Several indices are available to predict poor outcomes in older patients admitted to the emergency department (ED); however, there remains a need for more practical, sensitive, and easily applicable tools. This study aimed to develop a novel prognostic index to predict the risk of disability, hospitalization, and mortality in older patients presenting to the ED. This study included 356 patients aged 65 and older presenting to the ED. Exclusion criteria were: poor general condition preventing response to questions, low level of consciousness (GCS <15), inability to provide informed consent, and lack of prospective follow-up. The G8 scale, PRISMA-7 questionnaire, Katz Activities of Daily Living Questionnaire (ADL) scale, and Charlson Comorbidity Index were administered. Follow-up assessments were conducted via telephone on the 30th and 180th days post-application, using the Katz ADL scale. Patients or their relatives were also queried about repeated outpatient clinic visits, emergency admissions, hospitalizations, nursing home admissions, and survival status. Parameters significantly associated with adverse outcomes in univariate analysis were further analyzed using multivariate regression, resulting in the development of the GAZI Index. This new index includes six simple parameters independently associated with adverse outcomes. The predictive performance of the GAZI Index was compared to that of the PRISMA-7, a validated tool in the ED. The GAZI Index demonstrated significantly superior predictive ability for poor outcomes compared to the PRISMA-7 (p = 0.008). The GAZI Index is a novel, valid, and practical tool for predicting adverse outcomes in older patients presenting to the ED.

Background Natural killer/T-cell lymphoma (NKTCL) is a highly invasive non-Hodgkin lymphoma (NHL) characterized by extranodal onset, commonly observed in the nose and nasopharynx. NHL in the female reproductive system is rare, mostly secondary, occurring in the ovaries, cervix, uterine body, and endometrium. The prognosis of this disease is extremely poor, with most patients dying within a few months of diagnosis. Owing to its rarity, the prognostic factors are difficult to ascertain. Here, we report a case of extranodal NK/T-cell lymphoma in the uterus related to pregnancy. Case report A 31-year-old woman sought treatment for continuous vaginal discharge after cesarean section, however, anti-inflammatory treatment had no effect. A lump was found on the anterior wall of the uterus on transvaginal ultrasonography, so uterine lesion resection was performed. Owing to pathological misdiagnosis as uterine fibroids, treatment was delayed for 10 months. After readmission with a clear diagnosis, radiotherapy, chemotherapy, and autologous stem cell transplantation were done, and the disease was put into completely remission. Conclusion Primary uterine NKTCL is rare, and special attention should be given to women infected with Epstein-Barr Virus (EBV) during their pregnancy and post-partum period, especially patients with abnormal uterine bleeding, vaginal discharge, fever, or high LDH.

Background Ustekinumab (UST) reduced symptom prevalence, work productivity loss (WPL) and indirect costs among Crohn’s disease (CD) patients in clinical trial. However, little is known on real-world effectiveness of UST in relation to symptom prevalence, WPL, and indirect costs, which we aimed to evaluate in this study. Methods Data were drawn from the Adelphi Real World CD Disease Specific Programme, a cross-sectional survey of gastroenterologists and their CD patients in the United States of America. Gastroenterologists provided data on consulting patients capturing symptoms and treatment use; a proportion of those patients completed a voluntary questionnaire capturing the Work Productivity and Activity Impairment (WPAI) questionnaire. Outcomes were descriptively analyzed between patients receiving and not receiving UST, while symptom prevalence was compared using McNemars test. Results Gastroenterologists reported data on 197 UST patients and 72 non-UST patients with moderate-to-severe (M-S) disease activity. At last consultation, the proportion of patients with symptoms decreased from UST initiation to most recent consultation (p < 0.0001). Of those with WPAI data available, for UST patients (n = 39) (vs non-UST M-S, n = 39), mean percentage impairment in overall work was 21.1% (vs 51.0%), presenteeism was 19.8% (vs 44.9%) and absenteeism was 3.2% (vs 16.7%). Mean annual total work productivity loss cost/patient was $12,211 for UST vs $30,096 non-UST MS patients. Conclusions Patients with CD receiving UST had lower mean annual WPL costs and work impairment compared to moderate-to-severe patients with CD not receiving UST along with reduced symptomology over their UST treatment period, suggesting UST offers economic and health related quality of life benefits to this population.

Plain Language Summary What is this summary about? Alzheimer’s dementia is a disorder of the brain. People living with Alzheimer’s dementia have a slow decline of their thinking, memory, and behavior. Agitation is common among people living with Alzheimer’s dementia, and can show in different ways such as restlessness, repetitive questions, wandering, shouting, swearing, and kicking. Brexpiprazole is a medicine used to treat agitation in people living with Alzheimer’s dementia. Many types of medicine can cause harmful side effects when they are used by older people living with dementia. Therefore, researchers decided to have a detailed look at the side effects of brexpiprazole over 3 months and 6 months of use. Researchers combined information from four previous clinical studies of brexpiprazole in people with agitation in Alzheimer’s dementia. What are the key takeaways? Side effects were reported by roughly 1 in 2 people (around 50%) treated with brexpiprazole, over 3 months and over 6 months. This was slightly higher than in people taking placebo (a pretend medicine) over 3 months. The number of people with side effects like stroke, heart problems, movement-related (extrapyramidal) symptoms, sleepiness, infections, dizziness, and falls were generally similar between brexpiprazole and placebo. What are the main conclusions reported by the researchers? No new or unexpected safety problems were found in people with agitation in Alzheimer’s dementia who were taking brexpiprazole, even when it was taken for up to 6 months. These results, combined with previous results showing that brexpiprazole can improve agitation, suggest that brexpiprazole may be a helpful treatment for people with agitation in Alzheimer’s dementia. How to say (download PDF and double click sound icon to play sound)… Agitation: a-juh-TAY-shun Alzheimer’s: ALTS-hy-mers Antipsychotic: an-tee-sy-KOH-tick Brexpiprazole: brex-PIP-ruh-zohl Dementia: dih-MEN-shuh Placebo: pluh-SEE-bo Side effect: A new or worsening health issue that a person has during a clinical study. Clinical study: A study to evaluate the effects of potential new treatments in people. Extrapyramidal: Side effects to do with movement, such as shaking, stiffness, or muscle contractions. Safety: The risks associated with taking a treatment, such as its side effects. This is an abstract of the Plain Language Summary of Publication article. View the full Plain Language Summary PDF of this article to read the full-text Link to original article here Trial registration: ClinicalTrials.gov identifier: NCT01862640; NCT01922258; NCT03548584; NCT03594123.

Background As the cornerstone of ablation, cryoballoon Ablation (CBA) still has certain limitations, whereas Pulse Field Ablation (PFA) offers a non-thermal and tissue specific alternative. This review aims to compare the safety and efficacy of PFA and CBA. Methods A systematic search for eligible studies was conducted in trial registries and databases until August 31, 2024. A total of 1090 patients from eight studies were included. Results Most studies reported higher 1-year free recurrence rate in PFA, but did not yield statistical significance (RR 1.03, 95%CI: 0.94, 1.12, p = 0.55, I2 = 0%). PFA was associated with a significantly lower contrast volume (MD −41.63, 95% CI: −49.19 to −34.06, p < 0.00001, I2 = 0%), but showed non-significant differences in procedural time (MD −5.84, 95% CI: −12.35 to 0.66, p = 0.08, I2 = 83%) and fluoroscopy time (MD 1.43, 95% CI: −0.09 to 2.95, p = 0.07, I2 = 75%). Complications were comparable, except for phrenic nerve palsy (PNP) that occurred exclusively in CBA. PFA and CBA are comparable in the terms of acute success and 1-year free recurrence rates. Repeat procedures were more frequent after PFA. However, organized atrial tachycardia (AT) was more commonly observed in the CBA group, while recurrences in both groups were predominantly Atrial Fibrillation (AF). Conclusion PFA offers advantages in procedural time and contrast medium use. Complication rate for PFA and CBA was similar except for PNP which exclusively occurred in CBA.

Aim Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), and its more severe form, Metabolic Dysfunction-Associated Steatohepatitis (MASH), pose significant global health challenges. Conventional cardiovascular risk models, such as the ASCVD Risk Estimator Plus, are limited in accurately predicting CVD risk in MASLD/MASH patients. This study aims to enhance the predictive accuracy of cardiovascular events in MASLD/MASH patients by developing a novel regression model, the LIVER-ASCVD+ model, which integrates traditional cardiovascular risk factors with liver biomarkers. Methods A retrospective cohort study was conducted using data from 9,185 biopsy-confirmed MASH patients within an integrated delivery network in the US. The study compared the performance of the LIVER-ASCVD+ model against the ASCVD Risk Estimator Plus. Kaplan-Meier survival analysis was conducted to assess outcomes, with comparisons made to two propensity-matched non-MASH control cohorts. Results The LIVER-ASCVD+ model demonstrated superior predictive accuracy for myocardial infarction (MI)/stroke events (AUC: 0.68) and mortality (AUC: 0.63) compared to the ASCVD Risk Estimator Plus (MI/stroke AUC: 0.63; mortality AUC: 0.54). The model stratified patients into high and low-risk categories, with significant differences observed in 10-year MI/stroke incidence and mortality rates. Kaplan-Meier analyses further validated the improved performance of the LIVER-ASCVD+ model in predicting cardiovascular outcomes. Conclusion The integration of liver-specific biomarkers into cardiovascular risk assessment models for MASLD/MASH patients significantly enhances predictive accuracy. The LIVER-ASCVD+ model represents a promising approach to improving clinical decision-making and patient outcomes in MASLD/MASH, warranting further validation.

Objective To describe comorbidity and comedication burden among people living with HHIV(PLWH) compared with matched people without HIV and evaluate 5-year trends among PLWH from 2020–2024. Methods This retrospective study used administrative claims data (01/01/2016–01/31/2025) from Optum’s de-identified Clinformatics Data Mart Database. The PLWH cohort included adults with ≥1 medical or pharmacy claim for an antiretroviral therapy (ART) agent in 2024 or, for those not treated with ART, an HIV diagnosis code alone (index date: earliest ART or HIV claim). People without HIV were matched 2:1 to PLWH based on age group, sex, race/ethnicity, region, and insurance type. Baseline characteristics, comorbidity burden, and comedication burden were compared between matched cohorts. Results 26,078 PLWH and 52,156 matched people without HIV were included (mean age: 59 years). Compared with people without HIV, PLWH had greater baseline Quan-Charlson comorbidity index scores (mean [SD]: 1.24 [1.86] vs. 0.99 [1.85]; p < 0.001) and greater numbers of comorbid conditions (3.70 [3.63] vs. 3.14 [3.79]; p < 0.001) and non-ART comedications (9.2 [7.58] vs 7.1 [7.48]; p < 0.001). Multimorbidity (≥2 comorbidities: 66.4% vs. 53.6%) and polypharmacy (≥5 non-ART drugs: 68.5% vs. 52.7%) were significantly more prevalent in PLWH (both p < 0.001). The most prevalent comorbidities were hypertension (46.9% vs. 41.2%; p < 0.001), hyperlipidemia (46.0% vs. 34.4%; p < 0.001), and type 2 diabetes (21.8% vs. 22.1%, p = 0.393). Conclusions PLWH have greater comorbidity and comedication burdens than people without HIV. The findings suggest clinicians should consider these factors when choosing ART to minimize drug interactions and adverse events, thereby improving the long-term health of PLWH.

Objective Bowel urgency (BU) can place a considerable burden on patients with inflammatory bowel disease (IBD). However, data on its real-world impact on health-related quality of life (HRQoL) are limited. This cross-sectional study assessed the prevalence of BU and its impact on HRQoL in a real-world IBD population. Methods Adults with ulcerative colitis (UC) or Crohn’s disease (CD) were recruited from the IBD Partners cohort, an internet-based cohort of individuals with IBD. BU was assessed using the Urgency Numeric Rating Scale (UNRS). Scores were classified into “no or minimal” BU (UNRS = 0–1) and BU (UNRS = 2–10). Remission was measured via the Simple Clinical Colitis Activity Index or the Short Crohn’s Disease Activity Index. HRQoL was assessed via Patient-Reported Outcomes Measurement Information System (PROMIS) measures, reported via T-scores. Results The study included 2,417 patients (UC: 884; CD: 1533). BU was reported by 44% of patients with UC and 58% with CD. BU rates were higher among patients with active disease than in remission (UC: 77% vs 28%; CD: 87% vs 48%, p < 0.001). Patients experiencing BU reported significantly worse HRQoL than patients without BU across all assessed PROMIS measures, including depression, anxiety, pain interference, sleep disturbance, fatigue, and social satisfaction. BU correlated with disease activity strongly in the UC group (r = 0.62) and moderately in the CD group (r = 0.52). Conclusion In this real-world IBD population, BU significantly affected patients’ HRQoL. BU was associated with disease activity and HRQoL measures. BU assessments should be included in clinical trials and routine clinical practice for UC and CD.

Objective Although blood pressure (BP) variability (BPV) derived from home BP monitoring (HBPM) is a recognized cardiovascular risk marker, limited data on its reproducibility hinder its clinical application. This study aimed to address this gap. Methods We compared HBPM-derived BPV at two time points using three metrics [standard deviation (SDVar), coefficient of variation (CoV), and variability independent of the mean (VIM)] among 495 individuals not using antihypertensive medications (No-AH) (median time-span between HBPM exams = 392 [308–519] days) and 588 individuals using antihypertensive medications (AH) (time-span between HBPM exams = 400 [319–510] days). Results No significant changes were observed across the time points in systolic HBPM-derived BPV metrics: SDVar (8.55 ± 3.14 vs. 8.71 ± 3.52 in No-AH; 9.67 ± 3.62 vs. 9.50 ± 3.47 in AH), CoV (7.01 ± 2.47 vs. 7.10 ± 2.65 in No-AH; 7.65 ± 2.77 vs. 7.57 ± 2.62 in AH), and VIM (5.76 ± 2.10 vs. 5.87 ± 2.35 in No-AH; 6.29 ± 2.34 vs. 6.18 ± 2.24 in AH) (all p >.05). Similarly, diastolic HBPM-derived BPV metrics remained stable between the time points: SDVar-DBP (5.65 ± 2.32 vs. 5.62 ± 2.33 in No-AH; 5.99 ± 2.50 vs. 5.90 ± 2.37 in AH), CoV-DBP (7.26 ± 3.03 vs. 7.24 ± 3.13 in No-AH; 7.66 ± 3.20 vs. 7.63 ± 3.06 in AH) and VIM-DBP (4.78 ± 1.96 vs. 4.75 ± 1.97 in No-AH; 4.64 ± 1.93 vs. 4.58 ± 1.83 in AH) (all p >.05). However, the test–re-test correlation of all HBPM-derived BPV metrics was only modest (r ≈ .27–.45), revealing substantial intra-individual variability. In addition, similar results were obtained in an alternative sample of 498 individuals (265 using AH and 233 not using AH) who underwent OBP and HBPM measurements at four different time points. Conclusion These findings demonstrate that BPV parameters derived from HBPM had high reproducibility at the population level, but limited reproducibility at the individual level.