knowledge of hyponatremia since the mid-20th century, data on the prevalence and clinical profile of hyponatremia are scarce, to say the least, from the Indian subcontinent. We took up this hospital-based observational study to explore the clinicoetiological profile of hyponatremia. Mean serum sodium level was 122.24 ± 6.10. Most of the patients had severe hyponatremia (63.3%). The most common cause of hyponatremia, as well as severe and euvolemic hyponatremia, was syndrome of inappropriate antidiuretic hormone secretion (SIADH) (21.9%). Most patients with SIADH had tubercular meningitis (TBM). The most common type of hyponatremia was hypovolemic hyponatremia (42.4%), of which sepsis was the most common cause. Further prospective studies are required as hyponatremia remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, its causation by multiple etiologies with differing pathophysiological mechanisms, and marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of hyponatremia; also, optimal treatment strategies have not been well defined for these reasons.

Humans
Hyponatremia
Inappropriate ADH Syndrome
Tertiary Care Centers
Male
Female
India
Middle Aged
Adult
Sodium
Sepsis


Semaglutide in Practice: Insights from a Retrospective Case Series at a Jharkhand Tertiary Care Hospital

Abstract: Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated efficacy in improving glycemic control and reducing cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). However, real-world evidence from Indian populations remains limited. This study aimed to assess the effectiveness and safety of semaglutide on glycemic control, body weight, and metabolic parameters in patients with T2DM in a real-world clinical setting. This retrospective observational study was conducted at a tertiary care hospital in Jharkhand, India, between February 2023 and August 2024. A total of 60 patients with T2DM (44 males and 16 females), including treatment-naïve individuals and those with inadequate glycemic control (HbA1c >7%) despite ongoing therapy, were enrolled. Clinical and biochemical parameters were evaluated at baseline and after six months of semaglutide therapy. Statistical analysis was performed using paired t-tests, with a p-value <0.05 considered statistically significant. Significant improvements were observed following semaglutide therapy. Mean HbA1c decreased from 9.21% at baseline to 7.35% after six months (p <0.001). Mean body weight decreased by 2.6 kg (p <0.001). LDL cholesterol levels declined significantly from 92.03 mg/dL to 78.93 mg/dL (p <0.05). Renal parameters, including serum creatinine and urine albumin-to-creatinine ratio, showed numerical improvement; however, these changes did not reach statistical significance (p >0.05). Thyroid function remained stable throughout the study period. Improvements in diabetic retinopathy and neuropathy were also observed, although these findings were not statistically significant. Semaglutide was effective and well tolerated in patients with T2DM in routine clinical practice. Treatment was associated with significant reductions in HbA1c, body weight, and LDL cholesterol without adverse effects on renal or thyroid function. These findings support the use of semaglutide as an effective therapeutic option for the management of T2DM in real-world settings.

Humans
Semaglutide
Female
Male
Diabetes Mellitus, Type 2
Retrospective Studies
Glucagon-Like Peptides
Hypoglycemic Agents
India
Glycated Hemoglobin
Tertiary Care Centers
Middle Aged
Blood Glucose
Body Weight
Aged
Treatment Outcome


Imeglimin in Indian Adults with Type 2 Diabetes: A Prospective Multicenter Real-world Cohort Study of Prescription Patterns, Glycemic Change, and Safety

Abstract: Imeglimin is a novel oral glucose-lowering agent targeting mitochondrial dysfunction. While randomized trials demonstrate its efficacy, real-world data in diverse populations remain limited. We evaluated the effectiveness, safety, and utilization patterns of imeglimin in Indian adults with inadequately controlled type 2 diabetes (T2D). This prospective, multicenter, observational cohort study enrolled adults with T2D newly initiated on imeglimin across 11 Indian centers. Participants were followed for 6 months. The primary outcome was the change in HbA1c from baseline. Effectiveness was analyzed in a complete-case cohort using linear mixed-effects models to adjust for covariates, while safety was assessed in all participants with at least one post-baseline evaluation. The baseline cohort included 736 participants (mean age 52.4 years, mean baseline HbA1c 9.8%). Imeglimin was predominantly prescribed as an add-on therapy (84.6%), most frequently alongside three or more other agents (57.9%). In the complete-case cohort (n = 337; 46% of baseline), adjusted mean HbA1c decreased by 1.28% (95% CI -1.41 to -1.14) at 3 months and 2.27% (-2.41 to -2.13) at 6 months (p <0.001). Greater reductions were significantly associated with higher baseline HbA1c. Adverse events were reported in 9.9% of the safety cohort (n = 573), most commonly mild gastrointestinal symptoms (5.2%). Hypoglycemia occurred in 1.2%. Two cases of lactic acidosis were reported, though causality with imeglimin was not established. In routine clinical practice, the initiation of imeglimin among Indian adults with T2D was associated with clinically meaningful reductions in HbA1c, fasting plasma glucose, and postprandial glucose over a 6-month period, alongside a favorable safety profile. These real-world findings support the clinical utility and tolerability of imeglimin as an effective therapeutic option for glycemic management in this population. Future randomized controlled trials with extended follow-up are warranted to establish definitive causal treatment effects and evaluate long-term clinical outcomes.

Saboo B
Samajdar SS
Maheshwari A
Saboo B
Panda JK
Inamdar AV
Agarwal P
Ghosh S
Patil S
Saxena D
Gokalani R
Kiran G
Singh NK
Pamnani H
Chakravarti HN
Agrawala RK
Singh V
Ahmed R
Tamhankar G
Joshi S

Humans
Diabetes Mellitus, Type 2
Middle Aged
Female
Male
India
Prospective Studies
Hypoglycemic Agents
Glycated Hemoglobin
Adult
Blood Glucose
Treatment Outcome
Practice Patterns, Physicians'
Aged
Hypoglycemia
Triazines

Journal Article
Multicenter Study
Observational Study


A Study of the Clinical Profile of Acute Poisoning in Adults in a Rural Tertiary Healthcare Setup

Abstract: Acute poisoning remains a major public health concern in rural India due to easy accessibility of toxic substances and limited mental health support. This retrospective observational study was conducted at a tertiary care teaching hospital in rural Bengaluru to evaluate the clinical and epidemiological profile of poisoning cases. Medical records of 100 patients admitted with acute poisoning over 1 year were analyzed. The mean age of patients was 28 years, with the majority in the 21-30-year age group, and a female predominance (57%). Suicidal intent accounted for 85% of cases. Organophosphorus compounds were the most common agents, followed by drug overdoses and pyrethroid compounds. All exposures occurred via the oral route, and 74% of patients presented within 4 hours of ingestion. Vomiting was the most common presenting symptom, followed by abdominal pain and altered sensorium. Laboratory abnormalities included elevated liver enzymes and electrolyte disturbances. The mean duration of hospitalization was 4 days. No mortality was observed during the study period. Acute poisoning in rural Bengaluru predominantly affects young adults and is largely associated with suicidal intent. Early presentation and prompt management contribute to favorable outcomes. Preventive strategies focusing on mental health support and the regulation of toxic substances are essential.

Humans
Female
Adult
Male
India
Retrospective Studies
Poisoning
Young Adult
Middle Aged
Adolescent
Rural Population
Acute Disease
Suicide, Attempted
Organophosphate Poisoning
Tertiary Care Centers


Prevalence of Celiac Disease in Inflammatory Bowel Disease: A Prospective Cohort Study from Northern India

Abstract: Celiac disease (CeD) and inflammatory bowel disease (IBD) share immune and genetic pathophysiological pathways, suggesting a possible increased coexistence. Indian data on biopsy-confirmed CeD in IBD are limited, and false-positive anti-tissue transglutaminase (tTG) antibody results complicate interpretation. To determine the prevalence of biopsy-confirmed CeD in an Indian IBD cohort and compare clinical features between CeD-positive and CeD-negative IBD patients. In this prospective observational study, 477 IBD patients were assessed. All patients underwent IgA anti-tTG screening. Seropositive patients underwent upper gastrointestinal endoscopy with duodenal biopsies. The standardized prevalence ratio (SPR) for CeD was calculated, and clinical and laboratory parameters were compared between patients with and without CeD. Among 477 IBD patients (UC 421; CD 56), 14 (2.94%) were anti-tTG positive, and 11 had biopsy-confirmed CeD, giving a prevalence of 2.31% (95% confidence interval: 1.29-4.08%). Prevalence was 2.14% in UC and 3.57% in CD (p = 0.59). The SPR, compared with the Indian population prevalence of 1.04%, was 2.22. The anti-tTG false-positive rate was 21.4%. No significant differences were observed between CeD-positive and CeD-negative patients, although UC patients with CeD showed a non-significant trend toward pancolitis. In conclusion, CeD prevalence in Indian IBD patients was numerically higher than the Northern Indian general population but did not reach statistical significance. Larger multicenter studies are needed to definitively establish the CeD-IBD association in Indian populations. Selective screening is preferable, and histological confirmation remains essential due to high false-positive serology.

Kumar M
Sapra B
Sharma PN
Maharshi S
Sharma SS

Humans
Celiac Disease
India
Female
Prevalence
Prospective Studies
Male
Adult
Inflammatory Bowel Diseases
Middle Aged
Biopsy
Transglutaminases
Adolescent
Young Adult


Effect of Radiological Patterns on Response to Pulmonary Rehabilitation in Post-tuberculosis Lung Sequelae: A Prospective Observational Study

Abstract: Post-tuberculosis sequelae (PTBS) are increasingly recognized as a significant cause of long-term respiratory morbidity, manifesting with dyspnea, reduced pulmonary function, impaired exercise capacity, and diminished quality of life. Despite their burden, PTBS patients often lack access to structured rehabilitation. Pulmonary rehabilitation (PR), well-established in COPD, may offer functional and psychological benefits in PTBS, but its implementation in India and comparison across radiological phenotypes remains understudied. To evaluate the impact of a 24-week pulmonary rehabilitation program on clinical, functional, psychological, and radiological outcomes in patients with PTBS, and to compare the response among different radiological subtypes-fibrosis, fibrocavitary lesions, bronchiectasis, and combined lesions. In this prospective observational study, 60 patients with PTBS underwent hospital- or home-based PR. Assessments were conducted at baseline, 12 weeks, and 24 weeks and included spirometry (FEV1, FVC, FEV1/FVC, FEF25-75), 6-minute walk test (6MWT), body mass index (BMI), St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea grade, DASS-21 scale for psychological health, and radiological classification. Statistical analysis was performed to assess within-group and between-group changes over time. Significant improvements were observed in BMI (p < 0.005), 6MWT (mean improvement >150 m in most groups), and DASS-21 scores across all radiological subtypes. FEV1% predicted improved significantly (p < 0.05), especially in patients with fibrosis and bronchiectasis (>60% by week 24), while those with fibrocavitary + bronchiectasis showed the least gain (38%). Quality of life (SGRQ) improved in all groups, though intergroup differences were not statistically significant. Bronchodilator reversibility was rare (5%) and did not vary with lesion type. Pulmonary rehabilitation significantly improves nutritional status, exercise capacity, psychological well-being, and spirometric parameters in PTBS patients, with variable responses depending on radiological pattern. Despite greater impairment, patients with fibrocavitary lesions derived meaningful benefit, highlighting PR's role as an essential component of post-TB care. Tailored PR strategies should be integrated into national TB programs to address the long-term sequelae of TB in high-burden settings such as India.

Humans
Male
Prospective Studies
Female
Tuberculosis, Pulmonary
Middle Aged
Quality of Life
Adult
India
Respiratory Function Tests
Bronchiectasis
Lung
Treatment Outcome
Pulmonary Fibrosis


AI-powered ECG Interpretation System for Arrhythmia Prediction and Hyperkalemia Detection Using Machine Learning

Abstract: Artificial intelligence (AI) has emerged as a powerful tool for electrocardiogram (ECG) analysis, potentially surpassing conventional interpretation in detecting arrhythmias and metabolic disturbances such as hyperkalemia. This study evaluated the diagnostic performance and real-world applicability of an AI-powered ECG interpretation system for arrhythmia prediction and hyperkalemia detection. In this prospective observational study, patients presenting to the emergency department or cardiology clinic between March 2024 and February 2025 were enrolled. Standard 12-lead ECGs were analyzed in parallel by a validated deep-learning AI model and board-certified cardiologists blinded to AI results and clinical data. Primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for arrhythmia and hyperkalemia detection. Secondary outcomes assessed the impact of AI-driven alerts on workflow efficiency and time to therapy. Among 4,200 patients (mean age 56, 39% female), the AI-ECG system demonstrated 97.2% sensitivity and 96.1% specificity for arrhythmia detection, outperforming manual interpretation for atrial fibrillation, atrial flutter, and ventricular ectopy (p < 0.001). For hyperkalemia, sensitivity and specificity were 83.5% and 87.3%, respectively, reliably flagging all critical potassium elevations within 1 minute. AI alerts reduced median time-to-therapy by 19 minutes. Subgroup analysis showed robust performance in patients with chronic kidney disease and acute cardiac conditions. AI-powered ECG analysis enables highly accurate, rapid detection of arrhythmias and hyperkalemia, supporting earlier clinical intervention and improving workflow efficiency. These findings advocate for broader multicenter validation and integration of AI-ECG tools in routine cardiology practice.

Humans
Hyperkalemia
Electrocardiography
Female
Arrhythmias, Cardiac
Machine Learning
Prospective Studies
Artificial Intelligence
Male
Middle Aged
Sensitivity and Specificity
Predictive Value of Tests
Aged


From Recognition to Reporting: One-year Trends in Adverse Drug Reactions at a Newly Designated Adverse Drug Reaction Monitoring Center

Abstract: To analyze spontaneously reported adverse drug reactions (ADRs) during the first year after the adverse drug reaction monitoring center (AMC) recognition. A retrospective observational study was conducted from April 2023 to March 2024 at a tertiary care hospital in Pune, Maharashtra, India. All reported ADRs were included and analyzed by gender, age, department, drug class, and severity (modified Hartwig and Siegel scale). Causality was assessed using Naranjo's algorithm and World Health Organization-Uppsala Monitoring Center (WHO-UMC) assessment criteria. Data were expressed as frequencies and percentages. A total of 255 ADRs were reported. Most ADRs occurred in elderly patients aged 61-80 years (56%). Anticancer drugs were the most common culprits (45.67%), followed by antimicrobials (21.63%). Causality assessments of suspected ADRs were probable (47%), possible (51%), and certain (2%). Most ADRs were mild (78.43%) and nonserious, and patients recovered with drug withdrawal and supportive care (39%), while 47% were recovering when the ADR was reported. Adverse drug reactions (ADRs) were mild and preventable, with anticancer drugs being the leading cause. Elderly patients were most affected. Underreporting remains a challenge despite AMC recognition, underscoring the need for continued sensitization and feedback mechanisms to promote a culture of ADR reporting.

Drug-Related Side Effects and Adverse Reactions


Role of Expanded A-DROP Score in Predicting 14-day Mortality in Patients with Community-acquired Pneumonia: A Prospective Observational Study from a Tertiary Care Center in North India

Abstract: Community-acquired pneumonia (CAP) carries substantial mortality. Common scoring tools such as CURB-65, A-DROP, and PSI have limitations. The expanded A-DROP incorporates clinical and biochemical markers, showing promise and requires validation in Indian settings. This prospective observational study at a North Indian tertiary center (March 2024-June 2025) included 80 adults with CAP. Expanded A-DROP scores were calculated within 24 hours of admission, and patients were followed for ICU admission, in-hospital, and 14-day postdischarge mortality. Analyses used ANOVA, Chi-square, logistic regression, and receiver operating characteristic (ROC) curves (p < 0.05). Of 80 patients, 22 (27.5%) died within 14 days. Mortality was 1/23 (4.3%) in group I (0-2), 2/22 (9.1%) in group II (3-4), and 19/35 (54.3%) in group III (≥5) (p < 0.001). ICU admission rose with severity: 1/23 (4.3%), 8/22 (36.4%), and 25/35 (71.4%) (p < 0.001). Mean (SD) hospital stay increased: 4.0 (0.9), 7.0 (1.1), and 9.0 (1.3) days (p < 0.0001), with positive correlation to score (ρ = 0.53, p < 0.000001). ROC analysis gave an AUC of 0.871 (95% CI: 0.783-0.958). A score ≥5 predicted mortality with 86.2% sensitivity and 72.4% specificity. Multivariate regression identified Expanded A-DROP as the only independent predictor (OR 3.07, p < 0.001). Expanded A-DROP demonstrated strong predictive power for short-term mortality, ICU requirement, and hospital stay in CAP. It is a simple, clinically relevant, and effective tool for early triage, especially in resource-limited settings.

Humans
Community-Acquired Pneumonia
India
Prospective Studies
Tertiary Care Centers
Female
Male
Middle Aged
Severity of Illness Index
Aged
ROC Curve
Hospital Mortality
Adult
Intensive Care Units
Community-Acquired Infections


Hypothyroidism in Nonalcoholic Fatty Liver Disease

Abstract: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease with increasing global prevalence. Thyroid dysfunction, particularly hypothyroidism, has been implicated in its pathogenesis and progression. To evaluate the prevalence and pattern of hypothyroidism in NAFLD patients and assess its association with hepatic steatosis and fibrosis severity using imaging and noninvasive fibrosis scoring systems. This cross-sectional observational study was conducted on 158 adult NAFLD patients at a tertiary care hospital in northern India over 1 year. Patients with significant alcohol intake or other chronic liver diseases were excluded. Hepatic steatosis and fibrosis were assessed by ultrasonography and transient elastography, respectively. Fibrosis severity was categorized using FibroScan and the FIB-4 index. Thyroid function was evaluated by serum TSH, FT3, and FT4. Statistical analysis included intergroup comparisons and correlation assessments using SPSS v26, with p < 0.05 considered significant. Among 158 NAFLD patients, 41.14% were hypothyroid. The prevalence of hypothyroidism increased with disease severity: 71.43% in fibrotic NASH and 44.44% in cirrhosis (FibroScan-based). A dose-response trend was observed between steatosis grade and hypothyroidism, reaching 80% in grade 3 steatosis. FT4 showed a significant positive correlation with liver stiffness (r = 0.432, p < 0.001). Additional associations included positive correlations of liver stiffness with urea and INR, and negative correlations with serum protein, fasting glucose, and LDL. Overall, hypothyroidism emerged as a significant cofactor in NAFLD pathogenesis and fibrosis progression. This study demonstrates a strong association between hypothyroidism and both hepatic steatosis and fibrosis in NAFLD. Routine thyroid function screening is recommended in NAFLD patients, particularly those with metabolic syndrome or suspected fibrosis. Early detection and treatment of hypothyroidism may provide therapeutic benefits in slowing or reversing NAFLD progression.

Chaudhary SC
Singh P
Usman K
Sawlani KK
Gupta KK
Kumar V
Patel ML
Gupta AK
Rungta S
Parihar A

Humans
Non-alcoholic Fatty Liver Disease
Hypothyroidism
Male
Cross-Sectional Studies
Female
Adult
Middle Aged
Prevalence
Severity of Illness Index
India
Liver Cirrhosis
Elasticity Imaging Techniques
Ultrasonography
Disease Progression


Antenatal Prediction Model for Neonatal Intensive Care Unit Admission in Late Preterm Infants

Abstract: To develop and internally validate an antenatal prediction model for neonatal intensive care unit (NICU) admission among late preterm infants using routinely available maternal and obstetric parameters. This retrospective observational cohort study included deliveries between 340/7 and 366/7 weeks of gestation at a tertiary referral center. Maternal, obstetric, and perinatal data were extracted from electronic medical records. The primary outcome was NICU admission. Variable selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO), followed by penalized multivariable logistic regression. Model performance was assessed using Harrell's concordance index (C-index), bootstrap internal validation (1000 resamples), calibration analysis, and decision curve analysis. A nomogram was constructed to estimate individualized NICU admission risk. A total of 2007 late preterm pregnancies were included, and neonatal NICU admission occurred in 656 pregnancies (32.7%). Independent predictors of NICU admission were lower gestational age at delivery, fetal growth restriction, twin pregnancy, cesarean delivery, and antenatal corticosteroid exposure. The model demonstrated good discrimination with an apparent C-index of 0.752 and an optimism-corrected C-index of 0.747. Calibration analysis showed excellent agreement between predicted and observed risks. Decision curve analysis indicated a positive net benefit across a wide range of clinically relevant threshold probabilities. The resulting nomogram enabled individualized antenatal risk estimation. An antenatal model incorporating routinely available clinical variables may help estimate the risk of NICU admission among late preterm infants; however, external validation is necessary to confirm its generalizability.

The journal of obstetrics and gynaecology research

Yergin E
Taşkum İ
Sucu S
Yetişkin FDY
Özkan S
Makansi N
Barutçu C
Sınacı S

Humans
Female
Intensive Care Units, Neonatal
Pregnancy
Retrospective Studies
Infant, Newborn
Infant, Premature
Nomograms
Adult
Patient Admission
Gestational Age
Prediction Algorithms


Age-Related Impairment of Left Atrial Phasic Strain in Childhood Cancer Survivors Treated with Anthracyclines

Abstract: Childhood cancer survivors (CCSs) are at increased risk of cancer therapy-related cardiac dysfunction following anthracycline chemotherapy. Although left atrial (LA) strain assessed by speckle-tracking echocardiography has emerged as a sensitive marker of diastolic dysfunction, it remains unclear when during survivorship LA dysfunction becomes detectable in CCSs treated with anthracyclines.In this retrospective observational case-control study, 92 CCSs (aged 4-32 years) and 96 age-matched healthy controls underwent echocardiography. Participants were stratified into three age groups (4-12, 13-18, and 19-32 years). LA reservoir, conduit, and pump strains were measured using two-dimensional speckle-tracking echocardiography from the apical four-chamber view. Conventional echocardiographic parameters, including mitral inflow velocities (E and A waves), E/A ratio, and tissue Doppler-derived e' and E/e', as well as left ventricular longitudinal strain (LVLS), were assessed.Conventional diastolic parameters did not significantly differ between CCSs and controls within corresponding age groups. However, in young adult CCSs (19-32 years), all three components of LA phasic strain (reservoir, conduit, and pump strains) were significantly reduced compared with age-matched controls. LVLS was also significantly lower in this group, whereas younger CCSs showed no significant differences in LA strain.LA phasic dysfunction was most evident in young adult CCSs despite preserved conventional diastolic indices, suggesting that age-stratified LA strain assessment may help identify survivorship stages at which atrial dysfunction becomes detectable.

Sato H
Takahashi K
Hosono Y
Shigemitsu S
Akatsuka Y
Sato K
Kago H
Akiya A
Akimoto S
Ifuku M
Yazaki K
Wakatsuki H
Yaguchi A
Tomita O
Fujimura J
Saito M
Shimizu T

Humans
Anthracyclines
Retrospective Studies
Adolescent
Adult
Child
Young Adult
Cancer Survivors
Heart Atria
Female
Case-Control Studies
Male
Child, Preschool
Atrial Function, Left
Age Factors
Echocardiography, Doppler
Echocardiography
Neoplasms
Antibiotics, Antineoplastic


Early gait recovery following medial open-wedge high tibial osteotomy: A prospective gait analysis study

Abstract: This study aims to evaluate the effects of medial openwedge high tibial osteotomy (OWHTO) on gait analysis outcomes in patients with medial compartment osteoarthritis and varus alignment of the knee. This prospective, observational study included a total of 22 patients who underwent biplanar medial OWHTO between February 2023 and March 2024 were included. Gait analysis was performed preoperatively and at the sixth postoperative month using the DIERS formetric 4D system. Early postoperative (6 months) gait parameters, angular parameters (tibial slope and correction angle), and joint kinematics were evaluated. Patient-reported outcomes were obtained using the Oxford Knee Score (OKS) to assess pain and physical function before and after the procedure. Of a total of 22 patients included in the study, 4 were male and 18 were female with a mean age of 55.41 ± 5.86 (range, 47 to 63) years. Postoperatively, patients' walking speed (0.83 ± 1.12 m/s), step length (0.58 ± 0.73 m), and cadence (82.72 ± 92.05 steps/min) increased significantly (p < 0.001). The tibial slope angle showed a mean increase of 1.93° (p < 0.001). The mean correction angle was 7.53°. The mean knee flexion increased significantly from 35.05° ± 8.74° preoperatively to 52.96° ± 13.21° postoperatively (p < 0.001). Knee extension improved minimally but significantly from -7.55° ± 1.18° to -6.03° ± 0.05° (p = 0.046). Ankle dorsiflexion increased significantly (p < 0.001), whereas changes in plantar flexion were not statistically significant. The OKS score increased significantly from 18.30 preoperatively to 41.50 at the sixth postoperative month (p < 0.001). Medial OWHTO results in early improvements in walking speed, step length, and cadence, as well as enhanced knee flexion kinematics and patient-reported outcomes. These findings indicate that OWHTO is an effective surgical option contributing to the improvement of gait patterns in the early postoperative period.

Emir MM
Uysal ÖS
Javadov G
Yılmaz S
Hajouj J
Öktem U
Adıgüzel E
Tecimel O
Öçgüder DA

Humans
Osteotomy
Female
Prospective Studies
Male
Middle Aged
Tibia
Osteoarthritis, Knee
Gait Analysis
Recovery of Function
Gait
Biomechanical Phenomena
Treatment Outcome
Knee Joint


Perceptions about protein supplements among adults in Saudi Arabia (knowledge and attitude, use, health beliefs, and safety concerns)

Abstract: Protein supplements have gained popularity among gym users in Saudi Arabia. This study aimed to collect data from adults in Saudi Arabia focusing on six components related to protein supplements: demographic characteristics of participants, health and physical activity information, knowledge and attitudes, use, health beliefs, and safety concerns. This study was a cross-sectional, observational online survey targeting adults in Saudi Arabia. Participants included males and females aged 18 and older. Participants who did not complete the survey, as well as pregnant or breastfeeding women, were excluded. Ethical approval was obtained from the Deanship of Scientific Research at Qassim University. Data were analyzed by gender using SPSS version 25, with descriptive statistics and chi-square tests. A total of 358 participants completed the online questionnaire, while two participants did not complete it between March 29, 2024 and December 31, 2024. Regarding knowledge and attitudes, about 68.2% of participants (including both users and non-users of protein supplements) were aware of protein supplements, with males (81.3%) showing significantly higher awareness than females (63.7%). Additionally, 64.8% of participants (both male and female) were unaware of the risks associated with protein supplements. Of all participants, 56% of males and 39.3% of females did not believe that natural protein sources are enough for muscle building, indicating a significant difference. About 127 participants (35.5%) reported using protein supplements either currently or in the past, with no significant difference between males and females. Of those who reported using protein supplements, 11.8% experienced some side effects and were significantly less knowledgeable about the amount of protein they should consume from food and how much protein is enough for their needs. The majority of protein supplement users (48.8%) did not know if protein powders could contain doping agents, with females reporting significantly higher responses than males. Regarding safety concerns, only 43.3% of protein supplement users looked for protein supplements marked with NSF Certified for Sport® on the package, with no significant difference between males and females. Finally, 78% of protein supplement users expressed a need for more information on how to select the best protein supplements, with the highest need found in females and participants who exercise regularly, who showed significantly higher needs for additional guidance. There remains a significant need for increased education about the proper use of protein supplements to minimize potential side effects and increase understanding of their health risks and safety concerns.

Humans
Male
Saudi Arabia
Female
Health Knowledge, Attitudes, Practice
Dietary Supplements
Adult
Cross-Sectional Studies
Young Adult
Dietary Proteins
Surveys and Questionnaires
Middle Aged
Adolescent


Ultrasound-Guided Pericapsular Nerve Group Block vs Suprainguinal Fascia Iliaca Block for Analgesia in Hip Fracture Surgery: A Prospective Comparative Observational Study

Abstract: BACKGROUND Hip fractures cause severe perioperative pain, increased opioid use, and delayed recovery. The ultrasound-guided pericapsular nerve group (PENG) and suprainguinal fascia iliaca (SIFI) blocks are regional techniques targeting hip innervation. This study aimed to compare the effects of ultrasound-guided PENG and SIFI blocks on perioperative analgesia and clinical outcomes in hip fracture surgery. MATERIAL AND METHODS This prospective observational study included patients undergoing hip fracture surgery under spinal anesthesia. Patients received either an ultrasound-guided PENG block or a suprainguinal fascia iliaca block as part of routine clinical practice. The primary outcome was perioperative pain intensity measured using the numerical rating scale (0-10), including baseline pre-block assessments, pain during spinal positioning, and postoperative pain scores. All other variables, including ease of spinal positioning, hemodynamic parameters, cumulative 24-hour postoperative tramadol consumption, time to first analgesic requirement, range of motion of the affected limb, patient satisfaction, and adverse events, were evaluated as secondary outcomes. RESULTS A total of 67 patients were included (PENG, n=34; SIFI, n=33). The SIFI group had significantly lower pain scores in the neutral position (P=0.004), during limb elevation (P<0.001), and at 2 to 8 hours postoperatively (P<0.001). The 24-hour consumption of tramadol was lower (P=0.011), and active hip flexion at 8 hours was greater (P=0.001) in the SIFI group. Other outcomes were similar. CONCLUSIONS Both the PENG and SIFI blocks provided effective perioperative analgesia. SIFI was associated with lower pain scores at selected intervals and reduced opioid consumption; however, these findings represent time-specific associations rather than definitive superiority.

Medical science monitor : international medical journal of experimental and clinical research

Dedeoğlu A
Acil F
Andıç O
Uzundere O
Gökçek E
Kaçar CK

Humans
Female
Nerve Block
Male
Prospective Studies
Hip Fractures
Postoperative Pain
Analgesia
Aged
Ultrasonography, Interventional
Aged, 80 and over
Pain Measurement
Pain Management
Fascia
Treatment Outcome

Journal Article
Observational Study
Comparative Study


Validity and reliability of the smile perception scale in Turkish children aged 8-10 years

Abstract: Dental aesthetics plays a key role in children's social perception and psychosocial development. However, evidence on smile perception in children remains limited, highlighting the need for valid and reliable assessment tools. This study aimed to perform the cross-cultural adaptation and psychometric validation of the Smile Perception Questionnaire for Children Aged 8-10 Years (SPQ 8-10) for use in Turkish children. This observational methodological validity-reliability study included 300 healthy children aged 8-10 years who attended the Department of Pediatric Dentistry at Bursa Uludag University and met the predefined eligibility criteria. Eligible participants were healthy children aged 8-10 years whose parents provided informed consent; children with previous or ongoing orthodontic treatment, systemic diseases, or mental, physical, hearing, or visual impairments affecting communication or questionnaire completion were excluded. The SPQ (8-10) was translated into Turkish using forward-backward translation and expert review. Standardized perioral smile images were digitally generated to represent different dental conditions, and each participant evaluated one randomly assigned image using a five-point Likert scale. Exploratory factor analysis (principal axis factoring) and confirmatory factor analysis (DWLS estimation) were conducted to assess construct validity. Internal consistency (Cronbach's α, McDonald's ω) and test-retest reliability (ICC) were evaluated. Cronbach's α coefficient for the scale was 0.844, while McDonald's ω coefficient was 0.847. The analysis yielded ICC (3,1) = 0.803, 95% CI [0.628, 0.901], indicating that the scale had good temporal stability. CFI and TLI values above 0.95 and an SRMR value below 0.06 suggest a good fit. RMSEA value was at the threshold (0.084). The final 10-item Turkish version of the SPQ (8-10) demonstrates adequate psychometric properties in terms of factorial structure, internal consistency, and temporal stability.

Özgöçmen Tula E
Ayvallı Karagöz M
Alkış M

Humans
Child
Smiling
Turkey
Reproducibility of Results
Female
Male
Psychometrics
Surveys and Questionnaires
Esthetics, Dental

Journal Article
Validation Study
Observational Study


Autopsy in sudden unexplained death in youth: indispensable or in some cases redundant? An observational study

Abstract: Sudden Unexplained Death in Youth (SUDY) requires thorough investigation to identify underlying causes and guide prevention strategies. In the Netherlands, cases are investigated using the standardized Postmortem Evaluation of Sudden Unexplained Death in Infants and Children (PESUDIC), in which autopsy is offered as a standard component. However, its invasive nature and associated time burden may limit parental acceptance. This study evaluated to what extent the cause of death can be established using a limited set of diagnostic tests compared to the standard procedure including autopsy. In this observational study, children > 2 years of age who died suddenly and unexpectedly and underwent PESUDIC, including imaging and autopsy, were included. Two expert panels, consisting of a forensic and a pediatric specialist, independently assessed early diagnostic tests available before autopsy. Cases were classified by level of diagnostic certainty and need for autopsy. Panel conclusions were compared with the reference standard: a multidisciplinary audit incorporating all available information, including autopsy findings. Sixty-six cases were included (median age 12 years (IQR 4-14.7), 63% male). Panels identified indicative information for a cause of death in 60 patients (91%). Nevertheless, autopsy was required in most cases (n = 59) to confirm the diagnosis. In 7 cases (10.6%), panels were sufficiently confident to establish the cause of death without autopsy with complete agreement with the reference standard. Causes included obstructive gastrointestinal pathology (n = 5) and diabetic ketoacidosis with dehydration (n = 2). Only a small proportion of children > 2 years of age with sudden unexpected death have a cause of death that can be established with sufficient certainty at an early stage. In the vast majority of cases, the cause of death remains uncertain, supporting the recommendation to perform an autopsy. • Autopsy in sudden unexplained death in youth is worldwide recognized as the gold standard for postmortem examination. However, its invasive nature and associated time burden may limit parental acceptance. • In 7 of 60 sudden and unexplained deceased minors (10%), sufficient certainty regarding the cause of death can be obtained by other minimal invasive diagnostic test, so without the need of an autopsy. Causes without the need of an autopsy included obstructive gastrointestinal pathology and diabetic ketoacidosis with dehydration.

van der Gugten AC
Wemeijer TM
Semmekrot BA
Smit RBJ
Oostdam C
Duijst WLJM
de Gier S
van de Putte E
PESUDIC collaborative

Humans
Child
Male
Death, Sudden
Autopsy
Child, Preschool
Adolescent
Cause of Death
Female
Netherlands


Health complaints, social impacts, and perceived care effectiveness reported by children with obesity and their parents: a prospective observational study in the Obesity Center CGG cohort

Abstract: Obesity is a chronic relapsing disease leading to weight-related health risks for disorders such as cardiovascular diseases, type 2 diabetes, osteoarthritis, and depression. Many studies focus on these weight-related health risks. However, research on current self-reported social impacts and health complaints is limited. This study aims to investigate self-reported social impact and health complaints, received care aiming at lifestyle change, and perceived effectiveness of this care, by children with obesity and their parents. Secondarily, differences concerning sex, age, obesity-severity and frequency of received care were studied. Questionnaires were collected from children and adolescents aged 0-18 years visiting Obesity Center CGG. Data were analyzed regarding their social impacts, health complaints, received care, and perceived care effectiveness (0-10 scale). Children were categorized into sex, age, BMI, and care categories. Descriptive statistics were performed using chi-square tests and post hoc analyses to examine differences between categories. 86.8% of the patients self-reported experiencing social impact and 92.3% reported health complaints. Most frequently reported social impacts were difficulty to find fitting clothes (70.1%), problems in mobility and sports (63.7%), and bullying (41.6%); most reported health complaints were abdominal pain (38.8%), headache (34.8%), and musculoskeletal pain (34.1%). The dietician (64.1%) was most frequently reported as received care, and effectiveness scores ranged between 0 and 4 out of 10. A substantial percentage of patients experience social impacts and health complaints affecting their well-being and quality of life. Low perceived effectiveness of interventions calls for a more innovative and comprehensive care framework incorporating these children's needs. • Children with overweight and obesity face a wide range of adverse health consequences and social challenges. • However, the number and types of health issues experienced by children themselves and studying per range of age, BMI-stage or care trajectory have not been systematically investigated. • A high percentage of children experience social impacts (87%) and health complaints (70%) aff ecting their well-being and quality of life, and perceived eff ectiveness of lifestyle interventions is low. The main reported healthcomplaints abdominal pain, headache, musculoskeletal pain and snoring loudly were mostly observed in girls withobesity aged 12-18 years, who received three or more care types. • The study demonstrated that perceived treatment effectiveness by children and parents declined with increasingobesity severity.

van der Velden MMAM
van der Walle EEPL
Bindels PPJE
van Middelkoop M
van den Akker EELT

Humans
Female
Child
Male
Prospective Studies
Adolescent
Parents
Pediatric Obesity
Child, Preschool
Quality of Life
Infant
Surveys and Questionnaires
Self Report


Five years-real-world experience with FilmArray Pneumonia Plus Panel in the diagnosis of pneumonia in an intensive care unit in a tertiary hospital: Lights and shadows in pandemic and postpandemic COVID periods

Abstract: The main objective of the study is to evaluate the performance of the FilmArray® Pneumonia Plus (FA-PP) panel in critically ill patients with suspected pneumonia compared to conventional culture, in both pandemic and pospandemic periods, and its impact on therapeutic decision-making. Observational study including 225 patients (314 samples) during COVID-19 pandemic and post-pandemic periods. FA-PP and culture results were compared assessing sensitivity (Se), specificity, predictive values, level of concordance between them and the impact on antibiotic prescription. FA-PP detected 133% more bacterial targets than culture and 48% more positive samples. Excluding off-panel bacteria, the panel showed high sensitivity of up to 100% in patients with pneumonia and a negative predictive value (NPV) of over 98%. In the post-pandemic period, the overall Se (78.6%) and Se in patients with pneumonia (81%), as well as the overall NPV and in pneumonia (94%), were higher than in the pandemic period, with significant differences (p<0.05). Twenty-six per cent of pneumonia episodes involved bacteria not included in the panel. The positive concordance between the two tests was 72%. In 56% of cases with pneumonia, antibiotic was modified after the results. During the pandemic period, the panel served to modify treatment towards initiation or escalation. The FA-PP is a valuable tool for optimizing the diagnosis and management of pneumonia in the ICU, with a clinical impact on the appropriateness of antibiotic treatment. There were differences in the impact of the panel between the pandemic and post-pandemic periods.

Enfermedades infecciosas y microbiologia clinica (English ed.)

García-Lechuz JM
Arias A
Alonso P
Badenas-Alzugaray D
Viñeta V
Claraco L
Gurpegui M
Carrillo A
Viñuelas J

Humans
Intensive Care Units
COVID-19
Tertiary Care Centers
Female
Middle Aged
Male
Aged
Sensitivity and Specificity
Time Factors
Pandemics
Anti-Bacterial Agents
Predictive Value of Tests
SARS-CoV-2
Pneumonia
Pneumonia, Bacterial


Psychomotor Alertness and Subjective Fatigue in Helicopter Pilots

Abstract: Fatigue poses a significant safety risk in helicopter operations; however, subjective assessments of fatigue based on an individual's perception, awareness, and insight, such as self-perceived tiredness, may not accurately reflect objective performance impairment as identified by standardized tests or measurement tools. In this context, the present study investigated the relationship between subjective drowsiness and objective alertness performance among helicopter pilots during operational tasks using a computerized psychomotor vigilance task (PVT). This observational field study initially included 20 helicopter pilots. Complete pre- and postflight measurements were available for 15 pilots and were included in the final analysis. Subjective sleepiness was assessed before testing using the Karolinska Sleepiness Scale. Objective alertness was measured pre- and postflight using a PVT; mean reaction time (ms) was used as the primary outcome variable. The mean subjective sleepiness score was 3.98 ± 1.27 (range: 2.0-6.9). Mean PVT reaction time increased from 461.2 ± 118.1 ms preflight to 516.3 ± 100.8 ms postflight (an 11.9% increase), reaching statistical significance with a medium-to-large effect size (Cohen's dz = 0.65). Considerable interindividual variability was observed. Correlation analysis revealed a weak association between subjective sleepiness and postflight PVT reaction time (r = 0.16, P = 0.573), with prolonged reaction times observed in some pilots reporting low subjective sleepiness. Combining objective alertness measures with subjective scales may improve fatigue risk management. Gevrek I, Eroglu C. Psychomotor alertness and subjective fatigue in helicopter pilots. Aerosp Med Hum Perform. 2026; 97(8):633-637.

Aerospace medicine and human performance

Humans
Fatigue
Psychomotor Performance
Adult
Reaction Time
Male
Pilots
Aircraft
Sleepiness
Middle Aged
Aerospace Medicine
Attention
Wakefulness
Female


[Rabies post-exposure prophylaxis in travelers returning from endemic areas: A retrospective analysis of patients treated at Motol and Homolka University Hospital]

Abstract: To characterize the demographic and exposure characteristics and management of rabies post-exposure prophylaxis (rPEP) among international travelers, and to identify deficiencies in pre-travel prevention, initial wound management, and subsequent post-exposure care. A retrospective observational study was conducted at the Department of Infectious Diseases and Travel Medicine, Motol and Homolka University Hospital. The study included patients evaluated between December 2022 and December 2024 following animal-related exposures. Demographic data, exposure characteristics, wound management, and details of rPEP, including rabies vaccination and rabies immunoglobulin (RIG) administration, were anayzed. Exposures were classified according to the World Health Organization (WHO) categories. Data were analyzed using descriptive statistical methods. A total of 134 patients were included, with a median age of 31 years. Exposures predominantly occurred in Southeast Asia (35.1%) and Western Asia (25.4%), particularly in Türkiye, Thailand, and Indonesia. Dogs were the most frequently implicated animals (46.3%), followed by cats (23.9%) and monkeys (20.9%). Bites accounted for 66.4% of exposures, while 65.7% of cases were classified as WHO category III exposures. Initial wound management was frequently suboptimal; only 54.9% of patients reported immediate wound washing, and 76.1% applied a disinfectant. Preexposure rabies vaccination had been received by only 6.7% of travelers. rPEP was initiated abroad in 62.7% of cases. However, among patients indicated for RIG administration, 77.8% did not receive it. Deviations from recommended rabies vaccination schedules were documented in 38.2% of patients. Wound infections developed in 4.5% of cases. This study highlights significant gaps in rabies prevention and post-exposure management among international travelers. Low uptake of pre-exposure vaccination, frequent deviations from recommended rPEP protocols, and limited access to RIG in rabies-endemic settings represent major barriers to optimal prevention. These findings underscore the importance of comprehensive pre-travel counseling and broader implementation of pre-exposure rabies vaccination among travelers at increased risk of animal exposure.

Klinicka mikrobiologie a infekcni lekarstvi

Trojánek M
Šindlerová R
Jegorova V
Tulach M
Martišík S
Štefan M
Grebenyuk V
Stejskal F

Humans
Rabies
Retrospective Studies
Post-Exposure Prophylaxis
Female
Adult
Male
Animals
Rabies Vaccines
Travel
Middle Aged
Adolescent
Young Adult
Cats
Child
Hospitals, University
Dogs
Bites and Stings

Journal Article
Observational Study
English Abstract


Determination of Optic Nerve Sheath Diameter Cut-off after CSF Drainage in Adults with Elevated ICP: A Prospective Study

Abstract: AIM: To evaluate the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with acute ICP elevation controlled through external ventricular drainage (EVD). MATERIAL and METHODS: In this prospective observational study, simultaneous measurements of right and left ONSD, ICP, and cerebral perfusion pressure (CPP) were recorded in 46 adult patients undergoing EVD. Two patients were excluded due to ophthalmic pathology and missing data, resulting in a final cohort of N = 44 patients. After we obtained the baseline measurements, 5 mL of cerebrospinal fluid (CSF) were drained, and the measurements were repeated 2 minutes (min) later. RESULTS: CSF drainage led to significant reductions in both ICP and bilateral ONSD (p = .001 for all), while CPP significantly increased (p = .038). We identified an ONSD cut-off of 5.35 mm for detecting ICP values ≥15 mmHg, and this cut-off had 53% sensitivity and 86% specificity (Youden index: 0.395). However, we could not determine a reliable cut-off for detecting ICP values ≥20 mmHg (p = .076). CONCLUSION: When ICP is controlled through EVD, the linear relationship between ONSD and ICP observed during acute pressure elevations may be disrupted, particularly at higher ICP values (≥20 mmHg). Although we identified a cut-off ONSD value of 5.35 mm for detecting ICP values ≥15 mmHg, the low sensitivity of this cut-off significantly limits its clinical utility. Additionally, since no reliable cut-off could be established for ICP values ≥20 mmHg, ONSD may have limited value for monitoring pressure following CSF drainage.

Ozkaya G
Korkmaz Dilmen O
Akcil EF
Tunali Y

Humans
Optic Nerve
Female
Prospective Studies
Adult
Male
Middle Aged
Intracranial Pressure
Intracranial Hypertension
Drainage
Aged


Intrinsic Foot Muscle Cross-Sectional Area on MRI in People With and Without Plantar Heel Pain: A Cross-Sectional Observational Study

Abstract: This study compared the cross-sectional areas (CSA) of key intrinsic foot muscles in people with and without plantar heel pain (PHP). Seventy-five adults participated in the study: 50 participants with PHP and 25 age-, sex-, and body mass index (BMI)-matched participants without PHP (control group). Cross-sectional images were generated using 3.0T magnetic resonance imaging (MRI). CSAs of four intrinsic foot muscles-abductor hallucis, quadratus plantae, flexor digitorum brevis and abductor digiti minimi-were measured. The difference in CSA of each muscle was compared between the groups using independent samples t-tests and Cohen's d effect sizes were calculated. Participants were well matched: mean age 49.1 and 48.9 years, women accounted for 58% and 56%, and BMI 30.6 kg/m2 and 30.2 kg/m2 in the PHP and control groups, respectively. There were no significant differences in mean CSAs for all four muscles (p > 0.05) between the PHP and control groups, and effect sizes were tiny or very small. This study found no differences in muscle CSAs of key intrinsic muscles of the foot in people with and without PHP, indicating that people with PHP do not have key intrinsic foot muscle size deficits. As such, intrinsic muscle size does not appear to be a logical therapeutic target for PHP. Clinicians translating our findings into practice should, therefore, consider whether strengthening interventions targeting intrinsic muscles in PHP are warranted.

Osborne JWA
Azevedo AM
Menz HB
Whittaker GA
Cotchett M
Entwisle T
Connell DA
Munteanu SE
Landorf KB

Humans
Female
Middle Aged
Cross-Sectional Studies
Magnetic Resonance Imaging
Male
Muscle, Skeletal
Adult
Heel
Foot
Case-Control Studies
Fasciitis, Plantar


Mainstream and fast-track genetic testing in pancreatic cancer patients and its impact on treatment: our experience in a tertiary hospital in Spain

Abstract: Pancreatic cancer (PC) is a highly lethal malignancy. 4-10% are linked to inherited mutations in genes such as BRCA1/2, PALB2, ATM and mismatch repair (MMR) genes. Germline testing is essential to guide treatment decisions, yet delays remain common. Genetic testing models without pre-test assessment in a Hereditary Cancer Unit (HCU), have emerged as a strategy to improve earlier clinical decision-making. A retrospective, observational and descriptive study was conducted on 223 PC patients (55% male; average age 64 years) who underwent rapid germline genetic testing at Hospital General Universitario Gregorio Marañón (Madrid, Spain) between April 2019 and May 2024. Tests were ordered by oncologists with brief pre-test counseling, followed by a nurse-facilitated consent and peripheral blood collection. Post-test counseling in an HCU was offered for patients with variants of unknown significance (VUS) and pathogenic/likely pathogenic variants (PV), or upon physician or patient request. PV and VUS were identified in 32 (14.3%) and 82 (36.7%) patients, respectively. 50% of PV carriers did not meet familial PC criteria. Actionable mutations were detected in 14 (43.7%) of PV carriers, involving BRCA2 (6/32), PALB2 (1/32) and ATM (7/32). Treatment modifications occurred in 7/223 patients (3%), including PARP inhibitors or platinum-based regimens. Median time from the genetic test request to the results was 48 days (95% CI, 44-52). Mainstream genetic testing in PC is a viable approach to expedite results and facilitate precision oncology. Further studies are needed to evaluate long-term outcomes, cost-effectiveness and the psychosocial impact compared to traditional genetic counseling pathways.

Bringas M
Echavarría I
Polo C
Jiménez-Alduán N
Flores C
Muñoz A
Ortega L
Torres G
Soto-Alsar J
Calvo A
Alfonso PG
Pajares JA
Suárez-González J
Del Monte-Millán M
Massarrah T
de la Peña FA
Martín M
Márquez-Rodas I

Fanconi Anemia Complementation Group N Protein


RELEASE: demographic and criminological differences in post-imprisonment mental health and substance use-related service use

Abstract: To (1) describe the demographic, health∗ and criminological characteristics of people released from prison; (2) examine their associations with post-imprisonment service use. Retrospective observational cohort study of all individuals released from Scottish prisons in 2015 (n = 8,313). Scottish Prison Service data were linked with records covering community prescriptions, death registrations, admissions to general and psychiatric hospitals, outpatient contacts, and unscheduled care. Four years of service use before and following the release (index) date were extracted. Incidence rates for service contacts with a diagnosis or code related to mental health (MH) or substance use (SU) across all nine services were computed, adjusted for time-in-community. Negative binomial models were fitted to estimate the rates of service contact per time-in-community for each service. The cohort was 92% male, 97% white, 96% heterosexual, and 45% from large urban areas. Mean index age was 34.8 (SD=10.8) years, and pre-index mean days in prison were 524 (SD=433). Prior service contact was a strong predictor of service contact in the follow-up period, especially for inpatient and emergency contacts. Time in prison, and the number of prison episodes , were associated with higher rate of service contacts, as was female sex and disclosed disability. Age and release type had varied effects across services. It is vital for policymakers and practitioners in health and criminal justice to review how they accommodate varied population needs, and to minimise the iatrogenic harms of imprisonment. Linkage of prison and health records enables unique insights into this vulnerable and overlooked population.

International journal of population data science

Savinc J
Kjellgren R
Connell C
Dougall N
Kurdi A
Leyland A
Watson J
Hunt K

Humans
Female
Male
Scotland
Retrospective Studies
Substance-Related Disorders
Mental Disorders
Prisoners
Adult
Mental Health Services
Middle Aged


Fuel Poverty Interventions and Healthcare Usage: Insights from Warm Wales

Abstract: Warm Wales (WW) is a community-based programme addressing fuel poverty and its broader impact on health and well-being. Interventions combine tailored energy advice, practical support, and education with wellbeing and social prescribing projects to improve health outcomes. Fuel poverty is closely linked to poorer health, making evaluating such programmes using housing and health linked data crucial. To describe the demographic, socioeconomic, health, and housing characteristics of individuals supported by WW and examine the programme's impact on primary care interactions. Methodology: An observational longitudinal cohort study linking WW service data with routinely collected electronic health record and administrative data in the Secure Anonymised Information Linkage (SAIL) Databank. Descriptive statistics summarised the WW supported population. Difference in Differences (DiD) compared primary care interactions rates between cases and Coarsened Exact Matched controls. WW supported 4,083 individuals living across 1,317 properties (January 2021-December 2023). Most WW-supported properties were older (65% built before 1966 vs 60.7% in Welsh housing stock) and socially rented (62.3% vs 19.2% in Welsh housing stock 2021). The cohort mirrored Welsh population sex and ethnicity distributions but was notably younger (aged 18 and under 40.1% vs 25.8%), in the most deprived quintile (40.9% vs 24.0%), and predominantly urban (81.5% vs 73.1%). Health characteristics and DiD results are pending approvals. Warm Wales supports younger individuals living in most deprived areas and older housing. These characteristics are consistent with groups at risk of fuel poverty. DiD analyses are ongoing and will assess the intervention's impact on healthcare utilisation.

Alshams M
Bentley L
Peh J
Greene G
Davies A
Akbari A
Newman C
Davies O
Taylor-Collins E
Dundon J

Humans
Wales
Longitudinal Studies
Poverty
Female
Male
Middle Aged
Housing
Primary Health Care
Socioeconomic Factors
Social Prescribing


Students' knowledge, perceived access, and attitudes toward population health integration in undergraduate nursing education

Abstract: To address the growing population health challenges, the nursing workforce is expected to possess competencies of population health, which has been officially included as a new essential component in nursing and strongly advocated by nurse educators worldwide. However, no previous studies have explored the relevant opinions among nursing students, who act as recipients, beneficiaries, and key stakeholders in nursing education. This study aimed to explore students' population health knowledge, perceived access to relevant training, and attitudes toward integrating population health content within undergraduate nursing curricula. A cross-sectional observational survey was conducted using a self-developed questionnaire among nursing students from a Chinese university in January 2026. Data collected included demographic information, population health knowledge levels measured via both self-assessment and objective evaluation, perceived accessibility of undergraduate training related to population health competencies, attitudes toward integrating population health into undergraduate nursing education, and preferred integration models. A total of 163 nursing students who provided valid responses were included in the final analysis. The mean self-assessed and objective scores of population health knowledge (rated on a 5-point scale) were 2.98 ± 0.10 and 0.71 ± 0.06, respectively. Less than 20% of participants reported having frequent or very frequent access to educational opportunities targeting core population health competencies. Nearly half of the students agreed or strongly agreed with the importance of population health and its inclusion in nursing education, particularly at the undergraduate level, and 73.0% expressed their willingness to systematically learn about population health. Furthermore, 44.2% students believed that population health should be longitudinally integrated into the current undergraduate nursing education framework, while 21.5% preferred the "lecture-based elective course" as pedagogical model. Findings indicate insufficient preparedness in population health competencies among future nursing professionals. Integration of population health into undergraduate nursing education is necessary and generally acceptable to students.

Humans
Cross-Sectional Studies
Female
Male
Students, Nursing
Health Knowledge, Attitudes, Practice
Education, Nursing, Baccalaureate
Surveys and Questionnaires
China
Population Health
Adult
Young Adult
Curriculum
Attitude of Health Personnel


Diagnostic value of metagenomic next-generation sequencing in deep neck space infections: a retrospective study of 32 patients

Abstract: Deep neck space infections (DNSI) are rapidly progressive suppurative conditions in which early identification of causative pathogens is critical for clinical decision-making. This study evaluated the diagnostic performance and clinical utility of metagenomic next-generation sequencing (mNGS) in patients with DNSI. In this retrospective observational study, 32 patients with radiologically confirmed DNSI who underwent surgical drainage between October 2023 and August 2025 were included. Intraoperative purulent specimens were analyzed using both conventional bacterial culture and mNGS. A composite clinical reference standard integrating clinical presentation, imaging findings, surgical observations, inflammatory markers, and expert assessment was used to evaluate the clinical relevance of detected microorganisms. mNGS detected microbial DNA in 84.4% of patients and demonstrated a broader pathogen detection spectrum and shorter reporting time than conventional culture, particularly for anaerobic and fastidious organisms. Frequently detected organisms included Prevotella spp. and Streptococcus constellatus. Interpretation of these findings required careful consideration of anatomical involvement, organism abundance, and prior antimicrobial exposure to distinguish clinically relevant pathogens from colonizing organisms or residual nonviable DNA. Discordant findings between culture and mNGS, including culture-positive/mNGS-negative and dual-negative cases, were observed and likely reflected differences in sampling adequacy, organism viability, sequencing depth, and methodological limitations. Antimicrobial therapy was adjusted in selected patients following mNGS reporting. mNGS may serve as a valuable adjunct to conventional microbiological diagnostics by expanding pathogen detection in selected DNSI cases, particularly when fastidious or anaerobic organisms are involved. However, its results should be interpreted cautiously in the context of clinical and microbiological findings. Prospective controlled studies are needed to further define the clinical role of mNGS in the management of DNSI.

Frontiers in cellular and infection microbiology

Humans
High-Throughput Nucleotide Sequencing
Retrospective Studies
Metagenomics
Neck
Female
Male
Bacteria
Middle Aged
Aged
Bacterial Infections
Adult
Aged, 80 and over
DNA, Bacterial


Changes in Pain-Related Fear Predict Shoulder Disability in Rotator Cuff Tendinopathy With Resistance Exercise

Abstract: OBJECTIVE: To determine the trajectory of (1) change in pain-related fear and catastrophizing factors, (2) changes in pain-related fear and catastrophizing by treatment satisfaction groups, and (3) the relationship between pain-related fear trajectories, and catastrophizing factors and shoulder disability during an 8-week resistance exercise program. DESIGN: Prospective longitudinal observational study. METHODS: Sixty-four people with rotator cuff tendinopathy completed the exercise protocol. Outcomes of Penn Shoulder Score (Penn) shoulder disability and pain-related fear and catastrophizing via the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) were assessed at baseline and at 2, 4, and 8 weeks. Patient Acceptable Symptom State (PASS) defined satisfaction with treatment at 8 weeks. RESULTS: All pain-related fear and catastrophizing measures changed over time during resistance exercise (P < .01) but differed by PASS-defined responder and nonresponder groups. For the Fear-Avoidance Beliefs Questionnaire-Work subscale (FABQ-W), nonresponders had an increase (0.63 pt) while responders had a decrease (-3.5 pt) (mean difference, 4.2 pt; 95% confidence interval [CI]: -7.6, -0.7; P = .02). For TSK-11, nonresponders had less of a decrease (-0.1) than responders (-3.2 pt) (mean difference, 3.1 pt; 95% CI: -5.9, -0.3; P = .03). Reduced shoulder disability was related to less pain-related fear and catastrophizing (P < .01), and differed by responder group. Nonresponders had no relationship between change in pain-related fear and catastrophizing and disability (P>.05); responders had an overall negative relationship (P < .04). CONCLUSION: Pain-related fear and catastrophizing changed over time for individuals with rotator cuff tendinopathy, and changes varied by participant. Those who were not satisfied at 8 weeks had higher levels of pain-related fear and catastrophizing, while those who were satisfied had reduced pain-related fear and catastrophizing. Less pain-related fear and catastrophizing was related to decreased disability. J Orthop Sports Phys Ther 2026;56(8):546-554. Epub 9 Jun 2026. doi:10.2519/jospt.2026.13563.

The Journal of orthopaedic and sports physical therapy

Mears CK
Heindel MD
Abeles RE
Vila-Dieguez O
Beneciuk JM
Michener LA

Humans
Female
Male
Prospective Studies
Middle Aged
Catastrophization
Fear
Longitudinal Studies
Resistance Training
Tendinopathy
Disability Evaluation
Shoulder Pain
Pain Measurement
Adult
Patient Satisfaction
Kinesiophobia
Aged
Rotator Cuff Injuries


Amino Acid Deficiency Secondary to Continuous Venovenous Hemofiltration in Acute Decompensation of Organic Acidemias: An Anabolic Dead End?

Abstract: To evaluate the impact of continuous renal replacement therapy (CRRT) on plasma amino acid (AA) concentrations in patients with acute metabolic decompensation of organic acidemias (OAs), and to explore whether AA supplementation during CRRT may mitigate AA depletion. Multicenter retrospective observational study. PICUs managing acute metabolic decompensations of OAs. Patients with confirmed OAs who underwent CRRT for severe acute metabolic decompensation. CRRT was initiated according to current guidelines in cases of severe decompensation. Standard metabolic management included high caloric intake through carbohydrates and lipids with temporary protein withdrawal (24-48 hr). In one patient, AA supplementation (2 g/kg) during CRRT combined with thiamin and citrate (anaplerotic therapy) was administered. Plasma AA concentrations were measured before and after CRRT in nine patients with a median age of 21 days (interquartile range [IQR], 3-570 d). Quantitative variables are expressed as medians (IQR, 25th-75th). Before CRRT, 31% (95% CI, 24-39) of plasma AAs were below the normal range compared with 69% (95% CI, 59-77) after CRRT (p < 0.0001). A significant increase in lactatemia was observed following CRRT, without evidence of organ failure: median 2.2 mmol/L (IQR, 1.3-2.3) before CRRT vs. 5.3 mmol/L (IQR, 3.2-7.1) after CRRT; Hodges-Lehmann median difference +3.2 (95% CI, 0.8-5.6; p = 0.0065). In the patient receiving AA supplementation with anaplerotic therapy, plasma AA status improved markedly, with 65% of AAs below normal before CRRT vs. 15% after CRRT. In acute decompensated OAs, CRRT performed without protein supplementation, as currently recommended, significantly reduces total plasma AA concentrations and may impair restoration of anabolism. AA infusion during CRRT could help preserve or restore protein anabolism. Prospective studies are needed to assess the safety and efficacy of AA supplementation during CRRT, with or without anaplerotic therapy, in this setting.

Grosyeux C
Cammiciotto N
Jeannesson E
Feigerlova E
Villada V
Wicker C
Levy M
Schiff M
Imbard A
Coelho D
Feillet F
Wiedemann A

Humans
Amino Acids
Continuous Renal Replacement Therapy
Retrospective Studies
Male
Female
Middle Aged


Therapeutic Plasma Exchange in Pediatric Transplant and Organ Failure: Analysis of Indications, Adverse Events, and Clinical Outcomes

Abstract: Therapeutic plasma exchange has become an increasingly important extracorporeal therapy in pediatric intensive care and transplant settings. However, evaluations in large real-world pediatric cohorts of its effectiveness and safety across multiple indications remain limited. In this 5 -year single -center study, we provided our experience with therapeutic plasma exchange in critically ill children and assessed clinical outcomes, indications, and procedure -related complications. This retrospective observational study included 88 pediatric patients who underwent 702 therapeutic plasma exchange sessions in the pediatric transplant and nephrology intensive care unit of Başkent University Hospital (Ankara, Turkey) between December 2018 and December 2023. Indications were classified according to new American Society for Apheresis categories. We analyzed demographic data, indications, replacement fluids, treatment response, and adverse events. Median age of the 88 pediatric patients who underwent 702 therapeutic plasma exchange sessions was 7.5 years (range, 0 -18 y ), and 52.3 % of patients were male. Fresh frozen plasma was used in 89.8 % of sessions and albumin in 23.9 %. The most frequent indications for therapeutic plasma exchange were posttransplant hepatic dysfunction (36.4 % ) and acute or chronic liver failure (28.4 % ), followed by antibody -mediated renal disease (13.6 % ) and multiorgan failure or sepsis (8 % ). Overall, 73 of 88 patients achieved complete or partial improvement, corresponding to a favorable response rate of 82.9 %. Renal transplant-related indications demonstrated higher response rates compared with liver -related conditions (91 % vs 78.9 % ). No life-threatening or procedure -terminating complications occurred; minor adverse events included hypotension, fever, allergic reactions, and thrombosis. Therapeutic plasma exchange is a safe and effective supportive therapy for critically ill pediatric patients across a wide range of indications. When performed in experienced centers with close monitoring, complication rates are low. Multicenter prospective studies are needed to establish standardized protocols and further clarify disease-specific outcomes.

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation

Baskın E
Dönger U
Siddiqui MA
Özçay F
Sahin Eroglu E
Şafak A
Karakaya E
Haberal M

Humans
Plasma Exchange
Child
Female
Child, Preschool
Male
Retrospective Studies
Treatment Outcome
Infant
Adolescent
Risk Factors
Infant, Newborn
Time Factors
Organ Transplantation
Age Factors
Turkey
Critical Illness
Risk Assessment


A multicenter prospective observational multi-omics study protocol to identify biomarkers for severe dengue: COMBAT study clinical protocol

Abstract: Dengue virus (DENV) infection poses a major global public health burden, particularly in endemic regions where repeated exposure increases the risk of severe disease. Despite revisions to the World Health Organization (WHO) dengue classification, early prediction of progression to severe dengue remains challenging due to overlapping clinical and laboratory features. Current management strategies rely primarily on supportive care and reactive monitoring, underscoring the need for predictive biomarkers that enable early risk stratification and timely intervention. COMBAT is a prospective, multicenter, observational longitudinal study conducted in dengue-endemic regions of Guatemala and India. Patients will be classified according to WHO 2009 criteria into dengue without warning signs, dengue with warning signs, and severe dengue, alongside age- and sex-matched healthy controls. A single blood sample will be collected from non-hospitalized patients while two blood samples per participant will be collected during hospitalization and one at discharge. Multi-omics analyses, including transcriptomics, proteomics, glycomics and metabolomics, will be performed in a discovery cohort and validated in an independent cohort. Integrated systems biology approaches will be used to identify host immune and metabolic pathways associated with dengue severity in a mechanism-based prognostic biomarker discovery. This study aims to generate comprehensive systems-level insights into host-virus interactions driving dengue severity and to identify biomarkers predictive of disease progression. The findings may inform improved patient triage, early intervention strategies, and the identification of novel therapeutic targets. ClinicalTrials.gov ID NCT06751836 Registration Date: December 13, 2024, CTRI/2022/10/046293 (MAHE) Registration Date: October 10, 2022.

Mudgal PP
Veliz SPZ
Lourda M
Kadni TS
Varma M
Mazumder A
Budhiraja S
Jaggi N
Mukhopadhyay C
Sengupta S
Maitra A
Hug K
Sinha I
Ambikan AT
Filipovic I
Neogi U
COMBAT consortium

Humans
Biomarkers
Multiomics
Prospective Studies
India
Severe Dengue
Guatemala
Longitudinal Studies
Metabolomics
Proteomics
Dengue Virus
Female


Integrating validated scores with clinical parameters to predict NIV weaning outcomes: a prospective study in the respiratory ICU

Abstract: Early prediction of successful weaning from non-invasive ventilation (NIV) remains challenging in patients with acute respiratory failure. This study evaluated clinical, laboratory, and severity-score predictors of NIV weaning outcomes among patients admitted to the Respiratory Intensive Care Unit (RICU). This prospective observational cross-sectional study included 150 adult patients with acute respiratory failure, admitted to the RICU and required NIV for > 24 h between April 2024 and March 2025. Clinical characteristics, arterial blood gases, laboratory findings, ventilator settings, and APACHE II score were recorded. HACOR score was assessed after one hour of NIV discontinuation. Patients were classified into successful or failed weaning groups. Successful weaning occurred in 99 patients, while 51 experienced weaning failure. Failure was significantly associated with older age (p = 0.001), decompensated cor pulmonale (p = 0.003), lower hemoglobin and serum albumin levels (p = 0.008 and p = 0.005, respectively), higher APACHE II score (18.3 ± 3, p < 0.001), and higher HACOR score (8.1 ± 2.1, p < 0.001). Previous invasive mechanical ventilation ≥ 2 times was also significantly associated with failure (p = 0.001). Multivariate analysis identified age, serum albumin, APACHE II score, HACOR score, and previous invasive ventilation as independent predictors of weaning outcome. Receiver operating characteristic analysis showed good predictive performance for HACOR (AUC 81.6%) and APACHE II (AUC 76.2%) scores (p < 0.001 for both). Older age, poor nutritional status, previous invasive ventilation, high APACHE II score, and HACOR score independently predict NIV weaning failure. The incorporating of HACOR score into NIV weaning protocols may improve clinical decision-making and potentially reduce adverse outcomes associated with delayed recognition of respiratory deterioration.

Gadallah D
Esmaeel HM
Mahmoud HA
Khalaf AR

Humans
Ventilator Weaning
Prospective Studies
Female
Intensive Care Units
Male
Respiratory Insufficiency
Noninvasive Ventilation
Middle Aged
Aged
APACHE
Cross-Sectional Studies
Respiratory Care Units


High levels of parenting stress and trauma despite age-appropriate developmental outcomes following perinatal asphyxia: a cross-sectional observational study

Abstract: To examine the association of perinatal asphyxia across mild to moderate hypoxic-ischaemic encephalopathy (HIE) severity levels and therapeutic hypothermia (TH) with child developmental outcomes and parenting stress and to explore parental trauma and psychosocial support. Multicentre, cross-sectional, comparative observational study. Two university medical centres in Germany. Parents of children aged 1-5.5 years with a history of perinatal asphyxia treated with TH (n=58) or without TH (n=77), and unexposed control children (n=179). Parents completed the Ages & Stages Questionnaire, Third Edition, and the Parenting Stress Index (PSI) for the primary outcome, and reported on birth-related trauma, psychosocial support and family planning decisions as exploratory secondary outcomes. Most children showed age-appropriate developmental outcomes across all groups. In contrast, parents in both asphyxia groups reported elevated stress levels, with higher PSI scores in the TH group, particularly in the health, competence and attachment domains. Postnatal trauma was highly prevalent, affecting 88% of parents in the TH group, 73% in the non-TH group and 15% in controls. Psychosocial support was perceived as sufficient by only 20% of parents in the non-TH group, compared with 39% in the TH group. Birth-related trauma was a significant predictor of parental stress. Despite mostly age-appropriate development on screening, parental stress and trauma were highly prevalent regardless of HIE severity, and psychosocial support was markedly insufficient, particularly for families whose infants did not receive TH. These findings highlight the need for structured, accessible psychosocial support for all patient-families affected by perinatal asphyxia.

Sutterer-Verrelli A
Georg AK
Riecker A
Weiss VB
Puchwein-Schwepcke AF
Nussbaum C

Humans
Cross-Sectional Studies
Female
Asphyxia Neonatorum
Male
Infant
Stress, Psychological
Parents
Infant, Newborn
Parenting
Child, Preschool
Hypoxia-Ischemia, Brain
Germany
Hypothermia, Induced
Child Development
Social Support
Surveys and Questionnaires

Journal Article
Observational Study
Multicenter Study
Comparative Study