Search Results (701)

Population aging is reshaping later-life well-being, yet whether the tie–satisfaction association is itself stable over time is seldom researched. This study compares the 2011 (n = 10,899) and 2023 (n = 9951) waves of the Korean National Survey of Older Persons, a nationally representative repeated cross-section of Koreans aged 65+. Social contact was decomposed into total contact volume and non-face-to-face orientation, retaining socially isolated respondents via structural dummy variables. Models were estimated by year and pooled with year interactions. Mean life satisfaction rose from 3.04 to 3.36 even as the proportion reporting no friends rose from 0.2% to 10.1%. Total contact volume predicted life satisfaction in both years, but the association weakened significantly (interaction B = −0.042, p < 0.001), and this held under sampling weights. The old-old’s relative advantage reversed in the unweighted model (p = 0.001) but not under weights (p = 0.341) and is reported descriptively. Non-face-to-face orientation became a significant positive predictor by 2023, though its between-year change was not confirmed. Because the waves are independent samples, all between-year differences confound cohort and period and are not causal effects. Sustaining later-life satisfaction may depend on the mode, target, and quality of contact, not volume alone. Full article

Background and Objectives: Pulsed radiofrequency (PRF) of the cervical medial branches is a non-destructive neuromodulatory option for chronic cervical facet joint pain, yet evidence regarding the durability of clinical response and factors associated with sustained benefit remains limited. This study aimed to characterize the 6-month trajectory of pain and disability after fluoroscopy-guided cervical medial branch PRF and to explore baseline factors associated with meaningful pain relief (MPR). Materials and Methods: In this retrospective single-center cohort study, 75 patients with chronic cervical facet joint pain who achieved ≥50% temporary pain relief following a diagnostic medial branch block underwent fluoroscopy-guided cervical medial branch PRF, followed by injection of local anesthetic and corticosteroid at the treated levels. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores were evaluated at baseline and at 1, 3, and 6 months. MPR was defined as ≥50% reduction in NRS from baseline. Global Perceived Effect (GPE) and changes in analgesic medication use were assessed as complementary clinical outcomes. An exploratory multivariable logistic regression analysis was performed to examine factors independently associated with MPR at 6 months. Results: Median NRS scores decreased from 7.0 at baseline to 4.0, 4.0, and 5.0 at 1, 3, and 6 months, respectively, while median NDI scores decreased from 30.0 to 14.0, 16.0, and 20.0 (both overall p < 0.001). Despite sustained improvement relative to baseline, MPR progressively declined from 57.3% at 1 month to 49.3% at 3 months and 36.0% at 6 months (overall p < 0.001). Favorable GPE and reduced analgesic medication use showed parallel declines, supporting attenuation of overall clinical benefit over time. In the exploratory multivariable model, fibromyalgia was independently associated with 75% lower odds of 6-month MPR (OR = 0.25, 95% CI: 0.088–0.709; p = 0.009). Age, sex, and baseline NRS were not significantly associated with 6-month MPR. No serious acute periprocedural adverse events were documented during the 2 h observation period. Conclusions: Fluoroscopy-guided cervical medial branch PRF, combined with post-procedural corticosteroid and local anesthetic administration, was associated with clinically meaningful improvements in both pain and neck-related disability, with the greatest benefit during the first 3 months and partial attenuation by 6 months. The progressive decline across pain response, patient-reported global improvement, and analgesic-use outcomes highlights the time-dependent nature of the benefit associated with the combined intervention. Fibromyalgia was independently associated with substantially lower odds of 6-month MPR in this exploratory analysis; this association should be interpreted cautiously and requires prospective validation before it can inform patient selection, although it may be relevant when counseling patients regarding the durability of response. Full article

Background/Objectives: In older patients undergoing abdominal surgery, perioperative risk is influenced not only by chronological age but also by frailty, comorbidity burden, and diminished physiological reserve. These factors may limit tolerance of conventional abdominal surgery and increase interest in less invasive surgical approaches in high-risk patients. The trephine approach provides limited surgical access without routine laparotomy, but evidence regarding its use in this population remains limited. This study evaluated the technical feasibility and short-term outcomes of the trephine approach in high-risk older patients. Methods: Patients aged ≥65 years who underwent stoma surgery using the trephine approach at a tertiary referral center between January 2016 and January 2026 were retrospectively reviewed. During the study period, 488 patients underwent stoma surgery; of these, 10 (2.0%) were managed using the trephine approach and formed the study cohort. We used preoperative CT for surgical planning in all cases, with intraoperative endoluminal guidance when required. We analyzed demographic, perioperative, and short-term outcome data descriptively. Results: The mean age was 77.9 ± 9.6 years. Median ASA physical status was 4, median Clinical Frailty Scale score was 5.5, and median Charlson Comorbidity Index was 5.5. Eight patients (80%) underwent emergency surgery. The planned procedure was completed without conversion to laparotomy in 9/10 patients (90%), and bowel resection was performed through the same incision in 4/10 (40%). Median operative time was 32.5 min, and median hospital stay was 5 days. Major complications occurred in 3/10 patients (30%), and 30-day mortality was 2/10 (20%). Conclusions: In this small retrospective series of high-risk older patients, the trephine approach was technically achievable in most cases when used with preoperative CT-based planning and, when needed, intraoperative endoluminal guidance. These findings provide preliminary descriptive evidence regarding the feasibility of this approach in a highly selected clinical setting. Given the small sample size, lack of a comparator, and observed postoperative morbidity and mortality, no conclusions can be drawn about safety, comparative effectiveness, or patient-selection criteria. Full article

Background: Transfusion-transmitted infections (TTIs) continue to threaten the safety of blood supply systems worldwide. This study aimed to estimate the prevalence of malaria, HTLV I/II, and syphilis among blood donors at the Riyadh Regional Laboratory and Blood Bank from 2018 to 2022, and to assess associations with gender, age, nationality, and the ABO/RhD blood group. Methods: We conducted a retrospective analysis of 217,543 blood donations. Demographic and serological records were extracted from the blood bank’s electronic database and analyzed in SPSS v28. Chi-square, Fisher’s exact tests and multivariate logistic regression were used as appropriate, with significance set at p < 0.05. Results: Male donors accounted for 97% of the cohort, and 52% were non-Saudi nationals. Malaria was rare (0.03%; n = 58); all 58 cases were detected in 2018, and none were recorded in subsequent years. HTLV I/II antibodies were observed in 464 donors (0.21%), with the highest annual share in 2019 (39.7%). Syphilis was the most common TTI, identified in 1143 donors (0.52%), and showed a significant increasing trend over the study period (Cochran–Armitage test p < 0.001; Poisson regression IRR 1.21, 95% CI 1.15–1.28, p < 0.001). In multivariable logistic regression, non-Saudi nationality was independently associated with syphilis positivity (aOR 1.48, 95% CI 1.31–1.67), and ages 46–65 was associated with higher odds of all three TTIs. ABO and RhD blood groups were not significantly associated with TTI positivity in univariate or multivariable analyses. Conclusions: Current screening practices appear to maintain low TTI prevalence in the central region, but the rising syphilis trend and the clustering of malaria positivity among non-Saudi donors point to the need for closer surveillance and targeted donor counseling. The study also highlights the need for more granular demographic data collection, including specific country of origin and duration of residence, to enable more effective risk stratification and intervention targeting. Full article

Vanishing twin syndrome (VTS) denotes the spontaneous loss of one conceptus from an initially recognized multiple pregnancy, most often during the first trimester. Its clinical relevance has increased with in vitro fertilization and embryo transfer (IVF-ET), as multiple embryo transfer creates the substrate for dizygotic VTS, while blastocyst transfer may be followed by monozygotic splitting and serial early ultrasonography increases detection. However, the literature remains heterogeneous, with empty gestational sacs, losses after fetal cardiac activity, and later single fetal demise often grouped together despite different biological and prognostic implications. New evidence published in recent years on frozen embryo transfer outcomes, cell-free DNA screening, and early childhood development warrants an updated synthesis of vanishing twin syndrome to inform individualized risk assessment, counselling, and standardized research reporting. Overall, the surviving singleton appears to have a lower risk than an ongoing twin pregnancy but a higher risk than a primary singleton, particularly for preterm birth, low birthweight, and small-for-gestational-age birth, with risk increasing when loss occurs after fetal cardiac activity or later in gestation. Nevertheless, evidence is not unanimous, as several well-characterized cohorts and earlier meta-analyses reported no measurable perinatal disadvantage. Two reports from a single tertiary center, based on substantially overlapping recruitment periods, further suggest that VTS may be proportionally less frequent among established twin pregnancies after IVF/ICSI than after spontaneous conception, while IVF-associated VTS has been linked to placental abnormalities, diabetes, and fetal growth restriction; this observation requires independent confirmation. Contemporary frozen embryo transfer cohorts indicate that VTS remains relevant in modern practice, whereas limited long-term data have not demonstrated impaired early childhood growth or development. Management should document the initial number of gestational sacs, embryonic structures, cardiac activity, chorionicity, and timing of loss, while adapting aneuploidy screening to residual trophoblastic DNA and individualizing fetal-growth surveillance. Elective single-embryo transfer remains the most effective preventive strategy, although it cannot eliminate monozygotic twinning. Standardized definitions and long-term offspring follow-up are needed. Full article

Background: Alcohol consumption is common among women and men of reproductive age. The effects of alcohol use in the preconception and early-pregnancy periods on early reproductive outcomes are not well-known. Methods: In a population-based cohort study from preconception onwards among 3225 women and their partners, we examined the associations of preconception and early-pregnancy alcohol consumption, assessed by questionnaires, with fecundability (per-cycle probability of conceiving), infertility (time to pregnancy >12 months or use of assisted reproductive technology), and miscarriage (pregnancy loss before 22 weeks of gestation). Results: As compared to no alcohol consumption, preconception intake of <1 glass/week and ≥1 glass/week among women was associated with lower odds of infertility (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39, 0.94 and OR 0.54, 95% CI 0.35, 0.84, respectively). As compared to no alcohol consumption, early-pregnancy alcohol consumption among women of <1 glass/week and ≥1 glass/week was associated with increased odds of miscarriage (OR 1.99, 95% CI 1.36, 2.92 and OR 2.37, 95%CI 1.58, 3.57). Early-pregnancy binge drinking among women was also associated with increased odds of miscarriage (OR 1.52, 95%CI 1.04, 2.24). Alcohol consumption among men was not associated with infertility or miscarriage risk. Conclusions: The associations of low-to-moderate preconception alcohol consumption with lower odds of infertility might reflect healthier lifestyles, socioeconomic factors, and residual confounding by health-related abstinence from alcohol, all of which are associated with greater fertility. Therefore, preconception and early-pregnancy counseling should mainly focus on the risk of miscarriage and fetal health outcomes. Full article

Background and Objectives: Despite long-standing MMR vaccination programmes, outbreaks of vaccine-preventable diseases continue to occur worldwide, raising concerns regarding waning immunity and susceptibility gaps in adult populations. Between 2017 and 2019 alone, WHO reported over 880,000 measles cases globally—a fourfold increase over the preceding two years—with outbreaks in both low- and high-income countries despite high childhood vaccination coverage. This study evaluated the seroepidemiology of measles, mumps, and rubella among adults in Türkiye over a nine-year period. Materials and Methods: A retrospective laboratory-based study was conducted using ELISA IgM and IgG results obtained between 2014 and 2022 at a tertiary-care university hospital. Seropositivity rates were analysed by year, age group, and sex. Temporal trends were assessed using the Cochran–Armitage trend test; factors associated with IgG seropositivity were assessed using multivariable logistic regression. Results: Among 10,407 adult test records, overall IgG seropositivity was 75.8% for measles, 94.9% for rubella, and 86.3% for mumps; IgM positivity remained low throughout (0.9%, 0.4%, and 1.9%, respectively). Measles IgG declined significantly from 78.4% in 2014–2019 to 62.6% in 2022 (p < 0.001), whereas Rubella IgG remained stable (93.2–95.7%) and Mumps IgG showed no significant temporal change. Seropositivity increased markedly with age for measles (18–29 years: 70.2% vs. ≥50 years: 93.4%; p < 0.001) and mumps (p = 0.030). Multivariable analysis confirmed that Measles IgG seropositivity was substantially lower in 2022 than in the pooled 2014–2019 period (OR = 0.432, 95% CI: 0.319–0.584, p < 0.001). Rubella seroprotection among women of reproductive age was 94.7% (95% CI: 93.9–95.5%), close to but not statistically distinguishable from the 95% population immunity benchmark used in rubella elimination frameworks. Conclusions: A significant measles immunity gap exists among younger adults in Türkiye, with Measles IgG seropositivity declining from 78.4% in 2014–2019 to 62.6% in 2022, consistent with a cohort effect whereby vaccine-era cohorts exhibit lower protection than older adults with naturally acquired immunity. Rubella immunity, by contrast, remained close to the 95% elimination benchmark throughout. These findings underscore the importance of targeted serological surveillance and evidence-based booster vaccination strategies. Full article

The European Union has mandated digital reporting of cross-border VAT transactions from 2030, yet quasi-experimental evidence on the official compliance gap remains limited and does not cover the full range of national transaction-reporting architectures. This paper estimates their effect on that gap in 24 member states over 2000 to 2023, coding twelve mandates from the underlying legal instruments and applying the Callaway and Sant’Anna framework with never-treated comparisons. The baseline staggered estimate indicates a 4.23 percentage point reduction (95% CI [−6.45, −1.83]), remaining between 3.73 and 5.43 points across nineteen specifications including an imputation estimator and a neighbour-excluding comparison, and 2.76 under the most conservative identification check. Point estimates more than triple over five years. Pre-adoption coefficients are individually indistinguishable from zero though jointly significant, and formal sensitivity analysis shows the adoption-year and average post-adoption effects withstand modest though not large parallel-trend violations. The results do not show continuous reporting outperforms periodic reporting, and exploratory analysis detects no capacity moderation. What orders the cohort estimates is the completeness of the obligation, since the three mandates reaching one side of the transaction or part of the taxpayer population produce the three weakest effects. Findings support the fiscal premise of the VAT in the Digital Age reform and counsel patient evaluation of the rollout. Full article

Background: Bronchiolitis is a leading cause of hospitalization in infants, with respiratory syncytial virus (RSV) as the main etiological agent. The clinical relevance of respiratory pathogen co-infections and the role of emerging preventive strategies, including nirsevimab immunoprophylaxis, remain under investigation. Methods: We conducted two complementary observational analyses within the pediatric healthcare network of Western Sicily. The first was a retrospective study including 580 children younger than 24 months hospitalized for bronchiolitis between 2019 and 2025 at the “Giovanni Di Cristina” Hospital in Palermo, Italy, to investigate respiratory pathogen detection patterns and their clinical correlates. Patients were classified according to microbiological findings as single-virus infections or viral–viral/viral–bacterial co-detections. The second was a separate observational cohort of 458 newborns from two birth centers in Western Sicily during the 2024–2025 RSV season, established to evaluate the implementation, safety, and respiratory outcomes associated with nirsevimab prophylaxis. Results: Viral–viral and/or viral–bacterial co-detections were identified in 45.5% of hospitalized infants and were associated with longer hospital stay (8.86 vs. 6.35 days, p < 0.001) and a higher frequency of complications (18.6% vs. 8.5%, p < 0.001), without differences in age, sex, or respiratory support requirements. RSV remained the predominant pathogen throughout the study period. In the complementary observational subgroup analysis, the observed safety findings were reassuring, with only mild and self-limiting events reported during follow-up; however, the sample size and observational design limit the ability to assess rare or delayed adverse events. Among infants undergoing clinically indicated respiratory testing, RSV was detected in 7/9 (77.8%) non-prophylaxed infants and 5/24 (20.8%) prophylaxed infants. Among hospitalized infants, complications were less frequently observed among those who had received nirsevimab (3.5% vs. 26.9%, p < 0.001), although substantial baseline differences between groups precluded causal interpretation of this finding. Conclusions: Viral–viral and viral–bacterial co-detections are frequent in hospitalized bronchiolitis and are associated with increased clinical complexity, mainly through prolonged hospitalization and higher occurrence of complications. The observational nirsevimab analysis showed a favorable safety profile and a lower proportion of RSV detection among clinically tested prophylaxed infants. However, because respiratory testing was performed according to clinical indication and differed substantially between groups, these findings cannot be interpreted as estimates of RSV incidence or as definitive evidence of nirsevimab effectiveness. The observed difference in complications should also be interpreted cautiously because of substantial baseline differences between prophylaxed and non-prophylaxed infants. Prospective studies with systematic respiratory testing are warranted. Full article

Background: Young children are at high risk of influenza and its complications, yet evidence on the real-world effectiveness of egg-based inactivated influenza vaccines in children aged 6–59 months remains limited during antigenically drifted seasons. Methods: We conducted a population-based retrospective cohort study using linked immunization and influenza surveillance records from 4 August 2025 to 8 February 2026. Vaccinated and unvaccinated children aged 6–59 months were matched 1:1 using propensity scores based on demographic characteristics, routine and non-routine vaccination history, prior seasonal influenza vaccination (SIV), and prior influenza infection. For vaccinated children, the index date was defined as the date of the last SIV received during the study period; matched unvaccinated children were assigned the corresponding index date. Follow-up began 14 days later and continued until influenza onset or 8 February 2026. Adjusted vaccine effectiveness (aVE) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. Sensitivity analyses included a negative control outcome analysis using varicella infection, a multivariable logistic regression analysis with influenza infection as the outcome, and a time-dependent exposure Cox regression analysis in the full eligible cohort. Results: A total of 26,444 children were included in the final cohort (13,239 vaccinated and 13,205 unvaccinated). Influenza incidence rates were 28.70 and 40.21 per 100 person-years in vaccinated and unvaccinated groups, respectively. The aVE was 28.82% (95% CI: 23.07–34.14%). aVE was generally consistent across most subgroups, but was lower in children vaccinated in the previous season than in those without prior-season vaccination (20.41% vs. 34.28%; p for interaction = 0.016). Sensitivity analyses yielded comparable VE estimates. Conclusions: Egg-based inactivated influenza vaccination conferred moderate real-world protection against influenza in children aged 6–59 months during the 2025/26 season. Continued monitoring of vaccine effectiveness is needed to inform vaccination strategies in young children. Full article

Objectives: Adults exposed to the Bacillus Calmette–Guérin (BCG) vaccine demonstrate a reduced incidence of Parkinson’s disease (PD). This retrospective study evaluated whether early-life BCG vaccination predicts a long-term reduction in PD incidence during aging. Methods: Published age-adjusted incidence rates (AAIRs) of PD (2002–2021) were structured into single-age birth cohorts. Missing values were calculated via interpolation and shuffling simulations. Cohorts were categorized into three historical BCG policy periods: unvaccinated controls (born 1945–1949), vaccinated at age 12 (born 1950–1954), and vaccinated as newborns (born 1955–1959). AAIRs were compared at identical cross-sectional ages (57 and 62 years), applying an environmental drift penalty to control for temporal improvements. Results: In men, the age 12 policy showed a 21.8% AAIR reduction at age 57, which attenuated to 4.4% by age 62; the newborn policy showed a sustained reduction (25.8% at age 57; 20.4% at age 62). In women, the age 12 policy yielded a 67.5% reduction at age 57 (33.1% at age 62), while the newborn policy showed a 56.8% reduction at age 57 (44.0% at age 62). Conclusions: Early-life BCG vaccination is associated with reduced later-life PD incidence, displaying a profound sex-dependent effect favoring females. Newborn vaccination provides long-term resistance as well. Full article

Background/Objectives: Diazoxide is used for persistent or recurrent hypoglycemia when the clinical and biochemical pattern is compatible with hyperinsulinism, but neonatal treatment populations are heterogeneous. We evaluated the clinical and hormonal characteristics and short-term outcomes associated with diazoxide use in hypoglycemic neonates. Methods: This single-center retrospective cohort included 124 hypoglycemic neonates treated between January 2020 and January 2026; 36 received diazoxide and 88 did not. Critical hormonal samples were obtained concurrently with glucose < 47 mg/dL; in treated infants, sampling preceded the first diazoxide dose. Hormonal effects were estimated with parsimonious multivariable models. Diazoxide-selection factors were examined with a reduced logistic model and Firth sensitivity analysis. Results: Treated infants were more frequently preterm (80.6% vs. 52.3%; p = 0.003) and had greater pre-treatment sepsis and ventilation burden. Severe hypoglycemia < 25 mg/dL did not differ significantly (27.8% vs. 17.0%; p = 0.176). Insulin was higher with diazoxide (median 6.05 vs. 2.77 mU/L; adjusted GMR 2.23, 95% CI 1.38–3.61; p = 0.001), as was C-peptide (adjusted GMR 1.59, 95% CI 1.03–2.47; p = 0.038). Among treated infants, 35/36 had insulin > 1.25 mU/L; 17/29 with available maximum glucose-infusion-rate data required >8 mg/kg/min. Diazoxide began at a median postnatal age of 10.5 days; 30/36 infants remained on therapy at discharge. Fluid retention requiring diuretics occurred in 11/36 (30.6%) versus 11/88 (12.5%; p = 0.017). Pulmonary hypertension was not documented on routine day 5–7 echocardiography (0/36; exact 95% CI 0.0–9.7%). Conclusions: Diazoxide use identified a clinically vulnerable, treatment-selected subgroup with evidence of inadequate insulin suppression during hypoglycemia. The data do not establish uniformly confirmed hyperinsulinism. Fluid retention was the main documented treatment-period adverse event; rare or later cardiopulmonary complications cannot be excluded by this retrospective cohort. Full article

Stroke is a leading cause of death and foremost cause of disability in the United States, and extreme heat is the leading weather-related cause of death. We examined the association between ambient temperature and acute ischemic stroke (AIS) admissions in New York State. We leveraged an existing cohort of consecutive AIS admissions presenting to a large healthcare system during a ten-year period (January 2015–December 2024), identified based on discharge diagnosis codes for ischemic stroke. Meteorological data from gridMET (~4 km grids) were used to produce daily averages of maximum temperature (Tmax) for ZIP code tabulation area (ZCTA) boundaries in the New York metropolitan area, linked to residential ZIP codes. Time-stratified case-crossover models with distributed lags (0–1 days) were used to estimate the association between daily maximum temperature (evaluated as a 10 °F increase, 95th percentile temperature vs. median temperature, and 95 °F vs. median temperature) and AIS admissions, both for the entire year and restricted to warm season months of May–October. There were 27,926 AIS admissions from 2015 to 2024. The mean (standard deviation, SD) age was 71.7 (14.4) years, and 13,934 (49.9%) were female, while the mean (SD) Tmax was 62.8 (17.3) °F, and the mean 95th percentile Tmax was 87.9 °F. The relative risk (95% confidence interval) of AIS admissions was strongest on the same day of admission (10 °F increase: 1.041 (1.019, 1.064); 95th percentile: 1.105 (1.047, 1.165); 95 °F: 1.132 (1.059, 1.210), and effects were similar in warm season months. High daily maximum temperatures were associated with an increased risk of AIS admissions, with the highest risk on the same day of admission. These findings support the short-term impact of temperature on AIS admissions and can inform future public health efforts to reduce heat-related AIS risk in affected populations. Full article

Background: Post-surgical breast cancer (BC) survivors frequently experience clusters of persistent post-treatment physical and psychological symptoms, which can negatively affect their quality of life (QoL). Mind–body interventions such as Qigong may offer potential benefit, but evidence in oncology remains limited. Methods: We conducted a single-arm pilot feasibility study at the AMICO clinic (IRCCS-CROB, Southern Italy) to evaluate the feasibility, acceptability, safety, and exploratory pre–post symptoms associated with an 8-week Qigong programme in post-surgical BC patients. Fourteen women (aged 42–73 years; stage I–III) who reported symptom burden and emotional sensitivity attended weekly one-hour classes and were encouraged to practise at home. Feasibility outcomes included adherence, completion of post-intervention assessment, adverse events, and participant acceptability. Symptom severity was assessed at baseline and post-intervention using a 0–5 study-specific symptom questionnaire score. For the secondary descriptive prevalence analysis, scores ≥ 3 were classified as indicating moderate-to-severe symptom burden. Results: All 14 participants completed the post-intervention assessment, overall intervention adherence was 92%, and no adverse events were reported. In the secondary descriptive analysis, the prevalence of moderate-to-severe pain and mood changes decreased from 64.3% to 35.7%, fatigue from 57.1% to 28.6%, anxiety from 85.7% to 42.9%, and sleep disturbances from 35.7% to 14.3%. Hot flushes decreased from 64.3% to 42.9%. Despite the heterogeneity of individual symptom trajectories, most participants reported meaningful improvements in overall well-being. Conclusions: The 8-week programme was feasible, well tolerated, and acceptable in this small real-world cohort. Symptom burden decreased during the intervention period; however, because of the uncontrolled study design and small sample size, these changes cannot be attributed specifically to Qigong. Larger controlled studies are required to estimate treatment effects and identify potential moderators of response. Full article

Background: Candida auris (C. auris) has emerged as a multidrug-resistant fungal pathogen causing healthcare-associated outbreaks worldwide, particularly in intensive care units (ICUs). Its environmental persistence, multidrug resistance, and high mortality make it a major challenge for infection prevention and clinical management. This study aimed to investigate the clinical characteristics, clinical exposures, treatment outcomes, and mortality of adult ICU patients with C. auris candidemia during the first 30 months after the opening of a tertiary care hospital. Methods: This retrospective observational study included all adult patients (≥18 years) admitted to five ICUs between 1 July 2020 and 31 December 2022 who developed culture-confirmed C. auris candidemia. Isolates were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) with the Microflex LT/SH Smart MS system (Bruker Daltonics, Bremen, Germany) according to routine microbiological laboratory procedures. Demographic characteristics, underlying diseases, invasive procedures, clinical exposures, microbiological findings, treatment, APACHE II scores, and clinical outcomes were retrospectively analyzed. Results: During the 30-month study period, 3716 adult patients were admitted to the ICUs, and candidemia developed in 432 (11.6%). Of these episodes, 22 (5.1%) were caused by C. auris. The first C. auris candidemia case occurred 184 days after hospital opening. The mean age was 55 ± 17 years, and overall ICU mortality was 77.3%. Sepsis (36.4%), malignancy (22.7%), and cerebrovascular disease (18.2%) were the most common reasons for ICU admission. All patients had received broad-spectrum antibiotics, whereas central venous catheterization and invasive mechanical ventilation were present in 77.3% of cases. The mean interval from ICU admission to candidemia was 49 ± 15 days. Caspofungin was used as first-line antifungal therapy in all patients. Non-survivors had significantly higher APACHE II scores (32.8 ± 4.9 vs. 26.4 ± 6.6, p = 0.029) and predicted mortality rates (80.1% vs. 53.3%, p = 0.012). Antifungal treatment duration was significantly shorter among non-survivors (p < 0.001), whereas no significant differences were observed in age, ICU length of stay, or time to blood culture clearance. Conclusions: C. auris candidemia was observed in critically ill patients with prolonged ICU stays and frequent invasive interventions and was associated with high all-cause ICU mortality. Higher APACHE II scores were associated with mortality in this cohort, reflecting greater baseline severity of illness. Given the small sample size and descriptive, exploratory nature of the study, these findings should be interpreted with caution. The effectiveness of specific infection-control, diagnostic, or therapeutic interventions was not evaluated. Larger multicenter prospective studies are needed to better characterize the epidemiology, clinical outcomes, and factors associated with mortality in C. auris candidemia. Full article