Frontiers in Medicine

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has necessitated the urgent investigation of effective long-term therapeutic agents. This study aimed to evaluate the definitive, long-term causal effect of N-acetylcysteine (NAC) treatment on patient-reported outcomes (PRO) in patients with COVID-19 from hospital admission to six months after discharge. DesignProspective, multi-center, randomized, double-blind, placebo-controlled trial (RCT). SettingFive COVID-19-designated hospitals,...

BackgroundCutaneous melanoma incidence is rising globally, yet epidemiological data from the high ultraviolet (UV) environment in the United Arab Emirates (UAE), with its diverse expatriate population, remain scarce. This study aims to characterize the epidemiological and histopathological features of cutaneous melanoma in a large, multi-ethnic cohort in the UAE. MethodsThis cross-sectional study analyzed histopathologically confirmed cases of cutaneous melanoma diagnosed at a tertiary referral...

BackgroundAnti-tumor necrosis factor (anti-TNF), particularly infliximab, have transformed inflammatory bowel disease (IBD) management, but their high cost imposes a significant economic burden. Infliximab biosimilars were introduced to reduce the unmet needs. Despite the approval of infliximab biosimilars, real-world evidence of cardiovascular safety and effectiveness of infliximab biosimilars is lacking among patients with IBD. In this trial emulation, we compared the effectiveness and cardiov...

BackgroundPatients with chronic immune-mediated disorders (IMIDs), including inflammatory bowel disease (IBD), are at increased risk of cardiovascular disease. While advanced therapies show cardioprotective effects in other IMIDs, their impact on major adverse cardiovascular events (MACE) in IBD remains unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating MACE risk with advanced therapies in IBD. MethodsSystematic search of PubMed, Em...

BackgroundPatients with cirrhosis are highly susceptible to infections due to immune dysfunction and gut barrier impairment. Non-bloodstream infections frequently trigger decompensation and mortality, yet the global distribution of antimicrobial resistance (AMR) in these infections is poorly characterized. MethodsWe performed a systematic review and meta-analysis of studies reporting AMR in non-bloodstream bacterial infections among patients with cirrhosis. PubMed, Embase, and Web of Science we...

BackgroundPyoderma gangrenosum (PG) is a rare neutrophilic ulcerative dermatosis with no FDA-approved therapies and limited validated outcome measures. Investigators Global Assessments (IGAs) are widely used in dermatology but often lack objective criteria, robust validation, and comparability across studies. There remains a critical need for a PG-specific, standardized, and validated severity instrument. MethodsWe developed and conducted initial validation of the Investigator Global Assessment...

ObjectiveTo assess whether focal and non-focal COVID-19 ARDS exhibit different respiratory mechanics and arterial blood gas (ABG) trajectories during the first extended prone positioning (PP) session. DesignPost-hoc analysis of a previously published retrospective monocentric cohort study. SettingA university-affiliated intensive care unit in Paris (France) between March 2020 and April 2021. PatientsSeventy-four adult patients with moderate-to-severe COVID-19 ARDS who underwent extended prone...

Purposeto describe HRV metrics in Covid-19 patients at admission in the ICU and its relationship with mortality and invasive mechanical ventilation (IMV). Heart rate variability (HRV) in sitting position in critically ill patients has not been explored. Methodswe conducted a prospective single-centre observational study. Adult patients admitted in the ICU with respiratory failure due to RT-PCR-confirmed SARS-CoV-2 but not under IMV were included. Electrocardiogram was recorded at least for 15 m...

ObjectiveTo evaluate the ability of a natural language processing system to automatically reconstruct the SOFA score from unstructured clinical notes in patients with sepsis and validate its applicability in intensive care units. Materials and methodsRetrospective study in the MIMIC-III database that included 284 adults with sepsis. The SOFA calculated with structured data was compared with the SOFA reconstructed by free text extraction. Clinical rules were applied for calculation at 24 h and 4...

BackgroundSevere Fever with Thrombocytopenia Syndrome (SFTS) is an acute infectious disease with high mortality. This study aimed to develop a quantitative scoring system for grading SFTS severity using dynamic clinical data. MethodsA retrospective study included 547 confirmed SFTS patients from two hospitals. Clinical data were collected over a 14-day course (divided into four phases). Patients were grouped into survivors (n=451) and non-survivors (n=96). Statistical analyses, including Kaplan...

BackgroundSepsis is a major public health challenge, and reliable biomarkers are essential for distinguishing sepsis from other conditions. Neutrophil Gelatinase-Associated Lipocalin (Neutrophil gelatinase-associated lipocalin (NGAL)) has shown promise as a diagnostic marker due to its role in the immune response. This study evaluates plasma NGAL as a diagnostic tool at the time of ICU admission. MethodsWe analysed plasma NGAL and C-reactive protein (CRP) levels in 4732 adult patients admitted ...

BackgroundMedical students represent a critical population for photoprotection education, as future physicians responsible for skin cancer prevention counseling. However, no previous studies have characterized knowledge, attitudes, and practices (KAP) regarding photoprotection among medical students in Central America or the Caribbean. ObjectiveTo assess KAP related to photoprotection and identify associated factors among medical students at a Nicaraguan university. MethodsA cross-sectional st...

ImportanceRecent reports have highlighted an intense influenza activity related to the circulation of the influenza A(H3N2) subclade k variant. There is no data available on the impact of the emergence of H3N2 subclade k on the severity of the 2025-2026 epidemic or on the clinical phenotype of patients requiring admission to the intensive care unit (ICU). ObjectiveTo compare the clinical presentation, hospital mortality and virological characteristics of patients with laboratory-confirmed influ...

BackgroundHuge neutrophilic infiltrates within lesional and perilesional tissue in hidradenitis suppurativa (HS) give rise to the hypothesis that neutrophil extracellular trap (NET) formation may further drive systemic immune activation in HS. As intrinsic constituents of NETs, nucleosomes-particularly circulating nucleosome containing Histone H3.1 (H3.1-nucleosomes)-serve as reliable indicators of NETosis in the blood. ObjectivesTo investigate whether plasma H3.1-nucleosomes, fluctuate with HS...

ObjectivesTo provide real-world evidence on piperacillin exposure and outcomes in critically ill patients following the implementation of pharmacokinetic (PK)/pharmacodynamic (PD)-guided dosing in routine care. MethodsThis retrospective observational study included critically ill adults who received continuous piperacillin/tazobactam infusion between 2011 and 2019. Empiric doses were individualized using dosing software based on renal function and subsequently adjusted according to therapeutic ...

BackgroundSkin disease affects 4.7-4.9 billion individuals globally; however, little is known about access to dermatological care. MethodsWe conducted a multinational, cross-sectional survey of dermatological care across 194 WHO member states and three additional geographic areas in 2024-2025. Primary outcomes included dermatologist density per 100,000 population and number of dermatologists globally. Secondary outcomes included training programme density, workforce distribution, perceived acce...

BackgroundThere is growing evidence that individuals with different skin phototypes require tailored approaches to achieve optimal photoprotection. Individuals with darker skin phototypes are more prone to UVA1- and visible light-induced pigmentation, whereas lighter phototypes are more susceptible to shorter wavelengths such as UVB and UVA2. Thus, skin phototype is an important determinant of sunscreen efficacy. In the present study we have asked if ethnicity - independent of phototype - is ano...

Staphylococcus aureus plays a central role in the exacerbation of atopic dermatitis (AD), but the population structure and pathogenic determinants of strains colonizing AD patients remain poorly understood. It is unclear whether these strains mirror those circulating in the general community or whether specific clonal lineages are selectively adapted to the AD skin microenvironment. Data addressing this question are scarce, particularly in Portugal. In this study, we investigated the molecular e...

Cutaneous squamous cell carcinoma (SCC) can be time-consuming to treat with Mohs micrographic surgery (MMS) due to the need for intraoperative frozen section (FS) preparation. Two-photon fluorescence microscopy (TPFM) can generate H&E-equivalent images from fresh tissue specimens in a fraction of this time. To determine the accuracy of TPFM for the evaluation of squamous cell carcinoma in MMS margins compared to conventional FS Mohs slide preparation. TPFM was used to image 144 first stage MMS m...

BackgroundHealthcare system disparities have a significant impact on chronic disease management in conflict-affected settings. Vitiligo, a stigmatizing dermatological condition, requires sustained care, yet limited evidence exists regarding how healthcare sector differences affect patient outcomes in Afghanistan. This study addresses this critical knowledge gap in a post-conflict, resource-limited setting. The main objectives of this study were to compare socio-demographic profiles, clinical cha...