Introduction: Acute abdomen is a common emergency presentation with variable causes and outcomes. The clinical profile, aetiologies, and outcome predictors vary from region to region. Understanding regional patterns of disease enables protocolised care and improves efficiency and decision-making in Emergency Departments (ED). Aim: To study the clinical profile and predictors of outcomes in acute abdomen in the emergency department. Materials and Methods: This prospective cohort study was conducted over three months (June 2024- August 2024) in a tertiary-care ED in Northern India. Consecutive adults (>18 years) with acute abdominal pain were enrolled. Demographic, clinical, laboratory, and imaging data were collected in a structured proforma. Outcomes were classified as favourable (ED discharge or hospital stay ≤7 days) or unfavourable (surgical intervention, hospital stay >7 days, High Dependency Units (HDU) /Intensive Care Units (ICU) admission, or death). Data were analysed using appropriate parametric and non parametric tests, and multivariable logistic regression was used to identify independent predictors of various outcomes (p-value <0.05). Results: Of 499 screened patients, 198 were analysed (mean age 43.3±17.2 years; 54% male). Co-morbidities were present in 26.3%, most commonly hypertension (9.6%) and diabetes (8.1%); 33.8% reported substance use. The most frequent provisional ED diagnosis was non specific “acute abdomen” (39.9%). Common definitive diagnoses were ureteric colic (13.2%), pancreatitis (8.8%), and acid peptic disorders (10%). Favourable outcomes occurred in 44.4%. Unfavourable outcomes included prolonged hospital stay (19.7%), HDU admission (17.7%), ICU admission (6.1%), surgical intervention (9.1%), and in-hospital mortality (1%). Hypoalbuminaemia was independently associated with reduced odds of ED discharge (OR 0.03, 95% CI 0.00-0.45; p-value=0.012), prolonged stay (OR 0.34, 95% CI 0.17-0.67; p-value=0.002), and HDU/ ICU admission (OR 0.33, 95% CI 0.16-0.67; p-value=0.002). Abnormal abdominal examination predicted prolonged stay (OR 1.07, 95% CI 1.01-1.13; p-value=0.021) and HDU/ICU admission (OR 1.07, 95% CI 1.01-1.14; p-value=0.033). Fluid resuscitation predicted HDU/ICU admission (OR 3.71, 95% CI 1.15-11.94; p-value=0.028). Conclusion: Hypoalbuminaemia independently predicted unfavourable outcomes in adults presenting with acute abdominal pain and may represent a simple, low-cost marker for early risk stratification in the ED.

Suicide is a major global public health concern. Although data on suicide mortality are well documented, large-scale studies examining the clinical and behavioral profiles of suicide attempts (SAs) presenting to Psychiatric Emergency Departments (PEDs) remain scarce, particularly in Spain. This study aimed to describe epidemiological patterns, clinical correlates, and care pathway discontinuities associated with suicidal behavior in a major urban PED. A retrospective observational study was conducted using prospectively collected data from 40,306 consecutive presentations for suicidal ideation and/or SAs at the PED of Hospital Clínico San Carlos (Madrid, Spain) between 2006 and 2018. Variables included age, sex, ICD-10 psychiatric diagnosis, method of attempt, recurrence (repeat emergency presentations), and disposition following triage (psychiatric filiation). Suicidal behavior was more frequent among women (54.9%). Two age peaks emerged: one in young adults (18-24years) and a second in middle-aged adults (34-46years). Drug overdose was the most common method, predominantly among women (68% of intoxications), whereas higher-lethality methods (e.g., hanging, jumping) were more frequent in men. Psychiatric history was present in 86.6% of presentations. The most prevalent diagnoses were specific personality disorders in women and schizophrenia or alcohol use disorder in men. Only 70.9% of presentations were immediately routed to specialized psychiatric care after triage. The gender paradox in suicidal behavior is reflected in diagnostic patterns and method choice. High recurrence of emergency presentations underscores the central role of PEDs as points of clinical contact, while the 29.1% gap in immediate psychiatric filiation represents an observed discontinuity in care pathways. These findings may help inform efforts to optimize triage processes and strengthen continuity of care following emergency presentations for suicidal behavior.

Post-attempt NSSI patterns and timing of reattempt: Descriptive trends and adjusted hazard over 12months.

Distinct resilience phenotypes in depression and anxiety: Validation and network analysis of the Chinese Mount Sinai Resilience Scale.

Resting-state functional magnetic resonance imaging study of voxel-mirrored homotopy connections in patients with schizophrenia.

Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes. A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA. The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups. Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.

The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) has evolved substantially over the past decade, with androgen receptor pathway inhibitors, taxanes, poly (ADP-ribose) polymerase (PARP) inhibitors, radioisotopes, bone-protecting agents, and emerging targeted therapies improving survival for patients. At the same time, earlier treatment intensification in the hormone-sensitive setting has resulted in heterogeneous clinical presentations at the onset of castration resistance, adding complexity to treatment sequencing and clinical decision making. Here, we propose a pragmatic, patient-centered framework to help guide the management of mCRPC by integrating clinical features, molecular profiling, imaging findings, and supportive care considerations. Confirmation of castration resistance remains a critical first step and requires documented biochemical or radiographic progression in the setting of castrate testosterone levels. Treatment selection should consider prior systemic therapies, disease burden and tempo, symptom profile, comorbidities, and frailty. Molecular characterization, including evaluation for homologous recombination repair alterations and mismatch repair deficiency, is highly important for identifying candidates for PARP inhibitors or immune checkpoint blockade and other emerging biomarker-driven targeted strategies. Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy has emerged as a key treatment. PSMA-positron emission tomography-based selection, incorporating assessment of uptake intensity, tumor heterogeneity, and total tumor volume, may help identify patients who are most likely to benefit from this treatment. Clinical factors such as liver metastases and limited prior response to androgen receptor-directed therapy have been associated with less favorable outcomes. Early on-treatment assessment using prostate-specific antigen response and PSMA-based imaging may support adaptive treatment strategies and earlier recognition of resistance. Given the high prevalence of bone metastases, bone-protecting agents should be considered to reduce skeletal-related events. Early palliative care (EPC) is now widely recognized as a concurrent, patient-centered intervention that improves quality of life, symptom burden, coping, and satisfaction across advanced cancers. Prostate cancer represents an especially compelling setting for EPC because of prolonged advanced disease courses, cumulative symptom burden, repeated treatment transitions, and persistent unmet supportive needs.

Clinical and cognitive profile of nigral iron content in children with ADHD.

Clinical, pathologic, and molecular profiles of sarcomatoid and rhabdoid differentiated clear cell renal cell carcinoma: A series of 21 tumors.

To identify key risk factors associated with the progression from prediabetes to type 2 diabetes in a majority-minority county in the United States and evaluate their relative contributions. We conducted a retrospective cohort study using the deidentified EHR from the University of California, Irvine Health (2013-2023). Adults with prediabetes (confirmed by ICD codes and HbA1c values) were included, and those with diabetes of any form at baseline or with missing data were excluded. Baseline demographics and clinical factors were compared among those who progressed to T2D (converters) to those who did not (non-converters). Ordinal logistic regression and Cox proportional hazards models were used to assess predictors of conversion timing and risk. A total of 2648 adults had confirmed prediabetes, of which 510 (19.3%) developed T2D. Among converters, 81.6% progressed within 5 years of the initial prediabetes diagnosis. The two groups were similar at baseline, except converters had higher obesity rates and were more likely to have Hispanic/Latino ethnicity (p < 0.001). Elevated baseline HbA1c was a strong independent predictor of earlier conversion to T2D (OR 0.41 per 1% increase, p < 0.001). Baseline triglycerides provided a modest additional effect (p = 0.047). Hispanic/Latino ethnicity was associated with a significantly higher risk of progression to T2D (adjusted HR 1.25, 95% CI 1.03-1.49, p = 0.021). Elevated HbA1c and triglycerides at baseline were associated with early conversion to T2D. This study underscores the need for early, targeted intervention in individuals with high-risk ethnic and clinical profiles to stop T2D.

Prevalence and clinical correlates of cocaine use disorder among patients diagnosed with bipolar disorder: A systematic review, meta-analysis, and meta-regression.

New evidence on the clinical, genetic, and biochemical bases of GBA1-Parkinson's disease: prospects for treatment.

Non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from prescribed medication, leading to worsening of the medical condition, comorbidities, reduced quality of life, higher healthcare costs, and increased mortality. This study aimed to assess the harmful effects of medication shortages and their association with medication adherence among patients with diabetes in the context of multiple crises in Lebanon. A cross-sectional study was conducted among 430 type 1 and type 2 Lebanese diabetic patients attending primary healthcare centers, pharmacies, and private clinics. Participants were 18 years and older; non-Lebanese patients were excluded. Adherence to diabetes medications was measured using the Lebanese Medication Adherence Scale (LMAS-14) and the Harmful Impact of Medication Shortage (HIMS) score. All participants completed a self-report questionnaire, including sociodemographic and clinical profile variables. Univariate and multivariate analyses were carried out using SPSS version 28. Patients with lower education (8 years or less) were less adherent to medications than those with a university degree (21.00 vs. 17.00). Manual workers had less adherence to medication than non-manual workers (23.00 vs. 19.00). In addition, patients residing in Baalbeck, Beqaa, or Akkar, those who did not follow a diabetes-specific diet, smokers, and those not regularly testing their glycemia were less adherent to treatment. Most importantly, 36.3% of the total participants switched their medications due to their high cost and were less adherent to treatment. Patients unaware of DM as a disease had significantly lower medication adherence, similar to those who scored higher on the Harmful Impact of Medication Shortage. This cross-sectional study identified suboptimal medication adherence among Lebanese adults with diabetes, with lower adherence associated with low socioeconomic status and barriers to care and medication access. These findings support targeted interventions to improve affordability, continuity of follow-up, and reliable access to medication, while warranting the conduct of longitudinal studies using objective adherence measures.. Not applicable. The online version contains supplementary material available at 10.1007/s40200-026-01948-x.

Sickle cell disease (SCD) is characterized by chronic hemolysis, inflammation, and progressive kidney injury which leads to renal failure and increased mortality rates with limited therapeutic options available. Neuregulin-1 (NRG-1) is a cytoprotective growth factor with anti-inflammatory and antioxidant properties and an established clinical safety profile in humans. Using Townes humanized sickle cell (HbSS) mice, we investigated whether NRG-1 mitigates kidney injury by reducing hemolytic and inflammatory mediators and enhancing renal cytoprotective and repair factors. NRG-1 treatment reduced plasma heme, lactate dehydrogenase, and pro-inflammatory cytokines levels, while increasing the proportion of circulating fetal hemoglobin-containing red blood cells (F-cells). Treatment mitigated urinary cystatin C and neutrophil gelatinase-associated lipocalin (NGAL)elevations and improved renal histopathology, including reduced iron deposition, glomerular congestion, and sclerosis. NRG-1 also enhanced heme oxygenase-1 (HO-1) expression in HbSS kidneys and increased urinary renal repair biomarkers clusterin and epidermal growth factor (EGF). Collectively, these findings provide new mechanistic insight supporting further exploration of NRG-1 as a therapeutic agent for mitigating kidney injury in SCD.

Avoidant/restrictive food intake disorder (ARFID) is a relatively recent diagnostic category within feeding and eating disorders and is increasingly recognized in pediatric populations. Although ARFID shares some clinical features with other eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN), important differences in psychiatric comorbidity, sex distribution, and clinical severity have been suggested. This systematic review and meta-analysis aimed to compare the clinical profiles of ARFID with those of AN and BN in children and adolescents, focusing on anxiety, depression, sex distribution, age, and hospitalization rates. A systematic search was conducted in PubMed, Embase, PsycINFO, Scopus, and Web of Science from database inception to November 2025. Observational studies including participants aged ≤ 18 years diagnosed with ARFID, AN, or BN and reporting comparative data for at least one outcome of interest were eligible. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for each outcome. Twenty-two studies met the inclusion criteria. Compared with anorexia nervosa (AN), individuals with avoidant/restrictive food intake disorder (ARFID) showed significantly higher odds of anxiety (OR = 1.41, 95% CI: 1.05-1.89) and significantly lower odds of depressive disorders (OR = 0.30, 95% CI: 0.17-0.51). ARFID was also associated with a markedly higher proportion of males (OR = 4.18, 95% CI: 3.44-5.08) and lower hospitalization rates (OR = 0.23, 95% CI: 0.11-0.52). In addition, individuals with ARFID were significantly younger than those with AN (g = -0.90, 95% CI: -1.27 to -0.54). Comparisons with bulimia nervosa (BN) showed a similar pattern. Depressive disorders were significantly less frequent in ARFID (OR = 0.25, 95% CI: 0.12-0.53), and ARFID included a substantially higher proportion of males (OR = 5.29, 95% CI: 2.90-9.67). Anxiety tended to be higher in ARFID than in BN, although this difference did not reach statistical significance. Individuals with ARFID were also significantly younger than those with BN (g = -1.31, 95% CI: -1.89 to -0.74). ARFID demonstrates a distinct clinical profile compared with AN and BN in children and adolescents, characterized by higher anxiety-related features, lower prevalence of depressive symptoms, a more balanced sex distribution, and lower hospitalization rates. These findings support ARFID as a distinct eating disorder in youth and underscore the need for tailored assessment and treatment.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are liver disorders strongly associated with cardiovascular disease (CVD). The PWK/PhJ mouse strain is an emerging model for severe MASH, highly susceptible to Western diet (WD) and closely mimicking the clinical and molecular profile of human MASH. Here, we demonstrate that male and female PWK/PhJ mice develop hepatic fibrosis and cardiac dysfunction after 17 weeks of WD challenge. Elevated cholesterol levels and altered transcript profiles associated with translation and lipid metabolism characterize the early metabolic changes induced by WD. Chronic exposure to WD exacerbates hepatic lipid accumulation, inflammation, and fibrosis, while disrupting amino acid and mitochondrial metabolism. These alterations increase hepatic synthesis of ceramides and deoxy-ceramides, contributing to elevated sphingolipid levels in plasma and heart tissue. Collectively, these metabolic changes drive the development of MASH and significantly increase CVD risk. Our findings establish the PWK/PhJ strain as a robust model to study cardio-metabolic cross talk and identifying therapeutic targets for cardio-metabolic disorders.

Despite receiving triple therapy (i.e., long-acting β2-agonist + long-acting muscarinic antagonist + inhaled corticosteroid), patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations. This study aimed to investigate the moderate and severe annualized exacerbation rate (AER) and healthcare resource utilization of patients with COPD on triple therapy in China, addressing a significant evidence gap regarding the clinical and economic disease burden in this population. This retrospective cohort study was conducted using the Chongqing Regional Electronic Health Record Database (2018-2022). Patients with COPD aged ≥ 40years who had received ≥ 3months of triple therapy during the 12-month baseline period were included. AER, COPD-related hospital visits, length of hospital stay and readmissions, and direct medical costs during the 12-month observation period were analyzed. A total of 6393 patients with COPD on triple therapy were included in the study. Among patients with available data, 17.3% had blood eosinophil count of ≥ 300 cell/μL at baseline. The percentage of patients having at least one moderate and severe exacerbation during the observation period was 53.7%, with the moderate and severe AER (95% confidence interval) being 1.37 (1.32-1.42). The mean (standard deviation (SD)) numbers of outpatient, emergency room, and inpatient visit due to COPD were 6.1 (5.56), 0.4 (1.58), and 1.0 (1.64), respectively. The direct medical costs per patient per year were ¥14,208.7. Our findings reveal a high disease burden among patients with COPD in China despite stable triple therapy, reflecting the high-risk clinical profile of these patients and supporting an ongoing need for improved management strategies.

This dataset was acquired and curated to explore the spectrum of Motor Neuron Disease (MND) and Fronto-Temporal Dementia (FTD) with Ultra-High Field Magnetic Resonance Imaging (7 Tesla) and compare these to non-neurodegenerative disease controls (known colloquially as "The 7 T hEalthy Ageing study [7TEA]"). Twenty people living with neurodegenerative disease and 14 non-neurodegenerativecontrols underwent a comprehensive multimodal MRI protocol including structural, diffusion, quantitative MRI, resting state, and task fMRI, alongside cognitive testing and genetic screening. This dataset combines detailed imaging phenotypes with extensive clinical characterisations. It facilitates investigations into the spectrum of MND and FTD, has provided a basis for developing novel quantitative biomarkers, and supports the exploration of interactions between imaging features and clinical progression. The availability of this dataset supports various research avenues, from detailed hippocampal subfield analyses, network connectivity assessments, and multimodal genetic, cognitive, and imaging studies. The dataset is published on OpenNeuro (dataset ds007036) and is curated in the Brain Imaging Data Structure (BIDS) standard.

Fatal self-poisoning with the herbicide paraquat has been reported for decades as an important toxicological and public health concern in several countries, including China and Sri Lanka, and regulatory bans have been associated with subsequent reductions in cases. It is now becoming an emerging toxicological problem in India and Bangladesh. Data were collected in 10 tertiary hospitals in Bangladesh, which serve more than 65% of the population. Data were collected both prospectively from patient files and retrospectively from hospital records. Annual paraquat import (use) data were obtained from the National Board of Revenue of Bangladesh. A total of 1,420 patients were reported across sites between 2013 and 2024, and 257 patients' data were available for analysis. A consistent upward trend was observed in the number of cases, increasing from a single case in 2013 to 493 cases reported across the 10 study sites in 2024. Common presentations included leg swelling from acute kidney failure (183/257; 71.2%), vomiting (169/257; 65.8%), and abdominal pain (149/257; 58.0%). The case fatality rate was 43.2%, with a 95% CI (23.6-27.7). Markers of poor prognosis included male sex, large ingestion, fever, "paraquat tongue," acute kidney failure, and a low Glasgow Coma Scale score. The case fatality rate of paraquat poisoning is far higher than that of poisoning with other pesticides in Bangladesh. Banning its use in agriculture and replacing it with less toxic substitutes is urgently needed to reduce mortality and morbidity.

Mpox is caused by mpox virus and comprises distinct clades with differing clinical and epidemiologic profiles. Clade I (Ia, Ib) predominates in Central Africa, and clade IIb drove the 2022-2023 global outbreak. This review assessed clinical presentation, transmissibility, and virulence of mpox in African settings by viral clade. Searches of PubMed/MEDLINE, PubMed Central, Scopus, Cochrane Library, and Google Scholar identified studies from January 2023 to May 2025. Titles and abstracts were screened in Rayyan by two reviewers, with conflicts resolved by a third. Literature search was conducted between July to August 2025. Eligible designs included cohort studies, case series, case reports, and surveillance reports with clade assignment and clinical or transmission data. Risk of bias was appraised with the JBI tools. Data were synthesized narratively. PRISMA guidelines were followed. Ten studies from the Democratic Republic of Congo, Burundi, Uganda, Kenya, and Nigeria met inclusion criteria. Four were cohort designs and six were case reports or case series. Sample sizes ranged from 1 to 850. Reported clades were Ia, Ib, and clade I unspecified; several reports also described clade IIb-linked contexts. Rash was the most consistent symptom, reported in 80-100% of cases. Reported transmission routes included sexual contact, close non-sexual contact, household exposure, travel-related exposure, and vertical transmission confirmed by placental PCR in two studies. Adverse outcomes were frequent in pregnancy, with fetal loss reported in 50-67% in small series. Deaths occurred among people with untreated or advanced HIV infection. The reviewed evidence further affirms the dominant role of sexual transmission in current African outbreaks, contrasting with earlier assumptions of predominantly zoonotic or household spread. Strengthening surveillance systems that can distinguish mpox clades and track their clinical patterns is essential to guiding effective public health responses.