High burden of poor prognostic factors at first presentation in treatment-naïve relapsing multiple sclerosis: Real-world evidence from a large Egyptian cohort.

We demonstrate a near-real time forest disturbance alerting system for Europe using Sentinel-1 radar data. Sentinel-1 radar can penetrate clouds and offers high spatial (∼20 m) and temporal (3- to 6-day) detail. We directly integrated near-real time ERA5-Land temperature and Copernicus forest type data into the disturbance detection framework to address freezing temperatures and seasonal phenology, both of which influence the Sentinel-1 backscatter signal and thus need to be accounted for. This facilitates year-round monitoring across a range of environmental conditions (sub-zero, wet and dry) and forest types (coniferous, deciduous) throughout the boreal, temperate, and Mediterranean forests of Europe. Validation across Europe showed high accuracy, with a user accuracy of 91.2% (±1.3%) and producer accuracy of 74.5% (±6.0%). User accuracy increased to 99% (±0.4%) when excluding errors in the European-scale forest cover mask primarily caused by local overestimation of forest height and density. Disturbances were detected with a median delay of 27 days relative to the first high-resolution optical Planet reference image, which can further be reduced to 1 day through retrospective event-based correction of late detection bias. Compared to existing annual optical-based products, our method improves the detection of small-scale disturbances such as group fellings in Romania. We generated European-scale estimates of intra-annual disturbance seasonality, capturing variation in forest management practices and disturbance regimes such as winter harvesting in northern Europe, spring sanitation cutting in central Europe, and summer wildfires in southern Europe. Overall, this alerting system provides timely and detailed forest disturbance information in support of sustainable forest management, biodiversity conservation, carbon accounting, and law enforcement efforts across Europe. The alerts are available at https://wurnrt-raddeurope.projects.earthengine.app/view/radd-europe. • Near-real time Sentinel-1 forest disturbance alerting demonstrated across Europe. • Direct integration of ERA5-Land temperature data enabled year-round monitoring. • User accuracy of 91%, up to 99% with forest mask errors excluded; producer accuracy of 75%. • Median relative detection delays of 27 days and 1 day after event-based bias-correction. • First European-scale estimates of intra-annual forest disturbance seasonality.

Timeliness of children's vaccinations in 91 low-income and middle-income countries: an analysis of survey data.

Türkiye hosts over 3 million Syrian refugees, many from consanguineous communities, increasing the risk of inherited metabolic disorders (IMDs). Early IMD diagnosis is essential but remains challenging in displaced populations with limited access to specialized care. This case-based review combines a systematic synthesis of the published literature with a retrospective case series of Syrian refugee children evaluated for suspected IMDs at a pediatric metabolism clinic in Adana, Türkiye (June 2023-January 2024). Demographic, clinical, and diagnostic data were analyzed. Of 3095 children evaluated, 303 were Syrian, and 27 (8.9%) were diagnosed with IMDs. Consanguinity was present in 92.6% of cases. The median diagnostic delay was 8 months. Common clinical features included developmental delay and seizures. Diagnoses most frequently involved amino acid and carbohydrate metabolism disorders. Although responses to dietary and cofactor therapy were generally favorable, systemic barriers, such as limited newborn screening, language obstacles, and poor follow-up, were prevalent. By integrating original clinical data with systematically reviewed evidence, this study underscores the disproportionate burden of IMDs in refugee children and the cross-national consistency of diagnostic delays and healthcare access barriers. Targeted interventions, including expanded newborn screening panels, interpreter services, and culturally adapted educational resources, are critically needed to improve early diagnosis and long-term outcomes in displaced populations. Syrian refugee children referred to pediatric metabolism clinics with suspected IMDs show a high diagnostic yield, likely influenced by high rates of consanguinity within this clinically selected cohort. Many children experience prolonged delays in IMD diagnosis, with a median time of 8 months from symptom onset to clinic presentation, highlighting the need for more accessible and timely diagnostic services. Substantial healthcare access barriers, including language and financial constraints, limit follow-up and treatment adherence. Findings underline the need for improved diagnostic support and culturally tailored healthcare services, and support consideration of expanded newborn screening strategies for Syrian refugee children evaluated for IMDs.

The use of numerous sensors on edge devices, combined with the emergence of AI techniques, makes the IoT environment more intelligent and interactive. The resulting paradigm encompasses device-centric systems that operate instantly and remotely with zero clicks. However, with these advantages, many functional challenges affect remote sensing, including incomplete data, communication delay, lack of context awareness, and dynamically switching topology. To address these challenges, we have proposed a novel scheme, "LLM-Enabled Adaptive Scheduling in IoT Sensing for Optimized Network Performance (LLM-AS)." This scheme uses LLM to adjust the system's sensing to avoid redundant and useless data sending and enhance decision-making for optimized network resources. First, LLM-AS is trained with a defined data set for different parameters, such as packet loss trends, time-based fluctuations, event triggers, network failure patterns, and congestion signals with contextual decisions. Then, this scheme is deployed in a dynamic remote monitoring system for learning and updating task descriptions to utilize the feedback for future decisions and enhance the system performance. Evaluation of LLM-AS on various parameters using the CASAS dataset shows that the optimization functions of LLM are useful and make the IoT more usable. The LLM-AS optimization function confirms an improvement of 57.8% to 60% in MTP, a decrease of 26% to 60% in median delay, and an optimized energy solution with a confidence interval of 95% and a very small error margin. It also indicates that the precision score is about 0.86, the recall score is about 0.82, and the RMSE is about 0.21; all these values suggest high separability for varying conditions of IoT systems in dynamically changing situations.

Abstract Key summary points Aim For older patients at presumed high risk of short-term emergency department visits but without immediate hospital needs, we aim to describe a system that provides geriatrician telephone support to emergency medical dispatchers, offering a safe alternative to emergency department referral. Findings Providing geriatrician telephone support to emergency medical dispatchers could offer an alternative to referring certain older patients at presumed high risk of a short-term emergency department visit. Among older patients for whom an emergency department referral was not initially recommended, some experienced early unplanned hospital visits, highlighting the need to develop and strengthen reactive alternatives to emergency department referral. Message Collaboration between emergency medical dispatchers and on-phone geriatricians could provide a safe alternative to emergency department referrals for older patients at presumed high risk of short-term ED visits. Abstract Purpose To describe a system enabling Emergency Medical Dispatchers (EMD) to access direct geriatrician telephone support (SCAS: Senior Care Access System) with the purpose of providing alternatives to Emergency Department (ED) referral for older patients at presumed high risk of short-term ED visits. Methods This prospective study was conducted at the EMD of Toulouse University Hospital. EMD could contact the SCAS for patients aged 75 or older who were presumed to be at high risk of a short-term ED visit but did not require an immediate ED referral. The primary outcome was the alternative to ED referral decided by the SCAS, which included telephone advice, geriatric consultation, geriatric day hospital admission, admission to post-acute care and rehabilitation, or direct admission to an acute geriatric unit. Secondary outcomes were i) alternative follow-up destinations and ii) early unplanned hospital visits (ED visit or unplanned hospital admission within 7 days following the SCAS call). Results A total of 364 patients were included between September 1, 2023 and February 28, 2025. The mean age of the patients was 87.5 years (± 8.3), and 40.1% were male. The primary reason for the call was altered general health status (30.8%), followed by falls (17.9%). An alternative to ED referral was proposed for 287/364 patients (78.8%). Among the 117 patients for whom the SCAS decided no ED referral or admission to an acute geriatric unit, 32 (27.4%) patients experienced an early unplanned hospital visit within a median delay of 3 days. Conclusion Our study suggests that geriatrician telephone support for EMD could offer an alternative to ED referral for older patients with presumed high risk of short-term ED visit.

Commercial data marketplaces and clean rooms increasingly span edge devices, on-premise repositories, and multiple public clouds, yet most deployments still enforce consent, purpose, licensing, residency, and privacy budgets at coarse granularity or after execution. We present TrustDS, a governance layer that compiles human-readable policy into a guarded execution directed acyclic graph (DAG), jointly plans privacy-enhancing technologies (PETs) and placement across edge and cloud locations, and emits portable evidence bundles for every policy-relevant boundary. The paper intentionally narrows its claims: TrustDS is not a new cryptographic query engine and it does not claim machine-checked malicious security for arbitrary secure backends. Instead, it contributes systems-level policy safety, fail-closed revocation semantics, and reproducible compliance evidence under explicit assumptions about the underlying PETs. We formalize a multi-domain threat model, define operational semantics for guarded execution, and prove policy safety and passive-adversary confidentiality modulo explicit leakage functions. Empirically, we ground the study in primary publisher microdata that are also discoverable through marketplace or public-exchange channels: CDC BRFSS and NHANES, CFPB consumer complaints, NYC TLC trip records, and Iowa Liquor Sales. Across five matched workload families, TrustDS improves median end-to-end latency by 25.8% (95% CI 21.6-30.0) over centralized transfer and by 15.9% (95% CI 12.8-19.0) over a governed clean-room exchange, while maintaining 100% dynamic-consent coverage with 118ms median and 190ms p95 revocation delay. A separate 622-run split-ownership TPC-H campaign is used only as a scoped backend calibration study, showing that SecretFlow-SCQL offers the strongest latency-coverage balance in the tested two-party setting whereas ORQ offers a stricter confidentiality posture at materially higher latency. The resulting manuscript is aligned to scientific-validity expectations: explicit assumptions, restrained conclusions, documented limitations, figure source data, and reproducible benchmark artifacts.

Pancreatic cancer is difficult to diagnose early and at a curative stage, yet little is known about errors in management. The aim of the study was to investigate malpractice claims in Norway. All malpractice claims filed to the Norwegian System of Patient Injury Compensation between 2015 and 2024 for pancreatic cancer were evaluated. A total of 148 claims (median 15 [range 8-20] claims/year) were filed among 9548 patients with pancreatic cancer, for an average claim rate of 1.55% (1 claim per every 65 pancreatic cancers). Most claims were filed against hospital/specialists (n = 90), followed by general practitioners (n = 49) with nine claims towards private practice contractors (P < 0.001). A total of 33 claims (22.3%) were approved, of which 28 (85%) concerned delayed diagnosis. Radiology was involved in 18 of the 33 approvals. According to caretaker-level for the malpractice claim, approved claims were 23% for hospital-claims, with lowest approval-rate against general practitioners (12%), and highest against private contractors (66%). Median delay in diagnosis was estimated at 6 months. The outcome of the error was 'death' in 16 of 33. Prognostic loss was determined in five of 33 patients, while 12 patients had no prognostic loss despite an approved claim. Caretaker-level did not differ regarding death or prognostic loss in claims (P = 0.203). A total of 1.47 million EUR was paid in indemnity payments. The claim rate of 1.5% was stable, with about one in five claims approved. Diagnostic delay was the predominant cause, with several stakeholders involved across the healthcare system.

Transient global amnesia (TGA) is a striking model of isolated amnesia. While hippocampal lesions are well described, the network-level mechanisms and the precise neuropsychological profile remain debated. Our objective was thus to characterize functional and neuropsychological correlates of acute TGA and their longitudinal evolution. Prospective, single-center case-control study of 20 patients with acute TGA and 20 age- and sex-matched healthy controls. All participants completed neuropsychological testing and underwent structural and functional MRI at three time points: acute phase (< 24 h from onset), day 3, and 3 months. Primary outcomes were neuropsychological performance across episodic, semantic, and metamemory domains and resting-state fMRI connectivity within the episodic memory network. Secondary outcomes were functional connectivity within the Default Mode (DMN), Executive (ECN), and Salience (SN) networks. A total of 40 participants were included (20 patients with TGA, mean age 65.5 years, 45% women; 20 controls, mean age 64.3 years, 45% women). In patients, median delay from symptoms' onset to MRI was 6.67 h. Neuropsychologically, patients showed profound multimodal anterograde amnesia during the acute phase, resolving by 3 months. This deficit was largely isolated, sparing semantic memory and metamemory. Structurally, small bilateral lesions were present in most patients. Functionally, acute hypoconnectivity was observed within the extended hippocampal system, particularly between parahippocampal and cingulate cortices, normalizing by 3 months. No consistent disruption was found in large-scale networks (default mode, executive control, salience). TGA is associated with transient, selective hypoconnectivity within the mesiotemporal-cingulate episodic memory network, aligning with previous reports and further precising the functional anatomy. The finding of a profound anterograde amnesia was replicated and its recovery timecourse was elucidated. Semantic memory and metamemory remain preserved, clarifying inconsistencies in prior reports. These findings suggest that TGA reflects a transient limbic dysconnectivity syndrome rather than a diffuse network disorder, reconciling structural lesions with clinical and functional data.

Hurricanes can disrupt healthcare delivery and patients' access to timely cancer care. Such disruptions may contribute to adverse cancer outcomes, yet few studies have examined hurricane-related delays in treatment initiation. We conducted a quasi-experimental, observational study using a CITS to evaluate the association between hurricane exposure and time to initial treatment among patients diagnosed with breast, colorectal, or lung cancer in North Carolina following Hurricanes Matthew (2016) and Florence (2018). The analysis included 59,406 patients between November 2015 and August 2019 in the NC Central Cancer Registry. Hurricane-exposed areas was defined using (1) presidential disaster declarations (county level) and (2) flood extent data (FLDEX) at county and ZIP-code levels. Monthly median time to initial cancer-directed treatment within 12 months of diagnosis was modeled using ARIMA to estimate immediate (level) and sustained (trend) effects. No significant immediate or sustained changes in median time to treatment were observed using FEMA-based exposure definitions. However, using ZIP- code level FLDEX data, colorectal cancer patients in high-flood exposure areas (0.1% and 0.5% flooded) experienced significant immediate median delays of 10.39 (2.8, 18.0) and 10.97 days (95% CI: 2.1, 19.9), respectively. While no significant effects on time to treatment were observed using traditional measures of hurricane hazards, more granular flood extent data revealed treatment delays among colorectal patients living in areas with greater flooding extent. These findings provide support for further investigation of the use of ZIP code-level flood extent data to evaluate hurricane impacts on continuity of cancer care.

We investigate electrical signalling in substrates colonised by oyster fungi using long-term, multi-channel electrophysiological recordings. Electrical activity was recorded continuously for approximately fifteen days using a linear array of eight differential electrode channels sampled at 1Hz. Slow electrical spikes with durations from tens of seconds to tens of minutes and millivolt-scale amplitudes were identified, and spike trains exhibited highly variable inter-spike intervals on time scales of minutes to hours. Analysis of temporal relationships between channels reveals directional propagation of electrical activity along the electrode array, with delay distributions between adjacent channels showing pronounced positive peaks and a monotonic lead-lag ordering across channels. Median delays of approximately 180s between channels separated by approximately 2cm correspond to an estimated propagation speed of about 0.7cm/min (approximately 40cm/h). Control analyses using temporally shuffled spike trains indicated its biological origin. These results demonstrate that electrical activity in oyster fungi propagates through the mycelial network as slow travelling signals consistent with ionic wave dynamics.

To assess the effectiveness and safety of anakinra in crystal-related disease (CRD) flares, and to identify factors associated with treatment failure and risk of infection. We conducted a single-centre, retrospective, observational study including adult patients treated with anakinra for a CRD flare between January 2011 and July 2024. Patients were identified in a hospital clinical data warehouse using an electronic query. CRD was confirmed by the presence of crystals in synovial fluid or by characteristic radiological features. Clinical and biological data were collected through medical record review. Treatment effectiveness was assessed retrospectively based on the treating physician's global clinical judgment documented in medical records. Treatment failure was defined as insufficient clinical response requiring treatment escalation or persistent symptoms. Adverse events, including infections, were collected up to one month after anakinra initiation. Factors associated with treatment failure and infection were explored using univariable and multivariable analyses. A total of 292 patients were included. Effectiveness of anakinra was observed in 92.8% of patients after a median treatment duration of 3 days. In multivariate analysis, longer CRD duration (OR 1.11, 95% CI 1.03-1.19) and a history of diabetes (OR 4.00, 95% CI 1.25-14.29) were independently associated with treatment failure. Thirteen patients (4.5%) developed an infection within one month after anakinra initiation, with a median delay of 11 days. No variable was independently associated with infection risk. This large real-life study supports the effectiveness and overall safety of anakinra in the management of acute CRD flares.

Recently, the Chinese government has prioritized enhancing access to rare disease drugs, with the initial objective of addressing the challenge of drugs being "available abroad but not domestically." The United States, a leader in the development of treatments for rare diseases, serves as a benchmark for assessing a nation's progress in this field. This study examined the progression and influencing factors of the availability gap through the application of two principal metrics: "drug loss" and "drug lag" at the indication level. We conducted a retrospective analysis of rare disease indications approved in the United States and China from 2001 to 2024, focusing on diseases listed in China's official Catalogs of Rare Diseases. Our study indicated that "drug loss" in China had continued to escalate, with the total number of unapproved indications reaching 123 by 2024. Although the growth rate had decelerated since 2017, the "drug loss" associated with novel therapies recently approved by the FDA had intensified. Conversely, the "drug lag" in China for indications approved by the FDA after 2015 had decreased in comparison to those approved before 2015, with the median delay reducing from 4,049 to 2,812 days. The principal factors influencing drug availability were the global R&D and commercial strategies of sponsors. This finding highlighted that encouraging multinational sponsors to integrate China into their initial global development plans and to incentivize domestic companies to engage in earlier and more substantial international research and development collaborations were more important for mitigating "drug loss" and "drug lag" in China.

Early initiation of neurorehabilitation (NR) at the stroke unit is recommended and has been associated with improved outcomes. However, ensuring a direct, uninterrupted transition to subsequent inpatient NR remains challenging in clinical practice. This study investigates whether direct transfer to inpatient NR is associated with functional recovery at 3-month post-stroke. This study is based on prospectively collected registry data of all stroke patients discharged with functional dependence (modified Rankin Scale (mRS) 3-5) from five stroke units in Styria, Austria, between 2012 and 2023. All patients received standardized inpatient NR, either immediately after acute stroke care or-due to limited NR bed availability-following interim care on a general neurological ward without specialized rehabilitation. The primary outcome was a ⩾ 1-point mRS improvement from discharge to the 3-month follow-up. Outcome predictors were analyzed using univariable and multivariable methods. Of 2497 included patients (median age: 74 years; 44.7% female), 740 (29.6%) were directly transferred to NR after stroke unit care, while 1757 patients (70.4%) were not, with a median delay to NR of 8 days. Improvement in mRS during follow-up was observed in 1665 patients (66.7%). In multivariable analysis, direct transfer to NR was independently associated with mRS improvement (adjusted odds ratio 1.57, 95% CI 1.25-1.94) as were younger age, male sex, absence of prior stroke, and lower NIHSS score at discharge. Direct transition from the stroke unit to inpatient NR is associated with a greater likelihood of functional improvement at 3 months post-stroke. These findings support the value of implementing continuous post-stroke rehabilitation pathways.

Primary PCI is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI). We investigated benefits and safety of pretreatment with unfractioned heparin (UFH) in STEMI referred to primary PCI. Our single-center, open-label, randomized controlled trial assigned STEMI with ≤6 hours of symptom duration either to 70-100 IE/kg bolus of UFH at first prehospital medical contact (FMC) plus supplemental dose before PCI adjusted to activated clothing time ≥250 seconds or to control group undergoing standard UFH at the time of PCI. Primary efficacy endpoint was TIMI 2-3 flow in infarct related artery (IRA) at initial coronary angiography. Primary safety endpoint was BARC 3-5 bleeding during the index hospital stay. From March 2022 to February 2025, 298 patients were randomized to UFH pretreatment and 295 to the control group. Both groups were comparable in age, gender, risk factors, previous cardiovascular events and median delay from symptoms to coronary angiography (145 min vs 150 min; p=0.814). Median time from UFH pretreatment to coronary angiography was 60 min (25th and 75th IQR 47 - 55 min). TIMI 2-3 in IRA was documented in 43% in UFH pretreatment and 27% in control groups (RR 1.59 [95% CI 1.27-1.98]; p<0.001) without significant difference in BARC 3-5 bleeding (2.4% vs 2.0%; RR 1.16 [95% CI 0.39-3.45]; p=0.789). In patients with STEMI undergoing primary PCI in a mature STEMI network, pretreatment with UFH at FMC was associated with an absolute 16% increase in IRA patency without causing excessive bleeding.

Lenacapavir (LEN), a twice-yearly injectable long-acting capsid inhibitor used in combination with an optimized background regimen, is indicated for heavily treatment-experienced adults with multi-drug-resistant HIV-1 infection. From the US Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort, 116 adults with HIV with ≥1 set of LEN injections were included [baseline viral load (VL) <200 copies/mL = 74; ≥200 copies/mL = 42]. Many (56%) simplified their regimen at LEN initiation and/or later, and 31% maintained all the antiretrovirals (ARVs) from their prior regimen throughout LEN use. Among those with a baseline VL <200 copies/mL, the cumulative probability (Kaplan-Meier) of maintaining suppression to <200 copies/mL was 92% [95% confidence interval (CI): 80, 96]. Among those with a baseline VL ≥200 copies/mL, the cumulative probability of achieving suppression was 73% (95% CI: 59, 86). Among 78 individuals who received ≥2 sets of LEN injections, 82% received all sets of injections on time or early (≤28 weeks after the prior set) and 18% received ≥1 set late (>28 weeks after the prior set). The median delay was 11 days past the injection window (interquartile range: 4, 118). At study end, 91% remained on a LEN-containing regimen. In this cohort representative of routine clinical care in the United States, factors other than virologic control may be driving the decision to start LEN (e.g., safety, tolerability, resistance, simplification). Most people experienced favorable virologic outcomes and good adherence to LEN, which may serve as an effective option for those who could benefit from a long-acting injectable agent from a novel ARV class.

Erythropoietic protoporphyria (EPP) is a rare photodermatosis associated with delayed diagnosis and limited access to specialist care. In this patient-reported survey, we found a median diagnostic delay of 6 years, with many participants expressing unmet needs in follow-up and treatment, and high interest in emerging therapies. These findings highlight the importance of early recognition and improved referral pathways to optimize care for individuals with EPP.

Heterozygous loss-of-function variants in CTLA4 cause a spectrum of immune dysregulation, characterized by hypogammaglobulinemia, autoimmune cytopenias, and lymphoproliferation, yet penetrance and expressivity remain highly variable across cohorts. To characterize the clinical, genetic, and therapeutic features of a prospective Chinese cohort with CTLA-4 haploinsufficiency, and to compare their management outcomes with those reported in the largest international series. Seven patients diagnosed by whole-exome sequencing underwent systematic evaluation of clinical phenotypes, laboratory parameters, imaging and histopathology, and treatment responses. Data were contrasted against the largest global cohort of CTLA-4 haploinsufficiency. All individuals harbored heterozygous CTLA4 variants, four missense and three truncating mutations, exhibiting classical features of immune dysregulation alongside marked phenotypic heterogeneity, even among family members with identical genotypes. The median diagnostic delay from the first symptom onset to genetic confirmation was 8 years (range: 2–50 years). Importantly, for patients who initiated targeted therapy (P1, P2, P3, P5, and P6), abatacept was administered within a median of less than one year following molecular diagnosis, demonstrating the high clinical efficiency enabled by our prospective screening approach. Nearly all patients received abatacept achieving sustained disease stabilization and tapering of corticosteroids, complemented by IVIG to correct hypogammaglobulinemia. Proactive family screening identified asymptomatic carriers, underscoring the value of genetic counseling for at-risk relatives. This study demonstrates that early genetic screening coupled with prompt abatacept-based immunomodulation and IVIG replacement can markedly shorten diagnostic latency, stabilize multi-system disease.These findings provide a model for precision-medicine approaches in diverse populations.

Background: Sexual violence remains a serious public-health and medico-legal concern in India. There is limited state-wide published data describing patterns of reported sexual assault in Madhya Pradesh (India). This five-year retrospective descriptive study was undertaken to estimate the prevalence, describe victim and assault characteristics, and summarize key forensic findings among cases reported to health-care and police services between 2018 and 2022. Materials and Methods: We performed a retrospective study of medico-legal registers, forensic examination records and corresponding police First Information Reports from multiple tertiary and district hospitals across the state for the period 1 January 2018 to 31 December 2022. Extracted variables included victim demographics (age, sex, residence, marital status), assault circumstances (year, location, relationship to perpetrator, time to reporting), and clinical/forensic findings (genital and extra-genital injuries, pregnancy test, forensic specimen collection and laboratory results). Data were entered into a coded database and analysed using descriptive statistics (means/medians, proportions) and bivariate tests (chi-square for categorical variables; Mann–Whitney U or Kruskal–Wallis for non-parametric comparisons). Statistical significance was set at p&lt;0.05. Institutional ethics approval was obtained prior to data collection. Results: A total of 18,718 reported cases were identified over five years. Annual counts showed a decline in 2020 with partial recovery in 2021–2022. Females comprised the overwhelming majority of victims (&gt;95%). Minors (&lt;18 years) accounted for approximately 60% of cases. Median delay from incident to presentation was 5 days (IQR 2–15); only about one-third presented within 24 hours. In 85% of cases the perpetrator was known to the victim. Acute genital injuries were documented in roughly 25–30% of survivors; extra-genital physical injury was less common (~10%). Forensic specimens were obtained in a minority of cases and biological confirmation of semen/spermatozoa was infrequent. Delayed reporting was significantly associated with lower rates of positive forensic findings (p&lt;0.01). Conclusion: Reported sexual assaults in the study period disproportionately affected young, unmarried females and children, and were most often perpetrated by known persons. Long delays in reporting reduced opportunities for successful forensic evidence recovery. Strengthening community awareness, improving access to timely medico-legal services, and standardizing forensic sample collection are essential to improve care, documentation and legal outcomes.

Patients with polycythaemia vera are at a higher risk for thrombotic events, which may occur at any time before diagnosis, at diagnosis or later during the disease. Besides an increased haematocrit, thrombocytosis may be an early marker of polycythaemia vera. Our study aimed to analyse the frequency of thromboembolic events and the presence of thrombocytosis/erythrocytosis preceding the diagnosis of polycythaemia vera. This monocentric, retrospective study included patients diagnosed with polycythaemia vera, aged 18 years or over, seen at our institution between January 2008 and December 2018. Baseline demographics, polycythaemia vera diagnosis information, comorbidities, presence and type of thromboembolic events, and blood counts before thromboembolic events and polycythaemia vera diagnosis were analysed. A total of 79 eligible patients were included. There was a slight male predominance (57%) with a median age at polycythaemia vera diagnosis of 69 years. Fifty-two patients (66%) had a thromboembolic event (24 before or concomitant with polycythaemia vera diagnosis, 11 after polycythaemia vera diagnosis and 17 both before and after polycythaemia vera diagnosis). Overall, 40 patients experienced arterial thrombotic events and 31 experienced venous thrombotic events. For the 41 patients with thromboembolic events before or concomitant to the polycythaemia vera diagnosis, the median platelet count at the time of the thromboembolic event was 365×109/l before and 479×109/l at polycythaemia vera diagnosis; the median leukocyte count was 11.2×109/l and 11.5×109/l, respectively; haemoglobin (haematocrit) level was 168 g/l (50%) and 179 g/l (53%), respectively. We had access to 90 blood counts performed before polycythaemia vera diagnosis in 17 patients with a thromboembolic event prior or concomitant with the polycythaemia vera diagnosis. For these patients, the median time from the first blood count showing platelets >350×109/l or >450×109/l to the diagnosis of polycythaemia vera was 36 months and 24 months, respectively. Four patients had a thromboembolic event prior to polycythaemia vera diagnosis with a normal platelet count. In these four patients, the median delay between the thromboembolic event and the polycythaemia vera diagnosis was 32 months. For the remaining 13 patients, the median time from the first blood count with platelets >350×109/l or >450×109/l and the thromboembolic event was 46 months and 10 months, respectively. The median time from the earliest available blood count showing Hb >16.5 g/dl (Hct >49%) for men or Hb >16.0 g/dl (Hct >48%) for women to the diagnosis of polycythaemia vera was 25 months and 24 months, respectively, and to the thromboembolic event was 12 months and 13 months, respectively. Our study shows that both thrombocytosis and/or erythrocytosis are frequently present months and even years before the diagnosis of polycythaemia vera. In addition, the occurrence of a thrombotic event may be the earliest indicator of polycythaemia vera, particularly with thrombocytosis >350×109/l. The presence of thrombocytosis and/or erythrocytosis, even moderate, in the absence of a secondary cause, should evoke suspicion of a myeloproliferative neoplasia, including polycythaemia vera.