Search Results (978)

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM implantation without increasing infection risks. Our objective is to evaluate the safety and cost-effectiveness of LP implantation during the same procedure of CIED extraction, compared to conventional two-stage approaches. Methods: Pacemaker-dependent patients with systemic or pocket infection undergoing device extraction and LP implantation during the same procedure at Sheba Medical Center, Israel, were compared to a historical group of patients undergoing a semi-permanent (SP) pacemaker implantation during the procedure, followed by a permanent pacemaker implantation. Results: The cohort included 87 patients, 45 undergoing LP implantation and 42 SP implantation during the extraction procedure. The LP group demonstrated shorter intensive care unit stay (1 ± 3 days vs. 7 ± 12 days, p < 0.001) and overall hospital days (11 ± 24 days vs. 17 ± 17 days, p < 0.001). Rates of infection relapse and one-year mortality were comparable between groups. Economic analysis revealed comparable total costs, despite the higher initial expense of LPs. Conclusions: LP implantation during CIED extraction offers significant clinical and logistical advantages, including reduced hospital stays and streamlined treatment, with comparable safety and cost-effectiveness to conventional approaches. Full article

Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in identifying pharmacotherapy-related issues upon patient admission in a low-resource setting. A prospective observational study was conducted at a university hospital between 1 March and 31 May 2023. Within 24 h of admission, a clinical pharmacist documented each patient’s pre-admission medication regimen and compared it with the medication history obtained by the admitting physician. Discrepancies and pharmacotherapy problems were subsequently identified. Among 65 patients, pharmacists documented 334 medications versus 189 recorded by physicians (p < 0.01). The clinical pharmacist identified 155 discrepancies, 112 (72.26%) of which were unintentional. The most frequent type was drug omission (91.07%), followed by incorrect dosage (4.46%), incorrect dosing interval (2.68%), and medications with unknown indications (1.79%). Most discrepancies were classified as errors without harm (53.57%), while 41.07% were potentially harmful. These findings underscore the importance of integrating clinical pharmacists into the healthcare team. Their active participation during hospital admission can significantly enhance medication safety and reduce preventable adverse drug events. Full article

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study—47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00–1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57–22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83–10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63–36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00–1.04) and peak lactate (HR 1.16, 95% C.I. 1.11–1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights. Full article

Objectives: Burkholderia cepacia complex (Bcc), a Gram-negative organism, is a well-recognized cause of hospital outbreaks, often linked to a contaminated shared source, such as multidose medications. In this study, we report an outbreak of Bcc infections in a tertiary care hospital, associated with the intrinsic contamination of a prepared solution used in interventional radiology (IR) procedures. Additionally, we provide a detailed explanation of the interventions implemented to control and interrupt the outbreak. Methods: Records from the infection control committee from 1 January 2023 to 31 October 2024 were screened to identify cases with Bcc growth in cultured blood, urine, or respiratory samples. Clinical and laboratory data were collected in March 2025. Bacterial identification was performed using conventional methods and MALDI-TOF (Bruker Daltonics, Bremen, Germany). Controls were matched to cases by ward, date of initial growth, and duration of hospitalization. Demographic and clinical data of these patients were systematically collected and analyzed. Microbiological cultures were obtained from environmental objects of concern and certain medications. Results: A total of 82 Burkholderia species were identified. We enrolled 77 cases and 77 matched controls. The source of contamination was identified in ready-to-use intravenous medications (remifentanil and magnesium preparations) in the IR department. These preparations were compounded in advance by the team and were used repeatedly. Although the outbreak originated from contaminated IV medications used in IR, secondary transmission likely affected 28 non-IR patients via fomites, shared environments, and possible lapses in isolation precautions. The mortality rate among the cases was 16.9%. Infection with Bcc was associated with prolonged intensive care unit stays (p = 0.018) and an extended overall hospitalization duration (p < 0.001); however, it was not associated with increased mortality. The enforcement of contact precautions and comprehensive environmental decontamination successfully reduced the incidence of the Bcc outbreak. No pathogens were detected in cultures obtained after the disinfection. Conclusions: The hospital transmission of Bcc is likely driven by cross-contamination, invasive medical procedures, and the administration of contaminated medications. Implementing stringent infection control measures such as staff retraining, updated policies on medication use, enhanced environmental decontamination, and strict adherence to isolation precautions has proven effective in curbing the spread of virulent and transmissible Bcc. Full article

The significant advances in the surgical and medical treatment of gynecological cancer have led to improved survival outcomes of several subgroups of patients that were until recently opted out of treatment plans. Surgical cytoreduction has evolved through advanced surgical complexity procedures and the need for critical care of gynecological cancer patients has increased. Despite that, however, articles focusing on the need of perioperative monitoring of these patients completely lack from the international literature; hence, recommendations are still lacking. Critical care may be offered in different types of facilities with specific indications. These include the post-anesthesia care unit (PACU), the high dependency unit (HDU) and the intensive care unit (ICU) which have discrete roles and should be used judiciously in order to avoid unnecessary increases in the hospitalization costs. In the present review we focus on the pathophysiological alterations that are expected in gynecological cancer patients undergoing surgical treatment, provide current evidence and discuss indications of hospitalization as well as discharge criteria from intensive care facilities. Full article

This review explores the potential of magistral formulas (MFs) as a viable option to meet the needs of neonates, given the lack of adequate therapies for this vulnerable group. The scientific literature on medicines available for neonates is limited. The physiological differences between neonates and adults make it difficult to formulate these medicines. In addition, there are a variety of difficulties in conducting research on neonates: few clinical trials are performed, and there is frequent use of unauthorized medicines. Pharmacokinetics in neonates was investigated in comparison to adults, and different aspects of the absorption, distribution, metabolism, and excretion were observed. One of the main problems is the different pharmacokinetics between the two populations. It is necessary to promote and allow research related to pediatric drug design, approve a specific authorization for use in age-appropriate dosage forms, and improve the quality and availability of information on drugs. This study focused on the MFs typically used for pediatrics, specifically for neonates, analyzing the pharmaceutical forms currently available and the presence of indications and dosage recommendations of the European Medicines Agency. Medications were classified according to therapeutic group, as antihypertensives, corticosteroids, and antiepileptics. The use of off-label medicines remains high in neonatal intensive care units and in primary healthcare, besides in the preparation of MFs by pharmacists. The shortage of medicines specifically designed and approved for neonates is a serious problem for society. Neonates continue to be treated, on numerous occasions, with off-label medicines. Studies and research should be expanded in this vulnerable population group. Full article

Background: Intravascular albumin mass represents the total quantity of albumin circulating within the bloodstream and may serve as a physiologically relevant marker of vascular integrity and fluid distribution in sepsis. While low serum albumin levels are acknowledged as prognostic indicators, dynamic assessments based on albumin mass remain insufficiently explored in patients outside the intensive care unit. Objectives: To describe the temporal changes in intravascular albumin mass in patients with community-acquired sepsis and to examine its relationship with fluid balance and thirty-day mortality. Methods: This prospective observational study encompassed 247 adults diagnosed with community-acquired sepsis who were admitted to a high-dependency hospital ward specializing in acute medical care. The intravascular albumin mass was calculated daily for a duration of up to five days, utilizing plasma albumin concentration and estimated plasma volume derived from anthropometric and hematologic data. Net albumin leakage was defined as the variation in intravascular albumin mass between consecutive days. Fluid administration and urine output were documented to ascertain cumulative fluid balance. Repeated-measures statistical models were employed to evaluate the associations between intravascular albumin mass, fluid balance, and mortality, with adjustments made for age, comorbidity, and clinical severity scores. Results: The intravascular albumin mass exhibited a significant decrease during the initial five days of hospitalization and demonstrated an inverse correlation with the cumulative fluid balance. A greater net leakage of albumin was associated with a positive fluid balance and elevated mortality rates. Furthermore, a reduced intravascular albumin mass independently predicted an increased risk of mortality at thirty days. Conclusions: A reduction in intravascular albumin mass may suggest ineffective fluid retention and the onset of capillary leak syndrome. This parameter holds promise as a clinically valuable, non-invasive indicator for guiding fluid resuscitation in cases of sepsis. Full article

Monitoring Peripheral Oxygen Saturation (SpO₂) is an important vital sign both in Intensive Care Units (ICUs), during surgery and convalescence, and as part of remote medical consultations after of the COVID-19 pandemic. This has made the development of new SpO₂-measurement tools an area of active research and opportunity. In this paper, we present a new Deep Learning (DL) combined strategy to estimate SpO₂ without contact, using pre-magnified facial videos to reveal subtle color changes related to blood flow and with no calibration per subject required. We applied the Eulerian Video Magnification technique using the Hermite Transform (EVM-HT) as a feature detector to feed a Three-Dimensional Convolutional Neural Network (3D-CNN). Additionally, parameters and hyperparameter Bayesian optimization and an ensemble technique over the dataset magnified were applied. We tested the method on 18 healthy subjects, where facial videos of the subjects, including the automatic detection of the reference from a contact pulse oximeter device, were acquired. As performance metrics for the SpO₂-estimation proposal, we calculated the Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), and other parameters from the Bland–Altman (BA) analysis with respect to the reference. Therefore, a significant improvement was observed by adding the ensemble technique with respect to the only optimization, obtaining 14.32% in RMSE (reduction from 0.6204 to 0.5315) and 13.23% in MAE (reduction from 0.4323 to 0.3751). On the other hand, regarding Bland–Altman analysis, the upper and lower limits of agreement for the Mean of Differences (MOD) between the estimation and the ground truth were 1.04 and −1.05, with an MOD (bias) of −0.00175; therefore, MOD $\pm 1.96\sigma$ = −0.00175 ± 1.04. Thus, by leveraging Bayesian optimization for hyperparameter tuning and integrating a Bagging Ensemble, we achieved a significant reduction in the training error (bias), achieving a better generalization over the test set, and reducing the variance in comparison with the baseline model for SpO₂ estimation. Full article

Microbiological contamination of healthcare workers’ gowns represents a critical risk for the transmission of healthcare-associated infections (HAIs). Despite their use as protective equipment, gowns can act as reservoirs of antibiotic-resistant bacteria, favouring the spread of pathogens between healthcare workers and patients. The presence of these resistant bacteria on healthcare workers’ gowns highlights the urgent need to address this risk as part of infection control strategies. The aim of this work was to assess the microbiological risks associated with the contamination of healthcare staff gowns with Gram-negative bacteria, including the ESKAPE group, and their relationship with antimicrobial resistance. An observational, cross-sectional, prospective study was conducted in 321 hospital workers. The imprinting technique was used to quantify the bacterial load on the gowns, followed by bacterial identification by MALDI-TOF mass spectrometry. In addition, antimicrobial resistance profiles were analysed, and tests for carbapenemases and BLEE production were performed. The ERIC-PCR technique was also used for molecular analysis of Pantoea eucrina clones. Several Gram-negative bacteria were identified, including bacteria of the ESKAPE group. The rate of microbiological contamination of the gowns was 61.05% with no association with the sex of the healthcare personnel. It was observed that critical areas of the hospital, such as intensive care units and operating theatres, showed contamination by medically important bacteria. In addition, some strains of P. eucrina showed resistance to carbapenemics and cephalosporins. ERIC-PCR analysis of P. eucrina isolates showed genetic heterogeneity, indicating absence of clonal dissemination. Healthcare personnel gowns are a significant reservoir of pathogenic bacteria, especially in critical areas of Hospital Juárez de México. It is essential to implement infection control strategies that include improving the cleaning and laundering of gowns and ideally eliminating them from clothing to reduce the risk of transmission of nosocomial infections. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

Background: The yearly number of left ventricular assist device (LVAD) implantations is approximately twice the number of heart transplantations (HTX) in Germany. As the number of patients with an LVAD installed grows, so does the likelihood of their presentation to the emergency room (ER). Due to uneasiness in identifying their primary complaint, ER personnel are often likely to overlook important clues in the treatment of patients with an LVAD. Methods: To assess the urgency of patients’ conditions and their relationship with LVADs, we retrospectively examined the ER admissions of patients with HeartMate 3^TM (HM 3) LVADs installed between 2014 and 2024 at our university medical center. We counted referrals to the peripheral ward (minor) and to the intensive care unit (ICU, major). Relation to LVAD relation was also recorded. The survival was analyzed with respect to the severity of the cause of admission (minor/major) and the relationship to the LVAD therapy. Results: We observed 100 presentations to the emergency department. Of these, 77 were minor and 23 were major. The majority (92) was not related to the LVAD. Of the eight admissions related to the LVAD, two were major adverse events, accounting only for 2% of the total cases. Conclusions: An ER presentation of a patient with an HM 3 is very likely to have a medical cause not related to the LVAD. LVAD-related causes were mostly minor and could be treated on the ward. Full article

Background and Objectives: Acute kidney injury (AKI) is common in intensive-care unit (ICU) patients and is associated with increased mortality. Elderly patients tend to have more comorbid chronic diseases and are more prone to AKI than younger populations, resulting in higher rates of hospitalization and a higher incidence of AKI. Our aim in this study was to investigate the prognostic utility of BUN/albumin ratio (BAR) in predicting mortality in elderly critically ill patients with AKI. Materials and Methods: This study was conducted retrospectively on 154 elderly patients with AKI who were admitted to the ICU between October 2023 and September 2024.Data on the following demographic, clinical, and laboratory parameters were retrospectively collected from medical cards and electronic records. Results: In the non-survivor group, among comorbidities, lung disease was higher (p < 0.05), GCS was lower, and APACHE II was higher among clinical scores (p < 0.001). In the non-survivor group, diuretic use (p = 0.03), oliguria, RRT, vasopressor requirement, sepsis, and MV rates (p < 0.001),as well as BUN, phosphate, LDH, Crp, APTT, INR, and BAR rates, were higher (all p < 0.05) and albumin was lower (p = 0.01). Cut-off values of BUN, albumin, and BAR variables according to mortality status were determined by an ROC curve analysis, as follows:48.4 for BUN (p = 0.013), 31.5 for albumin (p = 0.001), and 1.507 for BAR (p = 0.001).According to the results of the ROC analysis performed to predict in-hospital mortality, the BAR level reached an AUC value of 0.655. A BAR value above 1.507 increases mortality by 3.944 times (p = 0.023). Conclusions: BAR is a simple and accessible biomarker that may serve as a predictor of in-hospital mortality in elderly patients with AKI. Its use may aid early risk stratification and decisionmaking in the ICU. Full article

Background and Objectives: This study aims to identify risk factors associated with MDRO infections and assess their impact on patient outcomes in Egyptian ICUs. Materials and Methods: The widespread overuse of antimicrobials has led to antibiotic multidrug resistance, posing significant challenges in intensive care units (ICUs) and leading to increased morbidity, mortality, and healthcare costs. A prospective observational study was conducted over 12 months, including 113 adult patients admitted to the ICU with confirmed bacterial infections. Comprehensive medical assessments and routine investigations were performed, including multisource cultures based on clinical suspicion. Patient histories, underlying conditions, and disease progression were documented. Patients were classified into two groups: those infected with MDROs and those without MDRO infections. Results: Significant differences were observed between patients with and without MDRO infections regarding temperature, pH, PaO₂, HCO₃, serum creatinine levels, high-dose inotropes, and inotrope dependence (p-values: 0.01, 0.028, 0.036, 0.008, <0.001, 0.013, 0.029, 0.039, <0.001, and 0.003, respectively). Additionally, cerebrovascular stroke and renal failure were significantly more frequent in MDRO-infected patients (p-values: 0.048 and 0.007, respectively). MDROs accounted for 42% of infections. The most commonly detected MDRO was Klebsiella spp. (52%). Patients with MDRO infections showed significantly higher mortality (42.6%), increased incidence of ARDS, invasive ventilation, and longer ventilation durations. Independent risk factors included prior antibiotic use (OR: 3.2; 95% CI: 1.5–6.8) and invasive device presence (OR: 2.7; 95% CI: 1.2–5.9). Conclusions: Cerebrovascular stroke and renal failure appear to be risk factors for MDRO infections. MDRO infections in ICUs are associated with poor clinical outcomes and increased complications. Improved antimicrobial stewardship and targeted prevention strategies are urgently required. Full article

Background and Objectives: Previous studies have shown that a major part of adverse drug reactions (ADRs) are preventable, and they contribute to increased morbidity, mortality, and costs. To our knowledge, no study investigating preventable ADRs has been carried out in Lithuania. Therefore, the aim of this study was to characterize ADRs in the intensive care unit (ICU) of a secondary care Lithuanian hospital as well as to identify drug classes and organ systems most commonly implicated in preventable and nonpreventable ADRs. Materials and Methods: This observational prospective study was conducted in an 18-bed ICU of Kaunas Hospital of the Lithuanian University of Health Sciences from 1 September 2021 to 31 August 2023. All ADRs were assessed for causality, severity, and preventability. The Anatomical Therapeutic and Chemical (ATC) system was used to classify drug classes implicated in ADRs. The organ systems affected were analyzed using the Medical Dictionary for Regulatory Activities (MedDRA). Results: A total of 154 patients with a median age of 78.8 years (range, 18–97) were enrolled into this study. There were 255 ADRs identified; preventable ADRs accounted for 87.5%. Among the preventable ADRs, the top three therapeutic subgroups were antithrombotic agents (26.5%), anti-inflammatory and antirheumatic products (22.0%), and blood substitutes and perfusion solutions (20.2%). Meanwhile, among nonpreventable ADRs, antibacterials for systemic use (62.5%) and antithrombotic agents (46.9%) were the two most common therapeutic subgroups. The gastrointestinal as well as the skin and subcutaneous tissues organ systems were more likely to be affected by nonpreventable ADRs (56.3% vs. 17.5%, p ˂ 0.05 and 12.5% vs. 0.4%, p ˂ 0.05, respectively), while the renal and urinary organ systems were more likely to be affected by preventable ADRs (38.1% vs. 6.3%, p ˂ 0.05). Conclusions: Our study showed a very high incidence of preventable ADRs (87.5%). Drugs affecting blood and blood-forming organs were most frequently implicated in these ADRs. This area deserves special attention and strategies need to be implemented to reduce the incidence of preventable ADRs and their impact on the healthcare system. Moreover, it emphasizes the need for future studies at a national level as, to our knowledge, this is the first study addressing the issues of avoidable harm at the ICU of one Lithuanian hospital. Full article