Introduction: Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, affecting 2–3% of children aged 10–16 years. Severe cases often require posterior spinal fusion (PSF) to correct curvature and improve quality of life. Despite its effectiveness, PSF is associated with significant postoperative pain due to extensive spinal instrumentation and muscle dissection. Opioids remain the mainstay of analgesia but carry risks such as respiratory depression, nausea, and dependence. Increasingly, multimodal analgesic strategies are being explored to reduce opioid use. Among these, gabapentin and ketamine have shown promise as adjuvants for effective perioperative pain management in AIS. The aim of the study is to evaluate the utility of gabapentin and ketamine as adjuvants in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion, with primary focus on postoperative opioid consumption (morphine equivalents) and associated complications.

Methods: Major electronic databases, including PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Library, were screened till December 2024 for randomized controlled trials (RCTs) and controlled cohort studies. Data was synthesized using the Review Manager 5.4 software using the generic inverse variance method and random model & reported in Standardized mean difference (SMD) and odds ratio (OR).

Results: Eleven studies comprising 520 patients indicated that children receiving gabapentin or ketamine required significantly lower morphine doses at 24 hours (SMD: -0.66; 95% confidence interval [CI]: -.92, -0.40; I² = 13% & SMD:-1.59; 95% CI:-3.09, -0.09; I² = 95 %, respectively) and 48 hours (SMD: -0.59; 95% CI: -0.88, -0.30; I² = 0%, SMD: -0.63; 95% CI: -1.61, 0.35; I² = 91%, respectively) compared to the control group. However, no significant differences were observed in terms of period of hospital stay (SMD: -0.10; 95% CI: -0.32, 0.13; I² = 0%, incidence of postoperative nausea & vomiting (OR: 0.40; 95% CI: 0.15, 1.06, I² = 56%).

Conclusions: Perioperative administration of gabapentin or ketamine significantly reduces opioid consumption within the first 48 hours following posterior spinal fusion in AIS patients.

Background

The growing elderly population has increased susceptibility to postoperative neurocognitive disorders, particularly delirium (POD) and cognitive dysfunction (POCD). POD occurs in 14–60% and POCD in 30–50% of older surgical patients. Emerging evidence implicates neuroinflammation, oxidative stress, and neuronal dysfunction. We hypothesize that Brain-Derived Neurotrophic Factor (BDNF) and Malondialdehyde (MDA) biomarkers may predict POD and POCD risk.

Methods

This prospective observational cohort study (IEC approval: 283/07.05.2021; CTRI/2024/12/077549) enrolled 80 patients >60 years undergoing major orthopaedic surgery. After informed consent, baseline demographics, comorbidities, and laboratory parameters were recorded. Cognitive and neuropsychiatric assessments were conducted pre and postoperatively using standardized psychological scales. Serum levels of biochemical markers, BDNF and MDA were measured using ELISA at both time points.

Results

The cohort had a mean age of 67.67 ± 6.2 years (44 males, 36 females) and mean BMI of 23.08 ± 4.2. Comorbidities were diabetes (17), hypertension (11), thyroid disorders (8), and hypercholesterolemia (11), where most cases were ASA Grade I (62) with 18 cases of PONV. Cognitive assessments revealed a significant postoperative decline in ACE-III (p = 0.01) and DRS-R-98 (p = 0.0001) scores with no significant changes in TMT-B, Stroop Test, or Porteus Maze scores. MDA levels demonstrated a near-significant reduction (885.01 ± 891.26 to 670.35 ± 570.41 nmol/mL; p = 0.07), indicating a possible decrease in oxidative stress post-surgery.

Conclusion

This study reveals a high risk of POD and POCD among elderly patients undergoing major orthopedic surgery. Significant cognitive decline by ACE-III and DRS-R-98 scores was observed postoperatively. MDA levels suggest a potential role of oxidative stress in cognitive outcomes. These findings highlight the importance of routine cognitive assessment and biochemical monitoring in the perioperative period. Further research is needed to confirm these associations and to develop preventive strategies.

Introduction: Accurate intraoperative monitoring of anesthetic depth is essential to prevent intraoperative awareness, excessive anesthesia, and associated complications. Electroencephalographic (EEG)-based tools, particularly the Bispectral Index (BIS), have emerged as useful adjuncts to guide anesthetic titration and improve clinical outcomes. This review explores the clinical utility, safety, and limitations of BIS-guided anesthesia management in adult surgical patients. Methods: A narrative literature review was conducted using the BVS database. Descriptors included “Electroencephalography”, “Bispectral Index”, “Intraoperative Monitoring”, “General anesthesia” and “Consciousness Monitors” combined using Boolean operators. Inclusion criteria encompassed clinical studies and reviews published between 2020 and 2025, available in English, Portuguese, or Spanish. Eleven articles were selected based on relevance to BIS use during general anesthesia in adult surgical patients. Results: BIS-guided anesthesia was consistently associated with lower anesthetic consumption, shorter emergence times, and improved postoperative recovery, especially in elderly patients. Studies demonstrated that maintaining BIS values within the 40–60 range helped optimize sedation without compromising hemodynamic stability. BIS values <40 combined with hypotension were linked to increased 90-day mortality. Evidence supports the use of BIS to reduce the incidence of intraoperative awareness, particularly during total intravenous anesthesia (TIVA). However, variability in BIS readings and response to anesthetics between individuals remains a challenge. EEG-based monitoring also shows promise in improving safety in high-risk populations, although some large trials reported no long-term mortality benefit. Conclusion: BIS monitoring contributes to more precise anesthetic depth control, reduced drug use, and potentially improved short-term outcomes. While not free from limitations, BIS remains a valuable tool in intraoperative monitoring, especially when used alongside clinical judgment and other physiological parameters. Further research is warranted to standardize protocols and evaluate long-term benefits.

Abstract

Background: The COVID-19 pandemic represented an unprecedented global health challenge, leading to the accelerated development and deployment of several vaccines. Their effectiveness in reducing severe cases and mortality is well established; however, concerns have emerged regarding rare but potentially significant cardiovascular adverse events. Understanding these manifestations is essential to strengthening post-vaccination surveillance and providing clinicians with reliable data.

Objective: This study aimed to analyze self-reported cardiovascular symptoms following COVID-19 vaccination, considering vaccine type, number of doses received, and medical history. A comparative analysis with a non-vaccinated group was also performed to identify potential differences in symptom occurrence.

Methods: A cross-sectional descriptive study was conducted in the Wilaya of Relizane, Algeria, between February and April 2025. The survey included 148 participants: 56 individuals vaccinated against COVID-19 and 92 non-vaccinated controls. Participants were voluntarily recruited through a structured self-administered questionnaire, distributed online and in health centers and public institutions. Collected data were analyzed using SPSS version 27.0, with the level of statistical significance set at p < 0.05.

Results: Among vaccinated participants, 75% reported at least one symptom suggestive of cardiovascular involvement after vaccination. The most frequently reported were chest pain (39.3%), palpitations (26.8%), shortness of breath (26.8%), and limb pain (30.4%). Symptoms typically appeared within hours (39.3%) or within a few days (28.6%) after vaccination. In most cases, they lasted only a few days (51.8%), although 14.3% of participants reported persistent symptoms at the time of the survey. Statistical analysis did not reveal any significant association between vaccine type and the occurrence of cardiovascular manifestations.

Conclusion: This exploratory study, the first of its kind in Algeria, provides valuable preliminary insights into post-vaccination cardiovascular symptoms. While no significant associations were found, the findings highlight the importance of continuous monitoring and the need for larger, more rigorous, and clinically documented national studies.

Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been shown to provide protective effects in patients with type 2 diabetes, heart failure, and chronic kidney disease. Evidence on their impact in the perioperative setting, particularly in cardiac surgery, however, remains scarce, thus, we aimed to evaluate the association between preoperative SGLT-2i use and postoperative outcomes in patients undergoing major cardiac surgical procedures.

Methods: This retrospective, single-center study included adult patients with SGLT-2i therapy, who underwent cardiac surgery between 2020 and 2024. The exposure was defined as documented SGLT-2i use within 14 days before surgery. The primary endpoint was postoperative acute kidney injury (AKI) defined according to KDIGO criteria; secondary endpoints included need for kidney replacement therapy, ICU length of stay, and 30-day mortality. A causal inference framework employing inverse probability of treatment weighting was applied to estimate the effect of SGLT-2i therapy.

Results: Of the study population (n=1257), 211 (16.8%) were female. Four hundred eighty two (38.3%) patients were SGLT-2i users and 775 (61.7%) non users. Users had a EuroSCORE II (median 2.5 [1.4–4.9] vs. 1.5 [0.9–2.6], p<0.001), and more frequent chronic kidney disease and heart failure. Baseline creatinine was higher among users, while preoperative hemoglobin was lower. Thirty-day survival did not differ significantly between groups (97.0% vs. 98.3%, p=0.253).

Conclusion: In patients undergoing cardiac surgery, preoperative SGLT-2i use was associated with distinct baseline characteristics including higher comorbidity burden. While mortality did not differ, the causal inference framework will allow for robust estimation of the therapy’s effect on postoperative AKI risk. These findings contribute to the growing body of evidence on the potential perioperative benefits of SGLT-2i and support the need for prospective validation.

Introduction: Dengue is a significant public health concern in Brazil, characterized by its extensive territorial distribution, seasonal patterns, and regional variations. A substantial increase in reported cases in 2024 placed a critical burden on emergency services. Objective: To describe the number of dengue notifications in Brazil from 2015 to September 2025 by age group and discuss their implications for Emergency Medicine. Methods: This ecological, descriptive, and quantitative study used secondary data from the National Notifiable Diseases Information System (SINAN) via the TABNET/DATASUS platform. All probable dengue notifications (excluding discarded cases) from 2015 to September 2025 were included. Results: A total of 18,231,381 cases were reported between 2015 and 2025, with the highest number occurring in 2024 (6,431,065; 35.3%). The most affected age group was 20–39 years, accounting for 6,592,263 cases (36.2%), while the least affected were individuals aged 80 years or older, at 260,518 (1.43%). Adolescents aged 10–19 years accounted for 2,862,216 cases (15.7%) and have been eligible for free dengue vaccination since 2024. In this group, 970,410 cases were reported in 2024, which represents an approximately 297% increase from the 244,423 cases reported in 2023. As of September 2025, 217,313 cases had been notified in this age group. Conclusion: Dengue notifications increased substantially between 2015 and 2024, with a potential decline in 2025, especially among adolescents. The high concentration of cases among this age group and young adults presents a significant challenge for emergency services, requiring rapid triage, fluid management, and the timely identification of severe cases. Therefore, these fluctuations have a significant impact on the organization of emergency services, underscoring the need for enhanced preparedness, staff training, and effective resource allocation to manage seasonal surges and mitigate morbidity and mortality.

Background and aims: Marfan syndrome (MFS) is an autosomal genetic disease caused by FBN1 mutation. Patients with the same FBN1 mutation type exhibit different phenotypes, which indicates extra risk factors. The primary risk factor for death in MFS patients is cardiovascular complications, including aortic root enlargement, aortic aneurysm and aortic dissection. Mitochondrial dysfunction was observed in the aortas of both MFS patients and marfan murine models. Single nucleotide variants (SNVs) in mitochondrial DNA (mtDNA) may cause mitochondrial dysfunction. However, the association of mtDNA mutations with MFS and its cardiovascular complications has been unclear.

Methods: Blood samples (48 healthy controls and 77 MFS patients, including 7 mother-offspring pedigrees) were obtained from the Beijing Anzhen Hospital, with informed consent. The identification of SNVs in the mitochondrial genome was through alignment to the GRCh38.p14 reference genome. Mutants were identified by VarScan2. Targeted mtDNA sequencing was used to detect single nucleotide variants in mtDNA.

Results: We found that, in the MFS group, 64.93% of patients enrolled have aortic manifestations, including width, dissection, and aneurysm. m.9738G>A was identified in a family whose dominant phenotype was aortic manifestations. The proband of pedigree Ⅱ is a 5-year-old boy with a maternally inherited FBN1 mutation (Exon2; p.R5C) and dilatation of the aorta (z-score = +5.63), whose mother has type A dissection. A mtDNA mutation m.9738G > A (VAF = 0.9993, AF in Mitomap = 0.0012) in the MT-CO3 gene was inherited from the Ⅰ-2 mother to the proband. The same variant was detected in a sporadic case, a 47-year-old woman with an FBN1 mutation who had an aneurysm (z-score = +9.19).

Conclusions: These data demonstrate frequent and specific mitochondrial mutational pattern in MFS patients with cardiovascular complications. The mtDNA mutation might be a potential modifier and diagnostics of MFS phenotypes, especially MFS patients with cardiovascular complications.

Objective: To explore the utility of ¹⁸F-FDG and ¹⁸F-AV45 PET/CT in patients with varying cognitive impairment severities. Methods: This retrospective study included 202 patients with cognitive impairment (70 males, 132 females; aged 41-91 years) who underwent both ¹⁸F-FDG and ¹⁸F-AV45 PET/CT between December 2020 and March 2025. Patients were classified into mild cognitive impairment (MCI, n=81), mild Alzheimer’s disease (AD, n=75), and moderate-to-severe AD (n=46) groups. A healthy control (HC) group (n=23) was also included. Regional ¹⁸F-FDG Z-scores and ¹⁸F-AV45 SUVR values were processed using Cortex ID software. Statistical analyses included Cohen's Kappa, ANOVA, Kruskal–Wallis test, Bonferroni correction, Pearson correlation, and ROC analysis. Results: Visual analysis method of PET imaging showed that the sensitivity in diagnosing MCI was 74.07% (Kappa=0.34, P<0.001); the sensitivity for diagnosing AD was 96.69% (Kappa=0.78, P<0.001). Semi-quantitative analysis revealed: With the progression of the patients' condition, the ¹⁸F-FDG Z-score of the whole brain and each brain region gradually decreased (H values: 25.53-85.31, all P<0.001). The ¹⁸F-AV45 SUVR gradually increased (H values: 37.93-49.08, all P<0.001). There was no statistically significant difference in ¹⁸F-AV45 SUVR among the AD subgroups (all P>0.05). ROC analysis identified the posterior cingulate gyrus as the most discriminative region for ¹⁸F-FDG in differentiating MCI from HC and AD from HC (AUC=0.68-0.99) and the parietal lobe for mild AD vs. MCI (AUC=0.71). For ¹⁸F-AV45, the posterior cingulate–precuneus region best distinguished MCI/AD from HC (AUC=0.87-0.99), and the occipital lobe best differentiated moderate-to-severe AD from MCI(AUC=0.66). Conclusions: ¹⁸F-FDG and ¹⁸F-AV45 PET/CT imaging can non-invasively evaluate brain Aβ deposition and neurodegenerative changes; Both their visual and semi-quantitative analysis methods can provide important imaging evidence for the early diagnosis and pathophysiological evolution of MCI and AD; ¹⁸F-FDG PET/CT is superior in evaluating disease severity and cognitive function.

Introduction: Cardiovascular diseases remain one of the biggest public health challenges in Croatia, with coronary artery disease (CAD) being the most prevalent. The uneven development and concentration of healthcare facilities in urban areas suggest that rural regions are lagging in providing adequate healthcare. This study aimed to investigate the epidemiological characteristics of patients admitted to the General Hospital in Ogulin (Croatia) with CAD.

Methods: This quantitative, retrospective study included a total of 732 patients with a diagnosis of CAD who were treated between January 1, 2014, and December 31, 2023. The data were extracted from the hospital information system. After data collection, statistical analysis was performed with a significance level of p < 0.05.

Results: CAD accounted for 2.2% of all patients treated during the study period. The results indicate a higher prevalence of CAD among men (56.6%) and individuals aged 60 years or older (76.1%). A clear seasonal pattern was observed, with a peak during the colder months from October to March (n = 462, 63.1%). Of all participants, 488 patients (66.7%) presented with acute coronary syndrome. Taking into account the fact that 58 patients with acute coronary syndrome died, the calculation shows that 66.9% of these patients were transferred to other medical centres.

Conclusions: The results of this study show that CAD is an important cause of hospitalisation in Ogulin General Hospital, especially in men and people over 60 years of age. A marked seasonal variation was observed, with the highest number of cases occurring in the colder months. The high prevalence of acute coronary syndrome and the need to transfer a significant number of patients to other centres demonstrate the limited diagnostic and therapeutic capacity of the regional hospital. At the same time, the fact that one-third of patients are not transferred highlights the importance of further expanding cardiology care in rural areas and of educational programs aimed at reducing healthcare inequalities and improving treatment outcomes.

Introduction

Diabetic Kidney Diseases (DKD) remain a leading cause of Chronic Kidney Disease (CKD) and End Stage Renal Failure (ESRD) worldwide. Conventional therapies confer only partial protection from disease progression. Recent clinical trials have explored novel therapeutic agents that target non-traditional pathways and offer potential reduction in Renal and Cardiovascular morbidity in patients with Type II Diabetes.

Methods

A data-driven review was conducted by extracting efficacy and safety outcomes from Phase II and III clinical trials published between 2019–2025, focusing on three emerging therapeutic classes: the nonsteroidal mineralocorticoid receptor antagonist finerenone, the dual SGLT1/2 inhibitor sotagliflozin, and the endothelin A receptor antagonist atrasentan. Key renal outcomes included reductions in albuminuria and slowing of estimated glomerular filtration rate (eGFR) decline, while cardiovascular outcomes and adverse events were also evaluated.

Results

Across 12 Phase II and III trials encompassing over 19,000 patients with DKD, unconventional therapies demonstrated consistent renal and cardiovascular benefits. Finerenone (n≈5,700) reduced the risk of kidney failure or cardiovascular death by 18% (HR 0.82; 95% CI 0.73–0.93; P=0.001) and the composite kidney outcome by 23–32%, while slowing eGFR decline by up to 20%. Sotagliflozin (n≈10,500) reduced kidney disease-related events by 20–24%, improved albuminuria, and decreased cardiovascular events, including heart failure hospitalizations, with pooled analyses showing a 24% reduction in composite cardiovascular endpoints (HR 0.76; 95% CI 0.70–0.83; P<0.001). Atrasentan (n≈2,900) lowered proteinuria by 30–36% (95% CI −44.6 to −26.4; P<0.001) and reduced the risk of kidney failure or doubling of serum creatinine by 35% (HR 0.65; 95% CI 0.49–0.88; P=0.005). Fluid retention remained the primary adverse effect. Collectively, these agents demonstrated statistically significant improvements in renal and cardiovascular outcomes across diverse DKD populations, offering clear advantages over standard therapy.

Conclusions

Emerging therapies such as finerenone, sotagliflozin, and atrasentan show substantial promise in mitigating renal and cardiovascular complications in DKD. Their unique mechanisms highlight a new paradigm in disease management, offering potential benefits beyond standard glycemic and blood pressure control.