Healthcare-Associated Infections (HAIs) in Pediatric Intensive Care Units (PICUs) are a global problem. Mortality due to HAIs is 10% and may be higher in developing countries.

To determine the association between HAIs and mortality in pediatric patients admitted to the Intensive Care Unit in a tertiary Hospital.

Observational retrospective cohort study. Demographic and clinical variables (diagnosis, origin area, length of stay, mortality), as well as infectious variables (type of microorganism, type of HAI, multidrug resistance), were analyzed. The relationship between mortality and the development of HAI was assessed using the Chi-square test. A logistic regression model was used to evaluate other explanatory variables of mortality.

363 patients were studied, 23.7% of them were diagnosed with HAIs. The median age was 3 years (IQR: 1-9) and 51.2% were male. The most frequent HAI was ventilator-associated pneumonia (36%). Overall mortality was 10.7%, with a significant difference between groups with and without HAIs (18.4% vs. 8.7%, respectively; p= 0.01). The predictive mortality model concluded an association between mortality and multidrug-resistant (MDR) bacteria (OR: 8.66; 95% CI 2.01-37.21; p= 0.004). This group had a longer stay in the PICU (18 vs. 6 days; p=<0.001).

For patients admitted to the PICU at Hospital Baca Ortiz in 2022, the presence of MDR bacteria was associated with increased mortality and length of stay.

The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report classifies individuals with chronic obstructive pulmonary disease (COPD) who have experienced ≥2 moderate (outpatient) or ≥1 severe (emergency department or hospitalization) exacerbations within the last year as being at high risk of future exacerbation (category E).

This study aimed to investigate the risk of exacerbation and death associated with the individual components of the GOLD E category.

We conducted a retrospective cohort study using health administrative data from Ontario, Canada (2007-2018). Individuals ≥65 years of age with physician-diagnosed COPD were followed for up to 5 exacerbations, until their death, or the study period ended. After each exacerbation, individuals were assigned to 1 of 3 GOLD subgroups: E moderate (≥2 moderate), E severe (≥1 severe), and AB (≤1 moderate). Under a landmark analysis framework, Fine-Gray subdistribution hazards (sdHR) competing risk models were created for each event, and the risk of exacerbation and death was estimated.

There were 279 798 individuals included. Individuals in the GOLD E moderate subgroup were at a higher risk of future exacerbation (COPD, chronic obstructive pulmonary disease exacerbations 3-5 = 1.16-1.23) and a lower risk of death (sdHR exacerbations 3-5 = 0.75-0.82) than GOLD AB individuals. In comparison, patients in the GOLD E severe subgroup were at lower risk of future exacerbation (sdHR exacerbations 2-5 = 0.89-0.95), but higher risk of death (sdHR exacerbations 2-5 = 1.56-1.59).

These findings indicate that COPD patients in the GOLD E moderate subgroup have a different risk of future exacerbation and death than individuals in the GOLD E severe subgroup.

Despite clear guideline recommendations, few patients with pulmonary hypertension (PH) are referred to -expert care, including high-risk patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary -hypertension (CTEPH). Characterizing population-level care networks for patients with PH may inform understanding of -referral patterns and help improve PH care quality.

We leveraged social network analysis to characterize existing provider networks for patients with PH and to identify provider-level factors associated with connections to PH experts.

We linked patient-level data from the Massachusetts All-Payer Claims Database with provider-level data to identify all adults diagnosed with PH in 2014-2018 and all relevant providers who saw those patients for PH. We constructed provider networks among all patients with PH ("All-PH network") and subsets of patients with risk factors for PAH or CTEPH ("PAH network" and "CTEPH network," respectively). Our provider-level outcome was connection to PH experts, defined as sharing at least 1 patient with an expert. Within each network, we conducted multivariable regression models to determine the association between provider-level variables (specialty, practice location, PH panel volume) and our outcome.

We identified 4766 providers and 8970 patients with PH, of whom 1768 (19.7%) had PAH risk factors and 2164 (24.1%) had CTEPH risk factors. Few providers shared patients with PH experts (31% All-PH network, 35% PAH network, 19% CTEPH network). Within the All-PH network, primary care providers had 59% decreased odds of PH expert connection compared to nonexpert pulmonologists (adjusted odds ratio, 0.41 [95% confidence interval, 0.32-0.51]). Providers practicing outside the greater Boston area and those with smaller PH panel volumes were also less likely to be connected to a PH expert. Findings were similar among the PAH and CTEPH networks.

We found significant gaps in connections to expert care, even among providers caring for patients at risk for PAH or CTEPH, which may be driven in part by limited provider experience, geographic barriers, and disconnected providers and care networks. Multifaceted strategies may be needed to improve referral rates for patients with PH.

Background Clinical practice guidelines define radiologic pattern categories based on the integration of multiple imaging features. However, the relative importance of each feature is unknown. Purpose To determine the relative weights of imaging features in distinguishing radiologic patterns and identify incongruencies between guideline-defined and radiologist-assigned patterns in fibrotic interstitial lung disease (ILD). Materials and Methods In this secondary analysis of the prospective Canadian Registry for Pulmonary Fibrosis (CARE-PF), consecutive patients were evaluated in multidisciplinary discussion between January 2021 and March 2022, with documentation of features and their extent at high-resolution CT. Radiologic pattern was identified according to American Thoracic Society clinical guidelines (guideline-defined pattern) and radiologist impression (radiologist-assigned pattern). Receiver operating characteristic curves were used to evaluate how continuous features distinguished usual interstitial pneumonia (UIP), fibrotic hypersensitivity pneumonitis (fHP), and nonspecific interstitial pneumonia (NSIP) patterns. Logistic regression was used to evaluate discordance between guideline-defined and radiologist-assigned patterns. A multinomial model was used to quantify the association of individual radiologic features with radiologist-assigned patterns. Results A total of 1498 patients (mean age, 66 years ± 12 [SD]; 753 male patients) were included, with radiologist-assigned patterns of UIP (36%; 544 of 1498), fHP (17%; 250 of 1498), NSIP (33%; 499 of 1498), and "no confident pattern" (14%; 205 of 1498). More honeycombing, less total ground-glass opacity (GGO), and less pure GGO distinguished UIP from non-UIP (area under the receiver operating characteristic curve [AUC], 0.75, 0.81, and 0.77, respectively); more hypoattenuating lung differentiated fHP from non-fHP (AUC, 0.84); and more total GGO and less honeycombing distinguished NSIP from non-NSIP (AUC, 0.71 and 0.70, respectively), with features with greater than 10% lung involvement commonly demonstrating specificities of 90% or greater. Certain features led radiologists to disagree with guideline-defined UIP (eg, admixed GGO, central component of disease), guideline-defined fHP (consolidation, peripheral and basal distributions), and guideline-defined NSIP (honeycombing, reticulation). Features most helpful for pattern identification according to experienced radiologists (odds ratio ≥3 or ≤0.33) were related to distribution or distinctive findings (eg, three-density sign, axillary lymphadenopathy). Conclusion Key continuous features with greater than 10% lung involvement commonly demonstrated good specificity, and radiologists emphasized disease distribution and distinctive dichotomous features when determining fibrotic ILD patterns. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Czum in this issue.

Not Applicable.

This study aimed to examine whether D-dimer and lymphocyte counts predict the risk of concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) and to identify critical thresholds for clinical use. We also investigated whether D-dimer mediates the protective effect of lymphocytes against tuberculosis (TB) dissemination.

One thousand nine hundred (1318 PTB and 582 PTB + EPTB) patients diagnosed between 2022 and 2024 were analyzed. Multiple regression analysis, smooth curve fitting, threshold effect analysis, and causal mediation analysis were conducted using EasyStat and R software to evaluate the association between lymphocyte counts (exposure), D-dimer (mediator), and PTB + EPTB risk (outcome) and to determine the critical value of lymphocyte counts and D-dimer.

PTB + EPTB patients had higher D-dimer and lower lymphocyte counts. Elevated D-dimer increased the risk of PTB + EPTB (adjusted OR = 2.28, 95% CI: 1.99-2.60). High lymphocyte counts reduced the risk (adjusted OR = 0.25, 95% CI: 0.13-0.46). Threshold effects showed increased risk when D-dimer exceeded 0.170 mg/L (OR = 2.35, 95% CI: 2.05-2.70) and reduced risk when lymphocyte counts exceeded 750 cells/μL (OR = 0.15, 95% CI: 0.07-0.32). D-dimer mediated 36.473% (95% CI: 25.469-53.168) of the protective effect of lymphocytes.

D-dimer is an independent risk factor and lymphocyte counts a protective factor for PTB + EPTB, with D-dimer mediating 36.473% of the lymphocyte effect. Clinically actionable thresholds (D-dimer > 0.170 mg/L and lymphocytes < 750 cells/μL) provide concrete targets for early intervention to prevent TB dissemination and improve outcomes.

Social distancing and wearing a face mask are highly recommended to mitigate the transmission of coronavirus disease 2019 (COVID-19). However, the success of these strategies relies on individuals' adherence and public compliance. This study was conducted to assess the level of belief in social distancing and face mask practices in communities in low- and middle-income countries (LMICs) and to identify their possible determinants.

A cross-sectional study was conducted in ten LMICs countries in Asia, Africa, and South America from February to May 2021. A questionnaire was used to assess the belief, practice, and their plausible determinants. Identification of the associated determinants was performed using a logistic regression model.

Our data revealed that only 62.6% and 66.9% of the participants had good beliefs in social distancing and good face mask practices, respectively. Residing in the Americas, having a healthcare-related job, knowing people in immediate social environment who are or have been infected and exposure to information of COVID-19 cases on social media or TV were factors significantly associated with good belief in social distancing. Residing country, gender, monthly household income, type of job and exposure to information of COVID-19 cases were significantly associated with face mask wearing practice.

The proportion of participants having good beliefs in social distancing and good face mask practices is relatively low (<75%). Hence, sustained health campaigns regarding social distancing benefits and face mask-wearing practices during COVID-19 are critical in LMICs.

Liver transplant (LT) anesthesiology has evolved alongside rising LT volumes in the United States. The formation of dedicated LT anesthesia teams (LTATs), formalization of director of LT anesthesia (DLTA), and standardization of LT anesthesia programs (LTAPs) have advanced the field. However, the current post-COVID-19 state of these initiatives remains poorly characterized.

From May 1 to June 31, 2024, we conducted a national electronic survey of 101 DLTAs representing 151 active adult LT programs in the U.S., excluding pediatric programs and programs without identifiable DLTA contacts. The survey assessed LTAT structure, clinical practices, professional perceptions, and anticipated future challenges.

The response rate was 32.7% (33 of 101), predominantly from academic institutions (90.9%). Estimated number of LTATs averaged 6.6 members, with 38% fellowship-trained in transplant anesthesia, 27% in cardiothoracic anesthesia, and 23% in critical care. Overall 52% received institution-specific training. Forty two percent of LTAPs offered one-year LT anesthesiology fellowship. Most (82%) LTATs operated at 1:1 (including solo anesthesiologist in 15%) vs. 1:2 (7%) staffing ratios, involving residents (91% of cases), fellows (52%), and CRNAs (9%). Nearly all programs (94%) anticipated staffing changes, with 20 programs projecting 22 net hires. Approximately half of DLTAs (52%) considered their workforce adequate, while 36% reported a need for additional LT anesthesiologists. Overall, 76% of DLTAs were satisfied with their role, though increased workload (45%) and supply-demand mismatches (41%) were challenges.

Addressing workforce expansion and workload-related challenges may support LT anesthesia programs in meeting the demands of increasing national transplant volumes.

Sweat testing remains central to the diagnosis of cystic fibrosis (CF), with the sweat chloride test (SCT) serving as the gold standard since 1959. However, SCT has important limitations, including restricted availability in low- and middle-income countries (LMICs), difficulty obtaining adequate sweat samples in infants, and diagnostically ambiguous intermediate results.

This narrative review summarizes established and emerging sweat-based diagnostic approaches for CF, with a focus on their clinical utility, limitations, and relevance across different healthcare settings.

SCT remains the reference method for confirming CF, but sweat conductivity has emerged as a practical screening tool, particularly in LMICs, because of its simplicity, low sample requirement, and high sensitivity. Advanced CFTR functional assays, including nasal potential difference and intestinal current measurement, provide sensitive assessment of CFTR dysfunction but are technically demanding and largely restricted to specialized centers. The β-adrenergic sweat test offers a promising in vivo alternative for evaluating CFTR-mediated sweat secretion and may help distinguish CF, CFTR-related disorders, carriers, and unaffected individuals. Emerging technologies, such as wearable sweat sensors, microneedle-based sweat induction systems, and other noninvasive approaches, may further expand diagnostic possibilities.

Combining accessible screening tools with functional and emerging sweat-based methods may improve CF diagnosis, particularly in LMICs and diagnostically challenging cases.

The COVID-19 pandemic and the Russia-Ukraine war are seen as global crises, possibly affecting mental health worldwide. Longitudinal research seeking to understand these effects is still scarce. The current study aimed to examine mental health trajectories and links between stress, anxiety, depression, and positive mental health (PMH) over time from pre-pandemics to the ongoing war in Ukraine. The four-measurement points study was conducted on a sample of young adults from Lithuania and Germany (N = 432; 76.4% female; M_age (SD_age) = 22.98 (6.35) at T1). The latent change analysis was used to reveal the change trajectories, the latent class change analyses to indicate the patterns of change, and the cross-lagged panel analysis was used to examine how mental health indicators predict one another over time. On average, no changes were observed in mental health indicators over the study period. Nevertheless, latent class analysis revealed two distinct trajectories: 76.4% of participants belonged to the low-symptom group, where depression (d = -0.61), anxiety (d = -0.19), and stress (d = -0.26) decreased over time, while 23.6% belonged to the high-symptom group, where depression (d = 2.32), anxiety (d = 0.79), and stress increased (d = 1.09) substantially, and positive mental health (PMH) decreased (d = 0.82). Moreover, better PMH before the pandemic and during the 2nd COVID-19 outbreak predicted lower stress a year after; higher anxiety before the pandemic and during the release of COVID-19 restrictions predicted higher stress a year after. Crisis interventions should target anxiety and positive mental health to help young adults cope with stress in times of change, threat, and unpredictability.