Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan-Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (-) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.

Background/Objectives: An increasing number of older individuals require general anaesthesia for major non-cardiac surgery, with 20% displaying postoperative complications. Regional cerebral oxygen saturation (rSO2) correlates with the gold standard of mixed venous oxygen saturation, indicating global perfusion. We hypothesised that rSO2-based anaesthesia reduces organ dysfunction and morbidity after major non-cardiac surgery. Methods: In Singapore and Toronto, we conducted a prospective, double-blind, randomised controlled trial in elderly patients undergoing major non-cardiac surgery, after obtaining research ethics board permission and informed consent. This RCT followed the CONSORT guidelines. Patients received bilateral cerebral oximetry sensors, and the control group received standard care. In the intervention group, an algorithm restored rSO2 if it dropped 10% below baseline for >15 s by adjusting cerebral perfusion pressure, inspired oxygen concentration, end-tidal carbon dioxide, depth of anaesthesia, haemoglobin, and cardiac index. Postoperative complications and outcomes were noted. Categorical data were analysed using Chi-square or Fisher's exact tests and continuous data using a t-test or a Mann-Whitney U test. The study was powered for 394 patients, but due to the COVID-19 pandemic and funding constraints, this study was terminated at 101 patients. Results: Of 101 patients, 49 were randomised to the control and 52 to the intervention group. A total of 31 (63%) patients in the control group and 30 (58%) in the interventional exhibited bilateral cerebral desaturation. Time of cumulative cerebral desaturation was longer in the control group (23 ± 48 min vs. 9 ± 15 min, respectively, p = 0.01). A total of 142 algorithm-based treatments were employed, restoring rSO2 in 29 (86%) patients. Both groups displayed equal postoperative outcomes. Conclusions: In major non-cardiac surgery, cerebral desaturation is prevalent in over 85% of patients. Although algorithm-guided therapy restored rSO2 in the majority of patients, it did not result in reduced postoperative morbidity.

Background/Objectives: Previous studies have shown that hypothyroidism with myxedema may significantly affect the vocal folds. The aim of this study was to investigate thyroid dysfunction and other possible risk factors, including smoking, for the development of Reinke’s edema (RE) in a group of men. Methods. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured in a group of men with first occurrence or recurrent RE and in age- and gender-matched control subjects without laryngeal pathology. All participants completed a questionnaire on other possible etiologic factors for the development of RE, especially smoking. Risk factors were compared between the two groups. Levels of TSH and thyroid hormones were also compared between patients with recurrent disease and those with a first occurrence of RE. Results. A total of 53 men with RE (mean age 53.82 years) and 45 controls (mean age 57.71 years) completed the study protocol. TSH and thyroid hormone levels were within the normal limits in all participants. Serum fT3 levels were significantly higher in patients with RE compared to controls (p = 0.034). After univariate analysis, all risk factors were included in a multivariate regression model. Only smoking remained a significant variable. Thyroid hormone levels did not differ between patients with first-onset RE and those with recurrent RE. Conclusions. An association between hypothyroidism and the development of RE was not confirmed. The significantly higher fT3 levels in patients compared to controls were still within the normal range and may reflect normal variation. Regression analysis of possible risk factors for RE showed the primacy of smoking.

Background: Emergency contraception (EC), also known as postcoital contraception, is a method used to prevent an unintended pregnancy following unprotected or inadequately protected sexual intercourse. The available options include emergency contraceptive pills or the insertion of an intrauterine device (IUD). Emergency contraception pills contain either levonorgestrel (a single 1.5 mg dose, effective within 72 h) or ulipristal acetate (a single 30 mg dose, effective within 120 h), both of which are most effective when taken as soon as possible after unprotected intercourse. Another highly effective option is the insertion of a copper or levonorgestrel-releasing intrauterine device, although IUDs are not registered for EC use in all countries. The aims of this cross-sectional, comparative, observational study were to collect data on the emergency contraception methods used by adolescent girls and young women to examine their association with various factors, such as religious beliefs, and to evaluate the effectiveness of different emergency contraception methods, including hormonal options and intrauterine devices. Methods: Data were collected from 240 women who attended our Family Planning Clinic using a structured questionnaire that included items on their demographic characteristics, religious beliefs, medical history, lifestyle factors, contraceptive use and side effects, prior use of emergency contraception, method selected, and reasons for seeking emergency contraception. Descriptive statistics were used to summarize the data, comparisons between religious groups were conducted using chi-square tests, and factors related to the timing of emergency contraceptive use were investigated using multinomial logistic regression analysis. Results: Most of the reasons for emergency contraception use did not differ significantly between Christian and Muslim participants. However, Christians were significantly more likely to use emergency contraception due to missed contraceptive doses (20.9% vs. 6.7%, p = 0.004) or the failure to take a progesterone-only pill (19.1% vs. 3.3%, p = 0.001). Levonorgestrel was the most frequently used method in both groups (48.9% of Christians vs. 60% of Muslims, p = 0.132), followed by ulipristal acetate (30.9% vs. 40%, p = 0.180). Notably, 18.5% of Christian participants used an intrauterine device (IUD) for emergency contraception, while no Muslim participants reported IUD use (p < 0.001), indicating a significant difference potentially influenced by cultural or religious factors. Conclusions: Both religious and individual sociodemographic factors affect not only the choice of emergency contraception but also the urgency with which the emergency contraception is used. Interventions aimed at improving contraception education, addressing partner-related challenges, and promoting timely access could improve reproductive health outcomes.

Objectives: The aim of our study was to assess the efficacy and safety of two different labor induction methods in patients after fetal demise beyond 28 weeks, with an unfavorable cervix: misoprostol-prostaglandin E1 analog (PGE1) and dinoprostone-prostaglandin E2 analog (PGE2). Methods: This retrospective single-center cohort study included all labor cases after fetal demise (intrauterine fetal death or termination of pregnancy with feticide) from 28 to 40 weeks of gestation, where labor was induced by either PGE1 or PGE2. The primary outcome was the induction-to-delivery time interval. Secondary outcomes included the proportion of patients who delivered within 24 h, the failed induction rate, the length of labor, pain during induction, the adverse outcome rate, and the post-labor hospital stay. Results: The induction-to-delivery time interval was shorter in the PGE1 group (p = 0.048). There was no statistically significant difference in the proportion of patients who delivered within 24 h (p = 0.651) and failed inductions (p = 0.18) between groups. The duration of labor was longer in the PGE2 group (p = 0.01). Oxytocin augmentation was more common in the PGE2 group (p < 0.001). Pain during induction was greater in women in the PGE1 group (p < 0.001). There were no statistically significant differences in adverse effects between groups. There was no significant difference in induction to delivery interval between the two methods when comparing lower and higher gestational ages (28 to 34 weeks, p = 0.18; 35 to 40 weeks, p = 0.343). Conclusions: Our findings support the use of a PGE1 regimen for third-trimester labor induction after fetal demise, when no contraindications exist. This approach appears to improve the efficiency of induction and may enhance overall patient care by reducing intervention needs.

Background/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein-Barr virus (EBV)-positive NK/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. This report presents a case of an ASP-related HSR and reviews the incidence within our institutional cohort. Detailed Case Description: A 60-year-old female presented an immediate Grade 2 HSR during her second PEG-asparaginase infusion, with pruritus, vomiting, and presyncope. The infusion was discontinued, and she was subsequently transitioned to crisantaspase-an alternative formulation-which was well tolerated without further adverse events. She remains disease-free to date. A retrospective review of institutional records (2015-2025) identified six patients with NKTCL treated with ASP-containing chemotherapy. The incidence of HSRs in this cohort was 1 of 6 (16.7%). Conclusions: As in acute lymphoblastic leukemia, HSRs to asparaginase remains a major challenge in the management of NKTCL with potential implications for treatment safety and efficacy. The establishment of standardized, consensus-based criteria for the diagnosis, classification, and management of ASP-related HSRs is urgently needed to optimize patient outcomes.

Background/Objectives: Phrenic nerve conduction (PNC) studies are essential for evaluating respiratory dysfunction and neuromuscular disorders. Despite international reference data, no normative values exist for the Mexican population. This study aimed to establish reference values for PNC latency and amplitude in healthy Mexican adults. Methods: We conducted a cross-sectional study between June 2022 and February 2023 including healthy adults (>18 years). Bilateral PNC studies were performed using surface electrodes and a 4-channel stimulation device. Latency and amplitude were recorded, and demographic and anthropometric data were collected. Results: Fifty subjects (22 women, 44%; 28 men, 56%) were enrolled. Mean latency was 6.10 ms (SD ± 1.48), and mean amplitude was 0.60 mV (SD ± 0.20). Significant differences were observed in left phrenic nerve latency between women and men (median 5.83 vs. 6.37 ms, p = 0.0348) and in amplitude between left and right phrenic nerves (0.55 vs. 0.65 mV, p = 0.0036). No significant correlations were found between latency and age or between amplitude and thoracic perimeter; however, the correlation coefficient suggests a positive relationship for both that should be confirmed in future studies with a larger sample size. Conclusions: This is the first report of PNC normative values in Mexican adults. Findings are consistent with international data and provide locally relevant reference values. Larger multicenter studies are warranted to validate and expand these results.

Background/Objectives: Written discharge explanations are crucial for patient understanding and safety in emergency eye care, yet their tone and clarity vary. Large language models (LLMs, artificial intelligence systems trained to generate human-like text) can produce patient-friendly materials, but direct, blinded comparisons with clinician-written texts remain scarce. This study compared patient perceptions of a routine clinician-written discharge text and a GPT-5-generated explanation, where GPT-5 (OpenAI) is a state-of-the-art LLM, based on the same clinical facts in emergency ophthalmology. The primary objective was empathy; secondary outcomes included clarity, detail, usefulness, trust, satisfaction, and intention to follow advice. Methods: We conducted a prospective, single-blind, within-subject study in the Emergency Ophthalmology Unit of the University Hospital Centre Split, Croatia. Adults (n = 129) read two standardized texts (clinician-written vs. GPT-5-generated), presented in identical format and in randomized order under masking. Each participant rated both on Likert scales with 1-5 points. Paired comparisons used Wilcoxon signed-rank tests with effect sizes, and secondary outcomes were adjusted using the Benjamini-Hochberg false discovery rate. Results: Empathy ratings were lower for the GPT-5-generated text than for the clinician-written text (means 3.97 vs. 4.30; mean difference -0.33; 95% CI -0.44 to -0.22; p < 0.001). After correcting for multiple comparisons, no secondary outcome differed significantly between sources. Preferences were evenly split (47.8% preferred GPT-5 among those expressing a preference). Conclusions: In emergency ophthalmology, GPT-5-generated explanations approached clinician-written materials on most perceived attributes but were rated less empathic. A structured, human-in-the-loop workflow-in which LLM-generated drafts are reviewed and tailored by clinicians-appears prudent for safe, patient-centered deployment.

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain limited. Objective: The objective of this study was to describe a single healthcare system’s implementation and early experience with an AI-enabled triage tool for pulmonary embolism patients across a multi-hospital network. Methods: This retrospective observational study evaluated the deployment of an AI-based clinical decision support system within a healthcare network. The AI tool detected PE and right ventricular (RV) strain and alerted the PE response team (PERT) to facilitate timely transfer and intervention. Three cohorts were evaluated: pre-AI, Year 1 post-AI, and Year 2 post-AI. Outcomes included transfer volumes, advanced therapy rates, and hospital length of stay (LOS). Results: A total of 183 PE transfer patients were analyzed: 36 pre-AI, 72 in Year 1 post-AI, and 75 in Year 2 post-AI. Transfers increased by 100% in Year 1 (p = 0.0005) and 108% in Year 2 (p = 0.011) compared to pre-AI. Catheter-based thrombectomy increased from 10 pre-AI to 18 in Year 1 (+80%, p < 0.0001) and 28 in Year 2 (+180%, p = 0.0006). After-hours diagnosis rose from 69.4% pre-AI to 70.8% in Year 1 (p = 0.027) and 77.3% in Year 2 (p = 0.088). Surgical embolectomy showed a borderline increase in Year 2 (p = 0.04), though case numbers were small. Conclusions: Implementation of an AI-assisted triage platform for PE was associated with sustained increases in interhospital transfers and advanced interventions, and a reduction in hospital length of stay. These findings support the potential for AI to standardize and expedite acute PE care in a multi-hospital health system.

The oral microbiome may be an indicator of oral pathologies and hormonal fluctuations. Consequently, the proper identification of methods for studying microbial factors is essential. Because more than half of the components of the oral microbiome belong to species that are very difficult or even impossible to cultivate in the laboratory, the assessment of the oral microbiome nowadays is based on genetic sequencing, using techniques such as DNA hybridization, 16S rRNA sequencing, and metagenomics, mainly analyzing saliva and subgingival plaque. Variations in results may be caused by differences in sample type, analysis methods, accuracy in determining cycle phases, and biases introduced by DNA extraction techniques and technical variations. Choosing the right primers for the 16S rRNA gene and reference databases (like HOMD, Greengenes2) is essential for accurately identifying microorganisms. Metagenomic sequencing offers greater taxonomic and functional detail, but it is costlier and presents bioinformatics challenges, including contamination with human DNA. When the patients under study are women, we have to take into consideration the cyclical changes in the menstrual cycle. Studies suggest that estrogen influences local immune and inflammatory responses and can worsen existing gingival inflammation. Certain oral bacteria can even utilize estradiol and progesterone as growth factors. The composition of the oral microbiome is also affected by hormonal contraceptives, carbohydrate intake, smoking, age, body mass index, genetics, and oral hygiene—all factors that need to be controlled for in future studies. Interpreting the biological significance of the reported cyclic changes requires careful examination of the specific methods used in each study.