Importance:Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives:To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants:This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure:A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures:The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results:The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance:This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.
BACKGROUND:For over a decade the Advanced Prostate Cancer Consensus Conference (APCCC) covers a variety of topics that greatly impact daily practice. In 2025, a dedicated event was organised to discuss key questions in clinical management of patients with prostate cancer (PC) related to diagnostic tools (APCCC Diagnostics). Here we present the voting results of the APCCC Diagnostics questions. OBJECTIVE; DESIGN, SETTING, AND PARTECIPANTS: APCCC Diagnostics 2025 is a pilot project. The scientific committee for APCCC Diagnostics 2025 developed 88 multiple-choice consensus questions on six different topics. Prior to the conference, the panel members (''panellists'') voted on these questions via a web-based survey. Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS:Consensus was only reached on 17 of 88 questions (19%), of which six (7%) received a strong consensus. Specifically, consensus was reached for two of 17 questions (14%) in "how to diagnose PC"; seven of 16 (44%) in "how to stage PC"; three of 14 (21%) in "Biochemical Recurrence Scenario"; two of 11 (18%) in "metastatic disease: what to do?"; zero of 18 (0%) in "monitoring metastatic PC"; and three of 12 (25%) in "radioligand therapy and imaging." CONCLUSIONS:The voting results and their discussion may assist physicians in navigating controversial areas of clinical management related to diagnosis, staging, and restaging in the different clinical settings for PC, particularly where high-level evidence is scarce or conflicting. The findings can also help funders and policymakers in prioritising areas for future research.
Long COVID is a multisystemic condition characterized by persistent symptoms after acute SARS-CoV-2 infection, whose biological mechanisms are not yet fully understood. Host genetic factors may be associated, and the sharing of genetic architecture with other chronic diseases such as viral hepatitis B and C may aid in understanding this disease. A cross-sectional study was conducted including 150 individuals stratified into two groups: (i) Long COVID and (ii) chronic viral hepatitis B and C. Eighteen single nucleotide polymorphisms (SNPs) previously associated with COVID-19 severity and inflammatory pathways were genotyped using TaqMan® real-time PCR assays. The analyses of genetic association models were performed using multivariate logistic regression adjusted for gender, self-reported skin color, and comorbidities. Mental health scales for assessing depression (Beck), anxiety (Hamilton), fatigue, and post-COVID functional scale were used both to define the syndrome and for subsequent analyses of the genotypic profile probably associated with Long COVID. Among all the SNPs analyzed, rs12610495 (A/G) in the DPP9 gene was the only variant consistently associated with Long COVID. After adjustment for sex, self-reported skin color, and hepatitis status, carriers of the G variant allele demonstrated increased odds of Long COVID under the dominant model (OR = 2.66; 95
A 72-year-old male patient, previously healthy, was admitted with fever, asthenia and pain in the right gluteal region at the site of a prior intramuscular corticosteroid injection. He had fever, tachycardia and laboratory tests showing leukocytosis with left shift, renal dysfunction, and elevated C-reactive protein and lactate levels. Blood cultures were collected and ampicillin-sulbactam was started. Pelvic magnetic resonance imaging showed pyomyositis with a large abscess in the gluteus medius and minimus muscles, extending to the adductor longus and iliopsoas. Surgical debridement with fasciotomy and culture collection was performed. Due to the severity of the condition, empirical daptomycin was added to the antimicrobial regimen. Intraoperative cultures identified methicillin-susceptible Staphylococcus aureus (MSSA), and therapy was de-escalated to cefazolin. The patient improved clinically and was discharged on sulfamethoxazole-trimethoprim to complete six weeks of treatment at home. Pyomyositis is a bacterial intraparenchymal infection of skeletal muscle, characterized by abscess formation and also known as tropical pyomyositis. The main pathogen involved is Staphylococcus aureus, and the frequently affected sites are the large muscles of the lower limbs. It is more often seen in immunosuppressed individuals. Mortality ranges from 0.89% to 23%, and early diagnosis is the most effective intervention to minimize disease complications. In advanced stages, fever and myalgia/claudication are the most common symptoms, sometimes associated with bacteremia and sepsis, toxic shock syndrome or osteomyelitis (by contiguity or hematogenous spread). In resource-limited settings, the diagnosis of pyomyositis is based on clinical presentation and ultrasound, although magnetic resonance imaging is the gold standard. Primary treatment regimens include anti-staphylococcal penicillins in suspected or confirmed MSSA infections. In suspected or confirmed MRSA, vancomycin, linezolid or daptomycin are indicated. In suspected anaerobic involvement, metronidazole is recommended. Surgical drainage is indicated for all patients. Treatment duration ranges from 2 to 4 weeks, depending on clinical response, with the possibility of switching to oral therapy if evolution is favorable.
AIMS:This study aimed to investigate the associations between glycemic outcomes and a range of clinical and demographic factors, including treatment modality, sex, age, diabetes duration, and body mass index, in youth with type 1 diabetes in an international registry. METHODS:This observational, cross-sectional cohort study included youth <21 years from 23 countries. Proportions of individuals using different treatment modalities (continuous glucose monitoring [CGM] with injections, CGM with pump, automated insulin delivery [AID]) and achieving recommended time in tight range (TITR >50%), time in range (TIR >70%), and glycated hemoglobin (HbA1c) (≤6.5% [48 mmol/mol] and ≤7% [53 mmol/mol]) were assessed using mixed-effects fractional logistic and linear regression models. Sex, age (categorized), diabetes duration (categorized), body mass index standard deviation score (categorized), and treatment modality were included as covariates. RESULTS:Data of 7691 individuals (mean [standard deviation] age of 13.7 [4.3] years, diabetes duration 6.3 [4.2] years, 47.8% female) were included. AID users were the most likely to achieve TITR target (adjusted mean [standard error of the mean] 41.2% [2.9]), followed by CGM with insulin pump (25.2% [2.3]) and CGM with injections (13.7% [1.5], P < 0.001). A similar association was observed for proportions of individuals achieving TIR and HbA1c targets (P < 0.001). Age <6 years was associated with a higher coefficient of variation (CV) (P < 0.001) and a lower probability of achieving both TITR and TIR targets compared with other age groups (P < 0.001). In analyses of TITR associated with mean sensor glucose stratified by CV, a higher TITR for a lower CV was observed only at mean glucose levels below 150-160 mg/dL; above this threshold, the pattern reversed, with lower CV associated with lower TITR at a given mean glucose level. CONCLUSIONS:Children younger than 6 years and individuals not using glucose-responsive insulin therapy were less likely to meet the recommended glycemic targets. It is imperative to minimize these disadvantages.
