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Effectiveness and quality of infant and neonatal cardiopulmonary resuscitation: a meta-analysis comparing the over-the-head and lateral positions
No full textINTRODUCTION: Effective chest compression techniques are critical in neonatal resuscitation, where hypoxiaand asphyxia are the leading causes of cardiac arrest. While current guidelines recommend the lateral (LAT) andtwo-thumb encircling techniques (TTT), practical challenges in real-world settings necessitate alternativeapproaches. The over-the-head (OTH) technique has emerged as a potential solution, offering advantagessuch as reduced rescuer fatigue and improved workflow efficiency, particularly in constrained environments.MATERIAL AND METHODS: A systematic PubMed, Embase, Web of Science, EBSCO, and the Cochrane Libraryliterature search was conducted to extract articles comparing LAT and OTH chest compression techniquesunder simulated infant cardiac arrest. The meta-analysis was conducted using random effects modelswhen appropriate.RESULTS: The mean chest compression depth was comparable between the groups (39.4 ± 8.7 mm vs 41.8 ±± 9.6 mm; SMD: 0.26; 95% CI: –0.32 to 0.84; p = 0.37), as was the compression rate (107.05 ± 16.49 vs106.14 ± 16.78 compressions per minute; SMD: 0.07; 95% CI: –0.14 to 0.28; p = 0.53). Airway managementefficacy did not differ significantly, with correct airway release rates of 86.8% ± 21.2% for OHT and87.9% ± 19.1% for LAT (SMD: 0.50; 95% CI: –1.06 to 2.05; p = 0.53). The time required for proper hand positioningshowed no significant variation (7.4 ± 1.2 s vs 7.6 ± 1.5 s; SMD: –0.16; 95% CI: –0.45 to 0.13; p = 0.28).CONCLUSIONS: The present findings demonstrate that the OTH technique is a viable alternative to the LATmethod in infant and neonatal resuscitation. Both techniques exhibited comparable effectiveness acrosskey performance metrics; however, the OTH method was associated with reduced rescuer fatigue. Theseresults underscore the potential advantages of the OTH technique in clinical practice, suggesting its broaderimplementation may enhance resuscitation outcomes and provider efficiency
Acute kidney injury in patients with spontaneous intracerebral hemorrhage — Is it a real problem?
No full textIntroduction. Acute kidney injury (AKI) is common in critically ill intensive care unit patients, including those with intracerebral hemorrhage (ICH). Spontaneous ICH (sICH) accounts for 10–15% of all strokes and is a significant cause of death and disability in people over 40 years of age worldwide, and the development of AKI in these patients might further worsen their outcomes. The aim of the study was to determine the incidence and risk factors for AKI, as well as short-term outcomes in patients with sICH.Material and methods. In this single-center study, we retrospectively analyzed the data of consecutive patients diagnosed with sICH.Results. Of the 237 patients with sICH included in the study, 13.5% developed AKI. Risk factors for AKI were as follows: severity of neurological deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), larger hematoma volume, as well as higher baseline mean systolic and diastolic blood pressure. Furthermore, patients who developed AKI had higher levels of serum glucose, urea, and serum creatinine and lower estimated glomerular filtration rate (eGFR) on hospital admission. In addition, the overall and in-hospital mortality were much higher in patients with AKI than in those without AKI. Finally, adjusted regression analysis identified the in-hospital use of nephrotoxic antibiotics as a major risk factor, increasing the likelihood of AKI eightfold.Conclusions. These findings highlight the importance of early identification of high-risk patients and careful management of nephrotoxic agents to reduce the incidence and adverse outcomes of AKI in ICH patients
Before headache in upper respiratory tract infection can be attributed to immune response, it must be quantified and causative virus identified
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Comparative study of dosimetry and treatment outcome of two different dose fractionation schedules of high dose rate intracavitary brachytherapy in locally advanced cancer cervix
No full textBackground: Optimizing high dose rate intracavitary brachytherapy (HDR-ICBT) fractionation regimens remains elusive due to concerns about radiation toxicity, despite varied schedules being used across centers for decades. This study investigates the effectiveness of two different HDR brachytherapy schedules for treating cervical cancer, comparing their outcomes in terms of acute toxicities and local control.
Materials and methods: 100 cervical carcinoma patients (stage IB3 to IVA, excluding IIIC2) were randomized into 2 arms and treated by concurrent chemo-radiotherapy followed by HDR brachytherapy, comparing 7 Gy per fraction per week for 3 fractions (Arm A) vs. 6Gy per fraction per week for 4 fractions (Arm B).
Results: The two fractionation schedules demonstrated similar efficacy for loco-regional control. While the mean equivalent dose at the bladder, sigmoid and bowel was higher in Arm B as compared to Arm A, the difference was statistically insignificant (p > 0.05). In contrast, the mean equivalent dose at the rectum was lower in Arm B as compared to Arm A but again statistically insignificant (p > 0.05). However, acute gastrointestinal toxicity (Grade 2 and 3) was found significantly lower (p < 0.001) in Arm B (46.0%) as compared to Arm A.
Conclusion: Both HDR brachytherapy schedules showed comparable efficacy with no significant difference in local control, but 6Gy per fraction for 4 fractions (Arm B) had a better toxicity profile and higher biologically equivalent dose, although long-term follow-up is needed to assess late toxicities
Real world outcomes of high dose hypo-fractionated radiation therapy for mucosal head and neck cancer in patients unsuitable for curative treatment
No full textBackground: A significant minority of patients in high income countries with symptomatic mucosal head and neck squamous cell carcinomas (HNSCC) warrant treatment of their locoregional disease but are not suitable for standard high dose radiation therapy (RT) with or without concurrent chemotherapy. This study aimed to determine the factors associated with locoregional control (LRC) and survival for patients undergoing high dose palliative-intent RT, to help improve patient selection for this treatment approach.
Materials and methods: This retrospective cohort study included all patients with HNSCC who received high dose RT (50–55 Gy in 20 fractions over 4 weeks) with palliative-intent from 2007–2023 at an academic Australian cancer centre.
Results: 53 patients comprised the study cohort, of which 92% completed the prescribed RT in full. Median overall survival was 21.6 months and in-field LRC at 12-months was 80%. Acute toxicities were low [Common Terminology Criteria for Adverse Events (CTCAE) grade 3 mucositis 17%, local pain 6.5%, and dysphagia 4.4%, with no grade 4–5 toxicities], with resolution of majority by six months post RT (7% grade 2, no grade 3 or higher toxicities). Larger primary tumours (T3 or T4) and more advanced stage disease [American Joint Committee on Cancer (AJCC) stage III–IV, 8th edition] were associated with worse in-field LRC.
Conclusions: High dose palliative-RT in patients with mucosal HNSCC not suitable for definitive chemoradiotherapy provided durable local control with low toxicities after 12 months. In-field locoregional failures were more likely for more advanced disease
Quality of density deformations in patient anatomy during synthetic CT guided online adaptive radiation therapy for pelvic cancer
No full textBackground: Online adaptive radiotherapy (oART) with cone-beam computed tomography (CBCT) enables real-time plan adaptation to daily anatomical changes in the patient. Synthetic CTs (sCTs), generated by deforming planning CTs (pCTs) to CBCTs, are crucial for precise dose calculations. However, variations such as gaseous volumes in the pelvis may impact alignment accuracy.
Materials and methods: This retrospective study analyzed 90 treatment fractions for nine patients with cancer in the pelvic region, treated with CBCT-guided oART on the Ethos system. SCTs were generated and compared to corresponding CBCTs using similarity metrics, focusing on bony structures, external body contours, and gaseous volumes. Symmetric differences and Dice Similarity Coefficients (DSC) were calculated to evaluate the registration accuracy.
Results: Bony structure deformations were minor (average volume change 0.2%, DSC 0.89). External body contours on sCTs aligned closely with CBCT (mean deviation 1.0 ± 0.4%), while gaseous volumes exhibited lower alignment (DSC < 0.5 in many fractions). Gaseous volume discrepancies were independent of the pCT and showed time-dependent variability, emphasizing the challenges in adapting density maps. Only a small portion of the gaseous volume differences overlapped with the planning target volume (PTV), suggesting limited direct impact on dose calculation.
Conclusions: CBCT-based sCT adaptation effectively aligns external contours but does not accurately handle gaseous volumes, which may vary in great extent. Minimizing the time between CBCT acquisition and treatment is crucial to maintain alignment accuracy. Advanced imaging solutions enabling direct dose calculation without involving sCT generation could further enhance dose reconstruction but may not resolve the time-sensitive nature of gaseous volume changes
Hypofractionated radiotherapy for glioblastoma: correlation with prognostic factors and survival outcomes
No full textPurpose: To evaluate the efficacy of hypofractionated radiotherapy (HFRT) followed
by conventional fractionated radiotherapy (CFRT) in glioblastoma multiforme (GBM)
patients and identify prognostic factors.
Methods: A retrospective analysis of 120 GBM patients treated postoperatively
between 2010 and 2017 with HFRT (30 Gy in 3 Gy fractions) followed by CFRT (24
Gy in 2 Gy fractions), for a total dose of 60 Gy. All patients received concurrent and
adjuvant Temozolomide (TMZ).
Results: Median age was 62.5 years. Median overall survival (OS) was 11.3
months; 1-, 2-, and 3-year survival rates were 43.3%, 16.1%, and 4.6%, respectively.
Full dose completion correlated with improved OS (12.2 vs. 7.3 vs. 4.6 months for
≥100%, 90–99%, and < 70% dose realization, respectively). Age ≤63 years and GTV
≤44.5 cm³ were associated with significantly better survival. Gender had no
significant impact.
Conclusions: HFRT followed by CFRT with TMZ is an effective alternative to
standard CFRT in patients with subtotal or partial resection. Age and tumor volume
are independent prognostic factors for overall survival
Rola diety ubogiej w aminy biogenne w leczeniu niespecyficznych objawów klinicznych — znaczenie dla praktyki żywienia szpitalnego i klinicznego
No full textIntroduction: Histamine intolerance and other biogenic amine intolerances can present with a wide array of non-specific symptoms, making them difficult to recognize and often leading to diagnostic delays.
Objective: To evaluate the effectiveness of a low-biogenic-amine elimination diet in alleviating non-specific clinical symptoms, drawing on published evidence and clinical experience.
Material and methods: Key publications from 2007–2025 were reviewed, and an outpatient case of a female patient with suspected histamine intolerance was analysed.
Results: Approximately 70–80% of adult patients reported marked improvement after introducing a low–histamine diet, however, effect sizes vary across observational protocols. Pediatric data suggest benefit but lack robust, uniform percentages. Many symptomatic individuals showed reduced diamine oxidase (DAO) activity. Food additives such as preservatives and colourants can trigger non-allergic reactions that mimic histamine intolerance.
Conclusions: A short-term low-histamine diet appears safe and may be an effective intervention in a selected group of patient. In hospital settings, menus and foods for special medical purposes (FSMP) formulations required modification accordingly.Wstęp: Nietolerancja histaminy i innych amin biogennych może manifestować się różnorodnymi, nieswoistymi objawami, co utrudnia jej rozpoznanie i sprzyja opóźnieniom diagnostycznym.
Cel pracy: Ocena skuteczności diety eliminacyjnej ubogiej w aminy biogenne w łagodzeniu niespecyficznych objawów klinicznych na podstawie piśmiennictwa oraz doświadczeń klinicznych.
Materiał i metody: Przeanalizowano kluczowe publikacje z lat 2007–2025 oraz ambulatoryjny przypadek pacjentki z podejrzeniem nietolerancji histaminy.
Wyniki: Około 70–80% dorosłych pacjentów zgłaszało wyraźną poprawę po wprowadzeniu diety niskohistaminowej — odsetki są zmienne i zależne od protokołu. W populacji pediatrycznej sygnalizowano korzyści, jednak bez spójnych, porównywalnych wartości procentowych. U wielu chorych stwierdzono obniżoną aktywność diaminooksydazy (DAO). Dodatki technologiczne (np. konserwanty, barwniki) mogą wywołać reakcje niealergiczne, przypominające nietolerancję histaminy.
Wnioski: Krótkoterminowa dieta niskohistaminowa wydaje się bezpieczna i może być skuteczną interwencją u wybranej grupy pacjentów. W praktyce szpitalnej konieczna jest modyfikacja jadłospisów oraz preparatów żywności specjalnego przeznaczenia medycznego (FSMP, foods for special medical purposes)
