To identify diuretic resistance (DR) in patients with congestive heart failure (CHF) during intensive care treatment by analyzing the diuretic effect (DE) and to investigate their clinical characteristics and prognosis. Data of 1,744 patients with CHF in the MIMIC-IV database were analyzed. The trajectory of DE was examined by group-based trajectory modeling and its relationship with the diuretic dose-response then evaluated. The area under the curve (AUC) was used to assess the characteristics of DE at different time points of DR. The association between DE, DR, and clinical outcomes was investigated using logistic and Cox regression with different covariate adjustment strategies. The final model identified four trajectories of DE, among which Class 1 patients were identified as having DR, defined as having a minimal diuretic response of 3.819 mL/mg (95% CI 3.223-4.414, p < 0.001) before peak dosing, and minimal changes in diuretic adjustments. The DE at different time points effectively distinguished DR, with AUC values of 0.966 (95% CI 0.959-0.973) and 0.979 (95% CI 0.973-0.985) and optimal cut-off values of 6.515 and 12.557 at 6 h and 24 h, respectively. The DR group had significantly higher rates of in-hospital mortality (20.08% vs. 8.92%, p < 0.001), all-cause re-admission (23.11% vs. 17.08%, p = 0.012), and one-year mortality (40.45% vs. 26.26%, p < 0.001) compared to those observed in the non-DR group. The method of constructing DE trajectory models offers an effective approach to identify DR and provides novel insights for analyzing its characteristics and prognostic implications.

Sex differences in intensive care treatment and mortality are well documented, but the timing of decisions to limit treatment remains unclear. We investigated whether sex differences in decisions to limit treatment arise at ICU admission or during the ICU stay. Nationwide cohort study using the Swiss Minimal Dataset for Intensive Care Units, including adult (≥ 18 years) ICU admissions between 2016 and 2024. Two adjusted logistic regression models assessed treatment limitations documented at ICU admission and those occurring later among patients admitted without limitations. Among 654,660 ICU stays, treatment limitations at admission were more common in women than men (12.0% vs. 8.6%), whereas rates during the ICU stay were similar (5.5% vs. 5.5%). Female sex was independently associated with limitations at admission (aOR 1.26, 95% CI 1.24-1.28) but only weakly associated with later limitations (aOR 1.10, 95% CI 1.08-1.13). Differences at admission varied by diagnosis and were most pronounced in trauma and cardiovascular conditions. Women more often had ceiling-of-care decisions and documented patient wishes, whereas men more frequently underwent withdrawal of life-sustaining therapies and physician-driven decisions. Mortality was highest with limitations at ICU admission and lowest without limitations, with minimal sex differences within categories. In Switzerland, sex differences in treatment limitations occur mainly at ICU admission and vary across diagnoses. These findings suggest that differences may reflect early triage heuristics, societal norms influencing advance care planning, and potential implicit biases under prognostic uncertainty. Structured goal-of-care discussions at ICU admission may help promote consistent and equitable decision-making.

Critical illness leads to profound metabolic, neuroendocrine and immune disorders that affect the prognosis of patients treated in intensive care units (ICUs). The ketogenic diet, a high-fat and low-carbohydrate eating model, is gaining increasing importance as a potential metabolic intervention in the ICU. Preliminary data suggest that the ketogenic diet (KD) may support the control of seizures in a super-refractive epileptic state (SRSE), stabilize glycemia, reduce insulin demand, and modulate the immune response in sepsis. The aim of this review was to present a synthetic presentation of the current state of knowledge regarding use of the KD in intensive care patients. The review was carried out in accordance with the guidelines of the Joanna Briggs Institute and PRISMA-ScR. PubMed, Scopus, EBSCO, Web of Science, Google Scholar and Cochrane Library databases were searched (10-19 April 2026) using the Population-Concept-Context model. Full-text observational studies, randomized trials and reviews of the use of KDs in ICU patients were included. Data extraction was performed independently by two reviewers. Of the 42 publications identified, seven studies were included in the analysis. The KD was feasible and safe in both critically ill adults and children. In SRSE, most patients achieved stable ketosis within a few days, which often allowed for reduction or discontinuation of anesthetics. In sepsis, the KD led to glycemic stabilization, reduced insulin demand and reduced immune deregulation; in one study, "after day 4, none of the patients in the KD group required insulin treatment." The KD also showed beneficial effects on cellular bioenergetics and mitochondrial function. The safety profile was acceptable and adverse reactions were manageable with appropriate monitoring. The KD represents a promising, non-pharmacological metabolic intervention in intensive care, particularly in the treatment of SRSE and in the stabilization of glucose metabolism in sepsis and other critical conditions. Despite the growing number of positive clinical observations, the available evidence remains limited due to small samples, heterogeneous protocols, and a lack of randomized trials. Further, well-designed prospective studies are needed to determine optimal KD implementation protocols and identify the patient populations that benefit most.

To evaluate the prevalence and reasons for perceived inappropriateness of care (PIC) among ICU clinicians, to identify organizational, clinician, and work-related characteristics associated with PIC, and to determine if PIC is associated with adverse patient outcomes within 6 months post-ICU. Single-day cross-sectional survey, supplemented with follow-up data. Physicians and nurses from 47 Dutch ICUs and 525 patients who were treated in the ICU on the survey day. None. PIC (i.e., a patient situation in which care provision conflicts with a clinician's personal values or professional judgment) and other relevant variables were collected through questionnaires and the National Intensive Care Evaluation registry. A total of 1058 physicians and nurses (response rate, 72%) and 215 of the 397 eligible patients (54.2%) completed the survey. Among clinicians, 276 (26%) reported PIC for at least one patient. Clinicians mostly referred to distributive injustice (n = 181; 70%) and disproportionality of care (66%). Being a nurse (adjusted odds ratio [aOR], 1.78; 95% CI, 1.37-2.33; p < 0.001) and working in a culture that avoids end-of-life decisions (aOR, 1.92; 95% CI, 1.51-2.45; p < 0.001) were associated with higher PIC risk. Larger ICU bed capacity (aOR, 0.97; 95% CI, 0.94-0.99; p = 0.004) and mutual respect within interdisciplinary teams (aOR, 0.84; 95% CI, 0.70-1.00; p = 0.045) were protective. PIC reported by multiple clinicians was independently associated with increased risk of death (aOR, 3.86; 95% CI, 1.23-12.16; p = 0.02) and the combined outcome (i.e., death, severely frail, or not living at home anymore; aOR, 2.91; 95% CI, 1.14-7.42; p = 0.03). PIC is common in the ICU, inversely associated with a supportive ethical work environment, and should be regarded as a legitimate concern that warrants team reflection, as it is a prognostic marker of poor patient outcomes.

Symptom trajectories in intensive outpatient treatment exposure and response prevention for obsessive-compulsive disorder.

This case involved the elderly woman with alcoholic cirrhosis and periodontal disease who developed suppurative spondylitis, multiple abscesses, and multi-organ failure. Although she initially improved following intensive care treatment, she developed calcification of both the myocardium and the cranial dura mater on day 70. Post-septic dural calcification has not been previously reported, and this case represents the first such report. As a hypothesis regarding the mechanism of onset, it is presumed that the effects of sepsis extended to the dura mater, and that abnormal calcification of the dura mater progressed due to the effects of various therapeutic interventions. These findings were limited to imaging results and had no clinical implications. This unique case adds a new cause to the list of known etiologies for cranial dural calcification.

Older adults with cancer frequently present to the emergency department (ED) with complex care needs, yet palliative care remains underutilized. We aimed to characterize palliative care utilization and advance care planning (ACP) among older adults with cancer presenting to the ED and examine associated outcomes. We conducted a retrospective chart review of a random sample of 200 patients aged ≥ 65 years with cancer who presented to the ED at a tertiary academic center in 2022. Data included demographics, oncologic factors, ED encounter characteristics, palliative care utilization, ACP documentation, and outcomes. Analyses were descriptive, with exploratory associations evaluated using chi-square tests and logistic regression. Patients were older (mean age 74.3 years), and had frequent ED use, averaging 3.1 visits annually (SD = 1.9). Most were White (88.5%), male (52.5%), married (54.0%), and had a solid tumor malignancy (77.5%), with 28.5% receiving palliative-intent treatment. ED encounters frequently resulted in hospitalization (60.0%), with 18.3% of hospitalized patients requiring ICU admission. Palliative care consultation occurred in 2.5% of patients in the ED and 16.5% overall. ACP documentation increased from 65.5% at presentation to 75.0% following the encounter, largely driven by new MOLST completion and changes in code status. Mortality was high, with 24.4% dying during hospitalization and 49.0% within 6 months of the ED encounter. Among those who died within 6 months, 66.3% had not received palliative care consultation. In exploratory analyses, palliative care consultation, intensive care interventions, and ED visit frequency were associated with mortality. Older adults with cancer presenting to the ED experience high rates of hospitalization, intensive care use, and short-term mortality, yet palliative care remains underutilized. Although ACP documentation increased during acute care encounters, these changes often occur with clinical deterioration. The ED offers an opportunity to identify unmet palliative care needs and facilitate earlier integration.

Decisions to limit life-sustaining treatment (LST) in intensive care frequently generate ethical tensions between physicians and patients' relatives. Although France and the United States both emphasize respect for patient autonomy, their decisional frameworks allocate different roles to physicians and surrogates, raising questions about how these models shape ethical practice. The aim of this study was to compare French and American approaches to LST decision-making to identify shared ethical difficulties in physician-relative interactions beyond framework differences. Qualitative comparative analysis combining a review of decisional frameworks with semi-structured interviews of intensivists and ethicists in France and the United States. Data were analyzed thematically. Three recurrent ethical issues emerged across both contexts. First, while patient autonomy remains a central normative reference, its implementation is limited by the scarcity, ambiguity, and contextual inadequacy of advance directives, as well as uncertainties in interpreting patients' wishes through relatives. Second, irrespective of formal decision-making authority, physicians report a strong sense of moral responsibility grounded in medical expertise and professional integrity, often associated with moral distress when asked to provide treatments perceived as non-beneficial. Third, conflicts with relatives commonly arise from value-based disagreements regarding proportionality of care and perceived medical futility. Despite contrasting legal models - physician-led decision-making in France and surrogate-led decision-making in the United States - ethical tensions surrounding LST decisions appear largely similar. These findings suggest that procedural frameworks alone are insufficient to address the moral complexity of end-of-life decision-making, underscoring the need to strengthen ethical deliberation, and recognition of shared moral responsibility between physicians and relatives.

INTRODUCTION: The epidemiology of adverse outcomes after abdominal surgery remains one of the key problems of modern surgery and anesthesiology-resuscitation because of an aging population and an increasing prevalence of comorbidity. OBJECTIVE: To describe the epidemiology of postoperative complications in high risk patients undergoing elective abdominal surgery and to compare their outcomes with the overall STOPRISK cohort. MATERIALS AND METHODS: A prospective, multicenter observational cohort study was conducted in 38 Russian centers and included 11 478 adults undergoing elective surgery on abdominal and pelvic organs; among them, 1367 patients (11.9 %) met guideline based criteria for high surgical risk. Postoperative complications within 30 days were recorded according to EPCO definitions and graded using the Clavien—Dindo classification, with detailed assessment of frequency, structure, severity and timing. RESULTS: In the high risk subgroup, at least one complication occurred in 14.2 % of patients and mortality was 1.8 %, approximately threefold higher than in the overall cohort (4.5 and 0.62 %, respectively). The most frequent complications were postoperative ileus (4.8 %), postoperative bleeding (2.6 %), wound infection and pneumonia (2.4 % each), anastomotic leakage (2.1 %), acute kidney injury and postoperative delirium (1.9 % each). Overall, 68.5 % of events were severe complications (Clavien—Dindo ≥ III), usually requiring intensive care and/or invasive interventions. Two thirds of all complications occurred within the first 5 postoperative days, which also concentrated most severe and fatal events, including circulatory arrest, severe respiratory and renal failure. CONCLUSIONS: High risk surgical patients, while representing a small proportion of the elective abdominal population, account for a disproportionally large share of severe complications and deaths. These findings support the implementation of targeted protocols for intensive monitoring, early diagnosis and prevention during the early postoperative window, as well as refinement of national perioperative risk stratification tools and resource planning.

Current real-world data on the utilization of atrial fibrillation (AF) catheter ablation (CA) are scarce, as is information on the impact of the COVID-19 pandemic on trends in interventional AF treatment. Aims of this study were to describe case characteristics and trends of CA management using a contemporary multicenter database. In this retrospective, cross-sectional analysis, we investigated administrative data provided by 87 German hospitals from 01/01/2016 to 12/15/2022. Based on ICD-10 and OPS codes, inpatient cases with a main or secondary discharge diagnosis of AF who underwent CA were extracted. Incidence-rate ratios (IRR) for case numbers with 95% confidence intervals (CI) were calculated using negative binomial models. Trends based on regression analysis were adjusted for baseline variables. Analyzing 29 144 CA cases (89.4% from high-volume centers), a significant increase in case numbers was observed throughout the study period (IRR 1.05, 95% CI 1.03-1.07, p < 0.001). There was no sustained impact on the overall trend from the COVID-19 pandemic, but a temporary drop in case numbers in 2020. Utilization of transesophageal echocardiography (OR 0.82, 95% CI 0.81-0.83, p < 0.001) and intensive care treatment declined (OR 0.92, 95% CI 0.89-0.94, p < 0.001) and there was a trend toward a reduced incidence of pericardial tamponade. The ratio of cryoablations to radiofrequency CA case numbers increased from 0.29 ± 0.06 in 2016 to 0.50 ± 0.07 in 2022. We observed an increase in AF CA case numbers over the study period without a sustained influence of the COVID-19 pandemic on this long-term trend. Reported adaptations in CA management deserve further attention.

Introduction The differentiation between smoking-related interstitial lung diseases (SR-ILD) and interstitial pneumonia with autoimmune features (IPAF) represents a major diagnostic and therapeutic challenge. We present a complex case of a 46-year-old male with a dual phenotype of desquamative interstitial pneumonia (DIP) and smoking-related interstitial fibrosis (SRIF), complicated by high-titer autoantibodies and recurrent pulmonary embolism. Case description A 46-year-old male former smoker presented with progressive exertional dyspnea, dry cough, and recurrent fevers. Physical examination revealed digital clubbing and bilateral Velcro-like crackles. Initial high-resolution computed tomography showed diffuse ground-glass opacities (GGO) and lymphadenopathy. Over a three-year observation period, the patient experienced significant functional decline, reaching a restrictive pattern (total lung capacity: 55% predicted) and critical diffusion impairment (diffusion capacity of the lungs for carbon monoxide: 19% predicted). Echocardiography consistently showed no signs of pulmonary hypertension. Surgical lung biopsy confirmed a dual histological pattern of DIP and SRIF. Extensive immunological screening revealed high-titer anti-nuclear antibodies (1 : 2,560) and scleroderma-associated antibodies (anti-Th/To, anti-RP155), yet the patient did not meet the full American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for systemic sclerosis. The clinical course was further exacerbated by recurrent pulmonary embolism and an admission to the Intensive Care Unit (ICU) and mechanical ventilation. Therapeutic strategies evolved from initial glucocorticosteroids to a combined regimen of mycophenolate mofetil, methylprednisolone pulses, and the addition of Nintedanib due to a progressive fibrotic phenotype. This multi-targeted approach was maintained throughout the patient’s critical stabilisation following the ICU stay. Conclusions This case demonstrates that “overlap” ILD phenotypes can lead to life-threatening respiratory failure requiring intensive care intervention. However, the subsequent clinical improvement and partial radiological regression of GGO highlight the effectiveness of combining potent immunosuppression with antifibrotics. The recovery of a patient requiring intubation underscores the need for aggressive, multi-targeted treatment even in high-complexity, refractory cases.

Background/Objectives: Traumatic spinal fractures are common injuries, and a proportion of these cases require surgical stabilization using various operative systems. This study aimed to analyze the epidemiology of surgical site infections (SSIs) following exclusively trauma-related spinal surgery and to identify potential risk factors for their occurrence, as there is a lack of studies focusing on non-elective trauma-related spinal surgeries and SSI in the literature. Methods: This retrospective single-center analysis examined 710 patients with traumatic spinal injuries treated surgically between 2012 and 2022 at the Level I Trauma Center at the Department of Orthopedics and Trauma Surgery of the University Hospital Wiener Neustadt, Austria. To investigate SSI risk factors, comparative statistical analyses and logistic regression were used, with a level of statistical significance of α = 0.05. Results: In total, 28 cases (with an incidence of 3.94%) developed SSI, and these cases were characterized by a significantly higher body weight/BMI, longer operative times, and more stabilized segments and implanted hardware. They were also more likely to have undergone open surgery, laminectomy in combination with dorsal stabilization, intensive care treatment, or to present with neurological deficits or ankylosing spondylitis. SSIs occurred most frequently in the thoracolumbar and cervicothoracic junctions, and were predominantly caused by Staphylococcus epidermidis, Staphylococcus aureus, and Cutibacterium acnes. As independent risk factors, a higher BMI (OR = 1.188) and the use of cross-connectors (OR = 4.948) were identified, whereas other initially significant variables did not remain significant after adjustment. Conclusions: There are surgery-related and potentially modifiable variables and non-modifiable patient-related risk factors for the occurrence of SSI. Patients with SSIs stayed an average of 25.3 days in hospital and had a mortality rate of 17.9%.

Guidelines discourage prediction of neurological outcome in comatose patients within the first 72 h after cardiac arrest. Increasing evidence suggests that patients with the most severe brain injury and those with no or minimal brain injury may be identified before 72 h using novel methods. We present a protocol for the EARLY-NEURO study, which aims to evaluate whether good and poor outcomes can be reliably predicted already from 24 h after cardiac arrest using the most commonly available methods. Protocol for a prospective international multicenter substudy within the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial where adults post-arrest are randomized to minimal or deep sedation, fever treatment with or without a temperature management device and to two different targets of mean arterial blood pressure. Patients sedated or still unconscious at 24 h are examined with head computed tomography (CT) and electroencephalogram (EEG). Blood samples are collected at 24 h after randomization, and stored for analysis of the brain injury marker neurofilament light. CT and EEG examinations will be centrally evaluated for signs of a likely poor or good outcome applying standardized criteria by raters blinded to treatment allocations and patient outcomes. Intensive care treatment, neurological prognostication, and criteria for withdrawal of care will be according to the STEPCARE protocol. Timepoint and reasons for withdrawal of life-sustaining therapy (WLST) will be recorded. WLST prior to 72 h after randomization based on a presumed futile neurological prognosis is strongly discouraged. Primary outcome will be good or poor functional outcome, assessed by the modified Rankin Scale (dichotomized as 0-3 versus 4-6) at 6 months. Results will be reported in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Earlier prognostication aims to balance the avoidance of premature treatment withdrawal in patients with favorable potential against the prevention of unnecessary intervention in patients with a definitely poor prognosis.

IntroductionCritically ill children with adenoviral pneumonia usually require intensive care treatment. In this study, the prevalence of viremia secondary to respiratory adenovirus infection and the host characteristics and inflammatory response of children with severe adenoviral pneumonia in the PICU were investigated.MethodsWe prospectively recruited children who were admitted to the PICU of a tertiary pediatric hospital due to severe adenoviral pneumonia from September 2022 to April 2025. Sputum and blood samples were tested for adenovirus DNA with polymerase chain reaction. The clinical characteristics, blood laboratory parameters, and outcomes of the patients were collected. Plasma cytokines were also detected by flow cytometry.ResultsFifty-one patients with severe adenoviral pneumonia were enrolled, 20 of whom had viremia. The proportion of children with comorbidities in the viremia group and nonviremia group was 40.0% and 71.0%, respectively. The viral loads in sputum; CRP, PCT, D-dimer, AST, LDH, IL-6, IL-8, IL-10, and IFN-γ levels; and pSOFA, PSS and PRISM-Ⅲ scores were significantly greater in the viremia group than in the nonviremia group, whereas the IL-5 and albumin levels were markedly lower in the viremia group. The number of Natural killer cells in the viremia group was lower than that in the nonviremia group, but there was no statistical difference. Multivariate logistic regression found that sputum viral load was an independent risk factor associated with viremia. The areas under the receiver operating characteristic curves for AST, LDH, PCT, CRP, D-dimer, IL-6 and IFN-γ could predict viremia. The mortality rate of the viremia group was higher than that of the nonviremia group, while the difference was not significant.ConclusionsThe prevalence of viremia is nearly 40% in children with severe adenoviral pneumonia in the PICU. Compared with the nonviremia group, the viremia group had higher sputum viral loads, CRP, PCT, IL-6, IL-8, IL-10, and IFN-γ levels; and more serious disease severity.Supplementary informationThe online version contains supplementary material available at 10.1186/s12879-026-13314-6.

Antimicrobial resistance (AMR) has emerged as one of the most pressing global public health challenges of the 21st century. Recent data indicate that drug-resistant infections were directly responsible for approximately 1.27 million deaths globally in 2019 and associated with nearly 5 million deaths, with projections suggesting a dramatic increase by 2050 if no effective interventions are implemented. The widespread misuse and overuse of antibiotics in human medicine, agriculture, and animal husbandry are key drivers of resistance. The rapid emergence of multidrug-resistant organisms threatens the effectiveness of routine medical procedures, including surgery, chemotherapy, and intensive care interventions. Low- and middle-income countries bear a disproportionate burden due to inadequate surveillance, limited diagnostic capacity, and poor infection control practices. This editorial explores the current burden, underlying mechanisms, clinical implications, and future strategies to combat AMR, emphasizing the urgent need for coordinated global action and sustainable antimicrobial stewardship.

ABSTRACT Purpose Critically ill patients with hematologic malignant (HM) diseases are a heterogeneous but vulnerable group, where intensive care (ICU) is associated with high mortality. The impact of ICU care on long‐term survival is less well described. This retrospective national cohort study investigates the long‐term survival outcomes of hospitalized HM patients, comparing ICU survivors with non‐ICU patients. In addition, focused analyses were performed on the ICU cohort to further investigate survival patterns. Methods Adult patients diagnosed with HM and admitted to hospital between May 6, 2014, and December 31, 2019, were identified through the National Patient Registry. ICU admissions from these patients were obtained from the Norwegian Intensive Care and Pandemic Registry. Survival was measured from the time of first diagnosis until death or December 31, 2020. The patients were divided into three diagnostic groups: lymphoma, chronic leukemia, myeloma and acute leukemia. Results Among 26,281 hospitalized patients with HM, 2094 required ICU care. Long‐term survival from diagnosis to end of follow up varied significantly by ICU status. Compared with patients who never required ICU, mortality rose sharply during ICU care (HR 148; 95% CI 133–165) and remained elevated after discharge (HR 4.47; 95% CI 4.42–5.07). Acute leukemia was identified as a strong risk factor (HR 4.27; 95% CI 3.99–4.56). In the focused ICU cohort analyses, ICU survival was 81%, and one‐year post‐ICU survival was 45%. Acute leukemia and elevated SAPS II score, but not allogeneic transplant status, independently predicted ICU mortality. Conclusion While most HM patients survive ICU admission, long‐term survival is decreased compared with non‐ICU patients. Editorial Comment This analysis of hematological malignancy cases in Norway presents and compares outcomes for those in the subgroup requiring intensive care treatment, compared to those not requiring care in the intensive care unit. Intensive care unit survival was high, but severity of illness in the ICU was associated with worse long‐term survival.

Globally, an estimated 2.3 million neonatal deaths occur annually, with over 90% concentrated in low- and middle-income countries (LMICs). As survival among preterm and low birth weight infants improves, there is a growing need to ensure survival with quality. Developmentally supportive care (DSC) and family participatory care (FPC) have emerged as evidence-based approaches that enhance neurodevelopment, reduce stress, and strengthen caregiver involvement, although their implementation in LMICs remains variable. This narrative review with systematic search strategy synthesizes global and Indian evidence on DSC and FPC, outlines key implementation models, and highlights contextual innovations and future priorities. A narrative review with systematic search strategy was conducted using PubMed, Scopus, WHO IRIS, Cochrane Library, UNICEF repositories, and Google Scholar. Eligible studies included human research evaluating DSC or FPC interventions in neonatal intensive care unit/special newborn care unit settings. Case reports, commentaries, and nonempirical studies were excluded. Evidence was synthesized thematically across developmental care, family engagement, health-system readiness, and clinical outcomes. DSC interventions, including protected sleep, positioning, sensory regulation, and pain mitigation, demonstrated improvements in neurodevelopment, breastfeeding, weight gain, and parental satisfaction. Family integrated care/FPC models from Canada, Australia, China, and India showed reduced parental stress, improved breastfeeding and growth, and, in some settings, lower infection rates and shorter hospital stay. Integration of kangaroo mother care (KMC/immediate KMC) further enhanced bonding and survival outcomes. India's policy frameworks (India Newborn Action Plan, LaQshya, and National Quality Assurance Standards) and state-led programs support contextual adaptation. DSC and FPC are essential components of high-quality neonatal care. Scalable, evidence-informed models such as India's DSC-FPC approach can advance national and global goals for neonatal survival and neurodevelopment.

IntroductionEarly risk stratification of critically ill patients is essential for optimizing intensive care unit (ICU) resource allocation and treatment decisions. Urinary liver-type fatty acid-binding protein (L-FABP) is a simple, noninvasive biomarker that may provide real-time information on organ dysfunction. However, its prognostic utility in patients admitted to the ICU from the emergency department remains unclear.Aim of the studyThe aim of this study was to evaluate the prognostic value of L-FABP levels measured shortly after ICU admission in predicting 28-day mortality among patients admitted from the emergency department.MethodsThis single-center retrospective observational study included patients admitted to the ICU between December 2020 and August 2022. Urinary L-FABP concentrations were measured at ICU admission (T0) and 3 hours later (T3). The primary outcome was 28-day in-hospital mortality. Prognostic performance was assessed using receiver operating characteristic curves and Cox proportional hazards models with inverse probability of treatment weighting. Results were compared with Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) scores, and lactate levels.ResultsData of 118 patients were included in the final analysis. Urinary L-FABP levels at T3 showed the highest AUC for predicting 28-day mortality (area under the curve [AUC] = 0.873), compared with APACHE II (AUC = 0.801), SOFA (AUC = 0.753), and the lactate level (AUC = 0.734). An elevated L-FABP (T3) level was independently associated with increased mortality (hazard ratio [HR] = 8.60, 95% confidence interval [CI]: 1.02–72.64, P = 0.047). The T3/T0 ratio showed only modest predictive value (AUC = 0.623).ConclusionsUrinary L-FABP levels measured 3 hours after ICU admission were an independent predictor of short-term mortality. The marker’s simplicity and bedside applicability suggest its potential utility not only in ICUs but also in emergency departments and triage decision-making.

Comparison of one anastomosis gastric bypass to standard bariatric interventions: a propensity score matching analysis using the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

A real-time register-based surveillance system for non-invasive and invasive pneumococcal disease.