The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.
Critically ill patients with acute leukemia often require an intensive care unit (ICU) admission. As major therapeutic advances have been made during the last decades, the aim of this study was to assess temporal trends in ICU mortality, and identify prognostic factors to inform clinician decision-making. We conducted an individual participant data meta-analysis of studies including adults with acute leukemia admitted to the ICU. Patients with a history of allogeneic hematopoietic stem cell transplantation were excluded. Mixed-effects logistic regression models, accounting for center of ICU admission as a random variable, evaluated factors associated with ICU mortality, with particular focus on year of ICU admission, age (> 65 years) and invasive mechanical ventilation. A total of 2003 patients from 55 ICUs across 19 countries were included (median age 58 years [IQR 44–67]; 72
AIM:To evaluate the real-world effectiveness, safety, and tolerability of ofatumumab in people with relapsing multiple sclerosis (pwMS) in Croatia. METHODS:We conducted a retrospective observational study in eight Croatian hospitals (March 2022-March 2025). Clinical, MRI, and laboratory data were collected before treatment initiation and every six months. Effectiveness measures included annualized relapse rate (ARR), MRI activity, and sustained accumulation of disability (SAD), and the proportion achieving no evidence of disease activity (NEDA-3). Safety assessments included adverse events (AEs), immunoglobulin levels, infections, and pregnancy outcomes. RESULTS:The study included 665 pwMS (65.6 % female; mean age 40.2 ± 10.7 years; 59.7 % treatment-naïve). Median follow-up was 1.55 years. ARR decreased from 0.70 ± 0.67 pre-treatment to 0.03 ± 0.18 post-treatment (p < 0.001). MRI activity occurred in 17.1 % of patients; 76.7 % achieved NEDA-3. SAD was observed in 6.3 % of pwMS, with male sex as the only independent predictor. Ofatumumab discontinuation occurred in 4.2 % of patients, mainly due to pregnancy. Injection reactions occurred in 15.8 % and infections in 7.4 % (3 hospitalizations). IgG and IgM declined slightly over time, with low IgM (<0.4 g/L) persisting in >10 % after two years, but without correlation to infection rates. Two malignancies were observed. Pregnancy outcomes were favorable in most cases. CONCLUSION:In a real-world Croatian cohort, ofatumumab demonstrated high effectiveness in reducing relapses and MRI activity, with a favorable safety profile over three years. These findings align with pivotal trial results, supporting ofatumumab as an effective and well-tolerated therapy for active relapsing MS in clinical practice.
BACKGROUND:Positron Emission Tomography (PET) is a medical imaging modality that utilizes positron-emitting isotopes for many diagnostic purposes. The positron annihilates with an electron, creating two photons of 511 keV energy and opposite momenta, entangled in their orthogonal polarizations. If each photon undergoes a Compton scattering process, the difference of their azimuthal scattering angles reflects the initial orthogonality of the polarizations, peaking at ±90°. This correlation, not yet utilized in conventional PET scanners, offers an additional, energy-independent method for background discrimination. METHODS:The correlation can be measured using single-layer Compton polarimeters, compatible with conventional PET architecture. We assembled a demonstrator with two such modules comprising 3×3×20 mm3 GAGG:Ce scintillating pixels in 16 × 16 matrix, read by silicon photomultipliers, mounted on a rotating gantry with 430 mm diameter. RESULTS:This paper reports on the study of random background in measurements with Ga-68 source with activities 200-380 MBq. We compare polarization-correlated Compton events, having a two-hit signature, to conventional single-pixel hits. The signal-to-random background ratio (SBR) obtained in the polarization-correlated events is larger than the one for the single-pixel hits, for all selected event samples. We also demonstrate a correlation between the SBR and the polarimetric modulation factor. CONCLUSION:The random background suppression in the measurements of the polarization-correlated annihilation quanta is higher than in the standard PET modality, which could be a valuable resource for PET imaging. Since there is a correlation between the SBR and the polarimetric modulation factor, it could serve as an estimator of the random background.
