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Background: In-hospital cardiac arrest (IHCA) constitutes a high-impact clinical event, associated with substantial mortality, frequent neurological and functional impairment. There is a pressing need for primary IHCA studies that evaluate risk predictors, given the inherent challenges of IHCA data collection, previously unharmonized reporting frameworks, and the predominant focus of prior investigations on other domains. Among potential contributors, the “off-hours effect” has consistently been linked to poorer IHCA outcomes. Accordingly, we sought to examine whether in-hospital mortality after IHCA varies according to the time and day of occurrence within a tertiary academic center in Northern Greece. Methods: We conducted a single-center observational cohort study using a prospectively maintained in-hospital resuscitation registry at AHEPA University General Hospital, Thessaloniki. All adults with an index IHCA between 2017 and 2019 were included, and definitions followed Utstein-style recommendations. Results: Multivariable logistic regression adjusted for organizational, patient, and process-of-care factors demonstrated that afternoon/night arrests, weekend arrests, heart failure comorbidity, and need for mechanical ventilation were independent predictors of higher in-hospital mortality. Conversely, arrhythmia as the cause of IHCA and arrests occurring in the intensive care unit or operating room were associated with improved survival. Subgroup analyses confirmed consistent off-hours differences, with weekend events showing reduced 30-day and 6-month survival and worse functional status at discharge. Afternoon/night arrests were more frequent, characterized by longer response intervals and lower survival at both time points. Conclusions: Organizational factors during nights and weekends, rather than patient case mix, drive poorer IHCA outcomes, underscoring the need for targeted system-level improvements.

Background/Objectives: In-hospital cardiac arrest (IHCA) carries high mortality and substantial risk of neurological and functional impairment. Given that contemporary, clinically relevant risk models remain limited, especially within Southern European systems, the aim of this study was to develop a process-aware model for bedside risk stratification. Methods: We retrospectively analyzed a single-center cohort from a prospectively maintained resuscitation registry (AHEPA University General Hospital, Thessaloniki). Adults (≥18 years) with index IHCA in 2017–2019 were included. Utstein-defined variables underwent univariable screening, LASSO selection, and collinearity checks before multivariable logistic regression for in-hospital mortality. We assessed discrimination (AUC) and calibration (Hosmer–Lemeshow). Results: Among 826 IHCAs, 137 survived to discharge and 689 died. Higher mortality was independently associated with longer CPR (aOR = 1.115, 95% CI: 1.080–1.158), older age (aOR = 1.034, 95% CI: 1.014–1.055), and CCU location (aOR = 7.303, 95% CI: 2.557–25.798), while operating room (aOR = 0.029, 95% CI: 0.003–0.252), ICU/HDU (aOR = 0.203, 95% CI: 0.065–0.630), and an initial shockable rhythm (aOR = 0.297, 95% CI: 0.144–0.611) were protective. Longer time to CPR initiation also predicted mortality (aOR = 1.746, 95% CI: 1.001–3.162). Model performance was strong (AUC = 0.897, 95% CI: 0.865–0.928) with good calibration (Hosmer–Lemeshow p = 0.879). Conclusions: A process-aware model integrating patient factors, intra-arrest metrics, and location showed excellent internal performance for predicting IHCA mortality. Findings reaffirm the prognostic importance of age, rhythm, and resuscitation timeliness/intensity and support future work extending prediction to neurological/functional outcomes and testing targeted care bundles in high-risk strata.

Background: Cardiac arrest is a time-critical medical emergency during which prompt and effective drug delivery plays a key role in patient outcomes. Current resuscitation guidelines recommend intravenous (IV) access as the first-line route, with intraosseous (IO) access recommended as an alternative when IV access is delayed or not feasible. Although the endotracheal (ET) route was previously included in resuscitation protocols, it is no longer recommended. This study aims to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) effects of resuscitation drugs administered through different injection sites and under varying hemodynamic conditions in in vivo animal models. Methods: PubMed, CENTRAL and ClinicalTrials.gov were searched up to August 2025 for studies comparing different injection sites for the same drug (adrenaline/epinephrine, amiodarone, lidocaine and vasopressin) during CPR. Study selection, data extraction, and quality assessments were performed independently by two reviewers. Frequentist random-effects models were used to calculate mean differences and odds ratios (ORs) with 95% confidence intervals (CIs). Results: Fourteen prospective experimental studies (sample sizes ranging from 15 to 49 animals) conducted on swine were included. For epinephrine under normovolemia, humeral IO (HIO) access achieved significantly higher maximum concentrations (Cmax; p = 0.0238) and a shorter time to the maximum concentration (Tmax; p < 0.01) compared to IV, translating into faster return of spontaneous circulation (ROSC) (p = 0.0681). Under hypovolemia, IV access proved superiority over IO for epinephrine administration (MD = +382.80 ng/mL; p = 0.0022). The time to ROSC was significantly shorter with sternal IO (SIO) compared to tibial IO (TIO) (p = 0.0109). For amiodarone and vasopressin, no consistent or statistically significant differences were observed between administration routes, and in several cases, the findings were based on a single study. Conclusions: The injection site significantly influences the PK and PD of epinephrine during cardiac arrest. Proximal IO routes may offer advantages under normovolemic conditions, while IV access appears superior in cases of hypovolemic shock. Further research is needed to guide optimal drug delivery in varying hemodynamic conditions during cardiac arrest.

Consumers differentiate milk-quality characteristics in relation to the production system, but data on retail milk composition are limited. This study investigated how farming methods and seasons affect proximate composition, fatty acid profile, antioxidant activity, and physicochemical characteristics of commercial cow’s milk. Milk samples, both conventional (n = 84, 7 manufacturers) and organic (n = 24, 2 manufacturers), were collected monthly over a year. Farming system did not significantly affect milk composition other than fat content, whereas seasonal effects were notable, impacting the contents of ash, protein, and added water. Fatty acid composition exhibited variations influenced by both production system and season. Compared to conventionally produced milk, organically produced milk exhibited higher levels of polyunsaturated fatty acids (4.54 vs. 3.88, p < 0.01) and a lower atherogenicity index (2.23 vs. 2.50, p < 0.05). The antioxidant activity showed that conventionally produced milk exhibited better radical-scavenging activity (DPPH) (14.54 vs. 12.30 μM TE/mL, p < 0.01). Seasonal variations were evident in both free radical-scavenging activity (DPPH), with values of 12.29 μM TE/mL in winter and 15.58 μM TE/mL in spring (p < 0.05), and ferric reducing-antioxidant power (FRAP), with levels of 21.81 μM TE/mL in autumn and 27.94 μM TE/mL in spring (p < 0.05). Season significantly affected (p < 0.001) milk pH, electrical conductivity, refractive index, and freezing-point depression. In conclusion, this study showed that the farming system has a limited impact on retail milk quality compared to the significant influence of season.

Dairy products from mountain-origin milk are known for their superior composition and quality. This study aimed to examine changes in composition, nutritional quality, and antioxidant properties of milk from semi-intensively managed goats in mountainous regions during the post-weaning to end-of-lactation period. Bulk tank milk samples from 10 farms were collected bi-weekly in the period from March to September. The farms were situated in regions with an average altitude of 772.20 m above sea level. The results revealed significant variations in milk composition, with fluctuations in fat, protein, lactose, and total solids. Milk yield per doe showed seasonal differences, with the highest yield in April and the lowest in September. Fatty acid composition exhibited changes throughout the sampling period, with variations in polyunsaturated fatty acids. Nutritional indices, such as the atherogenicity index and thrombogenicity index, remained within the recommended values. Antioxidant properties, including total phenolic content, DPPH, FRAP, and ABTS, showed significant differences, with higher values toward the end of the study. Milk pH, electrical conductivity, brix value, and refractive index also exhibited variations, while density and freezing point remained relatively stable. The study provided valuable information that can be used to develop breeding and feeding plans to achieve uniform milk quality in mountainous regions.