Nutrition in the critically ill in resource-limited settings/low- and middle-income countries.

Purpose Of Review: To share current concepts and provide an overview of the contextual issues and nutrition practices in critically ill patients in resource-limited settings (RLSs)/low- and middle-income countries (LMICs). Most of the world's population reside in these settings which also carries the greatest burden of critical illness.

Recent Findings: There is a paucity of evidence on nutrition practice in critically ill patients in RLSs and international guidelines are largely based on evidence derived from high-income countries (HICs).

Prediction of inpatient mortality in hospitalised children in low- and middle-income countries: An external validation of paediatric mortality risk scores.

Background: Risk prediction tools for acutely ill children have been developed in high- and low-income settings, but few are validated or incorporated into clinical guidelines. We aimed to assess the performance of existing paediatric early warning scores for use in low- and middle-income countries using clinical data from a recent large multi-country study in Africa and South-Asia.

Methods: We used data (children across three nutritional strata) from the Childhood Acute Illness and Nutrition (CHAIN) Network cohort study (n = 3101).

Impact of Imaging and Pharmacological Treatment Strategies in Refractory Ventricular Tachycardia in Critically Ill Patients: A Systematic Review.

Ventricular tachycardia (VT) is a life-threatening arrhythmia often leading to sudden cardiac death, particularly in critically ill patients. Refractory VT, characterized by recurrent episodes requiring intervention, poses unique challenges for management, necessitating advanced diagnostic and therapeutic strategies. This systematic review evaluates the impact of imaging and pharmacological treatments in managing refractory VT in critically ill patients.

Rates and Predictors of Malignancy in Bethesda III and IV Thyroid Nodules: A Prospective Study.

Aim: Thyroid nodules, based on high-resolution ultrasonography (HRUS), are among the most common endocrine abnormalities that affect the general population because of their high estimated prevalence rates. Fine needle aspiration cytology (FNAC) is a safe, cost-effective modality to differentiate between benign and malignant thyroid nodules based on the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), thus avoiding unnecessary surgery. However, categories III and IV of BSRTC remain a controversial issue in clinical practice, encompassing a wide range of risks of malignancy.

Kinetic estimated glomerular filtration rate and drug dosing in critically ill patients with acute kidney injury-A prospective observational study.

Objective: To study the impact of kinetic glomerular filtration rate (kGFR) on clinical decision making and its implications on drug dosing compared to that of estimated GFR (eGFR) using chronic kidney disease epidemiology collaboration (CKD-EPI) equation in critically ill patients with acute kidney injury (AKI) admitted in a tertiary level intensive care unit (ICU).

Methods: Cross-sectional, prospective, observational study design. All patients admitted to Medical ICU, Fortis Hospital, Bangalore with AKI defined as per AKI network (AKIN) criteria.

Weighting methods for truncation by death in cluster-randomized trials.

Patient-centered outcomes, such as quality of life and length of hospital stay, are the focus in a wide array of clinical studies. However, participants in randomized trials for elderly or critically and severely ill patient populations may have truncated or undefined non-mortality outcomes if they do not survive through the measurement time point. To address truncation by death, the survivor average causal effect has been proposed as a causally interpretable subgroup treatment effect defined under the principal stratification framework.

Perinatal psychiatric emergencies in rural Australia: In urgent need of attention.

Objectives: The burden of perinatal mental illness is a significant global concern, affecting approximately 10-20% of women at this stage of life. It is well recognised that Rural Australia has far less health services and mental health specialists per capita than metropolitan regions. While women have more babies in rural settings, their access to maternal health care is conversely limited or absent.

Indigenous people display lower mental illness stigma in Aotearoa.

Background: Mental illness stigma continues to be pervasive and problematic in society. Researchers have attempted to better understand this stigma through investigations into demographic factors that may predict stigma, focusing on factors such as age, ethnicity and education.

Method: We investigated demographic factors in the context of Aotearoa New Zealand, with a particular focus on Māori, the Indigenous people of Aotearoa.

A starch-polyvinyl alcohol polymer film-based on-site sensor for ammonia: a cost effective day-to-day technique for monitoring fish and meat spoilage.

Ammonia or biogenic amines released by protein degradation during food spoilage have various ill effects on human health and the environment. Herein, an economical colorimetric bisphenol-based sensor was developed from inexpensive reagents and a simple synthetic method for detecting ammonia and monitoring food spoilage. The slightest addition of NH significantly changed the absorption of BP, which was reflected in the detection limit value for NH (7.

Senotherapy: Implications for Transplantation.

Cellular senescence has been identified as a potential driver of age-associated loss of organ function and as a mediator of age-related disease. Novel strategies in targeting senescent cells have shown promise in several organ systems to counteract functional decline, chronic inflammation, and age-dependent loss of repair capacity. Transgenic models have provided proof of principle that senolysis, the elimination of senescent cells, is an attractive strategy to overcome many age-related pathologies.

Invasive aspergillosis in critically ill patients with diabetes mellitus: a systematic review and meta-analysis.

Background: In the intensive care unit (ICU), invasive aspergillosis (IA) has a poor prognosis. Some studies report a positive association between diabetes mellitus (DM) and IA in critically ill patients, but the relationship between DM and IA in the ICU remains controversial. We aimed to clarify the relationship between DM and IA among patients in the ICU in a systematic review and meta-analysis.

COVID-19 and influenza vaccine Hesitancy among adults hospitalized in the United States, 2019-2022.

Background: Understanding similarities and differences between hesitancy for influenza and COVID-19 vaccines could facilitate strategies to improve public receptivity toward vaccination.

Methods: We compared hesitancy for COVID-19 vaccines during the first 13 months of availability (January 2021-January 2022) with hesitancy for influenza vaccines in the 15 months prior to COVID-19 vaccine availability (October 2019-December 2020) among adults hospitalized with acute respiratory illness at 21 hospitals in the United States. We interviewed patients regarding vaccination status, willingness to be vaccinated, and perceptions of vaccine safety and efficacy.

Association Between Daily Insulin Dose Adjustments and Glycemic Control in Non-Critically Ill Hospitalized Hyperglycemic Patients: A Retrospective Cohort Study.

Objective: To evaluate the efficacy of daily insulin dose increases in managing inpatient hyperglycemia.

Methods: Retrospective study of patients discharged from two urban academic medical centers and three large suburban community hospitals between 2015 and 2019 who received ≥10 units of basal insulin on any day. On hyperglycemic days (mean glucose ≥180 mg/dL), we categorized the relative insulin dose increases into four categories based on percentage changes from the previous day.

Radiation exposure in neurosurgical intensive care unit patients: Balancing diagnostic benefits and long-term risks.

Background: X-ray, computed tomography (CT), and digital subtraction angiography (DSA) techniques are indispensable in managing critically ill neurosurgical patients. However, repeated diagnostic imaging leads to cumulative radiation exposure, raising concerns about long-term risks such as malignancies. This study evaluates the frequency, dosage, and implications of radiation exposure in a neurosurgical intensive care unit (NICU) patient cohort.

Trauma-informed HIV prevention for forcibly displaced adolescents and young adults.

The number of people forcibly displaced due to conflict is rising rapidly each year. Previous studies have documented associations between mental ill health, HIV risk, and poor engagement with HIV care in conflict-affected populations. Most people forced to migrate are adolescents and young adults, who might already be affected by a high burden of mental ill health due to factors such as high trauma exposure during the developmental period.

Rhythmic EEG patterns: The oldest idea in the EEG world, but without an obvious definition.

The word "rhythmic" was quickly introduced in the vocabulary of the electroencephalographers with the discovery of the alpha rhythm and typical discharges of spike-and-waves at 3 Hz in childhood absence epilepsy, but without any definition until recently. In its last revision (2017), the International Federation of Clinical Neurophysiology proposed a specific definition. The word "rhythmic" is "applied to regular waves occurring at a constant period and of relatively uniform morphology.

Sick of debt: How over-indebtedness is hampering health in rural Cambodia.

This paper evidences how many rural poor Cambodians are sick of debt. Based on original, mixed-method data (2020-2022), exploring credit provisioning in this context, the aim of this paper is to illuminate some of the conditions leading to rural Cambodians taking on debt to bolster their health, and the effects this is having on borrowers' physical, psychological, emotional and social health. Specifically, we show how the health of our participants is constrained by a range of major illnesses that many suffer from and their poor food conditions, both exacerbated by the effects of climate change.

Ultra-Low-Field Portable Brain Magnetic Resonance Imaging in Patients With Cardiac Devices: Current Evidence and Future Directions.

The use of cardiac devices, including mechanical circulatory support (MCS), cardiac implantable electronic devices (CIEDs), and pacing wires, has increased and significantly improved survival in patients with severe cardiac failure. However, these devices are frequently associated with acute brain injuries (ABIs) including ischemic strokes, intracranial hemorrhages, seizures, and hypoxic-ischemic brain injury which contribute substantially to morbidity and mortality. Computed tomography (CT) and magnetic resonance imaging (MRI), the standard imaging modalities for ABI diagnosis, can pose significant challenges in this patient population due to the risks associated with patient transportation and the incompatibility of ferromagnetic components of certain cardiac devices with high magnetic field of the MRI.

Net buffer load during regional citrate anticoagulated continuous renal replacement therapy.

Background: Regionally anticoagulated continuous renal replacement therapy with citrate is the first choice for critically ill patients with acute kidney injury. If citrate that reaches the patient exceeds the metabolic capacity, metabolic alkalosis will follow. Bicarbonate from the treatment fluids will also reach the patient and add to the bicarbonate load.

Cardiac MRI in Heart Transplantation: Approaches and Clinical Insights.

Orthotopic heart transplant (OHT) is a well-established therapy for end-stage heart failure that leads to improved long-term survival rates, with careful allograft surveillance essential for optimizing clinical outcomes after OHT. Unfortunately, complications can arise after OHT that can compromise the success of the OHT. Cardiac MRI is continually evolving, with a range of advanced techniques that can be applied to evaluate allograft structure and function.

Transgression of planetary boundaries and the effects on child health through an infectious diseases lens.

Purpose Of Review: Life on earth, as we know it, is changing. The likelihood of more frequent pandemics and disease outbreaks is something that current global healthcare infrastructure is ill equipped to navigate. Human activity is forcing our planet into a new geologic epoch, the Anthropocene, which is typified by increased uncertainty resulting from human disruption of earth's life-giving ecosystems.

Reporting completeness and methodological quality of guidelines for nutritional care of critically ill patients: A meta-research utilizing Reporting Items for practice Guidelines in HealTh Care (RIGHT) and Appraisal of Guidelines for Research & Evaluation (AGREE II).

Studies have demonstrated that the quality and transparency of reporting Clinical Practice Guidelines (CPGs) in healthcare are low. This meta-research aimed to evaluate the adherence of nutrition CPGs for critically ill adults to the reporting RIGHT checklist and its association with the methodological quality assessed by AGREE II, along with other potential publication-related factors. A systematic search for CPGs until December 2024 was conducted.

Peer-to-peer tele-consultative services for critical care, Afghanistan, Kenya, Pakistan, United Republic of Tanzania.

Objective: To develop a tele-intensive care service providing peer-to-peer teleconsultation for physicians in remote and resource-constrained health-care settings for treatment of critically ill patients, and to evaluate the outcomes of the service.

Methods: The Aga Khan University started the coronavirus disease 2019 (COVID-19) tele-intensive care unit in 2020. A central command centre used two-way audiovisual technology to connect experienced intensive care specialists to clinical teams in remote hospital settings.