University Hospitals Cleveland Medical Center (UH Cleveland Medical Center) is a major not-for-profit medical complex in Cleveland, Ohio, United States. Since 1986, University Hospitals Cleveland Medical Center has been an affiliate hospital of Case Western Reserve University.UH Cleveland Medical Center is the main campus of the University Hospitals Health System. With 150 locations throughout the Cleveland metropolitan area, the University Hospitals Health System encompasses hospitals, outpatient centers, and primary care physicians. UH Cleveland Medical Center is home to world-class clinical and research centers, including cancer, pediatrics, women's health, orthopedics, spine, radiology, radiation oncology, neurosurgery neuroscience, cardiology, cardiovascular surgery, organ transplantation, and human genetics.
Background: Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved thanks to new evidence, experience, and emerging technologies. This document updates evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP.Methods: A multidisciplinary panel integrated systematic reviews of comparative evidence with other relevant research and clinical experience, then applied Grading of Recommendations, Assessment, Development and Evaluation methodology to produce recommendations using the Evidence to Decision Framework.Results: The panel formulated clinical recommendations that address questions related to CAP, including lung ultrasound for diagnosis, empiric antibacterial therapy if a test result for a respiratory virus is positive, antibiotic duration, and the use of systemic corticosteroids.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with CAP.
Recent orthopaedic trauma literature has linked blood transfusions with poor outcomes due to proposed deleterious effects on healing. The aim of this study was to determine the association of perioperative allogenic blood transfusion after tibial shaft fixation with nonunion and fracture related infection (FRI). A retrospective cohort of patients at two level 1 trauma centers over a 12-year period who sustained extra-articular tibial shaft fractures treated with intermedullary nailing (IMN) or open reduction internal fixation (ORIF). A minimum follow-up of six months was required unless there was presence of clinical and radiographic union prior to six months. Peri-operative allogenic red blood cell transfusion was the primary independent variable. Outcomes included fracture-related infection (FRI) and nonunion. Sub-analyses were completed in patients with open and closed fractures separately. 550 tibia fractures met inclusion criteria. Mean age was 45 years. 333 (61
Since the publication of the previous consensus document on point-of-care lung ultrasound (PoCLUS) in 2012, new evidence has emerged. This consensus aims to update current recommendations by focusing on the clinical applications of PoCLUS as a standalone tool, while acknowledging that this focused approach represents a necessary preliminary step toward its effective integration with other organ-specific ultrasound examinations and complementary diagnostic modalities. A Delphi-based consensus process was conducted under the supervision of a Steering Committee (five voting members) and a Delphi Committee (two non-voting members). Experts were selected according to strict predefined criteria based on highly impactful scientific output and were assigned to specific domains. A structured literature review covering publications from 2012 to 2025 was performed. Statements were drafted, discussed through multiple online rounds, and iteratively refined. Anonymous voting was conducted for each statement using a predefined agreement threshold (80
Short stature may be caused by a multitude of conditions, including genetic and non-genetic causes. Over the last decade, advances in genetic sequencing technologies have revolutionized our understanding of the underlying physiology of growth and greatly increased our ability to identify genetic etiologies of short stature. The current guideline provides a general overview of the approach to the evaluation of a child with short stature, followed by recommendations identifying factors in the medical and family history, physical examination, radiographic, and laboratory work up which increase the likelihood of identifying a genetic etiology. An algorithm is proposed for the genetic workup of individuals with short stature based on their clinical presentation. The benefits and risks of genetic testing are discussed as well.
Kidney transplantation markedly improves survival and quality of life in patients with kidney failure, yet cardiovascular (CV) disease remains the leading cause of morbidity and mortality in kidney transplant recipients (KTRs). This review outlines the complex interplay of traditional, transplant-specific and recipient- and donor-related risk factors that sustain a high CV burden post-transplantation. While kidney function restoration reduces uremic toxins and improves cardiometabolic parameters, new challenges arise from immunosuppressive therapies, persistent hypertension, post-transplant diabetes mellitus and chronic inflammation. Common CV complications include coronary artery disease, heart failure, valvular disease, peripheral artery disease and refractory hypertension. Risk stratification tools and guidelines often fail to account for transplant-specific variables, resulting in suboptimal management. Although some pharmacological strategies and careful antihypertensive regimens show promise, most evidence is extrapolated from non-transplant populations due to the lack of dedicated randomized controlled trials. Emerging therapies like sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists hold potential but require further validation in this population. Moreover, sex disparities persist in access to transplantation and in post-transplant outcomes, with men generally experiencing higher CV risk but women potentially facing greater relative mortality. The review underscores the urgent need for transplant-specific CV research, personalized therapeutic strategies including precision medicine and greater inclusion of women in research. Optimizing CV outcomes in KTRs will require multidisciplinary collaboration, rigorous evidence generation, and an integrated approach to risk prediction, prevention and treatment.
