Sepsis remains a leading cause of mortality in intensive care units (ICUs) globally; however, the effectiveness of conventional prognostic scoring systems varies across healthcare settings and patient populations. This study aimed to evaluate the comparative discriminative ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index (CCI) in predicting 28-day mortality among critically ill septic patients. We conducted a retrospective observational study involving 392 consecutive adult patients diagnosed with sepsis according to the Sepsis-3 criteria, who were admitted to the ICU of a tertiary pulmonary care center in Serbia from January 2017 to December 2020. APACHE II scores were derived from the worst physiological values recorded within the first 24 hours of ICU admission; SOFA scores reflected the highest total score assessed during the same period; and CCI was calculated based on comorbidities present at admission. Discriminative performance was evaluated using receiver operating characteristic curve analysis. The overall 28-day mortality rate was 51.3%, which increased to 68.1% in patients with septic shock, with pneumonia being the source of infection in 97.4% of cases. APACHE II demonstrated the highest area under the curve (AUC) in the overall sepsis cohort (0.692, 95% CI 0.643-0.747), followed by SOFA (0.682, 95% CI 0.629-0.735) and CCI (0.667, 95% CI 0.613-0.720). In patients with septic shock, SOFA (AUC 0.671, 95% CI 0.561-0.782) and APACHE II (AUC 0.646, 95% CI 0.539-0.754) significantly outperformed CCI (AUC 0.423, 95% CI 0.302-0.543; p=0.006 and p=0.013, respectively), with no statistically significant difference between SOFA and APACHE II (p=0.828). Optimal cut-off values were identified as SOFA ≥8, APACHE II ≥21, and CCI ≥4, with corresponding sensitivities of 59.7%, 67.7%, and 56.2%, respectively. Both APACHE II and SOFA exhibited modest and comparable discriminative abilities for mortality prediction in this high-severity population, while CCI demonstrated limited utility in cases of septic shock. These findings underscore the continued relevance of conventional scoring systems and highlight the necessity for population-specific validation in high-acuity settings.
Hashimoto thyroiditis (HT) coexists with differentiated thyroid carcinoma (DTC), particularly papillary thyroid carcinoma, in approximately 25% of cases. However, the impact of this association on DTC outcomes remains controversial. The aim of this study was to analyze the influence of Hashimoto thyroiditis on disease-specific survival (DSS) and recurrence-free survival (RFS) in DTC patients. Methods: A retrospective study conducted at our institution between 2007 and 2020 analyzed 707 DTC patients treated with surgery and/or I-131 therapy. Cox proportional hazards regression was used to identify independent predictors, including sex, age, tumor histology, HT status, and initial TNM stage. Results: Among 707 DTC patients, 628 (88.8%) had papillary cancer, 582 (82.3%) were female, 395 (55.9%) were <55 years old; HT coexisted in 137 (19.4%) patients. During follow-up, 23 (3.25%) developed recurrent disease; at last follow-up, 638 (90.2%) were alive. Initial distant metastases (p < 0.001) and higher T stage (p = 0.002) independently predicted worse DSS. For RFS, male sex (p = 0.015), higher T stage (p = 0.018), and lymph node involvement (p = 0.023) independently predicted an increased risk of recurrence. HT was not an independent predictor of DSS (HR 0.97, 95% CI 0.21-4.52; p = 0.964) or recurrence (HR 0.36, 95% CI 0.05-2.73; p = 0.322). Conclusions: Although Hashimoto thyroiditis was associated with favorable clinicopathological features, it was not independently associated with disease-specific or recurrence-free survival. Conventional staging parameters, particularly tumor stage, remain the principal determinants of prognosis in differentiated thyroid cancer.
Early childhood caries (ECC) among children with type 1 diabetes mellitus (T1D) remains poorly characterized in the primary dentition (≤71 months), despite frequent reports of salivary and periodontal alterations that could plausibly increase caries susceptibility. This systematic review aimed to compare ECC prevalence and severity in children with T1D versus healthy controls and to examine associations with glycemic control, salivary parameters, periodontal indices, and preventive-care behaviors. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and International Prospective Register of Systematic Reviews (PROSPERO) registration (CRD42024602599), we searched five databases and Google Scholar for eligible observational studies; due to substantial heterogeneity in age ranges, dentition stages, and outcome reporting, findings were synthesized narratively. Twelve studies met inclusion criteria. Evidence on caries experience in primary teeth was inconsistent, with some studies reporting higher dmft in T1D and others showing comparable or lower values than controls. In contrast, secondary outcomes showed more coherent patterns: T1D was frequently associated with reduced salivary flow, diminished buffering capacity, lower salivary pH, and early gingival inflammation, while poorer glycemic control was commonly linked to worse oral-health parameters; preventive dental attendance and fluoride-related practices were variably reported and often irregular. Overall, current evidence does not conclusively demonstrate a higher ECC burden in T1D, but consistent salivary and periodontal vulnerability supports early, integrated preventive oral-health care within pediatric diabetes management.
Background: Colorectal cancer (CRC) remains a global health problem. It is the most common malignancy of the gastrointestinal tract, with a global incidence of over 1.9 million cases, making it the third most common cause of cancer-related deaths worldwide. The incidence is increasing particularly in low- and middle-income countries and among individuals under 50 years of age, with lifestyle and environmental factors contributing to this trend-many of which affect the gut microbiome. Main body: Advances in CRC treatment have introduced immunotherapy, particularly for tumours with mismatch repair deficiency (dMMR) and high microsatellite instability (MSI-H). This review explores the symbiotic relationship between the gut microbiome and immunotherapy in CRC. The human colon harbours a complex microbiome composed of diverse microbial species and vast genetic diversity, with structural, metabolic, and immunomodulatory functions. Dysbiosis, influenced by factors such as diet and lifestyle, contributes to CRC pathogenesis through inflammation and metabolic disruptions. Immunotherapy, specifically immune checkpoint inhibitors (ICIs), has revolutionized cancer treatment by enhancing T cell-mediated immune responses against cancer cells. In CRC, ICIs have demonstrated efficacy in MSI-H/dMMR tumours that represent less than 15% of all CRC cases. Challenges persist in treating microsatellite stable (MSS) CRC in regard to immunotherapy. Emerging evidence suggests that specific gut microbiota compositions influence the response to ICIs by modulating systemic immune responses and tumour microenvironments, potentially having a key role for MSS CRC patients. Strategies to manipulate the gut microbiome, including probiotics and faecal microbiota transplantation, hold promise in augmenting immunotherapy efficacy. Conclusion: The review underscores the potential of the gut microbiome as a predictive biomarker and therapeutic target in CRC immunotherapy. Ultimately, harnessing the therapeutic potential of the gut microbiome represents a promising avenue for enhancing immunotherapy outcomes and advancing personalized medicine in CRC care.
Introduction/Objective. Hyperhidrosis is a condition of pathological excessive sweating that exceeds the body’s physiological requirements for thermoregulation. Endoscopic thoracic sympathicotomy (ETS) is a commonly used treatment for primary focal hyperhidrosis (PFH); however, it may result in compensatory sweating (CS), which represents its most frequent postoperative complication. This study aimed to investigate whether heart rate variability (HRV) parameters could predict CS. Methods. A prospective single-center study was conducted in 100 patients with primary focal hyperhidrosis (PFH) who underwent ETS. Preoperatively, all patients underwent 24-hour Holter ECG monitoring to assess standard HRV parameters. ETS was performed by transection of the sympathetic chain at the level of the third (R3) and fourth rib (R4), including the accessory Kuntz fibers. One month after surgery, the presence and severity of CS were assessed. Results. CS was absent in 61% of patients (p=0.028). Mild CS was the most common form (p < 0.01). No statistically significant differences were observed in the analyzed preoperative HRV parameters between patients with and without CS (p > 0.05), including the low-frequency (LF)/high-frequency (HF) ratios, which represent balanced autonomic activity (LF/HF < 2) and sympathetic predominance (LF/HF ≥ 2). ROC curve analysis showed that age had significant predictive accuracy for CS (AUC 0.7333; 95% CI 0.634-0.833; p < 0.01), with an optimal cutoff of 23.5 years (sensitivity 0.82, specificity 0.47). Conclusion. HRV parameters cannot reliably predict CS following bilateral ETC in patients with PFH. The study confirmed that the optimal age for surgery is below 23.5 years.
