Saint Martin University

Background: Septic shock is associated with severe circulatory, cellular, and metabolic dysfunction. Norepinephrine is the first-line vasopressor; however, high catecholamine exposure may be associated with impaired tissue perfusion and increased mortality. Objective: To evaluate the association between vasopressor catecholamine exposure, tissue perfusion markers, and 28-day mortality in adult ICU patients with septic shock. Methods: A retrospective multicenter cohort study was designed including 300 adult patients with septic shock admitted to intensive care units between 2022 and 2025. The main exposure was maximum norepinephrine dose during the first 24 hours, categorized as low, moderate, or high exposure. Tissue perfusion was assessed using lactate, lactate clearance, capillary refill time, urine output, and SOFA progression. The primary outcome was 28-day mortality. Results: Overall 28-day mortality was 39.7%. Mortality increased from 19.5% in the low-dose group to 34.9% in the moderate-dose group and 64.1% in the high-dose group. High norepinephrine exposure was associated with higher lactate at 6 and 24 hours, lower lactate clearance, prolonged capillary refill time, reduced urine output, and greater SOFA progression. In multivariable analysis, norepinephrine dose ≥0.30 μg/kg/min was independently associated with 28-day mortality. Conclusions: High catecholamine vasopressor exposure was associated with impaired tissue perfusion and increased mortality in septic shock. Norepinephrine dose ≥0.30 μg/kg/min may serve as an early clinical warning marker when interpreted together with lactate clearance, capillary refill time, and urine output.

To evaluate the association of symptoms of myofascial pain and dysfunction with the presence of tinnitus in adults. A case-control study involving 80 cases presenting tinnitus and 160 controls without this condition was designed. Sociodemographic variables as well as symptoms of myofascial pain and dysfunction measured using the Brux-Screen, psychopathological symptoms obtained from the Symptom Checklist Revised (SCL-90-R) and Perceived Stress Scale (PSS-10), stressful life events score quantified through the Social Readjustment Rating Scale (SRRS) and presence of tinnitus supported by items of the Tinnitus Handicap Inventory (THI) were collected. A directed acyclic graphs (DAG) analysis was performed to identify potential relationships, and multivariable logistic regression used to assess associations. Exposure to high levels of noise (OR = 2.29; 95

Abstract The coexistence of diabetes mellitus (DM) and hypothyroidism in dogs represents a complex clinical challenge due to interactions between metabolic and hypothalamic–pituitary–thyroid axes. This case report describes the clinical, endocrine and metabolic evolution of a male Siberian Husky diagnosed with concurrent DM and hypothyroidism, monitored for 5 weeks under comprehensive outpatient management. Treatment included stepwise insulin therapy (regular insulin, followed by detemir and then glargine), thyroid hormone replacement with levothyroxine sodium, and a commercial low‐glycaemic, high–insoluble‐fibre diet. Daily blood glucose curves, serial biochemical profiles and thyroid function tests were used to correlate metabolic changes with clinical progression. The patient showed progressive weight gain (from 16.3 to 19.9 kg, +22.1%), reduced glycaemic variability, and stabilisation of plasma thyroxine levels. Metabolic control improved notably from the second week onward, coinciding with the introduction of the therapeutic diet and restoration of thyroid hormonal balance.

Background Oral nicotinamide has been proposed as a chemoprevention strategy to reduce new keratinocyte carcinomas in people with a history of skin cancer, but its effect may differ between immunocompetent patients and transplant recipients. Objective To evaluate the effectiveness and safety of oral nicotinamide for the secondary prevention of cutaneous squamous cell carcinoma and other keratinocyte carcinoma–related outcomes in adults with a history of skin cancer. Methods We conducted a systematic review following PRISMA 2020. We searched PubMed/MEDLINE, Embase, and LILACS through the Virtual Health Library from inception to May 30, 2026. We included comparative studies (randomized clinical trials and controlled nonrandomized studies) evaluating oral nicotinamide versus placebo, no treatment, usual care, or another preventive strategy. Risk of bias was assessed with RoB 2 for randomized trials and ROBINS‐I for nonrandomized studies, and the certainty of evidence was assessed with GRADE. We performed a narrative synthesis and an exploratory random‐effects meta‐analysis of randomized trials when clinically appropriate; effect measures were rate ratios for randomized trials and hazard ratios for the observational cohort. Randomized and nonrandomized designs were not statistically pooled together. Results We identified 1076 records; after removing 151 duplicates, 925 records were screened, 17 full texts were assessed, and 5 studies were included: 4 randomized clinical trials and 1 large retrospective cohort. In high‐risk immunocompetent adults, the benefit signal was driven by a single pivotal randomized trial (ONTRAC; n = 386), in which nicotinamide reduced new nonmelanoma skin cancers (rate ratio, 0.77; 95% CI, 0.62–0.96). In transplant recipients, the main exploratory meta‐analysis of two randomized trials ( n = 180) showed no significant reduction in total keratinocyte carcinoma/nonmelanoma skin cancer (pooled rate ratio, 0.97; 95% CI, 0.77–1.22; I 2 = 0.0%), cSCC/SCC (0.90; 95% CI, 0.65–1.25; 2 trials), or basal cell carcinoma (0.80; 95% CI, 0.20–3.18; 2 trials). A large retrospective cohort (Breglio et al.; 33,822 patients) reported an overall 14% reduction in skin cancer (hazard ratio, 0.86; 95% CI, 0.83–0.89) that was greatest for cSCC and greatest when nicotinamide was started after the first skin cancer, but there was no overall benefit in transplant recipients (hazard ratio, 1.02; 95% CI, 0.84–1.25). Certainty was low or very low for the transplant–recipient outcomes. Conclusions In high‐risk immunocompetent adults, oral nicotinamide may reduce new nonmelanoma skin cancers during active treatment, but this conclusion rests predominantly on one large randomized trial and should be regarded as provisional. In transplant recipients, the randomized evidence does not demonstrate a significant benefit, a finding concordant with the overall null result in the large observational cohort. An observational signal favoring early initiation is hypothesis‐generating and requires prospective confirmation. Limitations Evidence was limited by the very small number of randomized trials (only two contributed to the main meta‐analysis), imprecision, follow‐up of 12 months or less in all randomized trials, the observational nature of the largest study, and low or very low certainty for the transplant–recipient outcomes.