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Screening for coronary artery disease (CAD) in liver transplant candidates is challenging and often inefficient, with many unnecessary invasive tests. The Coronary Artery Calcium (CAC) Score has been proposed as a risk marker for CAD, but its predictive value in this specific population is not well studied. This study aims to examine clinical differences in transplant candidates with elevated CAC-Scores (≥400) compared to those with lower scores and to propose new CAC-Score cut-offs tailored to different cirrhosis etiologies for identifying patients with significant CAD who may benefit from revascularization. Out of 239 patients undergoing evaluation at the POIT of San Camillo Forlanini Hospital, 151 underwent coronary CT to measure CAC-Score, excluding those with pre-existing stents or other exclusion criteria. Patients were divided into two groups (CAC-Score ≥400 and <400) to compare clinical variables. Patients with CAC-Scores ≥400 were older on average (60 vs. 59 years, p = 0.036) and had a higher prevalence of previous CAD (p = 0.02), while other traditional risk factors showed no significant differences. Analysis by cirrhosis etiology revealed that elevated CAC-Scores were more frequent in patients with alcohol-related cirrhosis (POTUS, p = 0.004), whereas no significant associations were observed in patients with viral cirrhosis or MASLD. Additionally, patients with CAC-Scores ≥400 had significantly more areas of fibrosis (LGE) on cardiac MRI compared to those with lower scores (p = 0.037). ROC curves were generated to define optimal cut-offs for each etiology. For MASLD, the optimal cut-off was 150 (AUC 0.79, p = 0.05); for viral hepatitis, 234 (AUC 0.877, p = 0.003); and for POTUS, 696 (AUC 0.733, p = 0.005). Tailored CAC-Score cut-offs based on cirrhosis etiology could improve diagnostic accuracy in liver transplant candidates, reducing unnecessary coronary angiographies and enabling a more targeted diagnostic approach. [ABSTRACT FROM AUTHOR]

Background: In regions with a high prevalence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, coinfected patients face a heightened risk of developing hepatocellular carcinoma (HCC), termed HBV/HCV-related HCC (HBCV-HCC). We aimed to investigate the contribution of preexisting chronic hepatitis B (CHB) and subsequent chronic hepatitis C (CHC) to the development of HBCV-HCC. Methods: We examined HBV's involvement in 93 HBCV-HCC cases by analyzing HBV DNA integration as an indicator of HCC originating from HBV-infected hepatocytes, compared with 164 HBV-HCCs and 56 HCV-HCCs as controls. Results: Next generation sequencing revealed that 55% of HBCV-HCCs exhibited clonal HBV integration, which falls between the rates observed in HBV-HCCs (88%) and HCV-HCCs (7%), with similar integration patterns to HBV-HCCs. Common HCC somatic mutation analysis indicated HCV superinfection in HBCV-HCCs correlated with increased mutation rates in the telomerase reverse transcriptase (TERT) promoter and beta-catenin genes. Transcriptome analysis showed a prevalence of replicating HCV over HBV in HBCV-HCCs, with preexisting HBV exerting a proliferative role. The comparison of clinical characteristics revealed similarities between HBCV-HCC and HCV-HCC patients, including later onset for HBCV-HCC, possibly due to HCV superinfection slowing carcinogenesis. Notably, HBCV-HCCs with the same driver mutation, HBV integration at the TERT promoter, tended to develop later and showed a better prognosis post-tumor resection than HBV-HCCs. Conclusions: Our findings shed light on the interplay between preexisting CHB and subsequent CHC in elevating the risk of HBCV-HCC. These insights are crucial for understanding viral etiology-specific carcinogenesis and guiding surveillance policies for HBCV-HCC post-antiviral therapy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the first-drug efficacy rate in newly diagnosed children with epilepsies treated with antiseizure medications. Methods: This retrospective study was conducted on 1003 children (age range: 3-10 years, and the mean duration of follow-up: 22 ± 13 months) with newly diagnosed epilepsy. The following parameters were evaluated: first-drug efficacy rate, first-drug-failure rate, and drug resistance rate in the cohort. Results: The first-drug-failure rate was defined in 335/1003 (33%) of the patients, no seizure control in 315 (31%), and drug withdrawal in 20 (2%). There was no significant difference between the group with focal-onset seizures and the group with generalized onset seizures. The first-drug efficacy rate was 67% in children with focal-onset seizures and 66% in children with generalized-onset seizures. Adjunctive antiseizure medication therapy was initiated in 335 patients—dual therapy with 180 patients (18%) and polytherapy with 155 (15%). Drug-resistant epilepsy was defined as 15% in the follow-up period. Etiology-specific diagnoses of the cohort were structural (n = 165, 17%), genetic (n = 25, 3%), metabolic (n = 15%), immune-infectious (n = 17 (2%), and unknown (n = 781, 77%). With a comparison of the 2 most common etiology subgroups (structural versus unknown), a first-drug efficacy rate of 53% and a higher prevalence of drug-resistant epilepsy at 30% were observed in children with structural etiology. First-drug efficacy was statistically lower in children without well-defined epilepsy syndromes (65%) compared with the rate of those with well-defined epilepsy syndrome (79%). Conclusion: This study revealed a first-drug failure rate (33%) in the presented cohort with a drug-resistance epilepsy rate (15%). [ABSTRACT FROM AUTHOR]

Chronic hepatobiliary damage progressively leads to fibrosis, which may evolve into cirrhosis and/or hepatocellular carcinoma. The fight against the increasing incidence of liver-related morbidity and mortality is challenged by a lack of clinically validated early-stage biomarkers and the limited availability of effective anti-fibrotic therapies. Current research is focused on uncovering the pathogenetic mechanisms that drive liver fibrosis. Drugs targeting molecular pathways involved in chronic hepatobiliary diseases, such as inflammation, hepatic stellate cell activation and proliferation, and extracellular matrix production, are being developed. Etiology-specific treatments, such as those for hepatitis B and C viruses, are already in clinical use, and efforts to develop new, targeted therapies for other chronic hepatobiliary diseases are ongoing. In this review, we highlight the major molecular changes occurring in patients affected by metabolic dysfunction-associated steatotic liver disease, viral hepatitis (Delta virus), and autoimmune chronic liver diseases (autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis). Further, we describe how this knowledge is linked to current molecular therapies as well as ongoing preclinical and clinical research on novel targeting strategies, including nucleic acid-, mesenchymal stromal/stem cell-, and extracellular vesicle-based options. Much clinical development is obviously still missing, but the plethora of promising potential treatment strategies in chronic hepatobiliary diseases holds promise for a future reversal of the current increase in morbidity and mortality in this group of patients. [ABSTRACT FROM AUTHOR]

Background: Non-infectious epiglottitis, an infrequent but significant condition, presents challenges in airway management and treatment due to its potential for rapid progression. Objective: To analyze differences in clinicodemographic characteristics, management strategies, and clinical outcomes between pediatric and adult cases of non-infectious epiglottitis. Methods: A systematic search of four databases identified 57 patient records, all diagnosed with non-infectious epiglottitis. Children (<18 years) were compared to adults (≥18 years). Differences in clinicodemographic characteristics, management strategies, and clinical outcomes were analyzed. Outcomes included intubation, complications, and intensive care unit (ICU) admission. Risk factors of these outcomes were identified through uni- and multi-variable logistic regression analyses. Results: Twenty-three children and 34 adults were analyzed. The presentation with stridor (56.52% vs. 14.7%), drooling (56.52% vs. 26.47%), cyanosis (17.39% vs. 0%), and sternal retraction (13.04% vs. 0%) was more common among children. Prior vaccination was evident in only 5 pediatric cases. The etiology of epiglottitis was similar across groups. Children had significantly higher chances of receiving epinephrine (34.78% vs. 8.82%), undergoing intubation (82.60% vs. 20.58%), being admitted to the ICU (56.52% vs. 17.64%), and having complications (47.82% vs. 14.70%), compared to adults. In the multivariate regression model, pediatric age was a risk factor for intubation (p = 0.015) and ICU admission (p = 0.040), while foreign body ingestion (p = 0.039) and dyspnea (p = 0.014) were predictors of intubation and complications, respectively. Conclusions: The study highlights the necessity for age-specific management strategies in non-infectious epiglottitis. Understanding the distinct clinical presentations and responses in different age groups can lead to improved patient care. [ABSTRACT FROM AUTHOR]

Objective: Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023. Methods: A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant. Results: Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11–0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13–0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09–0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05–0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03–0.08) in 2000–2004 to 36% (95% CI: 0.20–0.55) in 2021–2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01–0.24) to 17% (95% CI: 0.07–0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000–2004 and 2005–2008 periods to 20% (95% CI: 0.03–0.66) in 2009–2012 and 30% (95% CI: 0.11–0.60) in 2017–2020. Yersinia spp. was only determined in 2000–2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33–0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran. Conclusion: This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) remains a significant public health challenge globally. This study aims to systematically analyze the global HF disease burden from 1990 to 2021 across temporal, spatial, and demographic dimensions to provide evidence for targeted prevention and control strategies. Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the global HF burden through prevalent cases, years lived with disability (YLDs), and age-standardized rates per 100,000 population. Temporal trends were evaluated using estimated annual percentage change (EAPC) and joinpoint regression analysis. The relationship between the Socio-demographic Index (SDI) and disease burden was explored through Pearson correlation analysis, while attribution analysis identified the main causes of HF. When appropriate, analyses were stratified by 5 SDI regions, 21 GBD regions, 204 countries and territories, 20 age groups, and both sexes. Results: Global HF prevalence and YLDs burden showed substantial increases from 1990 to 2021, with age-standardized prevalence increasing from 641.14 to 676.68 per 100,000 population. Notably, high-SDI regions exhibited a declining burden since 2019, indicating a potential global turning point. High-income North America bears the heaviest burden while South Asia shows the fastest growth rate. The correlation between disease burden and SDI level was negligible. The disease burden in males consistently exceeded that in females, with prevalence and YLDs rates rising sharply after age 60. The main causes and their attributable proportions were: ischemic heart disease (34.53%), hypertensive heart disease (22.53%), other cardiomyopathies (7.61%), chronic obstructive pulmonary disease (6.51%), and congenital heart anomalies (5.69%), with their distribution patterns differing across age groups and regions. Conclusion: Global burden of HF increased significantly over recent decades, with a potential turning point in 2019 and marked regional disparities. It is essential to prioritize regions with heavy burdens or rapid growth rates, strengthen the management of major causes, and monitor HF burden trends in the post-COVID era. [ABSTRACT FROM AUTHOR]

Background: Intermediate phenotypes, such as characteristic neuroimaging patterns, offer unique insights into the genetic and stress-related underpinnings of neuropsychiatric disorders like depression. This study aimed to identify neuroimaging intermediate phenotypes associated with depression, bridging etiological factors to behavioral manifestations and connecting insights from animal models to diverse clinical populations. Methods: We analyzed datasets from both rodents and humans. The rodent studies included a genetic model (P11 knockout) and an environmental stress model (chronic unpredictable mild stress), while the human data comprised 748 participants from three cohorts. Using the amplitude of low-frequency fluctuations, we identified neuroimaging patterns in rodent models. We then applied a machine-learning approach to cluster neuroimaging subtypes of depression. To assess the genetic predispositions and stress-related changes associated with these subtypes, we analyzed genotype and metabolite data. Linear regression was employed to determine which neuroimaging features predicted core depression symptoms across species. Results: The genetic and environmental stress models exhibited distinct neuroimaging patterns in subcortical and sensorimotor regions. Consistent patterns emerged in two neuroimaging subtypes identified across three independent depressed cohorts. The subtype resembling P11 knockout demonstrated higher genetic susceptibility, with enriched expression of risk genes in brain tissues and abnormal metabolites linked to tryptophan metabolism. In contrast, the stress animal-like subtype did not show changes in genetic risk scores but exhibited enriched risk gene expression in somatic and endocrine tissues, along with mitochondrial dysfunction in the antioxidant stress system. Notably, these distinct subcortical-sensorimotor neuroimaging patterns predicted anhedonia, a core symptom of depression, in both rodent models and depressed subtypes. Conclusions: This cross-species validation suggests that these neuroimaging patterns may serve as robust intermediate phenotypes, linking etiology to anhedonia and facilitating the translation of findings from animal models to humans with depression and other psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: Pathogenic variants in ALDH7A1 are associated with pyridoxine-dependent epilepsy (PDE), a rare autosomal recessive disorder characterized by epileptic seizures, unresponsiveness to standard antiseizure medications (ASM), and a response only to pyridoxine. Here, we report two patients (from a consanguineous family) with neonatal seizures and developmental delay. Case presentation: Patient 1 (a 13-year-old girl) was born normally at term. Her pregnancy was complicated by antiphospholipid syndrome, and persistent vomiting was managed with several medications, including pyridoxine (40 mg daily). Seizures occurred 6 h after birth and did not respond to antiseizure medications. However, they ceased 2 days later when pyridoxine (40 mg daily) was administered. She continued her medications and had delayed early milestones. Phenobarbitone was discontinued at 18 months, and pyridoxine was increased to 100 mg daily at 8 years of age. She was able to join a regular school and performed well. Patient 2, a 12-year-old boy, was delivered normally at term. Seizures started 10 h after birth, and he immediately received 40 mg of pyridoxine. Seizures have been controlled since then, and he experienced delayed milestones. Pyridoxine was increased to 100 mg daily at 7 years of age. He is currently in fifth grade and has dyslexia. Whole exome sequencing (WES) revealed that both patients 1 and 2 harbor a novel homozygous missense variant in ALDH7A1 (NM_001202404: exon 12: c.1168G>C; (p.Gly390Arg)). Conclusion: The present study reports a novel ALDH7A1 variant causing PDE and highlights the associated developmental delay and intellectual disability, despite early seizure control treatment. [ABSTRACT FROM AUTHOR]

Background: Huntington's disease (HD) is a multifaceted neurological disorder characterized by the progressive deterioration of motor, cognitive, and psychiatric functions. Despite a limited understanding of its pathogenesis, research has implicated abnormal trinucleotide cytosine-adenine-guanine CAG repeat expansion in the huntingtin gene (HTT) as a critical factor. The development of innovative strategies is imperative for the early detection of predictive biomarkers, enabling timely intervention and mitigating irreversible cellular damage. Lipidomics, a comprehensive analytical approach, has emerged as an indispensable tool for systematically characterizing lipid profiles and elucidating their role in disease pathology. Method: A MedLine search was performed to identify studies that use lipidomics for the characterization of HD. Search terms included "Huntington disease"; "lipidomics"; "biomarker discovery"; "NMR"; and "Mass spectrometry". Results: This review highlights the significance of lipidomics in HD diagnosis and treatment, exploring changes in brain lipids and their functions. Recent breakthroughs in analytical techniques, particularly mass spectrometry and NMR spectroscopy, have revolutionized brain lipidomics research, enabling researchers to gain deeper insights into the complex lipidome of the brain. Conclusions: A comprehensive understanding of the broad spectrum of lipidomics alterations in HD is vital for precise diagnostic evaluation and effective disease management. The integration of lipidomics with artificial intelligence and interdisciplinary collaboration holds promise for addressing the clinical variability of HD. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review discusses the state of racial and ethnic inequities in heart failure with preserved ejection fraction (HFpEF) focusing on disease burden, risk factors, management, and outcomes. The review also highlights an implementation science-based framework for alleviating disparities and improving quality equitable care. Recent Findings: HFpEF is common, underdiagnosed, and characterized by uneven distribution of risk factors across racial and ethnic groups. Modest advances in HFpEF therapeutic agents have been made recently but access may be suboptimal in minoritized racial and ethnic groups. Phenocopies of HFpEF are also increasingly being recognized in Black populations. Summary: Despite recent advances in understanding the pathophysiological mechanisms, diagnosis, and treatment, HFpEF remains under-recognized in Black and Hispanic patients. Racial and ethnic inequities undergird disparities across the continuum of HFpEF care from access to specialized cardiovascular care to the utilization of guideline-directed therapies. Sodium-glucose cotransport 2 inhibitors are effective in HFpEF but are underutilized in minoritized racial and ethnic groups. There is a need for increased diagnostic certainty of phenocopies of HFpEF such as cardiac amyloidosis and hypertensive heart disease. Multi-pronged strategic interventions are critically needed to decrease racial and ethnic disparities across the HFpEF care continuum and foster improved outcomes for all patients. Key points: •Racial and ethnic disparities in heart failure including HFpEF are widely prevalent and influence adverse outcomes. • Underdiagnosis of HFpEF is a common diagnostic challenge often encountered clinically as "unexplained dyspnea". • Biological factors (such as low levels of brain natriuretic peptide in African Americans) and other operational factors such as the application of clinical risk scores derived from non-diverse cohorts may diminish ascertainment of HFpEF diagnosis in African American patients. • Phenocopies of HFpEF such as infiltrative cardiomyopathies, hypertensive heart disease, and/or HCM need to be considered in the diagnostic schema of unexplained dyspnea. • Guideline-directed pharmacologic therapy and cardiac rehabilitation are generally underutilized in racial and ethnic minority groups. • Implementation science-based approaches that incorporate social determinants of health are required to achieve health equity and optimize HFpEF care. [ABSTRACT FROM AUTHOR]

Acute liver failure (ALF) is a rare, life-threatening condition marked by the sudden loss of liver function in individuals without prior liver disease. It presents with hepatic encephalopathy, coagulopathy, jaundice, and often multiorgan failure. The most common causes in India include viral hepatitis, drug-induced liver injury (especially antitubercular drugs) contrary to western world where drugs induced ALF (especially acetaminophen) and metabolic disorders are common. Early diagnosis is vital, relying on clinical evaluation, laboratory tests, and imaging studies. Management is complex and multidisciplinary, focusing on stabilizing the patient, preventing complications, and treating the underlying cause. Intensive care is essential for monitoring and managing complications such as cerebral edema, renal dysfunction, and sepsis. Specific treatments include N-acetylcysteine for acetaminophen toxicity, antivirals for hepatitis, or plasmapheresis in autoimmune cases. Liver transplantation is the definitive treatment for those who do not recover spontaneously, guided by prognostic tools like the King's College Criteria. Despite advancements in care, ALF remains associated with high mortality, emphasizing the need for timely intervention and continued research into new therapies. [ABSTRACT FROM AUTHOR]

Survival outcomes of patients with heart failure (HF) based on their disease etiology are not well described. Here, we provide one-year mortality outcomes of 10850 patients with HF (mean age = 59.9 years, 31% women) in India. Ischemic heart disease (71.9%), dilated cardiomyopathy (17.3), rheumatic heart disease (5.4), non-rheumatic valvular heart disease (1.9), hypertrophic cardiomyopathy (0.8), congenital heart disease (0.7), peri-partum cardiomyopathy (0.5), restrictive cardiomyopathy (0.4), and infective endocarditis (0.1) were the main disease etiologies. Mortality rate per 100-person years of follow-up varied from 13.8 (95% CI: 6.2–30.7) in peri-partum cardiomyopathy to 92.9 (46.5–185.9) in infective endocarditis. Compared to ischemic heart disease, the mortality was two to five times higher in rheumatic heart disease (HR = 2.0; 95% CI: 1.6–2.4), congenital heart disease (2.9; 1.9–4.2), and infective endocarditis (4.8; 2.4–9.8). The wide variations in mortality rate in HF patients may bring possible clinical applicability of risk stratification. The NHFR is India's first nationally representative heart failure (HF) registry. Here the authors studied the survival outcomes of 10,850 HF patients and found wide variations in mortality rates based on HF etiologies. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to explore the prevalence, predictors and outcomes of infections in pediatric acute liver failure (PALF)., Methods: Data were retrieved from a prospectively maintained database of patients admitted with PALF between January 2012 and June 2024. "Sepsis" was defined as the presence of systemic inflammatory response syndrome with suspected or proven infection. Patients with positive bacterial and/or fungal cultures were labeled as "culture-positive sepsis." Outcome variables included native liver survival (NLS) and overall survival (OS) at day 28., Results: A total of 422 patients of PALF were included in the study of whom 195 (46.21%) fulfilled the criteria of sepsis and 71 (16.8%) had culture-positive sepsis. Bronchoalveolar fluid (37/81, 45.7%) was the commonest site of culture positivity followed by blood (29, 35.8%). More than 80% of cultures grew Gram-negative organisms with a high prevalence of carbapenem (77.1%) and multidrug (60%) resistance. These organisms were sensitive to colistin and newer beta-lactam combinations. Intensive care unit (ICU) stay, mechanical ventilation, grade 3-4 hepatic encephalopathy and use of extracorporeal liver support systems were associated with culture-positive sepsis. Patients with culture-negative sepsis had lower NLS and OS, whereas patients with culture-positive sepsis had outcomes comparable with patients without sepsis. However, culture-positive severe sepsis patients had significantly lowered NLS (33.3%) and OS (42.9%) at day 28., Conclusion: There is a high prevalence of carbapenem and multidrug-resistant sepsis in PALF. ICU stay and use of extracorporeal support are factors independently associated with sepsis. While culture-positive sepsis did not significantly affect survival, patients with severe sepsis had lower NLS and OS., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Antimicrobial resistance is an escalating public health threat in Africa, and an awareness of the devastating impact on children is growing. This review highlights the prevalence and patterns of antimicrobial resistance among children in Africa, focusing on pathogens responsible for bloodstream infections, community-acquired pneumonia, bacterial meningitis, neonatal infections, diarrhea and malaria. Current strategies to tackle antimicrobial resistance in pediatric populations are discussed., Recent Findings: Bloodstream infections significantly contribute to child mortality, with high resistance observed in pathogens like Salmonella spp., Klebsiella spp., Escherichia coli, and Staphylococcus aureus. Additionally, rising resistance in pathogens causing community-acquired pneumonia, meningitis and bacterial diarrhea challenges the effectiveness of WHO-recommended therapies. Antibiotics used to treat neonatal infections, such as ampicillin, gentamicin and cefotaxime, are threatened by high resistance in Escherichia coli and Klebsiella spp, contributing to adverse neonatal outcomes. PfKelch 13 mutations linked to artemisinin resistance in parts of Africa raise public health concerns, as malaria remains a major cause of illness and death., Summary: Stronger collaborative efforts are needed to enhance surveillance, improve diagnostic capabilities and update treatment protocols based on local pathogen sensitivities. More research is required on pediatric antimicrobial resistance in Africa., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: This article discusses a tailored approach to managing cardiogenic shock and temporary mechanical circulatory support (tMCS). We also outline specific mobilization strategies for patients with different tMCS devices and configurations, which can be enabled by this tailored approach to cardiogenic shock management., Recent Findings: Safe and effective mobilization of patients with cardiogenic shock receiving tMCS can be accomplished. Appropriate patient selection, tailored device management, and dynamic multidisciplinary approaches to mobilization are critical to success. Cardiogenic shock is a heterogeneous condition characterized by end-organ dysfunction due to hypoperfusion and low cardiac output. Temporary mechanical circulatory support (tMCS) is an increasingly valuable tool in managing these patients, with various devices and configurations available. Critically ill patients receiving tMCS are at risk for complications and deconditioning associated with prolonged bed rest, making it essential to implement strategies that promote mobility when feasible. We advocate for a tailored approach to the selection and management of tMCS in patients with cardiogenic shock. This approach focuses on the early identification of patients who may benefit from tMCS before further deterioration, alongside the selection of devices that provide ventricular-specific support and facilitate upper-body cannulation to enhance mobilization while also considering patients' potential exit strategies from tMCS. Understanding this approach is vital to appropriately facilitating safe and effective mobilization., Competing Interests: Compliance with Ethical Standards. Competing Interests: Dr. Wakefield has been a speaker and provided education for Abiomed. All other authors have no relevant disclosures. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In the United States, hepatitis C virus-associated hepatocellular carcinoma incidence and mortality are highest among minorities. Socioeconomic constraints play a major role in inequitable treatment. We evaluated the association between race/ethnicity and outcomes in a population that overcame treatment barriers., Methods: We report a retrospective cohort study of 666 patients across 20 institutions in the United States Hepatocellular Carcinoma Liver Transplantation Consortium from 2015 to 2019 with hepatitis C virus-associated hepatocellular carcinoma who completed direct-acting antiviral therapy and underwent liver transplantation. Patients were excluded if they had a prior liver transplantation, hepatocellular carcinoma recurrence, no prior liver-directed therapy, or if race/ethnicity data were unavailable. Patients were stratified by race/ethnicity. Primary outcomes were recurrence-free survival and overall survival, and secondary outcome was major postoperative complication., Results: Race/ethnicity was not associated with differences in 5-year recurrence-free survival (White 90%, Black 88%, Hispanic 92%, Other 87%; p = 0.85), overall survival (White 85%, Black 84%, Hispanic 84%, Other 93%; p = 0.70), or major postoperative complication., Conclusions: Race/ethnicity was not associated with worse oncologic or postoperative outcomes among those who completed direct-acting antiviral therapy and underwent liver transplantation, suggesting that overcoming socioeconomic constraints equalizes outcomes across racial/ethnic groups. Eliminating barriers that prohibit care access among minorities must be a priority., Competing Interests: Disclosures: M.B. Majella Doyle has served as an Intuitive proctor and OrganOx educator. Frances J. Bennett, Jessica M. Keilson, Michael K. Turgeon, Kailey M. Oppat, Emilie A.K. Warren, Shimul A. Shah, Vatche G. Agopian, Joseph F. Magliocca, Andrew Cameron, Susan L. Orloff, Chandrashekhar A. Kubal, Robert M. Cannon, Mohamed E. Akoad, Juliet Emamaullee, Federico Aucejo, Parsia A. Vagefi, Mindie H. Nguyen, Kiran Dhanireddy, Marwan M. Kazimi, Christopher J. Sonnenday, David P. Foley, Marwan Abdouljoud, Debra L. Sudan, Abhinav Humar, William C. Chapman, and Shishir K. Maithel have no relevant disclosures to declare., (© 2024. Society of Surgical Oncology.)

Purpose: Comparison of intracytoplasmic sperm injection cycles with testicular sperm extraction in obstructive azoospermia and non-obstructive azoospermia are limited, and few studies have addressed obstetric and neonatal outcomes., Design: This study analyzed couples who underwent testicular sperm extraction-intracytoplasmic sperm injection cycles for obstructive azoospermia and non-obstructive azoospermia to determine whether impaired spermatogenesis in non-obstructive azoospermia patients would lead to worse reproductive outcomes and higher rates of pregnancy complications and fetal anomalies. This study is a retrospective, single-center analysis of all testicular sperm cycles performed between January 1, 2001 and December 31, 2020., Results: A total of 392 couples were considered in the study, leading to 1066 induction cycles, 620 (58.2%) from patients with obstructive azoospermia and 446 (41.8%) from non-obstructive azoospermia. The cumulative delivery rate did not significantly differ between the two groups (34% vs. 31%; p = 0.326). The miscarriage rate was similar between obstructive azoospermia and non-obstructive azoospermia patients. Fertilization rate instead showed a statistically significant difference (obstructive azoospermia: 66.1 ± 25.7 vs. non-obstructive azoospermia: 56.1 ± 27.0; p < 0.001). The overall maternal complication rate in the non-obstructive azoospermia group was higher (10.7% vs. 18.4%; p = 0.035), but there was no statistical significance for each pathology. There was no statistical difference in gestational age between the two groups for both single and twin pregnancies. Seven cases of congenital defects occurred in the obstructive azoospermia group, while two cases occurred in the non-obstructive azoospermia group., Conclusions: Despite impaired spermatogenesis in non-obstructive azoospermia patients, there were no substantial differences in reproductive outcomes compared to patients with obstructive azoospermia, even in terms of obstetric safety and neonatal well-being., (© 2023 American Society of Andrology and European Academy of Andrology.)