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AI-Based Models to Predict Decompensation on Traumatic Brain Injury Patients.
No full textTraumatic Brain Injury (TBI) is a form of brain injury caused by external forces, resulting in temporary or permanent impairment of brain function. Despite advancements in healthcare, TBI mortality rates can reach 30%-40% in severe cases. This study aims to assist clinical decision-making and enhance patient care for TBI-related complications by employing Artificial Intelligence (AI) methods and data-driven approaches to predict decompensation. This study uses learning models based on sequential data from Electronic Health Records (EHR). Decompensation prediction was performed based on 24-h in-mortality prediction at each hour of the patient's stay in the Intensive Care Unit (ICU). A cohort of 2261 TBI patients was selected from the MIMIC-III dataset based on age and ICD-9 disease codes. Logistic Regressor (LR), Long-short term memory (LSTM), and Transformers architectures were used. Two sets of features were also explored combined with missing data strategies by imputing the normal value, data imbalance techniques with class weights, and oversampling. The best performance results were obtained using LSTMs with the original features with no unbalancing techniques and with the added features and class weight technique, with AUROC scores of 0.918 and 0.929, respectively. For this study, using EHR time series data with LSTM proved viable in predicting patient decompensation, providing a helpful indicator of the need for clinical interventions
Chronic Osteomyelitis of the Jaws: Management and Outcomes in a Tertiary Maxillofacial Surgery Unit.
No full textObjective: This study aims to evaluate the management and outcomes over 14 years at a tertiary maxillofacial surgery unit.
Methods: Retrospective cohort study of patients from a Portuguese tertiary center of maxillofacial surgery with histopathologically confirmed diagnoses of chronic osteomyelitis of the jaws between January 2010 and December 2023. Demographic and clinical characteristics, treatment, and progression of the disease were evaluated.
Results: Fifty-three patients were included-28 women (52.8%), mean age 55 (95% CI 5-90) years. The mandible was affected in 84.9% (n = 45) of cases. Secondary chronic osteomyelitis was diagnosed in 88.7% (n = 47), with medication-related osteonecrosis of the jaw (MRONJ) being the most common etiology (38.3%). Bacteriological samples were contributory in 52% (n = 13) and 46.1% (n = 6) were resistant to amoxicillin. All received antibiotics for a median time of 27.3 days. Surgical treatment included sequestrectomy (n = 40, 75.5%), marginal (n = 5, 9.4%), and segmental mandibulectomy (n = 8, 15.1%). Clinical remission was achieved in 77.4% (n = 41) of cases with higher success in MRONJ (n = 15, 83.3%) than ORN (n = 4, 57.1%).
Conclusions: Almost half of the isolates were amoxicillin-resistant, reinforcing the need for susceptibility testing. Surgical management guided by etiology and disease stage remains essential, with more extensive resection needed in MRONJ and ORN
The Role of Nurses Caring for Children Diagnosed with Sickle Cell Anemia and Their Families in a Hospital Setting: A Rapid Review of the Recent Literature.
No full text: Sickle cell anemia (SCA) affects a significant number of children worldwide, for whom the progression of the disease can lead to functional disability-impaired development. Nurses are pivotal in providing holistic care to these children and their families. This review aims to identify recent evidence on the role of nurses in intervening with children with SCA and their families in a hospital setting. : A rapid review reported under the PRISMA methodology was carried out in the CINAHL, MEDLINE, and Scopus databases with the expression (sickle cell anemia OR sickle cell disease) AND (child* OR family OR pediatric*) AND (nurs* OR "nursing interventions" OR "pediatric nursing") AND (hospital*), considering studies between 2019 and 2024, written in English, identifying articles with insights about the role of nurses in this context. Articles other than primary or secondary studies were excluded. Data were analyzed through a rapid qualitative approach. : Fifty-two studies were identified and seventeen articles were included. The nurse's role is key and multidisciplinary, focusing on the child and family (care management and therapeutic education), the team (training, and the promotion of safety and quality of care), and the health system (optimizing access to care and promoting adequate resources for its implementation). Such a role is important for short-term clinical problems and to prevent long-term complications. : Nurses play a central role in empowering families and coordinating multidisciplinary care. Greater investment is needed at a clinical level, through a more effective response to the needs of these patients, and in research, through experimental studies and other designs focused on multidisciplinary interventions
Individualização do Tratamento contra CMV com Mutação UL97 del597-599: Além da Resposta Incomum a um Aumento Menor da Dose de Ganciclovir
No full textHuman cytomegalovirus (CMV) infection is the most prevalent infection affecting organ transplant recipients, and it is a cause of morbidity and mortality in patients undergoing kidney transplantation. The introduction of ganciclovir (GCV) for both prophylaxis and treatment has vastly improved patient outcomes. GCV resistance can be caused by mutations in the UL97 phosphotransferase gene or the UL54 polymerase gene. It occurs in 1 to 2% of kidney transplant recipients with CMV infection or disease. Antiviral resistance should be considered when increased viral loads and disease progression are observed despite the administration of adequate antiviral therapy. The degree of resistance varies depending on the type of mutation present. We report a patient with resistance to GCV due to a UL97 del597-599 mutation who, despite typically requiring an 8-fold increase in GCV dose, showed a significant decrease in viral load with just a double dose increase. However, the patient’s overall clinical course
remained complicated. Due to severe leukopenia, maribavir had to be started, with a good response. Nevertheless, he ultimately died due to indirect CMV-related complications. This case also highlights the complexity of transplant patients, who present multiple challenges ranging from infections to therapy management.A infecção pelo citomegalovírus humano (CMV) é a infecção mais prevalente que afeta os receptores de transplante de órgãos e é uma causa de morbidade e mortalidade em pacientes submetidos a transplante renal. A introdução do ganciclovir (GCV) para profilaxia e tratamento melhorou muito os resultados dos pacientes. A resistência ao GCV pode ser causada por mutações no gene da fosfotransferase UL97 ou no gene da polimerase UL54. Ela ocorre em 1 a 2% dos receptores de transplante renal com infecção ou doença por CMV. A resistência antiviral deve ser considerada quando se observa aumento da carga viral e progressão da doença, apesar da administração de terapia antiviral adequada. O grau de resistência varia de acordo com o tipo de mutação presente.
Relatamos um paciente com resistência ao GCV devido a uma mutação UL97 del597-599 que, apesar de normalmente exigir um aumento de 8 vezes na dose de GCV, apresentou uma diminuição significativa na carga viral com apenas um aumento de duas vezes na dose. Entretanto, a evolução clínica geral do paciente permaneceu complicada. Devido à leucopenia grave, o Maribavir teve de ser iniciado, com uma boa resposta. No entanto, ele acabou morrendo devido a complicações indiretas relacionadas ao CMV. Esse caso também destaca a complexidade dos pacientes transplantados, que apresentam vários desafios, desde infecções até o gerenciamento da terapia
Short and Long-Term Trajectories of the Post COVID-19 Condition: Results From the EuCARE POSTCOVID Study.
No full textBackground: Post COVID-19 condition (PCC) affects 10-40% of patients and is characterized by persisting symptoms at ≥ 4 weeks after SARS-CoV-2 infection. Symptoms can last 7 or even more months. How long PCC persists and any changes in its clinical phenotypes over time require further investigation. We investigated PCC trajectories and factors associated with PCC persistence.
Material and methods: We included both hospitalized COVID-19 patients and outpatients from February 2020 to June 2023, who underwent at least one follow-up visit after acute infection at San Paolo Hospital, University of Milan. Follow-up visits were conducted at the post COVID-19 clinic or via telemedicine. During each follow-up examination, patients completed a short version of the World Health Organization (WHO) Case Report Form (CRF) for ongoing symptoms, the Hospital Anxiety and Depression Scale (HADS), and a screening tool for Post-Traumatic Stress Disorder (PTSD). Statistical analyses involved Chi-square, Mann-Whitney, Kruskal-Wallis tests, and logistic regression analysis.
Results: We enrolled 853 patients (median age 62, IQR 52-73; 41% females). 551/853 (64.6%), 152/418 (36.4%) and 21/69 (30.4%) presented PCC at median follow up of 3 (IQR 2-3), 7 (IQR 6-10) and 26 (IQR 20-33) months, respectively (p < 0.001). The main clinical phenotypes were fatigue, respiratory sequelae, brain fog and chronic pain; anosmia/dysgeusia was observed mostly in the first post-acute period. Female sex, acute disease in 2020, a longer hospital stay and no COVID-19 vaccination were associated with persistence or resolution of PCC compared to never having had PCC. Anxiety, depression and PTSD were more common in PCC patients. By fitting a logistic regression analysis, acute infection in 2020 remained independently associated with persistent PCC, adjusting for age, sex, preexisting comorbidities and disease severity (AOR 0.479 for 2021 vs 2020, 95%CI 0.253-0.908, p = 0.024; AOR 0.771 for 2022 vs 2020, 95%CI 0.259-2.297, p = 0.641; AOR 0.086 for 2023 vs 2020, 95%CI 0.086-3.830, p = 0.565).
Conclusions: There was a reduction in the PCC burden 7 months following the acute phase; still, one third of patients experienced long-lasting symptoms. The main clinical presentations of PCC remain fatigue, respiratory symptoms, brain fog, and chronic pain. Having had SARS-CoV-2 infection during the first pandemic phases appears to be associated with persistent PCC
Retrospective Observational Study of the Carbon Dioxide Insufflation Technique for Epicardial Access Ablation of Refractory Arrhythmias.
No full text: Accessing intramural or epicardial arrhythmogenic substrates is limited in endocardial ablation, and in these circumstances, epicardial ablation may overcome these limitations. Because epicardial access may be associated with severe complications, intentional distal coronary vein exit and carbon dioxide (CO) insufflation have emerged as techniques to facilitate safer access. : We conducted a single-centre retrospective observational analysis of all patients who underwent epicardial ablation using the CO insufflation technique between September 2021 and October 2024. : Among 21 patients selected for the procedure, successful pericardial access was achieved in 19 (90.5%). The main indication for ablation was ventricular tachycardia (14 patients, 66.7%), and 16 patients (76.2%) had previously undergone endocardial ablation for the same arrhythmia. Most patients had non-ischemic cardiomyopathy (17 patients, 81.0%). Three intra-procedural complications occurred: one (5.3%) was access-related, and two (10.5%) were ablation-related. Early post-procedural complications occurred in three patients (15.8%). Acute procedural success was achieved in 16 of 17 patients (94.1%) who underwent ablation. In-hospital mortality occurred in three cases (15.8%), including one procedure-related death (5.3%). : Intentional coronary vein exit and CO insufflation provide a safe and reproducible technique to obtain subxiphoid pericardial access for epicardial ablation
Overcoming Diagnostic Challenges in Constrictive Pericarditis: Why Volume Is Important?
No full textA 65-year-old male with chronic liver disease and refractory ascites was being evaluated for liver transplant, when constrictive pericarditis (CP) was suspected. Initial diagnostics were inconclusive due to overdiuresis. After suspension of diuretics, cardiac magnetic resonance confirmed CP, leading to successful pericardiectomy and normalization of liver function, emphasizing volume status and multimodality imaging role in CP diagnosis
The Use of Continuous Glucose Monitoring in People Living with Obesity, Intermediate Hyperglycemia or Type 2 Diabetes.
No full textA global trend towards increased obesity, intermediate hyperglycemia (previously termed prediabetes) and type 2 diabetes, has prompted a range of international initiatives to proactively raise awareness and provide action-driven recommendations to prevent and manage these linked disease states. One approach, that has shown success in managing people already diagnosed with type 2 diabetes mellitus, is to use continuous glucose monitoring (CGM) devices to help them manage their chronic condition through understanding and treating their daily glucose fluctuations, in assocation with glucose-lowering medications, including insulin. However, much of the burden of type 2 diabetes mellitus is founded in the delayed detection both of type 2 diabetes mellitus itself, and the intermediate hyperglycemia that precedes it. In this review, we provide evidence that using CGM technology in people at-risk of intermediate hyperglycemia or type 2 diabetes mellitus can significantly improve the rate and timing of detection of dysglycemia. Earlier detection allows intervention, including through continued use of CGM to guide changes to diet and lifestyle, that can delay or prevent harmful progression of early dysglycemia. Although further research is needed to fully understand the cost-effectiveness of this intervention in people at-risk or with early dysglycemia, the proposition for use of CGM technology is clear
DNA Methyltransferase Expression (DNMT1, DNMT3a, and DNMT3b) as a Potential Biomarker in Age-Related Macular Degeneration.
No full textAge-related macular degeneration (AMD) is a global cause of vision loss, with limited therapeutic options highlighting the need for effective biomarkers. This study aimed to characterize plasma DNA methyltransferase expression (, , and ) in AMD patients and explore divergent expression patterns across different stages of AMD. : Thirty-eight AMD patients were prospectively enrolled and stratified by disease severity: eAMD, iAMD, nAMD, and aAMD. Comprehensive ophthalmological assessments were performed, including best-corrected visual acuity, digital color fundus photographs, and Spectral Domain Optical Coherence Tomography. Peripheral blood samples were collected for RNA extraction and qRT-PCR to access epigenetic effectors' transcriptional expression, namely , , and genes. The collected data were analyzed using IBM SPSS 29. expression was significantly downregulated in late AMD (-0.186 ± 0.341) compared to early/intermediate AMD (0.026 ± 0.246). Within late AMD, aAMD exhibited a marked downregulation of (-0.375 ± 0.047) compared to nAMD (0.129 ± 0.392). and showed similar divergent expression patterns, correlating with disease stage. This study identified stage-specific transcriptional differences in expression, emphasizing its potential as a biomarker for AMD progression and a target for future research into personalized therapeutic strategies
Instruments for Short-Term (24 h) Violence Risk Assessment and Strategies for Managing Violence Risk Among Adolescents With Risk for Violent Behaviour: A Systematic Review.
No full textShort-term (24 h) violence risk assessment and management can reduce violence in institutional settings, yet they remain understudied in adolescent populations. This systematic review aimed to identify instruments used for short-term violence risk assessment and strategies for managing violence risk among adolescents in institutional settings, as well as to evaluate related outcomes. PRISMA was used as an evidence-based minimum set of items for reporting systematic reviews. The literature search (March 2024 and March 2025) was conducted in PubMed, PsycINFO, Web of Science, CINAHL, The Cochrane Library and Scopus, and references from selected studies were reviewed. Data extraction and analysis were performed in Covidence. Nine studies met inclusion criteria describing six assessment instruments: DASA, DASA-YV, V-RISK-Y, Kennedy Axis V, Pedi-BEWS and BVC. No studies regarding strategies for short-term violence risk management were identified. DASA-YV, BVC and V-RISK-Y predicted violence among adolescents within 24 h (AUC = 0.70-0.95); DASA predicted violence moderately (AUC = 0.50-0.69). Pedi-BEWS (ICC = 0.83) and Kennedy Axis V (ICC = 0.79) demonstrated similar inter-rater reliability. Due to the lack of studies, firm conclusions on the best instrument for clinical practice in institutional settings remained elusive. Further research is necessary to ascertain if youth-specific instruments (e.g., DASA-YV, V-RISK-Y) predict violence more effectively than non-age-specific instruments (e.g., DASA). The lack of youth engagement in violence risk assessment stands out clearly. Scoring was done by the staff, mostly by nurses. Future studies should involve adolescents in the scoring or evaluation of assessment and management. There is a need for evidence-based recommendations for youth engagement