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Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary. The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose. A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink. More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis.

Aim of this study was identify the prevalence of frailty in patients with idiopathic Parkinson's disease (PD), to describe the relationship between severity of the disease and frailty, and to evaluate if timed up and go (TUG) is an eligible test for determination of frailty in idiopathic PD patients. We conducted a cross-sectional study which included 66 patients, aged 60 and over in a tertiary hospital. Frailty was assessed by the Fried Frailty Index (FFI). Severity of the idiopathic PD was detected by the Hoehn and Yahr (H&Y) scale. Mobility was measured by the TUG test. Demographic characteristics and comprehensive geriatric assessments were evaluated. Descriptive statistics and logistic regression were used in analyses. Receiver operating characteristic (ROC) curves were used to identify the discriminative effect of TUG test on frailty. The numbers of frail, prefrail, and robust subjects were 34 (51.5%), 24 (36.4%), and 8 (12.1%), respectively. Dependency in (IADL) was significantly associated with frailty (Odds ratio (OR): 36.00, Confidence interval (CI): 8.43-153.80). Multivariate logistic regression analysis results yielded, depression (OR: 10.37, CI: 2.82-38.12) and higher levodopa doses (OR: 6.28, CI: 1.77-22.24) were independently associated with frailty. TUG test performance was strongly associated with frailty with high sensitivity (0.806) and specificity (0.826) (Area under the curve (AUC): 0.831). Frailty is highly prevalent in idiopathic PD and is strongly associated with disabilities as well as specific risk factors of the disease. The TUG may be a reliable test for prediction of frailty in patients with idiopathic PD.

Background/aimTo assess sarcopenia and dynapenia and their relationship with disease severity and disabilities in PD and to state body composition in PD.MethodsWe conducted a case–control, cross-sectional study that included 70 patients with idiopathic PD and 85 controls. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Dynapenia was detected by a handheld dynamometer. Bioimpedance analysis (BIA) was performed, and the SARC-F questionnaire was applied. Disabilities were appointed according to the Katz and Lawton indexes.ResultsSarcopenia and dynapenia were more prevalent in PD than in controls (50 vs 30.6% and 31.4 vs 17.6%, respectively). Dynapenia was significantly associated with the severity of the disease and disabilities (p = 0.047, p = 0.001); however, sarcopenia was not. The skeletal muscle mass index (SMMI), fat mass index (FMI), and fat-free mass index (FFMI) did not differ between the PD and controls. FMI was lower in the advanced stages of the disease. Higher scores in the SARC-F questionnaire were significantly associated with disabilities and the severity of the disease (p < 0.001, p < 0.001).ConclusionMuscle strength was closely associated with the severity of the disease and disabilities in PD, but muscle mass was not. Sarcopenia, defined by the SARC-F questionnaire, was a good predictor of disabilities in PD, while the EWGSOP criteria were not. PD patients have a favorable body composition even in advanced stages of the disease with lower FMI and protected lean mass.

The increasing reliance on commercial inorganic fertilizers has raised significant environmental and economic concerns, including soil degradation, nutrient leaching, water pollution, and greenhouse gas emissions. This review critically evaluates biomass-derived chars produced via thermochemical processes, i.e., pyrolysis, gasification, and hydrothermal carbonization, as potential alternatives to synthetic fertilizers. Among the three biomass-derived chars, biochar stands out as the most viable option for soil amendment due to its high stability, nutrient retention capacity, and long-term carbon sequestration benefits. Gasification char, despite its high porosity and adsorption capacity, often lacks bioavailable nutrients, whereas hydrochar, though rich in organic compounds, poses challenges related to stability and phytotoxicity. Biochar application has been shown to significantly reduce N2O emissions, enhance soil water retention, and mitigate nutrient runoff, offering clear environmental advantages over conventional fertilizers. Moreover, biochar has transitioned from an experimental soil amendment to a commercially available product with increasing adoption in agriculture worldwide, further reinforcing its practical viability. However, large-scale implementation still faces economic and logistical constraints, including high production costs, transportation inefficiencies, and regulatory uncertainties. Addressing these challenges through policy incentives such as subsidies and carbon credits can enhance the economic feasibility of biochar production and application. Given these findings, this review focuses on biochar as the most practical and sustainable alternative to commercial inorganic fertilizers.

Objective: To evaluate the relationship between polypharmacy and the risk of recurrent falls and to assess the fall risk with different pharmacological groups of drugs. Materials and Methods: In this cross-sectional study, falls risk-increasing drugs were defined as cardiovascular drugs, analgesics, central nervous system drugs, endocrine drugs, and others. Falls were evaluated according to their presence during the past 12 months. Two or more falls were recorded as recurrent fallers. Results: Five hundred and eighteen participants had a mean age of 71.9 years (7.5) and 71.0% were female. While 87 (51.4%) participants fell once, 82 (48.5%) participants reported recurrent falls. Two hundred and eighty-eight (55.6%) participants had polypharmacy. The percentage of patients who used at least one potentially inappropriate mediation on admission, as defined by the Beers criteria, was 155 (29.9%). The determinants of the risk of recurrent falls were older age and use of angiotensin-converting enzyme inhibitors (ACE-I) [odds ratio (OR) 1.05: 95% confidence interval (CI) 1.00-1.09 and OR 4.04: 95% CI 1.70-9.60, respectively]. Low handgrip strength (HGS) increased the risk of falls approximately 1.7 times (OR 1.69 95% CI 1.11-2.58). Conclusion: Although the polypharmacy rate of the participants was high, there was no significant relationship between polypharmacy and falling. However, we found low HGS, a component of sarcopenia, as a risk factor for falls, and use of ACE-I and older were risk factors for recurrent falls. Keywords: Falls risk-increasing drugs, handgrip, older adults, polypharmacy, recurrent falls

Background Adolescents diagnosed with Celiac Disease are at risk of experiencing physical, psychological and social difficulties that affect their quality of life. Dietary restrictions also create stress related to social difficulties in daily life.This study aimed to examine the associations between diet quality, social participation, quality of life, and occupational balance among adolescents diagnosed with Celiac Disease, and to evaluate the interrelationships among these variables. Methods The study sample consisted of 52 adolescents diagnosed with Celiac Disease (aged 12–18 years) and 55 age-matched healthy controls. Data were collected on participants’ body composition, anthropometric measurements, adherence to the Mediterranean diet (assessed via the KIDMED index), social participation (Child and Adolescent Scale of Participation, CASP), Quality of Life (Pediatric Quality of Life Inventory, PedsQL), and occupational balance (Adolescent Occupational Balance Scale, A-OBS). Spearman’s rank-order correlation analysis was conducted to examine the associations among the study variables. Results The mean KIDMED score was significantly higher in adolescents with Celiac Disease compared to healthy controls (24.09 ± 1.65 vs. 22.96 ± 2.45; p  = 0.006). Additionally, the Celiac Disease group demonstrated significantly higher scores in total PedsQL, physical functioning, and school functioning domains ( p  < 0.05). Scores for the Adolescent Occupational Balance Scale (A-OBS), including total score, temporality, and rest and sleep subdomains, were also significantly elevated in the Celiac group ( p  < 0.05). The correlation analysis revealed no significant associations between the total KIDMED score and other measured parameters, except for a weak but statistically significant negative correlation with the CASP Home and Community Living Activities subscale (rho = − 0.292, p  = 0.036). Furthermore, total PedsQL score was positively correlated with A-OBS total, temporality, and rest and sleep scores. Conclusions This study demonstrated that adolescents with Celiac Disease exhibit higher diet quality compared to their healthy counterparts; however, this improved dietary adherence may be negatively associated with social participation. These findings underscore the importance of a holistic approach in the clinical management of Celiac Disease, taking into account not only nutritional adequacy but also psychosocial well-being.

Background. ZFYVE19 mutation has been recently identified as one of the non-syndromic causes of cholestasis. It is associated with elevated gamma-glutamyl transferase levels and is likely a cause of neonatal-onset and intrahepatic cholestasis. Case. Here, we report a rare case of ZFYVE19 defect, confirmed by whole exome sequencing (WES). Our patient, who is currently 4 years old, presented to us at the age of 2 years with elevated levels of serum transaminases and bilirubin. WES revealed a homozygous ZFYVE19 mutation despite preserved synthetic liver function. This gene has recently been identified in the literature as a cause of non-classical progressive familial intrahepatic cholestasis (OMIM # 619849). Treatment with an appropriate dose of ursodeoxycholic acid resulted in the regression of elevated liver enzymes and itching. The patient’s body mass index progressively increased throughout the treatment period. No medication side effects were observed at any point. Currently, the patient remains asymptomatic during follow-up. Conclusion. We have identified the ZFYVE19 mutation as a variant that is not accompanied by any other symptoms. However, we have limited knowledge about the progression of the disease and are closely monitoring the patient for potential liver-related issues. Using WES in cases of undiagnosed liver enzyme elevations or cholestasis can help identify new genes and improve our understanding of the underlying pathophysiology.

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, rpb = 0.380 and p < 0.001, rpb = 0.447 respectively) and TUG performances were worse (p = 0.009, rpb = − 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, rpb = 0.345, p = 0.008, rpb = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia.

Aims: It has been reported that there is a link between celiac disease and other autoimmune diseases in children. We aimed to compare the presence of autoimmune thyroid disease in children with celiac disease and the ultrasonographic evaluations of these patients with healthy controls. Methods: This cross-sectional, case-control study enrolled pediatric patients diagnosed with celiac disease and healthy children as controls. All patients and controls were tested for celiac antibodies (anti-tissue transglutaminase immunoglobulin A), thyroid function tests (thyroid-stimulating hormone, free thyroxine, free triiodothyronine, thyroid peroxidase antibody, and anti-thyroglobulin antibody), and thyroid ultrasonography. The primary endpoint was the difference in the frequency of autoimmune thyroiditis between patients and controls. Results: The study included 50 children with celiac disease [mean[+ or - ]standard deviation (SD) age: 10.98[+ or -]3.84, 59% girls] and 50 healthy controls (mean[+ or -]SD age: 11.36[+ or -]4.17 years, 65% girls). Five patients (10%) with celiac disease and none of the controls were diagnosed with autoimmune thyroiditis at the time of enrolment (p=0.022). No relationship was identified between the severity of small bowel pathology and autoimmune thyroiditis in patients with celiac disease. Additionally, no significant differences were observed in the ultrasonographic evaluation between celiac patients and controls. Conclusions: In this low-sample study, patients with celiac disease were more likely to have autoimmune thyroiditis than the controls. However, the severity of small bowel damage in celiac disease may not be associated with autoimmune thyroiditis. Keywords: Autoimmune, celiac disease, children, thyroiditis, ultrasonography

Objectives The aim of this retrospective study is to evaluate the effect of age and gender on the alveolar bone destruction pattern with cone beam computed tomography (CBCT) in the posterior region of the maxilla. Materials and Methods The study group included CBCT image records of 361 consecutive patients (180 males and 181 females) aged 20 years and older. Alveolar crest morphology in the maxillary right and left first and second molar teeth on retrospective images was classified as a horizontal or vertical defect (one‐walled, two‐walled, three‐walled, and combined bone defect) on four surfaces (mesial, distal, buccal, and palatinal). Bone crater defects were defined, and furcation involvements and combined periodontal–endodontic lesions (CPELs) were placed in another category. Results In 361 patients, 1444 teeth were evaluated from adults between 20 and 63 years of age; 49.9% of the patients were male and 50.1% were female. Female patients had a considerably greater rate of one‐walled horizontal damage in the right molar teeth than male patients (p = 0.002; p < 0.05). Patients with combined horizontal destruction in the right and left molar teeth, horizontal destruction in the palatinal, and horizontal three‐walled destruction had a significantly higher mean age than patients without these periodontal destructions (p = 0.000; p < 0.05). Males were shown to have statistically higher frequencies of horizontal defects when defects were combined or distally and palatally located. Conclusions Age and gender affect the alveolar bone loss pattern. Except for single‐walled destructions, it has been found that the frequency of horizontal destruction increases with age. Horizontal destruction in the palatinal along with horizontal three‐walled destruction increased with age. Clinical Relevance Recognizing the alveolar bone destruction patterns and affecting demographic factors in the maxillary molar area, the most susceptible region to periodontal abnormalities, may provide a better understanding of alveolar bone loss with accurate diagnosis and effective treatment planning.