Laniado Hospital

First-trimester ultrasound has evolved to incorporate a detailed fetal anatomy scan (FAS) with nuchal translucency (NT) screening. Many institutions use a 2-visit protocol: NT followed by detailed FAS at 14-16 weeks. We aimed to evaluate whether integrating detailed FAS into the NT window (12 + 5 to 13 + 6 weeks) is non-inferior in diagnostic yield to the 2-visit protocol. We enrolled 755 mixed high- and low-risk pregnant women with singleton gestations into either integrated NT + FAS group (n = 243, 12 + 5 to 13 + 6 weeks) or 2-visit group (n = 512, 14-16 weeks). All underwent follow-up at 20-24 weeks. Scans followed ISUOG guidelines; the primary outcome was detection of fetal anomalies during detailed early scans. Non-inferiority was defined as a margin of ≤6% difference in detection rates. Study groups were similar except in parity (mean 2.6 [0-9] vs. 3.1 [0-10], P = .0081 in FAS + NT and 2-visit group, respectively). Anomalies were identified in 16 fetuses (7.5%) in the NT + FAS group and 16 (3%) in the 2-visit group (P = .033). Additional anomalies were detected at mid-trimester in 2/227 (0.9%) NT + FAS and 4/496 (0.8%) 2-visit group fetuses (P = 1.0). The integrated approach met non-inferiority criteria. Detailed FAS during the final NT window week is non-inferior to the 2-visit approach. This integrated protocol offers earlier reassurance without compromising diagnostic accuracy.

Background/Objectives: Multiparametric MRI (mpMRI) and targeted biopsies have revolutionized prostate cancer (PC) detection through the Prostate Imaging Reporting and Data System (PIRADS). However, the effect of prostate volume on cancer detection and the predictive accuracy of PIRADS in the mpMRI-guided biopsy era remains unclear. The aim was to assess whether prostate volume affects detection rates of clinically significant prostate cancer (CSPC) and high-risk prostate cancer (HRPC) and modifies the predictive performance of the PIRADS score. Methods: We retrospectively analyzed 361 biopsy-naïve men who underwent mpMRI-fusion transperineal biopsies between 2016 and 2023. Lesions graded PIRADS ≥ 3 were targeted alongside systematic sampling. A receiver-operating characteristic (ROC) curve (AUC = 0.74) defined a 44 mL cutoff separating small (<44 mL; n = 160) and large (≥44 mL; n = 193) prostates. Logistic regression and cubic-spline analyses evaluated associations between prostate volume, PIRADS, and cancer outcomes. Results: Any cancer was detected in 74.3% of small versus 35.5% of large prostates (p < 0.001); CSPC in 42.5% vs. 19.6% (p < 0.001); HRPC in 14.3% vs. 5.5% (p < 0.001). Small prostate volume independently predicted any cancer (OR 7.31; 95% CI 4.22–12.7), CSPC (OR 5.08; 95% CI 2.87–8.99), and HRPC (OR 4.50; 95% CI 1.80–11.3). Between 40 and 70 mL, each 10 mL increase in volume reduced CSPC risk by 61% (p = 0.008). Prostate volume significantly modified PIRADS accuracy: in large glands, PIRADS 3 lesions carried only 2% risk for CSPC and 0% for HRPC, while in small prostates, PIRADS 3 conferred a 16.9-fold increased CSPC risk. Conclusions: Prostate volume inversely correlates with cancer detection and aggressiveness. PIRADS performance is volume-dependent; PIRADS 3 lesions in large prostates rarely represent significant cancer and may not warrant biopsy.

Several publications have suggested that elderly patients with open ankle fractures may have grave prognosis in terms of mortality, similarly to elderly patients with hip fractures. In this study we evaluated the effect of open ankle fractures on patient mortality in elderly population, including octogenarians and nonagenarians. This retrospective cohort included all patients above the age of 60 treated in Japan public emergency care hospitals between the years 2010 and 2018. Patients with lateral malleolus, medial malleolus, bimalleolar, trimalleolar and pilon fractures were included. The outcomes were mortality, length of hospital stay, surgical site infections and readmissions within one year. There was a total of 6766 patients ages above 60, of whom 6062 had closed fractures and 704 had open fractures. Open fractures were not associated with higher mortality than closed fractures. Patients with open fractures stayed in the hospital for longer time (median of 51 vs 37 days, p < 0.001), had higher rate of surgical site infections (5.3 % vs 1.7 %, p < 0.001) and a lower rate of readmissions (2.6 % vs 6.2 %, p < 0.001). The study shows that elderly patients with open ankle fractures are hospitalized for longer time and experience a higher rate of surgical site infections. However, they do not experience excess short-term mortality in this study setting. IV (non-experimental study).

ABSTRACT Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important threat to hospitalized patients. The virulence of A. baumannii varies between strains and geographic locations, which is believed to be related to its genetic plasticity. A comprehensive evaluation of virulence factor (VF) content of CRAB across genetically related clones is lacking. Therefore, we aimed to determine the evolution of VFs among 246 CRAB isolates belonging to major STs, ST2 and ST3. We used WGS to assess 136 VFs and found that 110 VFs were present in most isolates (49 VFs were universally present, 61 were ubiquitous) and 25 occurred sporadically. The distribution of the 25 sporadic VF genes was homogenous in ST3 but heterogeneous in ST2. Within ST2, we found high intra-clade homogeneity and high inter-clade heterogeneity of VFs. The homogeneity of VF content in ST2 clades and its uniformity in ST3 suggest a distant evolutionary segregation of VFs at the root of ST/clade divergence. VF content reflects remote events resulting in minimal variation between isolates belonging to the same ST/clade. Thus, the alleged differences in virulence of CRAB strains between geographical locations reflect differences in clonal distribution.

Chronic kidney disease (CKD) has significant clinical and therapeutic implications. This study assessed CKD prevalence, risk factors, and long-term outcomes in patients with systemic lupus erythematosus (SLE), both with and without lupus nephritis (LN). This single-center, retrospective, medical records review study, conducted between 2014 and 2023, included adult patients with SLE. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or albuminuria ≥ 30 mg/24 h in ≥ 2 consecutive tests, spaced ≥ 3 months apart. Statistical analyses included chi-square tests, t tests, multivariable regression, and Cox proportional hazards models. A total of 175 patients with SLE were included, with a mean follow-up of 18.3 (SD 14.7) years. Of these patients, 12 required kidney replacement therapy. CKD was diagnosed in 54.6% (89/163) of patients, including 15.7% with reduced eGFR only, 52.8% with albuminuria only, and 31.5% with both. LN was associated with a higher hazard ratio (HR) of 5.4 for CKD, and 46.1% of patients with CKD had no history of LN. CKD was associated with increased cardiovascular morbidity and hospitalization rates for SLE exacerbations and infections. Cox analyses identified LN as the strongest predictor of CKD, with age and lower eGFR at diagnosis identified as other predictors. CKD was an important predictor of mortality among patients with SLE, in both univariate and multivariable analyses (19.1% vs 1.4%, P < 0.001). CKD is highly prevalent in SLE, including in patients without prior LN. CKD is associated with increased morbidity and mortality. This study emphasizes the clinical relevance of CKD diagnosis and management in patients with SLE.

Hyponatremia is common among hospitalized children, including those with community acquired pneumonia. The prevalence and severity of hyponatremia were reported to correlate with disease. However, data regarding the association between hyponatremia and causative infectious pathogens are limited and results are inconsistent. To investigate the associations between sodium levels, severity and causative pathogen in children with pneumonia. A retrospective study of all children (< 18 years) hospitalized with pneumonia from 1 January 2018 to 31 December 2020. Admission sodium levels were compared to the presumed etiological pathogens, clinical parameters, and inflammatory markers. Among 751 (52% males) children, 10 (1%) had sodium levels < 130 mEq/L, 187 (25%) had mildly decreased levels 130-134 mEq/L, and the remaining 554 (74%) had normal levels 135-145 mEq/L. Sodium levels < 130 mEq/L were found in 7/236 (3%) of the patients with presumed bacterial pneumonia, in 0/20 of patients with presumed atypical-bacterial, and in only 3/495 (0.6%) of the patients with a presumed viral infection, P < 0.001. Sodium levels < 135 mEq/L conferred an odds ratio of 3.1 (95% confidence interval [95%CI] 2.1-4.3) and levels < 130 mEq/L an odds ratio of 6.8 (95%CI 1.8-33.0) for bacterial infection, P < 0.001 for both. Hyponatremia was also inversely associated with high white blood cell counts, absolute neutrophil cell counts, and C-reactive protein levels. Hyponatremia was common among children hospitalized with pneumonia and was associated with elevated inflammatory markers and presumed bacterial pneumonia.

A patient with longstanding alcohol abuse disorder presented with subacute abdominal pain with increasing girth, and acute severe diarrhoea. Diarrhoea was due to concurrent acute bacterial pancolitis which resolved with treatment. Ascites with high serum albumin-ascites gradient was diagnosed, secondary to recent-onset portal hypertension, due to acute alcoholic hepatitis. Examination, laboratory or imaging stigmata of liver cirrhosis were conspicuously absent, and no alternative explanation other than acute alcoholic hepatitis was found. Thus, acute alcoholic hepatitis can rarely cause marked portal hypertension.