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Search Results (7,653)

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14 pages, 278 KB  
Review
Comparison of the Clinical Course, Management and Outcomes of Acute Pancreatitis in Aged and Young Patients
by Agnieszka Krajewska, Katarzyna Tłustochowicz, Adrianna Kowalik and Ewa Małecka-Wojciesko
Biomedicines 2026, 14(1), 139; https://doi.org/10.3390/biomedicines14010139 - 9 Jan 2026
Abstract
Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in [...] Read more.
Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended. Full article
(This article belongs to the Special Issue Innovations in Understanding and Treating Pancreatic Diseases)
26 pages, 7617 KB  
Article
Combustion Behavior of Flexible Polyurethane Foam in Oxygen-Enriched Atmosphere and Its Implications in the Development of a Fire in an ICU for COVID Patients—Case Study
by Florin Manea, Emilian Ghicioi, Marius Cornel Suvar, Maria Prodan, Daniel Gheorghe Pupazan, Daniel Florea, Bogdan Adrian Simon-Marinica, Robert Laszlo, Gabriela Alexandra Ursut and Gheorghe Ilia
Fire 2026, 9(1), 33; https://doi.org/10.3390/fire9010033 - 9 Jan 2026
Abstract
On 2021, in the intensive care unit of a County Emergency Hospital where oxygen therapy treatment was applied to COVID patients, located in the municipality of Ploiesti, Prahova County, a fire occurred that resulted in the destruction by burning of the ICU room, [...] Read more.
On 2021, in the intensive care unit of a County Emergency Hospital where oxygen therapy treatment was applied to COVID patients, located in the municipality of Ploiesti, Prahova County, a fire occurred that resulted in the destruction by burning of the ICU room, the death of two people, and the injury of a medical professional. In order to elucidate the accelerating causes of the combustion phenomenon of materials in the ICU room, a combustion stand was designed whose atmosphere can be controlled in terms of achieving high oxygen concentrations of 40% vol., in accordance with the treatment schemes applied to the patients and with the configuration of the room and the frequency of use of the access door. In this experimental stand, a series of combustion tests of flexible polyurethane foam samples were performed, which highlighted the acceleration of combustion and the complete consumption of the mass. The purpose of this work is to explain the rapidity of the fire in a hospital ward, both with experimental methods and with the help of FDS. Full article
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23 pages, 917 KB  
Review
Irrational and Inappropriate Use of Antifungals in the NICU: A Narrative Review
by Niki Dermitzaki, Foteini Balomenou, Chrysoula Kosmeri, Maria Baltogianni, Aikaterini Nikolaou, Anastasios Serbis and Vasileios Giapros
Antibiotics 2026, 15(1), 73; https://doi.org/10.3390/antibiotics15010073 - 9 Jan 2026
Abstract
Invasive Candida infections in the neonatal intensive care unit (NICU) are associated with significant morbidity and mortality, particularly among extremely preterm neonates. Early treatment with antifungals is critical to improve survival rates and avoid long-term adverse outcomes. Prevention with antifungal prophylaxis in high-risk [...] Read more.
Invasive Candida infections in the neonatal intensive care unit (NICU) are associated with significant morbidity and mortality, particularly among extremely preterm neonates. Early treatment with antifungals is critical to improve survival rates and avoid long-term adverse outcomes. Prevention with antifungal prophylaxis in high-risk neonates has been shown to reduce the prevalence of invasive Candida infections effectively. However, the irrational and/or inappropriate use of antifungals has been documented. This narrative review aims to provide an overview of the rationales for the inappropriate use of antifungals in the NICU, the consequences that ensue, and the promising strategy of antifungal stewardship programs to optimize antifungal use. The nonspecific clinical presentation of systemic Candida infections and the lack of rapid, accurate diagnostic techniques for Candida identification and specification in most settings lead to a high rate of empirical treatment in neonates without a proven infection. Moreover, evidence on the optimal dosing of antifungal agents and the treatment duration in the neonatal population is lacking, which may result in excessive or subtherapeutic drug exposure. Antifungal misuse is associated with microbiological consequences, including the emergence of antifungal-resistant Candida strains, and clinical consequences, such as drug toxicities and alterations in the intestinal mycobiome. It is therefore imperative to optimize antifungal use in the NICU. The implementation of antifungal stewardship programs, which, through a multidisciplinary approach, aim to improve diagnosis and guide clinicians on antifungal selection, dosing, and duration for both prevention and treatment according to the local epidemiology, represents a promising strategy for antifungal optimization in the NICU. Full article
(This article belongs to the Special Issue Inappropriate Use of Antibiotics in Pediatrics)
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10 pages, 546 KB  
Article
Prognostic Value of Serial Lactate Measurement in Pediatric Cardiac Surgery Patients with Congenital Heart Disease in Southeast Mexico
by Ely Sanchez-Felix, Amonario Olivera-Mar, Miguel Santaularia-Tomas, Joan Johnson-Herrera, Laura Ortiz-Vera, Adrian Perez-Navarrete, Marcos Rivero-Peraza and Nina Mendez-Dominguez
Med. Sci. 2026, 14(1), 35; https://doi.org/10.3390/medsci14010035 - 9 Jan 2026
Abstract
Background/Objectives: Lactate, traditionally considered a byproduct of anaerobic metabolism, is increasingly recognized as a biomarker of tissue perfusion and systemic stress. While hyperlactatemia is frequent after pediatric cardiac surgery, evidence regarding its prognostic role remains controversial. This study aimed to evaluate whether serial [...] Read more.
Background/Objectives: Lactate, traditionally considered a byproduct of anaerobic metabolism, is increasingly recognized as a biomarker of tissue perfusion and systemic stress. While hyperlactatemia is frequent after pediatric cardiac surgery, evidence regarding its prognostic role remains controversial. This study aimed to evaluate whether serial lactate measurements predict mortality in children undergoing surgery for congenital heart disease in Southeast Mexico. Methods: We conducted a retrospective cohort study including children aged 0–210 weeks with confirmed congenital heart disease who underwent first-time cardiac surgery between January 2022 and December 2024. Serum lactate was measured intraoperatively, at intensive care unit (ICU) admission, and at 12 and 24 h postoperatively using a Gem® Premier™ 3500 analyzer. Sociodemographic, clinical, and surgical data were recorded. Associations between lactate levels and mortality were analyzed with Cox regression, adjusting for RACHS-2 category and intraoperative complications. Predictive performance was assessed with ROC curves and Harrell’s C-index. Results: 103 patients were included (median age 49.2 weeks; 60% female). Lactate levels overlapped intraoperatively but significantly discriminated against survivors from non-survivors thereafter. ICU admission lactate ≥ 4.2 mmol/L predicted mortality with 100% sensitivity and 60% specificity (AUC = 0.84). Hazard ratios confirmed that lactate at ICU admission (HR 2.17, 95% CI 1.16–4.06; p = 0.015), 12 h (HR 6.37, 95% CI 1.02–39.6; p = 0.047), and 24 h (HR 1.81, 95% CI 1.07–3.09; p = 0.028) were significant predictors of mortality. The model showed excellent discrimination (Harrell’s C = 0.986), though optimism due to the limited number of deaths should be considered. Conclusions: Serial lactate monitoring, particularly upon ICU admission, provides strong prognostic information for in-hospital mortality in pediatric cardiac surgery patients. Incorporating early postoperative lactate into routine monitoring may allow timely therapeutic adjustments. Preoperative lactate assessment warrants further evaluation as a potential risk stratification tool. Full article
(This article belongs to the Section Critical Care Medicine)
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10 pages, 433 KB  
Article
Pediatric Trauma Undertriage: Working Toward a Better Threshold Based on Trauma Center Resource Utilization
by Caitlin J. Crosier, Amber Mehmood, Keith Thatch, David J. Cisela, Etienne E. Pracht and Christopher W. Snyder
Children 2026, 13(1), 95; https://doi.org/10.3390/children13010095 - 9 Jan 2026
Abstract
Background/Objectives: Pediatric trauma systems require accurate metrics for evaluating triage decisions. Undertriage occurs when an injured child requires pediatric trauma center resources but is treated at a center lacking those resources. Current undertriage definitions utilize mortality-based scores, including the Injury Severity Score [...] Read more.
Background/Objectives: Pediatric trauma systems require accurate metrics for evaluating triage decisions. Undertriage occurs when an injured child requires pediatric trauma center resources but is treated at a center lacking those resources. Current undertriage definitions utilize mortality-based scores, including the Injury Severity Score (ISS) > 15 or the International Classification of Disease (ICD) Injury Severity Score (ICISS) > 10. However, resource-based metrics like the ICD Critical Care Severity Score (ICASS) may be preferable in children. This study evaluated the relationship of ISS, ICISS and ICASS to the need for pediatric trauma resources (NFPTCR) to derive a more empiric definition of undertriage. Methods: The American College of Surgeons Trauma Quality Improvement Program database was queried for patients aged ≤ 15 years old. NFPTCR was defined as blood product transfusion within 4 h, invasive procedure for cardiopulmonary stabilization/contamination/bleeding within 72 h, initial admission to intensive care unit (ICU) or ICU stay ≥ 3 days, intubation, mechanical ventilation and general anesthesia ≤ 5 years old, or physical child abuse. ICASS and ICISS were derived from 2014 to 2018 datasets and applied to the 2019 dataset. The ability of ISS, ICISS and ICASS to distinguish NFPTCR patients was assessed using multivariable logistic regression and receiver–operator characteristic (ROC) analysis. Results: Out of 97,773 children, 15,985 (16%) were NFPTCR+. ISS, ICISS and ICASS had areas under the curve of 0.760, 0.701 and 0.812 for NFPTCR+, respectively (all p < 0.001). ISS had 36% sensitivity at 15; whereas ICASS had 95%, 93% and 89% sensitivity at 5, 10 and 15, respectively. Conclusions: ICASS was superior to ISS and ICISS for identifying NFPTCR. Consideration should be given to redefining pediatric trauma undertriage based on resource-based metrics, like ICASS. Full article
(This article belongs to the Section Pediatric Surgery)
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21 pages, 3001 KB  
Review
The Role of Zinc Against Bacterial Infections in Neonates, Children, and Adults: A Scoping Review from the Available Evidence of Randomized Controlled Trials About Zinc Supplementation to New Research Opportunities
by Domenico Umberto De Rose, Nicola Mirotta, Andrea Dotta, Guglielmo Salvatori, Maria Paola Ronchetti, Laura Campogiani, Francesca Ceccherini-Silberstein and Marco Iannetta
Antibiotics 2026, 15(1), 66; https://doi.org/10.3390/antibiotics15010066 - 8 Jan 2026
Viewed by 23
Abstract
(1) Background: Zinc is an essential micronutrient involved in immune regulation, epithelial barrier integrity, and the host response to bacterial infections. However, the clinical benefits of zinc supplementation across different age groups remain uncertain, with heterogeneous findings and variable dosing strategies reported [...] Read more.
(1) Background: Zinc is an essential micronutrient involved in immune regulation, epithelial barrier integrity, and the host response to bacterial infections. However, the clinical benefits of zinc supplementation across different age groups remain uncertain, with heterogeneous findings and variable dosing strategies reported in the literature. (2) Objectives: To map and summarize randomized controlled trials (RCTs) evaluating zinc supplementation (either as treatment or prophylaxis) for bacterial infection outcomes in neonates, children, and adults, and to identify gaps requiring further research, including the use of zinc-based nanoparticles. (3) Eligibility Criteria: We included English-language RCTs that evaluated zinc supplementation and reported clinical outcomes related to bacterial infections. Observational studies, trials without infection-related outcomes, and studies not involving human participants were excluded. (4) Sources of Evidence: A MEDLINE (PubMed) search was conducted from 2000 to 1 November 2025 using predefined keywords related to zinc supplementation, neonates, children, adults, and bacterial infections. Reference lists of eligible articles were screened to identify additional studies. (5) Charting Methods: Data were charted for each included study, including population characteristics, zinc dosing and regimen, type of supplementation (therapeutic or prophylactic), main infection-related outcomes, and key findings. Data charting was performed independently and verified within the research team. (6) Results: A total of 51 RCTs were included: 10 in neonates, 32 in children, and 9 in adults. In neonates, therapeutic zinc supplementation as an adjunct to antibiotics showed heterogeneous results, with some studies reporting reductions in morbidity, inflammatory markers or mortality, while others found no significant differences in clinical outcomes. In children, zinc supplementation consistently reduced the duration and severity of diarrheal episodes and, in several trials, improved the resolution of respiratory infections. In adults, the evidence was limited but suggested potential benefits in selected populations, such as burn patients or those with zinc deficiency or immunologic dysfunction. Variability in zinc dosage, treatment duration, and outcome definitions limits direct comparison across studies. (7) Conclusions: Zinc supplementation appears to provide benefits in neonates and children, whereas evidence in adults remains mixed and inconclusive. Standardized, well-powered RCTs are needed to define optimal dosing strategies, identify populations most likely to benefit, and clarify the mechanisms underlying zinc’s anti-infective effects. Future research should consider the use of zinc oxide nanoparticles (ZnO-NPs) demonstrated broad-spectrum antimicrobial activity and potential synergy with antibiotics, although clinical data remain still limited. Full article
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14 pages, 892 KB  
Review
Recognizing Coagulation Disorders in Sepsis in the Emergency Room: A Narrative Review
by Toshiaki Iba, Tomoki Tanigawa, Hideo Wada, Kenta Kondo, Ricard Ferrer and Jerrold H. Levy
J. Clin. Med. 2026, 15(2), 488; https://doi.org/10.3390/jcm15020488 - 8 Jan 2026
Viewed by 40
Abstract
Sepsis remains a leading cause of global mortality, and early management in the emergency department (ED) is a key determinant of clinical outcomes. Among the earliest physiological derangements in sepsis are abnormalities in coagulation, which represent not merely laboratory disturbances but fundamental reflections [...] Read more.
Sepsis remains a leading cause of global mortality, and early management in the emergency department (ED) is a key determinant of clinical outcomes. Among the earliest physiological derangements in sepsis are abnormalities in coagulation, which represent not merely laboratory disturbances but fundamental reflections of dysregulated host response, endothelial injury, and evolving microvascular thrombosis. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) form a dynamic continuum that frequently begins before shock is clinically apparent. Despite their prognostic value and pathophysiologic significance, these abnormalities are often underrecognized in the ED, where coagulation tests are still commonly interpreted through the narrow lens of bleeding risk rather than as markers of systemic thromboinflammation. This narrative review synthesizes current understanding of the mechanisms linking sepsis, endothelial dysfunction, and coagulation abnormalities; outlines the distinction between SIC and overt DIC; and highlights why early identification of coagulopathy in the ED is essential. We discuss practical bedside approaches, including recommended laboratory testing, pattern recognition, and application of validated scores such as the SIC and ISTH DIC criteria. System-level strategies, such as embedding coagulation testing into sepsis bundles, automating score calculation, and enhancing communication between the ED and ICU teams, are explored as avenues to improve early detection. Evidence suggests that ED recognition of SIC/DIC may refine risk stratification, guide triage decisions, and identify patients who may benefit from targeted anticoagulant strategies once stabilized. Ultimately, recognizing coagulation disorders in the ED reframes sepsis not solely as a hemodynamic crisis but as a complex, thromboinflammatory syndrome in which early intervention may alter trajectory and improve outcomes. Full article
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10 pages, 228 KB  
Article
Determination of Risk Factors, Incidence, and Mortality Rates of Acute Kidney Injury in COVID-19 Patients Hospitalized in the Intensive Care Unit
by Gizem Kahraman, Pınar Karabak Bilal and Mustafa Kemal Bayar
J. Clin. Med. 2026, 15(2), 483; https://doi.org/10.3390/jcm15020483 - 7 Jan 2026
Viewed by 175
Abstract
Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical [...] Read more.
Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical importance extending beyond the acute phase due to its association with long-term renal outcomes and persistent morbidity. The incidence of AKI is particularly high among patients admitted to the intensive care unit (ICU), where its development has been consistently associated with prolonged hospitalization and increased mortality. The primary aim of this study was to determine the incidence of COVID-19-associated AKI, identify factors related to its development and severity, and evaluate mortality as a clinical outcome. Methods: Data from 238 COVID-19 patients monitored in the Intensive Care Unit of Ankara University Ibni Sina Hospital (ISH-ICU) between 1 January 2021 and 1 January 2022 were retrospectively reviewed. Patients were divided into two groups according to the presence of AKI. Those with AKI were staged according to KDIGO criteria (stages 1–2–3). Demographic characteristics, comorbidities, disease severity scores, laboratory parameters, and mortality outcomes were analyzed and compared between groups. Results: AKI was identified in 54.6% of patients. Of the patients with AKI, 32 (13.4%) had stage 1, 25 (10.5%) had stage 2, and 73 (30.7%) had stage 3 AKI. Thirteen patients (5.5%) had already developed AKI at ICU admission. AKI developed at a median of 11 days after symptom onset and 3 days after ICU admission. Advanced age, hypertension, cardiovascular disease, and chronic kidney disease were more frequent in patients with AKI (p < 0.001). Higher Charlson Comorbidity Index (CCI) and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores were observed in patients with stage 3 AKI. Lymphopenia and elevated levels of D-dimer, ferritin, IL-6, CRP, and procalcitonin were significantly higher in patients with stage 3 AKI than in patients with other AKI stages and the non-AKI group. Mortality rates were higher in patients with AKI and increased with advancing AKI stage (p < 0.001). ICU length of stay was significantly longer in the AKI group (p < 0.001). Conclusions: AKI is a common complication among critically ill patients with COVID-19 and is associated with prolonged ICU stay and higher mortality rates, particularly in advanced stages. Early identification of clinical and laboratory factors associated with AKI may support timely risk stratification and targeted management in this high-risk population. Full article
(This article belongs to the Section Nephrology & Urology)
16 pages, 1457 KB  
Article
Prediction of Chronic Obstructive Pulmonary Disease Using Machine Learning, Clinical Summary Notes, and Vital Signs: A Single-Center Retrospective Cohort Study in the United States
by Sabrina Meng, Hersh Sagreiya and Negar Orangi-Fard
Adv. Respir. Med. 2026, 94(1), 5; https://doi.org/10.3390/arm94010005 - 7 Jan 2026
Viewed by 50
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early identification and timely intervention for COPD exacerbations can reduce hospitalizations and complications, as well as improve patient outcomes. Methods: To develop and evaluate predictive models for COPD exacerbations [...] Read more.
Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early identification and timely intervention for COPD exacerbations can reduce hospitalizations and complications, as well as improve patient outcomes. Methods: To develop and evaluate predictive models for COPD exacerbations using machine learning (ML), we performed a retrospective study using intensive care unit patient records. Records including 31,667 clinical notes and 10,489 vital signs were used to train and validate two machine learning models to predict COPD exacerbations in patients with known or suspected COPD. Predictive performance was evaluated for support vector machine, quadratic discriminant analysis, and adaptive boosting algorithms using area under the receiver operating characteristic curve (AUC). Results: The clinical note-based support vector machine model achieved an AUC of 0.81 and accuracy of 84.0% in predicting COPD exacerbations. Data from patient monitors and hospital information systems provided sufficient information for accurate prediction, demonstrating the utility of combining physiological signals with clinical text data. Discussion: Clinically available patient data and vital signs can effectively predict COPD exacerbations, potentially enabling earlier interventions, improved outcomes, and reduced healthcare burden. These findings suggest that integrating unstructured clinical notes with structured vital signs using ML frameworks may improve early detection of exacerbation risk, thus enabling appropriate patient counseling, triage, and treatment based on COPD severity. Full article
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9 pages, 311 KB  
Article
Delayed Sternal Closure for High-Risk Cardiac Surgery Patients: Life-Saving Strategy for Improved Outcomes
by Sahin Iscan, Ertürk Karaağaç, Nuri Utkan Tunca, Hacı Anıl Solak, Hasan İner, Serkan Yazman, Yuksel Besir, Orhan Gökalp, Levent Yılık and Ali Gürbüz
J. Clin. Med. 2026, 15(2), 423; https://doi.org/10.3390/jcm15020423 - 6 Jan 2026
Viewed by 95
Abstract
Background/Objectives: Delayed sternal closure (DSC) is a useful management strategy for complex cardiac interventions. The aim of this study was to investigate the patients who had DSC in our clinic over a 12-year period and to evaluate the postoperative results. Methods: [...] Read more.
Background/Objectives: Delayed sternal closure (DSC) is a useful management strategy for complex cardiac interventions. The aim of this study was to investigate the patients who had DSC in our clinic over a 12-year period and to evaluate the postoperative results. Methods: A total of 124 DSC patients from a total cardiac surgery practice during a 12-year period (n = 6532, 1.8%, between January 2014 and September 2025) were retrospectively analyzed. Preoperative and intraoperative patient characteristics, morbidities, and mortality rates were collected and compared with the group undergoing primary sternal closure (PSC), which were matched with the DSC group in terms of preoperative and intraoperative patient characteristics. Results: A total of 124 (1.8%) patients required DSC, and 33.1% of the patients were females. The indications were bleeding (n = 81, 65%) and hemodynamic instability (n = 43, 35%). Total bypass times, cross-clamp times, and CPB temperature were higher in patients with DSC. A higher rate of inotropic support, intra-aortic balloon pump, extracorporeal lung support, blood transfusion, and bleeding were found in the DSC group. There was no difference in terms of sternal infection rate (2.4%). Intensive care unit stay, hospital stay, and mortality rate were also significantly increased in patients with DSC. Mortality rate in the DSC group was 16.1%. Conclusions: Multiple sternum revisions due to bleeding and low cardiac output syndrome may lead to increased mortality in high-risk patients. Planned postponement of sternal closure in these high-risk cardiac surgery patients helps to reduce perioperative morbidity and mortality. Full article
(This article belongs to the Section Cardiovascular Medicine)
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13 pages, 270 KB  
Review
The Changing Landscape of Sodium Needs in the Preterm Neonate for Optimizing Growth and Development
by Chrysoula Kosmeri, Maria Baltogianni, Niki Dermitzaki, Chrysanthi Maria Tsiogka and Vasileios Giapros
Nutrients 2026, 18(2), 186; https://doi.org/10.3390/nu18020186 - 6 Jan 2026
Viewed by 115
Abstract
Sodium (Na) is essential not only for maintaining extracellular fluid homeostasis as the dominant extracellular cation, but also for supporting the rapid tissue growth characteristic of the neonatal period. Despite its importance, the precise sodium requirements of preterm infants remain insufficiently defined. The [...] Read more.
Sodium (Na) is essential not only for maintaining extracellular fluid homeostasis as the dominant extracellular cation, but also for supporting the rapid tissue growth characteristic of the neonatal period. Despite its importance, the precise sodium requirements of preterm infants remain insufficiently defined. The immature renal tubules of preterm neonates lead to significant renal sodium losses, making negative sodium balance a common feature in this population. This issue has become increasingly relevant as survival rates improve among extremely preterm infants, while most available data are derived from studies involving more mature preterm or even full-term neonates. Fractional excretion of sodium (FENa) shows a clear inverse correlation with both gestational age and postnatal age, highlighting the developmental limitations in sodium retention among the youngest and most vulnerable infants. Current guidelines on sodium supplementation aim to promote optimal growth and neurodevelopment but vary across organizations. For instance, the most recent ESPGHAN recommendations suggest higher sodium intakes, in the range of 3–8 mEq/kg/day, whereas the American Academy of Pediatrics (AAP) provides more conservative guidance. These discrepancies underscore ongoing uncertainty in determining optimal sodium provision. This narrative review examines both classic and contemporary data on sodium needs in preterm neonates, with the goal of clarifying existing evidence and offering practical insights for clinical care. It also emphasizes unresolved questions and the need for well-designed studies that address the unique physiology of extremely preterm infants. A deeper understanding of sodium metabolism in this population is crucial for improving outcomes and guiding evidence-based supplementation strategies. Full article
(This article belongs to the Section Pediatric Nutrition)
13 pages, 540 KB  
Article
Healthcare-Associated Infections in Critically Ill COVID-19 Patients Across Evolving Pandemic Waves: A Retrospective ICU Study
by Nihan Altintepe Baskurt, Esra Akdas Tekin, Onur Okur and Namigar Turgut
Medicina 2026, 62(1), 118; https://doi.org/10.3390/medicina62010118 - 6 Jan 2026
Viewed by 81
Abstract
Background and Objectives: Healthcare-associated infections (HAIs) significantly increase morbidity and mortality in critically ill patients, and their burden became more pronounced during the COVID-19 pandemic. However, data describing the temporal evolution of HAIs, pathogen distribution, and associated risk factors across consecutive pandemic [...] Read more.
Background and Objectives: Healthcare-associated infections (HAIs) significantly increase morbidity and mortality in critically ill patients, and their burden became more pronounced during the COVID-19 pandemic. However, data describing the temporal evolution of HAIs, pathogen distribution, and associated risk factors across consecutive pandemic waves remain limited. This study aimed to characterize the epidemiology, microbiology, and outcomes of HAIs in COVID-19 intensive care units (ICU) patients and to identify clinical and laboratory predictors of mortality. Materials and Methods: This retrospective observational study included adult patients with RT-PCR–confirmed COVID-19 who developed at least one HAI ≥ 48 h after ICU admission between March 2020 and December 2020, encompassing the first three pandemic waves in Türkiye, in a tertiary-care ICU. Demographic, clinical, laboratory, and microbiological data were collected. Inflammatory markers and severity scores (SAPS-II, MCCI, and NLR) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for mortality prediction. Results: Among the 1656 ICU admissions, 145 patients (8.7%) developed HAIs; after exclusions, 136 patients were included in the final analysis. Bloodstream infections were the most frequent HAI (57%), followed by urinary tract infections (31%), ventilator-associated pneumonia (9%), and surgical site infections (1%). Klebsiella pneumoniae was the predominant pathogen, followed by Candida albicans and Acinetobacter baumannii. Multidrug-resistant organisms, including MRSA and VRE, showed variable distribution across pandemic periods. Overall in-hospital mortality was 74.3%. Non-survivors had significantly higher SAPS-II, MCCI, and NLR values. ROC analysis identified NLR > 38.8 and SAPS-II > 35.5 as mortality-predictive thresholds. Dynamic inflammatory marker patterns correlated with infection timing, and early peaks of CRP, WBC, and IL-6 were associated with worse outcomes. Conclusions: HAIs imposed a substantial clinical burden on critically ill COVID-19 patients, with high mortality driven predominantly by multidrug-resistant bloodstream infections. Severity indices and inflammation-based biomarkers demonstrated strong prognostic value. Temporal shifts in pathogen ecology across pandemic waves underscore the need for adaptive infection-prevention strategies, continuous microbiological surveillance, and strengthened antimicrobial stewardship in critical care settings. Full article
(This article belongs to the Section Epidemiology & Public Health)
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14 pages, 767 KB  
Article
Sequential Versus Non-Sequential Polymyxin B Hemoperfusion in Severe Sepsis and Septic Shock: A Real-World Cohort Analysis of Survival in an Asian ICU
by Wei-Hung Chang, Ting-Yu Hu and Li-Kuo Kuo
Diagnostics 2026, 16(1), 173; https://doi.org/10.3390/diagnostics16010173 - 5 Jan 2026
Viewed by 169
Abstract
Background: Severe sepsis and septic shock remain major causes of ICU mortality despite advances in critical care. Polymyxin B hemoperfusion (PMX-HP) is widely used in Asia for refractory endotoxemia, yet the optimal session strategy remains unclear. Methods: We retrospectively analyzed adult ICU patients [...] Read more.
Background: Severe sepsis and septic shock remain major causes of ICU mortality despite advances in critical care. Polymyxin B hemoperfusion (PMX-HP) is widely used in Asia for refractory endotoxemia, yet the optimal session strategy remains unclear. Methods: We retrospectively analyzed adult ICU patients with severe sepsis or septic shock treated with PMX-HP between 2013 and 2019 in a tertiary center in Taiwan. Patients were divided into sequential (≥2 sessions within 24 h) and non-sequential groups. The primary outcome was 28-day mortality; secondary outcomes included ICU and hospital mortality, length of stay, organ support, and vasoactive-inotropic score (VIS) changes. Results: Among 64 patients, 33 (51.6%) received sequential therapy. The 28-day mortality was 46.9%, with no difference between groups after adjustment for baseline severity. Patients receiving sequential PMX-HP had longer hospital stays and more frequent CRRT use, likely reflecting greater underlying disease severity rather than a causal effect of treatment sequencing. Conclusions: Multivariate analysis identified higher APACHE II score, positive VIS change, and CRRT requirement as independent predictors of mortality. Sequential therapy itself was not associated with improved outcomes. Prognosis in PMX-HP-treated patients is determined mainly by underlying severity and hemodynamic instability, underscoring the need for patient selection and biomarker-guided strategies rather than routine sequential use. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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37 pages, 1873 KB  
Article
General Movements Assessment and Amiel-Tison Neurologic Examination in Neonates and Infants: Correlations and Prognostic Values Regarding Neuromotor Outcomes
by Adrian Ioan Toma, Vlad Dima, Lidia Rusu, Andreea Necula, Roxana Pavalache Stoiciu, Larisa Andrășoaie, Andrada Mirea and Anca Roxana Bivoleanu
Life 2026, 16(1), 81; https://doi.org/10.3390/life16010081 - 5 Jan 2026
Viewed by 124
Abstract
Background: Our study aimed to investigate whether the general movements assessment (GMA) and Amiel-Tison Neurologic Examination performed at term-equivalent age (TEA) and 12 weeks corrected age (CA) could predict the occurrence of cerebral palsy (CP) and delayed gross motor milestones in a [...] Read more.
Background: Our study aimed to investigate whether the general movements assessment (GMA) and Amiel-Tison Neurologic Examination performed at term-equivalent age (TEA) and 12 weeks corrected age (CA) could predict the occurrence of cerebral palsy (CP) and delayed gross motor milestones in a sample of term and preterm infants and whether the predictive values could be increased by using the two examinations during the same visit. Methods: A total of 70 infants (62 preterm and 8 at term) were examined at TEA and 12 weeks CA using GMs (General Movements) and Amiel-Tison (AT) examinations. We determined the correlation between the results of the examinations and several selected items (scarf sign, popliteal angle, and axial tone) and neuromotor outcomes (presence of cerebral palsy (CP), independent sitting, and independent walking). We attempted to build binary logistic regression models using items from both examination techniques to assess whether the combined use of the two exams could have a better predictive value than using one technique alone. Results: We analyzed the entire group and, separately, the subgroup of preterm infants. For the whole group, there was a statistically significant correlation between the GM examinations at TEA and 12 weeks CA (p < 0.008) as well as between the results of GM and AT exams performed at TEA (p < 0.001) and 12 weeks CA (p < 0.001). The strongest individual predictor for CP in the whole group was the absence of fidgety movements at 12 weeks CA (AUC (Area Under the Curve) = 0.873; CI (confidence interval) 95%: 0.748–0.998; p < 0.001) and a non-optimal result at the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.755; CI 95%: 0.617–0.892; p < 0.003). In the subgroup of 62 premature neonates, absent fidgety movements at 12 weeks CA (AUC = 0.925; CI 95%: 0.819–1.031; p < 0.001) and a non-optimal result in the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.772; CI 95%: 0.620–0.924; p < 0.005) were statistically significant predictors for the risk of CP. In the case of delayed sitting and delayed/absent walking, absent fidgety movements and non-optimal results in the AT exam at TEA and 12 weeks CA were the strongest individual predictors in the whole group as well as in the subgroup of preterm infants. The following exploratory logistic regression models reached statistical significance: one model combining absent fidgety + abnormal scarf sign + abnormal popliteal angle at 12 weeks CA for CP in the whole group (p < 0.032) and preterm infants (p < 0.034) and for delayed sitting in preterm infants (p < 0.041) and a second model combining absent fidgety + abnormal scarf + abnormal popliteal + abnormal axial + abnormal synthesis for CP risk (p < 0.046) and delayed sitting (p < 0.001) in preterm infants at 12 weeks CA. Conclusions: The absence of fidgety movements at 12 weeks CA represented the strongest individual predictor for the occurrence of CP and delayed gross motor milestones in our sample, both in the whole group and the subgroup of preterm infants. The combination of GM and AT findings reached statistical significance for the detection of CP risk in the whole group and CP risk and delayed sitting in the subgroup of preterm infants. Due to sample size limitations, the results should be regarded with caution, and larger studies are needed before robust conclusions can be drawn. Full article
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Review
A Rare Intruder: Neonatal Meningoencephalitis by Edwardsiella tarda Requiring Systemic and Intrathecal Antibiotics and Repeated Neurosurgery
by Domenico Umberto De Rose, Ludovica Martini, Francesca Campi, Daniela Longo, Alessia Guarnera, Giulia Lucignani, Marta Conti, Alessandra Santisi, Carlotta Ginevra Nucci, Giacomo Esposito, Lorenza Romani, Paola Bernaschi, Bianca Maria Goffredo, Gianfranco Scarpelli, Laura Lancella, Andrea Dotta and Maria Paola Ronchetti
Antibiotics 2026, 15(1), 59; https://doi.org/10.3390/antibiotics15010059 - 5 Jan 2026
Viewed by 145
Abstract
Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal [...] Read more.
Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
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