Background/Objectives: Caries adjacent to restorations or sealants (CARS) is among the most frequent biological causes of composite restoration failure, resulting from the interplay between the patient’s cariogenic risk and restoration-related factors such as marginal adaptation. The study aimed to investigate whether cariogenic risk modifies the effect of marginal adaptation on the occurrence of caries adjacent to posterior composite restorations (CARS), using risk-stratified univariate analysis and a clustering-adjusted approach, to identify associated clinical, socio-demographic, and local risk factors. Methods: This retrospective cross-sectional study evaluated 453 posterior direct composite resin restorations (Class I, Class II) in 88 patients at the Faculty of Dental Medicine, “Grigore T. Popa” University, Iași, Romania. CARS and marginal adaptation were assessed using FDI Criteria. Patients were classified as high or low cariogenic risk using a multifactorial institutional protocol. Univariate analysis and Generalized Estimating Equations (GEE) accounting for within-patient clustering were performed. Results: CARS prevalence was 27.9% in high cariogenic risk patients versus 3.15% in low cariogenic risk patients. Univariate analysis identified high cariogenic risk (OR = 11.904), deficient marginal adaptation (OR = 25.929–69.475), restoration age of 3–5 years (OR = 3.045), and Class II configuration (OR = 2.597) as significant risk factors. GEE analysis, adjusted for clustering of restorations within patients, confirmed high cariogenic risk (OR = 12.597) and deficient marginal adaptation (OR = 121.320) as independent correlates of CARS. A significant interaction between the two (p < 0.001) showed that marginal adaptation remained the dominant local risk factor in low cariogenic risk patients, while its association with CARS was largely attenuated in high-risk patients. Conclusions: GEE analysis confirmed high cariogenic risk and deficient marginal adaptation as independent correlates of CARS, with marginal adaptation acting as the dominant local risk factor only in low-risk patients.
Background: Cardiac amyloidosis is characterized by progressive myocardial infiltration leading to ventricular dysfunction. While left ventricular strain assessment is well established, evaluation of right ventricular (RV) mechanics remains challenging because of the ventricle’s complex geometry and limitations of conventional speckle-tracking methods. We aimed to evaluate an alternative approach for RV strain assessment based on a continuous biventricular tracking pathway within the apical four-chamber view. Methods: We retrospectively studied 32 patients with cardiac amyloidosis and 32 age-, sex-, rhythm-, and ejection fraction–matched controls. RV free-wall longitudinal strain was measured using a novel investigational biventricular tracking approach from the basal RV free wall through the apex to the basal lateral left ventricular wall and compared with conventional RV strain. Investigational biventricular strain (BVS) was also obtained automatically as a surrogate marker of global ventricular function. Reproducibility was assessed in a subset of 20 patients using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland–Altman analysis. Results: Investigational RV free-wall strain was significantly reduced in patients with cardiac amyloidosis compared with controls (−15.3 ± 4.1% vs. −21.2 ± 5.4%, p < 0.001). Compared with conventional RV strain, the investigational biventricular tracking approach yielded more negative global RV strain values in both patients with amyloidosis (−15.3 ± 4.1% vs. −13.8 ± 4.8%, p = 0.003) and controls (−21.2 ± 5.4% vs. −17.4 ± 5.8%, p < 0.001). The greatest differences were observed at the apical RV segment. Bland–Altman analysis demonstrated a mean bias of −2.64 percentage points with 95% limits of agreement from −8.41 to +3.12 percentage points. A significant regional deformation pattern along the investigational tracking contour was observed in patients with cardiac amyloidosis (p < 0.001), whereas no significant regional variation was observed in controls. BVS correlated strongly with LV global longitudinal strain (r = 0.83 in amyloidosis; r = 0.58 in controls; r = 0.84 overall; all p < 0.001). Inter- and intra-observer reproducibility of investigational RV free-wall strain was excellent (ICC 0.976 and 0.985, respectively). Conclusions: The investigational biventricular tracking approach is a feasible and highly reproducible method for assessing ventricular longitudinal deformation using a single continuous contour. It provides complementary information while remaining an exploratory investigational technique. Further studies are required to validate its anatomical specificity, clinical applicability, and prognostic value.
Background/Objectives: Severe dengue and dengue–malaria coinfection represent major diagnostic and therapeutic challenges in tropical endemic settings, where overlapping clinical manifestations may delay recognition of deterioration. This study aimed to describe the clinical and epidemiological characteristics of patients with severe dengue, dengue with warning signs, and dengue–malaria coinfection treated at a referral hospital in Montería, Córdoba, Colombia. Methods: A retrospective case series was conducted by reviewing medical records of patients diagnosed with dengue between 2018 and 2023. Cases classified as dengue without warning signs were excluded. The final analysis included patients with dengue-warning signs, severe dengue, and dengue–malaria coinfection. Dengue classification followed the 2009 World Health Organization criteria, and malaria was confirmed by thick blood smear. Sociodemographic, clinical, laboratory, geographic, and outcome-related variables were collected. Descriptive analyses were performed, and selected categorical variables were compared using Fisher’s exact test. Results: Fifty-three patients were included: 25 (47.17%) with severe dengue, 14 (26.42%) with dengue with warning signs, and 14 (26.42%) with dengue–malaria coinfection. Severe dengue was more frequent among females, whereas dengue with warning signs and coinfection predominated in males. Children accounted for the highest proportion of severe dengue cases, while coinfected cases were mainly distributed between childhood and adolescence. Fever was documented in all patients. Edema, elevated hematocrit, severe plasma leakage, and hemodynamic compromise were more frequent among severe dengue cases, whereas myalgia differed significantly across clinical groups. Ten deaths were recorded, six occurring in coinfected patients. Conclusions: Severe dengue and dengue–malaria coinfection are clinically complex conditions with overlapping manifestations and potentially fatal outcomes, highlighting the need for early recognition, differential diagnosis, and close monitoring.
Background: Legionella pneumophila is a rare but severe cause of community-acquired pneumonia and can lead to acute respiratory distress syndrome (ARDS). Awake prone positioning (APP) has been recognized as an effective adjunct for non-intubated patients with hypoxemic respiratory failure, primarily studied in coronavirus disease 2019 (COVID-19) and other ARDS etiologies. Its application in Legionella-associated ARDS remains poorly documented. Therefore, in this work, we present a case of Legionella-associated ARDS successfully managed with APP, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), levofloxacin, and corticosteroids. Case presentation: A 62-year-old male with multiple comorbidities, including type 2 diabetes mellitus (T2DM) and a history of coronary artery bypass surgery, presented with a 3-day history of productive cough, exertional dyspnea, and general malaise. Oxygen saturation on admission was 90%, with fever and tachycardia. Inflammatory markers were markedly elevated. Chest computed tomography (CT) revealed extensive bilateral pulmonary infiltrates. Despite a negative urinary Legionella antigen test, sputum polymerase chain reaction (PCR) confirmed Legionella pneumophila on day 2. A Horowitz index of 147 mmHg on day 2 established moderate ARDS. The patient was treated with HFNC oxygen therapy, NIV, and APP for up to 12 h daily. Antibiotic therapy was initiated with amoxicillin/clavulanic acid and clarithromycin, subsequently streamlined to levofloxacin upon microbiological confirmation. Methylprednisolone 40 mg/day was administered for 8 days as adjunctive ARDS therapy. The patient demonstrated gradual clinical and respiratory improvement without requiring endotracheal intubation. Follow-up chest CT on day 7 showed regression of bilateral consolidations and ground-glass opacities (GGOs). The patient was transferred to pulmonary rehabilitation on day 11 and completed antibiotic therapy as an outpatient. Conclusions: This case illustrates the successful use of APP combined with HFNC and NIV alongside standard medical therapies, including appropriate antibiotics and corticosteroids, to avoid intubation in moderate ARDS secondary to Legionella pneumonia. Early initiation of APP may be a valuable strategy in Legionella-associated ARDS in carefully selected patients.
Background/Objectives: Calcaneal insufficiency fractures may be overlooked in older adults presenting with atraumatic heel-region pain because early radiographic findings can be absent or inconclusive. Evidence regarding how often these fractures are identified in routine outpatient practice remains limited. This study aimed to describe the observed frequency, diagnostic pathway, clinical characteristics, treatment, and documented clinical course of calcaneal insufficiency fractures in an orthopaedic outpatient cohort. Methods: We retrospectively reviewed consecutive patients aged 60 years or older who presented with atraumatic pain localised to the heel or calcaneal region between April 2012 and March 2020. All patients underwent initial plain radiography. Follow-up radiography and MRI were performed selectively when weight-bearing heel pain persisted, radiographic findings remained negative or equivocal, and clinical suspicion of an occult fracture remained. Observed fracture frequencies and exact 95% confidence intervals (CIs) were calculated. Results: Among 123 included patients, calcaneal insufficiency fractures were identified in 10, corresponding to an observed frequency of 8.1% (95% CI, 4.0–14.4%). Among 89 independently ambulatory patients, 9 fractures were identified, corresponding to an observed subgroup frequency of 10.1% (95% CI, 4.7–18.3%). These subgroup findings were descriptive and were not adjusted for potential confounders. All 10 fracture cases occurred in women, with a mean age of 78.4 years. Osteoporosis was newly identified in all fracture cases; the mean femoral-neck T-score was −3.42. Four fractures were identified on radiographic findings, whereas six required MRI to establish the diagnosis after radiographs remained negative or inconclusive. All cases were managed non-operatively. The mean interval from symptom onset to the first documented clinical improvement or resolution of heel pain was 28.4 days, and no displacement or subsequent surgical intervention was documented during the available follow-up. Conclusions: In this retrospective single-centre cohort, calcaneal insufficiency fractures were identified in a subset of older adults presenting with atraumatic heel-region pain. The observed frequencies should be interpreted as descriptive estimates rather than population prevalence figures. Calcaneal insufficiency fracture may be considered when focal heel pain persists despite normal or equivocal initial radiographs, with repeat radiography and MRI considered according to the clinical context. Prospective studies using standardised imaging and follow-up protocols are needed.
Background/objective: Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother–infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive age is very high (affecting 60–87 percent of pregnant women globally). The review aims to synthesize current evidence and highlight priority research areas to improve maternal mental health outcomes. Methods: A systematic literature search of PubMed, Scopus, and Google Scholar (2015–2026) was conducted, followed by narrative synthesis of mechanistic, observational, and interventional evidence. Results: Adequate vitamin D status may contribute to a reduced risk of postpartum depression through multiple interacting pathways, including serotonin synthesis and metabolism (via tryptophan hydroxylase 2 (TPH2) and monoamine oxidase-A (MAO-A) regulation), neuroplasticity via brain-derived neurotrophic factor (BDNF) signaling, and suppression of the pro-inflammatory cytokine cascade. Dose–response meta-analyses and large prospective cohort studies indicate consistent negative relationships between maternal vitamin D levels and postpartum depressive and anxiety symptoms with optimal serum 25-hydroxyvitamin D (25(OH)D) levels of 90–110 nmol/L. Conclusions: There is still limited evidence on the intervention; it is still methodologically diverse, and only a few randomized controlled trials have been carried out on specifically postpartum populations.
Background: Guselkumab, a monoclonal antibody selectively targeting the p19 subunit of interleukin-23, is typically administered with an induction phase at weeks 0 and 4 followed by maintenance dosing every 8 weeks for the treatment of psoriatic arthritis (PsA). In Europe, a four-week regimen (Q4W) has recently been approved for patients at high risk of joint damage progression; however, real-world evidence on this intensified schedule remains limited. This study aimed to evaluate the effectiveness and safety of guselkumab Q4W in routine clinical practice. Methods: This retrospective observational study included 18 PsA patients at high risk of structural damage treated with guselkumab Q4W at two psoriasis referral centers in the Lazio region of Italy. Baseline and 24-week clinical data were collected from medical records. Outcome measures included Disease Activity Index for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), pain Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), and Psoriasis Area and Severity Index (PASI). Results: After 24 weeks, mean DAPSA decreased from 34.3 ± 7.6 to 3.7 ± 3.0; 55.6% of patients achieved DAPSA remission and 77.8% achieved MDA. Significant improvements were observed in pain VAS, DLQI, and PASI scores. All patients achieved PASI 75, while 83.3% achieved PASI 90 and PASI 100. Treatment was generally well tolerated, with no adverse events or new safety signals documented during follow-up. Conclusions: In our study, guselkumab Q4W showed marked multidomain effectiveness and a favorable safety profile, supporting its use in PsA patients at high risk of joint damage progression.
Introduction: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. Materials and Methods: We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. We included articles from 2000 to 2026. Our search yielded 150 articles, out of which we selected 45 articles. Inclusion criteria were strictly limited to adult patients with a solitary mediastinal lymphangioma. Cases involving diffuse systemic lymphangiomatosis, mixed histological features such as lymphangiomyomas or hemangiolymphangioma or studies on pediatric populations were explicitly excluded from the analysis. We also reported a case of mediastinal lymphangioma in a 42-year-old patient, which was surgically resected at the “Marius Nasta” National Institute of Pneumology in Bucharest, Romania. Case Description: An asymptomatic 42-year-old male presenting with exertional chest discomfort following minor trauma demonstrated a lower left hemithorax opacity on chest X-ray. Imagistic studies revealed a 13 × 9 × 6 cm cystic mass in the left supradiaphragmatic costophrenic recess. The patient underwent a complete radical excision. The postoperative recovery was uneventful. Histopathology confirmed a benign cystic mediastinal lymphangioma. Conclusions: Adult mediastinal lymphangiomas are rare entities that require a high index of clinical suspicion. While advanced cross-sectional imaging is invaluable for delineating their characteristics, definitive diagnosis relies on histopathological confirmation. Complete surgical resection, increasingly performed via minimally invasive approaches or standard thoracotomy, remains the therapeutic gold standard, offering an excellent long-term prognosis with virtually no risk of recurrence. For inoperable cases, several non-surgical approaches are available.
Background: Patients with coronary artery disease (CAD) receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remain at risk of early adverse outcomes, including in-hospital mortality. Simple risk stratification based on routinely available variables may help identify higher-risk patients, but a limited number of outcome events constrains robust prediction-model development and validation. Aim: This exploratory study aimed to derive a preliminary, interpretable clinical score based on routinely available variables for risk stratification of all-cause in-hospital mortality in CAD patients receiving DAPT after PCI. In the clopidogrel-dominant practice setting of the participating centers, the score was conceived as a hypothesis-generating risk-enrichment framework rather than a validated treatment-selection tool or a surrogate measure of platelet reactivity. Methods: We analyzed a retrospective cohort of 1600 adults with CAD admitted between 2022 and 2024; 36 in-hospital deaths occurred. Twenty demographic, clinical, laboratory, and instrumental variables were evaluated. The primary outcome was all-cause in-hospital mortality during the index hospitalization. For exploratory score derivation, the dataset was randomly divided into a derivation subset (75%; n = 1200) and a hold-out assessment subset (25%; n = 400). Predictors were explored using univariable and multivariable logistic regression with stepwise selection. Continuous variables were categorized using Weight of Evidence binning, and an integer point score was derived. Performance was summarized using ROC analysis, AUC, sensitivity, specificity, and accuracy. Given the small number of deaths and the data-driven modelling workflow, all performance estimates were considered preliminary rather than definitive internal validation. Results: The exploratory six-variable score included age ≥ 57 years, estimated glomerular filtration rate < 45 mL/min/1.73 m2, body mass index ≥ 25 kg/m2, troponin I ≥ 100, prior myocardial infarction, and current smoking. In the derivation subset, each additional point was associated with higher odds of mortality (OR 1.39; 95% CI 1.29–1.51; p < 0.001), and the AUC was 0.654. A Youden-index threshold of approximately 6 points yielded sensitivity of 0.41, specificity of 0.80, and accuracy of 0.72. In the hold-out assessment subset, sensitivity was 0.53, specificity was 0.70, accuracy was 0.70, and AUC was 0.61. These estimates indicate modest discrimination and should be interpreted cautiously because only 36 outcome events were available. Conclusions: This exploratory clinical score showed modest discrimination for all-cause in-hospital mortality and should be regarded as a preliminary, hypothesis-generating risk-stratification approach. It is not sufficiently validated for routine prognostic classification, platelet-reactivity triage, or antiplatelet treatment selection. Model redevelopment using event-efficient methods, resampling-based internal validation, and subsequent external validation are required before clinical implementation.
Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up.
Objective: To report a rare case of bilateral iris metastasis from small cell lung carcinoma (SCLC) and systematically review the literature on SCLC-associated iris metastases, with emphasis on clinical presentation, management, and outcomes. Materials and Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, ScienceDirect, Scopus, and Web of Science were comprehensively searched on 10 July 2025. Eligible studies included English-language reports of iris metastasis originating from SCLC in human subjects. Case report: A 58-year-old woman with previously treated SCLC developed bilateral iris metastases one year after complete remission of the primary tumor. Ophthalmic examination revealed whitish-gray, vascularized iris masses with iridocorneal angle involvement, associated with secondary angle-closure glaucoma and markedly elevated intraocular pressure (48 mm Hg) in the left eye. Cyclocryotherapy, preceded by systemic and topical antiglaucoma therapy, resulted in pain relief and a reduction in intraocular pressure; the patient died four months later due to pneumonia. Results (Systematic Review): Seventeen studies comprising 17 patients were included; the median age was 60 years, and 64.7% were male. The median interval from SCLC diagnosis to ocular presentation was 4 months, although iris metastasis was occasionally the initial or concurrent manifestation of disease. The most common presenting features were visual impairment (58.8%), ocular pain (41.2%), and elevated intraocular pressure (41.2%), while iris neovascularization (35.3%) and synechiae (29.4%) were also frequent. Bilateral involvement was reported in only one previous case. Treatment approaches were heterogeneous and included antiglaucoma therapy, systemic chemotherapy, local radiotherapy, anti-VEGF therapy, and enucleation. Among patients with available follow-up (n = 12), 58.3% died within a median follow-up of 7.5 months. Conclusions: Bilateral iris metastasis from SCLC is rare and may occur as a manifestation of recurrent disease after remission. It is an aggressive condition characterized by nonspecific ocular symptoms, variable management, and poor survival, underscoring the importance of early recognition and the need for evidence-based diagnostic and therapeutic strategies.
Apert syndrome is a rare genetic disorder characterized by premature fusion of the cranial sutures, syndactyly of the extremities, and distinct craniofacial deformities. The condition results from mutations in the FGFR2 gene, which disrupt normal craniofacial growth and lead to complex functional and morphological abnormalities. Patients with Apert syndrome commonly present with stomatognathic abnormalities, which significantly affect oral function and facial development. The management of Apert syndrome requires a multidisciplinary therapeutic approach. Surgical treatment strategies are typically staged according to the patient’s age and clinical severity. Early interventions focus on cranial vault expansion procedures, such as fronto-orbital advancement and posterior vault distraction osteogenesis, aiming to relieve intracranial pressure and improve cranial morphology. During childhood and adolescence, midface advancement techniques are commonly performed to address midfacial hypoplasia and associated functional impairments. Early diagnosis and appropriate surgical planning play a crucial role in preventing complications and improving the functional, aesthetic, and psychosocial outcomes of patients with Apert syndrome. This narrative review summarizes current evidence while highlighting areas of ongoing controversy, particularly regarding surgical sequencing, orthodontic management and the integration of digital technologies into multidisciplinary care.
Background/Objectives: This study aimed to compare the visualization rates of fetal anatomical structures with standard 2D ultrasound examination versus a single 3D volume acquired during the first trimester. Methods: This multicenter prospective study was performed in nine tertiary referral centers, by experienced sonographers. A standard protocol was adopted in both 2D and 3D modalities to assess the 17 anatomical structures listed in the national and international guidelines. The included cases were non-anomalous fetuses from women booked for combined screening test between 11 + 0 and 13 + 6 weeks. Results: Two hundred and thirty-nine women were included in the study. The mean gestational age at ultrasound examination was 12 weeks ± 5 days (±5.4 SD). All the 17 structures were seen in 155/239 fetuses (64.85%) at 2D evaluation and in 84/239 (35.15%) at 3D evaluation (p = 0.001). Comparing 2D and 3D visualization, the following anatomical structures showed a statistical difference: posterior fossa (92% vs. 74%, p < 0.005); neck (94.2% vs. 87.2%, p < 0.001); orbits (93% vs. 85.6%, p < 0.001); nasal bone (93% vs. 88.8%, p = 0.016); lung fields (99.5% vs 96.7%, p = 0.046); cardiac axis (99.5% vs. 83.9%; p < 0.001); bladder (97.5% vs. 91.7%, p < 0.001); abdominal wall (98.7% vs. 94.2%, p < 0.001). For the other anatomical portion, no statistically significant differences were found. Conclusions: Our study demonstrates that a full assessment of fetal anatomy is best performed using 2D ultrasound, while 3D ultrasound showed lower overall visualization rates, with comparable performance for selected structures, suggesting a potential supplementary use in specific clinical contexts.
Background and Objectives: Gambling disorder (GD) is a behavioral addiction associated with distress, comorbidity, and functional impairment. This exploratory cross-sectional study examined associations between DSM-5-TR symptom burden, personality dimensions, cognitive emotion regulation, quality of life, and sociodemographic variables in a Romanian clinical sample. Materials and Methods: The sample included 122 adults with psychiatrist-confirmed pathological gambling/GD recruited from “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest. Personality was assessed with the Personality Clinical Form (PCF; 109 valid profiles), cognitive emotion regulation with the Cognitive Emotion Regulation Questionnaire, and quality of life with the Quality of Life Inventory. Symptom burden was measured using a nine-item binary DSM-5 symptom burden index. Results: The symptom burden index showed a pronounced ceiling effect: median = 9.00 (IQR = 9.00–9.00; range = 4–9), with 91.0% classified as severe and 77.9% meeting all nine criteria. In PCF analyses, symptom burden was positively associated, after Benjamini–Hochberg correction, with broad personality pathology, including maladaptive personality dimensions, personality-functioning indicators, and personality-disorder feature scales; the strongest association involved borderline features. Catastrophizing and Blaming Others were positively associated with severity, whereas Positive Reappraisal, Putting into Perspective, and Positive Refocusing were negatively associated. Quality of life was very low overall and associated with personality and coping variables, but not directly with symptom burden. Criterion-count rank distributions differed by marital status and perceived social support; occupational status showed an omnibus distributional difference, but no pairwise contrast survived correction. Conclusions: GD was characterized by severe symptom burden and restricted score variability. Findings support multidimensional assessment of personality functioning, emotion regulation, quality of life, and social–contextual vulnerability.
Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical or endovascular intervention. This revised narrative review synthesizes contemporary evidence on clinical, genetic, environmental, and health-system determinants of prolonged hospitalisation, intensive care unit (ICU) utilisation, bed occupancy, and costs in patients with AAS. Beyond summarising established risk factors, the review adds a resource-oriented framework that links hypertension, advanced age, female sex, smoking-related comorbidity, hereditary aortopathies, haemodynamic instability, malperfusion, delayed diagnosis, operative complexity, and postoperative complications to measurable downstream outcomes such as ICU length of stay, total hospital length of stay, reoperation, readmission, and longitudinal imaging surveillance. We searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant studies, registries, guideline documents, and cost analyses published between January 2000 and May 2026, with particular emphasis on studies from the last five years. The review was not designed as a meta-analysis; therefore, effect estimates are interpreted according to study design and generalisability. AAS imposes a disproportionate burden on hospital systems because high-risk patients often require advanced imaging, prolonged haemodynamic monitoring, complex open or endovascular repair, ICU care, and lifelong follow-up. Earlier diagnosis, structured risk stratification, targeted genetic evaluation, aggressive control of modifiable risk factors, and system-level pathways such as dedicated aortic networks may shorten hospital stay and reduce avoidable costs.
Background/Objectives: As population aging increases the prevalence of atrial fibrillation (AF), the use of direct oral anticoagulants (DOACs) has expanded for thromboembolism prevention. Although DOACs offer advantages over vitamin K antagonists (VKAs), gastrointestinal bleeding (GIB) remains the most common extracranial adverse event. Current guidelines address global bleeding risk but provide limited guidance on site-specific gastrointestinal risk assessment and prevention. This narrative review aims to summarize current evidence on the mechanisms, etiologies, and risk factors for DOAC-associated gastrointestinal bleeding and to propose a pragmatic, risk-based framework to support clinicians in individualized bleeding prevention. Methods: A narrative review of studies published between 2004 and 2025 was conducted, including randomized clinical trials, real-world evidence, meta-analyses, and major society guidelines. Evidence addressing DOAC safety profiles, gastrointestinal bleeding etiologies, patient-level risk factors, medication interactions, and preventive strategies was analyzed. Results: Gastrointestinal bleeding in patients treated with DOAC is strongly influenced by underlying gastrointestinal pathology, comorbid conditions, and concomitant medications. Established risk factors include prior gastrointestinal hemorrhage, Helicobacter pylori infection, gastrointestinal malignancy, diverticulosis, and angiodysplasia, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet therapy, or selective serotonin reuptake inhibitors (SSRIs). DOACs differ in gastrointestinal safety: apixaban consistently demonstrates the most favorable profile, whereas rivaroxaban and high-dose dabigatran show higher GIB rates. Preventive strategies such as H. pylori testing and eradication, proton pump inhibitor use in high-risk individuals, avoidance of NSAIDs and unnecessary antiplatelet therapy, and individualized DOAC selection may help reduce bleeding risk. Conclusions: Gastrointestinal bleeding risk in patients receiving DOAC therapy should be assessed using a site-specific and dynamic approach. A structured strategy integrating baseline risk evaluation, correction of modifiable factors, tailored anticoagulant selection, and risk-adapted follow-up may improve the safety of anticoagulation. The proposed framework may provide a pragmatic approach to individualized bleeding risk mitigation while preserving the benefits of DOAC therapy; however, prospective validation is required before its routine implementation can be recommended.
Background: Guselkumab, a selective interleukin-23 inhibitor, is effective in moderate-to-severe plaque psoriasis, but real-world long-term data in elderly patients remain limited. Objective: To evaluate the long-term effectiveness of guselkumab in elderly patients with moderate-to-severe psoriasis in a real-world setting. Methods: This retrospective, multicenter study included 102 patients aged 65 years or older treated with guselkumab across seven Italian centers. PASI scores and PASI 75/90/100 responses were assessed as observed cases at weeks 4, 16, 28, and 52, and annually up to 4 years, with last-observation-carried-forward and non-responder imputation as sensitivity analyses. Subgroups by biologic experience and BMI were analyzed. Results: Mean PASI decreased from 12.4 to 0.3 at week 52, remaining low through year 4 (p < 0.001). At week 52 and year 4, PASI 90 was achieved by 89.7% and 86.5%, and PASI 100 by 79.3% and 73.0%, respectively. Responses were comparable between biologic-naïve and biologic-experienced patients. Obese patients had higher baseline PASI; after adjustment for baseline severity, responses did not differ from non-obese patients. Conclusions: Guselkumab was associated with high and durable PASI improvement in elderly patients, regardless of prior biologic exposure or body weight. The retrospective design and absence of systematic safety data warrant cautious interpretation.
Background: Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, and an overactive bladder (OAB) among MS patients in the Qassim region, Saudi Arabia. Methods: This cross-sectional study was conducted in the neurological department of King Fahad Specialist Hospital in the Qassim region, Saudi Arabia, from January to December 2024. Data on age, sex, marital status, occupation, body mass index (BMI), MS duration, comorbidities, anxiety, depression, and OAB symptoms (frequency, nocturia, urgency, and urge incontinence) were obtained. Results: Of the 262 MS patients in this study, 184 (70.2%) were females, and 78 (29.8%) were males. The median values [IQR] of age and MS duration were 34 [26-40] and 5 [2-9] years, respectively. The prevalence of depression, anxiety, and OAB were 53.4%, 43.9%, and 50%, respectively. Nocturia was the most frequent urinary symptom, and urge incontinence was significantly higher among females. Multiple logistic regression analyses were conducted to assess factors associated with three binary outcomes: depression, anxiety, and OAB. For depression, being single and anxiety were associated with increased risk. Regarding anxiety, being a student was related to decreased risk, while being female and having depression were associated with increased risk. For OAB, only anxiety was associated with increased risk. Conclusions: Approximately one in two MS patients experience either depression or OAB, while anxiety was reported by fewer than half of the patients. This high prevalence of the three outcomes has critical implications for healthcare policy and resource allocation. Thus, screening, early diagnosis, and intervention, as well as integrated care, should be prioritized by healthcare institutions and practitioners to address these conditions and improve MS patients' quality of life.
Background: Post-thyroxine treatment of thyroid dysfunction remains a clinical concern, especially in Middle Eastern populations. Methods: This descriptive cross-sectional study was conducted in 2023 at King Fahad Hospital, Hufof, Kingdom of Saudi Arabia. Of the 237 patients treated with L-thyroxine (L-T4) for hypothyroidism, 163 patients, almost exclusively females (152 females, 11 males), met the inclusion criteria and were enrolled. Thyroid hormones, lipid profiles, and 25-hydroxyvitamin D (25OH-D) were measured using standard laboratory assays. Results: Only 57% of patients achieved euthyroid status following L-T4 treatment, while 12.3% developed post-thyroxine-treatment (PTT) hyperthyroidism, and 30.7% developed PTT hypothyroidism. Older age was significantly associated with dysthyroidism (p = 0.018), whereas obesity (p = 0.937) and vitamin D levels (p = 0.982) were not. Total cholesterol (TC) and LDLc positively correlated with TSH levels, while elevated triglycerides (TGs) were significantly associated with PTT hyperthyroidism. The two dysthyroid subgroups were comparable across all non-thyroid parameters, including age, BMI, 25(OH)D levels, and lipid fractions. However, free T4 was significantly higher in PTT hyperthyroidism (p < 0.001); free T3 showed a trend toward higher levels in PTT hyperthyroidism (p = 0.052); and TSH was significantly higher in PTT hypothyroidism (p < 0.001). Conclusions: The proportions of patients with PTT hypo- and hyperthyroidism are aligned with international observations. Furthermore, the age was significantly associated with dysthyroidism, and dyslipidemia is the most consistent biochemical correlate of suboptimal thyroid status; however, the associations of PTT dysthyroidism with hypovitaminosis D and BMI were not noticed in this setting.
Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential differences in clinical characteristics, comorbidities, and survival rates between patients diagnosed with pulmonary embolism (PE) during the pre-pandemic period (2018-2019) and those diagnosed during the pandemic era (2020-2022). Additionally, as a secondary objective, we analyze the clinical profiles, risk factors, and survival outcomes of patients with and without COVID-19 infection during the 2020-2022 period. Methods: A retrospective observational study was conducted to analyze survival and comorbidities in patients admitted for PE at the Hospital Central de la Defensa 'Gómez Ulla' between 2018 and 2022, comparing two periods (2018-2019 and 2020-2022). In addition, a sub-analysis was performed within the second period group comparing patients with and without COVID-19. Results: It was observed that the majority of patients in the first period were men, while in the second period, 55% were women. With regard to comorbidity and risk factors, thrombophilia and dementia were more prevalent in the first period, while asthma was more prevalent in the second period. No differences were found with regard to mortality. Conclusions: Significant differences were observed between the two periods of the study with regard to some comorbidities. Patients with COVID-19 showed a greater tendency toward immobilization and a higher prescription of thromboprophylaxis during hospitalization.
