To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve. A retrospective single-center cohort included all infants undergoing LP between June 2011–2025. Cases were categorized as specialist- or trainee-performed (eight pediatric surgery specialists, three supervised trainees). Baseline characteristics, operative variables, surgery-related complications, incomplete pyloromyotomy, postoperative recovery, reintervention, and readmission were compared. Temporal trends and institutional CUSUM analysis were performed. Seventy-seven infants were included (45 specialist-operated, 32 trainee-operated). Baseline characteristics were similar. Operative time was longer for trainees (45 versus 40 min, p = 0.037). Surgery-related complications occurred in 11.1
Botulinum toxin (BoNT) is widely used in the management of neurological disorders and in aesthetic medicine. Although generally safe, facial injections may be associated with complications with relevant functional or aesthetic impact. This narrative review aimed to summarize reported facial complications following BoNT injections and to describe available management strategies. A PubMed search up to November 2025 identified 239 articles; after screening and full-text review, 20 studies met the inclusion criteria. Data were synthesized narratively due to the heterogeneity of study designs. Upper eyelid ptosis was the most frequently reported clinically significant complication and was mainly managed with topical alpha-adrenergic agonists. Diplopia was rare but functionally disabling and was treated conservatively with occlusion or prisms or with targeted extraocular BoNT injection in selected cases. Ocular surface changes, facial asymmetry, perioral dysfunction, local reactions, and headache were generally mild and self-limited. Systemic adverse events were uncommon but occasionally required hospital evaluation. Overall, management strategies were predominantly conservative and supported by low-level evidence. Facial BoNT injections are generally safe, but clinically relevant complications can occur. Management is largely conservative, apraclonidine 0.5% is most commonly used for toxin-induced ptosis, and oxymetazoline 0.1% (FDA-approved for acquired blepharoptosis) is an additional option; other events are treated symptomatically. Overall, evidence is limited, supporting the need for prospective studies and standardized management pathways.
Abstract Introduction Myotonic dystrophy type 1 (DM1) is a genetic, inherited, multisystem disease in which cardiac involvement (CI) is a major cause of morbidity and mortality. Early identification of markers is essential for a preventive and personalized approach. Objectives To identify clinical, electrocardiographic, and imaging predictors of cardiac involvement in patients with DM1. Methods We conducted a single-center, retrospective, observational study including 38 adults with DM1 followed at the Cardiology Department of between 2010 and 2025. Clinical, electrocardiographic, and imaging characteristics at the time of diagnosis were assessed. Their association with future CI and their ability to discriminate it were analyzed using univariable and multivariable logistic regression and ROC curves. Results Mean age was 52.32 years, with diagnosis at 40.68 years. Age showed moderate overall performance in predicting CI (AUC = 0.704; p = 0.064). The presence of electrocardiogram (ECG) abnormalities at diagnosis demonstrated high discriminative ability (AUC = 0.804; p < 0.001). The PR interval was significantly associated with CI in univariable analysis (OR = 1.03; p = 0.045), showed the same trend in multivariable analysis (aOR = 1.02; p = 0.062), and retained predictive value on the ROC curve (AUC = 0.734; p = 0.008). The PR interval was also a predictor of advanced atrioventricular (AV) conduction abnormalities (AUC = 0.779; p = 0.005). Global longitudinal strain (GLS) was marginally associated with left ventricular dysfunction (OR = 1,87; p = 0,064) but showed excellent performance on ROC analysis (AUC = 0.806; p = 0.013). Conclusions PR-interval prolongation and ECG abnormalities at diagnosis enabled early identification of patients at risk of developing CI. GLS may serve as an early marker of left ventricular dysfunction.
INTRODUCTION/OBJECTIVE:Acute intracranial stenting during endovascular thrombectomy (EVT) for ischemic stroke requires intraprocedural antiplatelet therapy (APT) to maintain patency. However, the hemorrhagic risk of combining APT with intravenous thrombolysis (IVT) remains uncertain. We evaluated the safety of IVT combined with conservative versus aggressive intraprocedural APT in patients requiring stenting during EVT. METHODS:This multicenter RESISTANT registry subanalysis (2016-2023) included 823 adults. APT was categorized as conservative (aspirin +/- oral P2Y12) or aggressive (including GPIIb/IIIa inhibitors or cangrelor). The primary outcome was a composite of symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma (PH1/PH2). Multivariable logistic regression assessed associations and interactions between IVT and APT. RESULTS:A total of 823 patients were included: 44 (5.3%) received IVT + conservative APT, 130 (15.8%) No IVT + conservative APT, 145 (17.6%) IVT + aggressive APT, and 504 (61.2%) No IVT + aggressive APT. Frequencies of sICH-PH1-PH2 were 9.3% with IVT + conservative APT, 10.7% with IVT + aggressive APT, 3.2% with No IVT + conservative APT, and 9.9% with No IVT + aggressive APT. In multivariable analysis without interaction terms, neither IVT (aOR 1.18, 95% CI 0.58-2.27; p = 0.64) nor aggressive APT (aOR 2.10, 95% CI 0.92-5.69; p = 0.10) was independently associated with increased risk of sICH-PH1-PH2. However, in the interaction model, IVT within the conservative-APT stratum (aOR 5.84, 95% CI 1.07-43.92; p = 0.05) and aggressive APT within the no-IVT stratum (aOR 4.81, 95% CI 1.41-30.22; p = 0.03) were each associated with higher odds of sICH-PH1-PH2, while the IVT-by-APT interaction term was < 1 (aOR 0.15, 95% CI 0.02-0.94; p = 0.05), indicating attenuation of the joint effect on the multiplicative odds scale. CONCLUSION:Among patients requiring intracranial stenting during EVT, we found no evidence that IVT and aggressive intraprocedural APT act synergistically to increase hemorrhagic risk. Rather, the negative IVT-by-APT interaction suggested attenuation of the joint effect on the multiplicative odds scale, although patients receiving both therapies remained at increased hemorrhagic risk relative to the reference group.
Objective: To determine the proportion of axial psoriatic arthritis (axPsA), describe how it is diagnosed in clinical practice, and identify clinical and demographic characteristics independently associated with axPsA. Methods : A multicentre retrospective observational study was conducted using data from patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with a diagnosis of PsA or spondyloarthritis with psoriasis. Peripheral involvement was defined as the presence of peripheral joint disease. Axial involvement was defined by the presence of physician-reported spondylitis and/or imaging findings suggestive of axial disease. Patients were divided into four non-exclusive groups: axPsA, axial involvement with or without peripheral joint disease; ax-PsA_only, axial involvement exclusively; peripheral PsA (pPsA)_only, peripheral joint disease, without axial involvement; pPsA, peripheral joint disease with or without axial disease. Results : This study included 2,304 patients. axPsA was present in 37.1% of patients and axPsA_only in 8.1%. The diagnosis was made based on suggestive imaging findings in 30.1%, and on physician judgement in 69.9%. axPsA was independently associated with HLA-B27 positivity (odds ratio [OR]=2.90; p<0.001), enthesitis (OR=1.64; p<0.001), and younger age at symptom onset (OR=0.97; p<0.001); pPsA_only with dactylitis (OR=1.89; p<0.001) and nail dystrophy (OR=1.42; p=0.010). axPsA_only was independently associated HLA-B27 positivity (OR=3.35; p<0.001) and uveitis (OR=2.56; p=0.004); pPsA with nail dystrophy (OR=2.11; p=0.002), dactylitis (OR=18.18; p<0.001), and enthesitis (OR=1.74; p=0.031). Conclusion : Axial involvement is present in over one-third of PsA patients, often in association with peripheral joint disease. ax-PsA patients demonstrate distinct clinical and demographic characteristics compared to those without axial disease.
