This paper explores the unique nature and evolution of Euroscepticism in Iceland, which originates not from contemporary identity politics but from a deeply embedded national ideology prioritising sovereignty and democratic control over natural resources. Historically, Iceland's relationship with Europe has been defined by a dual imperative: seeking economic prosperity through integration mechanisms like the European Economic Area, while fiercely protecting its hard-won political autonomy by resisting full European Union membership. The study examines the multiparty political landscape, demonstrating how mainstream factions have traditionally navigated this ambivalence. Special emphasis is placed on the rise of populist and quasi-populist actors, notably the Centre Party and the People's Party. The Centre Party deploys a hard, historically grounded Euroscepticism framing the EU as a threat to Icelandic self-determination, whereas the People's Party utilizes a more reactive, welfare-centric critique. However, the trajectory of Icelandic Euroscepticism is not static. The paper argues that recent geopolitical shocks - including the complexities of Brexit, the COVID-19 pandemic, the war in Ukraine, and shifts in U.S. foreign policy - have tempered nationalist resistance, prompting a pragmatic re-evaluation of external alignments. Consequently, a 2024 coalition government has committed to holding a referendum on resuming the EU accession process, signalling a potential paradigm shift in Iceland's European orientation. Ultimately, this case study illuminates the complex interplay between nationalism, populism, and strategic pragmatism within a small-state setting. Icelanders have long hesitated to fully join the European Union, preferring to protect their hard-won independence and retain control over natural resources, particularly fisheries. To balance these concerns, Iceland cooperates economically with Europe through the European Economic Area (EEA) agreement but avoids the political oversight of full EU membership. Populist factions, particularly the Centre Party and People’s Party, have capitalised on this national pride. They strongly oppose integration, warning that it would surrender Icelandic sovereignty to foreign elites and bureaucrats. However, recent global shocks - including Brexit, the COVID-19 pandemic, and the war in Ukraine - have shifted this perspective. Recognising the need for collective security in a volatile world, a government coalition formed in late 2024 has pledged to hold a referendum on resuming EU accession talks.
Subclinical mastitis (SCM) is characterized as inflammation of mammary gland with absence of clinical signs. S. aureus, one of the principal causes of disease is known for production of various virulence factors, including enterotoxins, biofilm production and antibiotic resistant genes. Therefore, the present study was carried out with the objective of molecular characterization for various virulence associated genes, antibiogram profile, and MLST typing of S. aureus from milk samples from various districts of Haryana state of India. In our study, milk samples from 1154 quarters affected with subclinical mastitis (by CMT) subjected to isolation of Staphylococcus spp. yielded 519 isolates. Of them, 352 isolates were identified as S. aureus by targeting 23 S rRNA gene by PCR. Various genes possessed by these isolates were: (13.35%) mecA (methicillin resistant gene), (11.64%) biofilm formation gene icaD, (11.36%) biofilm formation gene icaA, and (9.37%) toxic shocks syndrome gene (tsst). Enterotoxin genes detected were: sec in (8.52%), sea in (8.23%), sed in (4.54%), seb in (2.84%) and see in (1.7%). Exfoliative genes etb and eta were detected in (3.97%) and (3.12%) isolates, respectively. Antimicrobial sensitivity assay revealed sensitivity in descending order to gentamicin, doxycycline, sulfisoxazole, neomycin, ceftriaxone, cefoperazone, chloramphenicol, ciprofloxacin, enrofloxacin, vancomycin, clindamycin, linezolid, cefoxitin and least susceptible to oxytetracycline. The finding of 'Multilocus Sequence Typing' (MLST) showed high diversity of sequence types and clonal complex of S. aureus isolates.
Lemierre's syndrome is a life-threatening septic thrombophlebitis that typically follows an oropharyngeal infection and is most commonly caused by Fusobacterium necrophorum (F. necrophorum). We report a case of a previously healthy woman in her 20s who developed septic shock and acute kidney injury after a recurrent episode of acute pharyngotonsillitis. She was initially treated at a local clinic with a short course of oral third-generation cephalosporin for presumed group A streptococcal pharyngotonsillitis, resulting in temporary clinical improvement. However, she subsequently experienced a recurrence of fever and sore throat, necessitating emergency hospitalization. She was treated immediately with intensive intravenous ampicillin/sulbactam and vasopressor support. A contrast-enhanced CT several days later demonstrated septic pulmonary emboli, and blood cultures subsequently yielded F. necrophorum. Although internal jugular vein (IJV) thrombosis was not evident, a diagnosis of Lemierre's syndrome was established based on antecedent pharyngotonsillitis, F. necrophorum bacteremia, and metastatic septic emboli. This report suggests that short-course oral cephalosporin therapy for presumed group A streptococcal pharyngotonsillitis does not necessarily prevent the subsequent development of invasive F. necrophorum infection. It may also delay the recognition of Lemierre's syndrome.
Superficial thrombophlebitis (STP) is a vascular condition that can mimic deep-vein thrombosis (DVT) and cellulitis, necessitating careful evaluation to guide management. This case report describes the case of a 78-year-old female with a history of recurrent DVT who presented with lower extremity pain and erythema after discontinuing anticoagulation. Point-of-care ultrasound revealed a superficial venous thrombus with noncompressibility, confirming STP, while additional imaging identified chronic thrombi in the deep venous system.
Boerhaave syndrome (spontaneous esophageal rupture) remains a surgical emergency with high mortality, particularly when complicated by mediastinitis, pleural empyema, and septic shock. Concomitant intra-abdominal perforation significantly increases morbidity. We report a case of a 61-year-old male patient presenting with hemodynamic instability due to distal esophageal rupture and duodenal perforation. Imaging revealed bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, and extensive pleural effusions. The patient underwent emergent exploratory laparotomy with esophageal repair over T-tube placement, mediastinal lavage, primary duodenal repair, bilateral chest tube placement, decompressive gastrostomy, and feeding jejunostomy. The postoperative course was complicated by septic shock, bilateral pleural empyema requiring re-interventions including thoracotomy and pleurodesis, multidrug-resistant pulmonary infections, axillary vein thrombosis, Clostridioides difficile colitis, and prolonged mechanical ventilation. After comprehensive multidisciplinary management in the ICU, gradual respiratory and hemodynamic stabilization was achieved.
To characterise time intervals preceding antimicrobial administration in community-onset sepsis and identify rate-limiting steps. In this multicentre prospective observational study of patients with community-onset sepsis in South Korea (June 2020-December 2023), the antimicrobial workflow was defined by five time points: time zero, blood culture prescription and collection, and antimicrobial prescription and administration. Patients were categorised into three groups by step sequence, and four key intervals were analysed. Among 3,623 patients (mean age 74.3 ± 13.0 years; 56.6% male), 1,838 (50.7%) were assigned to Group A (antimicrobials and cultures prescribed before culture collection), 1,517 (41.9%) to Group B (cultures obtained before antimicrobial prescription), and 268 (7.4%) to Group C (antimicrobials given before culture collection). Median time from time zero to administration was shortest in Group C (63.5 min), then Group A (87.0 min) and Group B (115.0 min). The rate-limiting step differed by group: prescription-to-administration in Group A, time-zero-to-prescription in Group B, and culture prescription-to-collection in Group C. Septic shock was associated with shorter intervals overall, except prescription-to-administration, which was unchanged. Rate-limiting steps in antimicrobial delivery differ by clinical workflow. Early concurrent prescription of antimicrobials and blood cultures was associated with shorter time to antimicrobial administration.
As a common and devastating complication of sepsis, sepsis-induced acute kidney injury (SAKI) confers a significant risk of mortality. This work focused on the utility of miR-126-5p as a biomarker for SAKI. A total of 95 patients with SAKI and 70 patients with sepsis alone were enrolled. Serum levels of miR-126-5p and Caspase-3 (CASP3) were measured using RT-qPCR. The regulatory interaction between miR-126-5p and CASP3 was validated using a dual-luciferase reporter assay. Cell proliferation, apoptosis, inflammatory cytokine levels, and oxidative stress markers were evaluated using the CCK-8 assay, flow cytometry, ELISA, and corresponding commercial kits, respectively. Serum miR-126-5p levels were downregulated in SAKI patients and showed significant negative correlations with kidney injury markers, including serum creatinine (Scr), cystatin C (Cys-C), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1). Overexpression of miR-126-5p in lipopolysaccharide (LPS)-stimulated HK-2 cells was shown in vitro to facilitate cell proliferation, restrain apoptosis, and suppress the production of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Concurrently, it reduced oxidative stress markers, reactive oxygen species (ROS), and malondialdehyde (MDA), and enhanced superoxide dismutase (SOD) activity. Mechanistically, CASP3 was identified as a direct downstream target of miR-126-5p, and its expression was negatively regulated by miR-126-5p. Furthermore, overexpression of CASP3 significantly reversed the protective effects of miR-126-5p in vitro. MiR-126-5p showed diagnostic value for SAKI and exerted a protective effect in vitro through targeted regulation of CASP3 expression.
A solid pseudopapillary tumor (SPT) of the pancreas is a rare, low-grade epithelial-lined tumor that typically follows a benign course and is potentially curable with surgical excision. We describe a patient presenting to the emergency department with vague abdominal symptoms and moderate tenderness on deep palpation of the right hemiabdomen on exam ination. Computed tomography (CT) imaging showed evidence of an SPT in the tail of the pancreas. An SPT is a rare, low-grade tumor that typically has a benign prognosis and is potentially curable with surgical excision. SPT tumors can be found on CT imaging in the setting of trauma, and it should be in the differential in the setting of vague abdominal symptoms after abdominal trauma. We discuss the presentation, pathophysiology, prognosis, and management of SPTs based on a literature review.
Cardiogenic shock secondary to acute myocardial infarction (AMI) is often complicated by acute kidney injury (AKI). Although percutaneous ventricular assist devices (pVADs) are used to treat organ failure in cardiogenic shock, it is difficult to predict whether AKI is reversible or not and how long treatment should be continued to improve renal function. A 57-year-old woman with AMI complicated by cardiogenic and anaphylactic shock developed persistent anuria and required dialysis. Despite initial mechanical support, she remained dependent on advanced circulatory assistance. She received prolonged pVADs (Impella CP® and Impella 5.5®) for over 4 months. Remarkably, urine output resumed after 2 months of anuria, allowing discontinuation of dialysis. She underwent successful left ventricular assist device (LVAD) implantation on Day 138 and remained dialysis-free thereafter. Cardiogenic shock complicated with AKI limits options for durable mechanical circulatory support. While dialysis-dependent renal dysfunction is considered a contraindication for LVAD implantation in our country, our case illustrates that recovery of renal function may still be achievable even after prolonged anuria. By maintaining renal perfusion with extended pVAD support, dialysis withdrawal was ultimately successful, enabling LVAD implantation. This case highlights that prolonged circulatory support may be a feasible bridge to durable LVAD or heart transplantation.
Primary small cell carcinoma of the liver is an exceptionally rare malignancy and must be distinguished from metastatic pulmonary small cell carcinoma by excluding a pulmonary primary. We report a 55-year-old man with suspected alcohol-related cirrhosis and diabetes who presented for elective lithotripsy and was found to have jaundice, hepatomegaly, and acute liver dysfunction. Laboratory evaluation demonstrated marked hyperbilirubinemia and transaminitis with normal alpha-fetoprotein. Imaging revealed interval hepatomegaly with diffuse hepatic involvement compared to CT performed three months earlier, which had shown no focal lesions. Liver biopsy demonstrated small cell carcinoma with immunohistochemical positivity for CD56 and synaptophysin and negative TTF-1 staining. Chest radiograph showed no evidence of pulmonary malignancy, supporting a primary hepatic origin. The patient developed progressive liver failure, hypoxic respiratory failure, and shock and died seven days after admission. A review of 31 previously reported cases demonstrates a predominance in middle-aged males, frequent association with cirrhosis or diabetes, common presentation with abdominal pain and jaundice, and typically normal tumor markers. These findings were consistent with those observed in our patient. Reported survivors most often received combined surgical resection and platinum-based chemotherapy. This case highlights the rare yet aggressive course of primary small cell carcinoma of the liver and its potential to cause rapid liver failure.
Hemostatic agents (bleeding-stopping agents) are pharmacological or biological substances used to induce hemostasis in cases of trauma, surgical interventions, or spontaneous bleeding. These agents act at various steps of primary and secondary hemostasis, promoting clot formation, reducing blood loss, and improving patient outcomes. This narrative review examines the current status of hemostatic agents and highlights major developments and gaps in the field. A systematic literature search was used to identify relevant articles. Consecutive trials in English between 2005 and 2025 investigating the indications and use of hemostatic agents were abstracted with a search in Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE registries. Case reports, editorials, and expert opinions were excluded from the analysis. The use of tranexamic acid has recently been reintroduced, especially in trauma patients. It should be used in exsanguinating victims of trauma and resultant hemorrhagic shock. Prothrombin Complex Concentrates (PCC) have emerged as a favorable choice over Fresh Frozen Plasma (FFP) in bleeding due to vitamin K antagonists and other anticoagulants, and their use is increasing with studies. On the other hand, FFP is recommended when alternative treatment options are unavailable or in conjunction with first-choice agents, in narrowed indications due to possible complications. The evidence underscores that no single hemostatic agent is universally superior; optimal management requires individualized selection based on the mechanism of bleeding, underlying coagulopathy, and patient-specific factors. TXA has demonstrated consistent survival benefits in traumatic hemorrhage when administered early, yet its efficacy diminishes beyond the 3-hour window, emphasizing time-sensitivity in clinical decision-making. PCC offers practical advantages over FFP in anticoagulant reversal, including faster INR normalization, lower volume load, and no compatibility requirements, but its role in massive transfusion remains limited by the absence of factor V. FFP retains utility as an adjunct in complex coagulopathies and resource-limited settings. The integration of point-of-care viscoelastic testing (TEG/ROTEM) represents a significant advancement in guiding goal-directed hemostatic therapy and reducing unnecessary transfusions. Emerging agents and antidotes for DOAC reversal further expand the therapeutic landscape, though cost and availability remain barriers. Treatment with hemostatic agents can be lifesaving, especially after being adjusted for individual risks and benefits. Therefore, the selection of agents should be tailored on a case-by-case basis.
In the recent years, multiple myeloma (MM) has been associated with long-term survival. Life-threatening complications may occur in those patients leading to high risk of ICU admission. Within the same period, survival of critically ill patients with malignancy improved. The aim of this study was to evaluate severity and outcome in patients with MM admitted to ICU within the last 16 years. In this monocentric retrospective study, patients with MM admitted to ICU within two periods (2007-2015) and (2016-2023) around major therapeutic changes, were included. Patients from two periods were compared in terms of short and long terms outcomes. In the recent period, factors associated with mortality were assessed by multivariate analysis. During the first period (2007-2015), 199 patients were included and compared to 229 patients admitted within the second period (2016-2023). Median delay from MM diagnosis to ICU was 25.9 (2.2-70.6) months and 82 (19.2%) patients were newly diagnosed patients. MM classified as high risk concerned 119 (52%) or Stade III Salmon-Durie for 142 (71.4 %) patients. SOFA score on Day 1 was 5 (2-7). During ICU stay, 115 (26.9%) patients needed invasive mechanical ventilation, 105 (24.5%) patients received vasopressors and 97 (22.7%) had renal replacement therapy. Median length of ICU stay was 3 (2-6) days. Reason for ICU admission was different between the two periods: Shock was more frequent in the second period (29.7% vs 13.7%) whereas acute respiratory failure was more frequent in the first period (35.2% vs 46.7%) (p < 0.001). ICU and one-year mortality rates were respectively 12.1% (n = 50) and 40.6% (n = 170). Mortality rates, adjusted on age, comorbidities, more than 2 lines treatment, time between hospital and ICU admission >1 day, kidney amyloidosis, SOFA score at ICU admission and reason for ICU admission, were lower in the recent period compared to the first period (0.68 (0.49-0.95), p = 0.02). Survival in MM patients admitted to ICU improved in the recent years. Particularly, patients who were not previously heavily treated had better outcome and should be admitted to ICU.
The present study was conducted to assess the effects of lycopene (LP) supplementation on antioxidant status, lipid peroxidation, heat-shock proteins, and lipid profile in heat-stressed goat kids. Twenty-one healthy growing Barbari goat kids (4-8 months old) with an average body weight of 9.87 ± 1.09 kg were randomly allocated into three experimental groups, comprising seven animals per group. The activities of superoxide dismutase, catalase, glutathione peroxidase, and total antioxidant capacity increased linearly (P < 0.023) with increasing dietary LP levels. Conversely, concentrations of myeloperoxidase, reactive oxygen species modulator-1, and thiobarbituric acid reactive substances declined linearly (P < 0.001) as LP inclusion in the diet increased. Dietary LP supplementation significantly decreased (P < 0.05) heat shock protein 70, heat shock protein 90, and cortisol concentrations, with the lowest values observed at 100 mg LP/kg DM. Total cholesterol levels were not affected by LP supplementation. However, dietary LP reduced (P < 0.05) low-density lipoprotein cholesterol and triglyceride concentrations, with the most pronounced effect at 100 mg LP/kg DM. High-density lipoprotein cholesterol concentrations were significantly increased (P < 0.05) by LP supplementation, showing the greatest response at 100 mg LP/kg DM. Overall, supplementation of LP at 50 or 100 mg/kg DM improved antioxidant status and modulated the lipid profile by reducing oxidative stress markers, with the highest beneficial response observed at 100 mg LP/kg DM.
Hemorrhagic shock (HS) remains a leading cause of trauma-related mortality, primarily due to severe hypovolemia and systemic hypoperfusion. These pathophysiological changes may profoundly affect the pharmacokinetics of fentanyl, an opioid widely used for analgesia in trauma care. Previous studies, predominantly based on fixed-pressure shock models, may not adequately reflect clinically relevant hemodynamic conditions. Therefore, we employed a fixed-volume HS model as an alternative approach to reflect hypovolemia-associated perfusion deficits influencing fentanyl disposition. This study aimed to evaluate the pharmacokinetics of fentanyl and its primary metabolite, norfentanyl, in an experimental model of fixed-volume HS. Male Wistar rats were randomly divided into two groups: a control group (C; n = 6) and a fixed-volume hemorrhagic shock group (HS; n = 6). In the HS group, hemorrhage was induced by withdrawal of 30% of the estimated blood volume (EBV) following vascular cannulation. Fentanyl (10 µg/kg) was administered intravenously, and serial blood samples were collected over 60 min. The concentrations of plasma fentanyl and norfentanyl were determined by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). Pharmacokinetic parameters were calculated using Phoenix WinNonlin software. Non-compartmental analysis demonstrated significantly increased systemic exposure to fentanyl in the HS group, reflected by higher area under the concentration-time curve (AUC0-∞ and AUC0-t) values, accompanied by a marked reduction in systemic clearance (CL). Mean residence time (MRT) and terminal elimination half-life (t½λz) were significantly prolonged. Compartmental analysis confirmed a more than two-fold increase in fentanyl exposure, driven primarily by reduced clearance and prolonged elimination. In contrast, peak plasma concentrations (Cmax) showed only a borderline increase, and no statistically significant differences were detected in distribution-related parameters. These findings suggest that the major detectable pharmacokinetic changes associated with HS were primarily related to impaired fentanyl elimination. The metabolic conversion ratio (MCR), defined as the ratio of norfentanyl AUC0-t to fentanyl AUC0-t, was lower in the HS group (0.117) compared with controls (0.197). HS significantly alters fentanyl pharmacokinetics in rats by reducing clearance and increasing systemic exposure. The lower norfentanyl-to-fentanyl AUC0-t ratio suggests that HS may also affect metabolite formation or disposition.
We report a case demonstrating the evolution of diffusion lacunae (DL) into thrombus, supported by serial MRI and MR-pathologic correlation. A 36-year-old woman with a pregnancy achieved via frozen-thawed embryo transfer presented with complete placenta previa and vaginal bleeding. MRI at 27 weeks of gestation revealed an irregular intraplacental hypointense area on diffusion-weighted imaging corresponding to DL. Follow-up MRI at 32 weeks showed that the DL had become less discernible and appeared hyperintense, similar to the surrounding placenta. On the following day, the patient developed hemorrhagic shock and underwent emergency cesarean delivery, without evidence of placental adherence and decidual deficiency, indicating that the DL represented a placental lake rather than placental lacunae. Histopathologic examination demonstrated a paucity of chorionic villi and thrombus formation with lines of Zahn in the DL area. These findings provide direct evidence that DL may undergo thrombus formation over time, reflecting dynamic changes related to blood flow stasis within the placenta.
This study aimed to investigate the changes in HSP27 and HSP70 immunoexpression after hyperthermia in the lung and heart of rats on days 5, 10, 20, 25, and 30 of postnatal development. The body temperature of rat pups in the hyperthermia groups was increased to 40°C under the infrared lamp. The recovery time after hyperthermia was kept at 5 hours. HSP27 was present in cardiomyocytes and bronchiole and alveolar epithelial cells of control rats. Compared to the control groups after hyperthermia, HSP27 expression was only significantly different on day PND10 for cardiomyocyte cells (P < 0.05), but not on any day of postnatal development for bronchiole and alveolar epithelial cells (P > 0.05). In control group rats, HSP70 was almost absent in cardiomyocytes and alveolar epithelial cells but was evident in bronchiole epithelial cells. A significant increase in HSP70 expression after hyperthermia was observed throughout the postnatal days in cardiomyocytes and alveolar epithelial cells, but only on day PND20 in bronchiole epithelial cells (P < 0.05). In conclusion, during postnatal development, HSP27 is essential for the development of cardiomyocytes and bronchiole and alveolar epithelial cells, and HSP70 is essential for the development of bronchiole epithelial cells. On the other hand, HSP70 may participate in cytoprotective and repair mechanisms against hyperthermia-induced stress in cardiomyocytes and alveolar epithelial cells during postnatal development.
Faculty development is crucial to sustaining medical education excellence, yet structured, targeted approaches remain limited in emergency medicine. This study explores emergency physicians' perceptions of their educator roles and identifies faculty development needs in Singapore. A cross-sectional electronic survey was conducted from March to June 2024 across three emergency departments. Emergency physicians (associate consultant level and above) rated familiarity, confidence, and perceived importance of 12 educator roles based on the Association for Medical Education in Europe (AMEE) framework. Data were analyzed using IBM SPSS Statistics software. Sixty-two emergency physicians participated. Familiarity with AMEE educator roles was low (Mean = 2.24, standard deviation [SD] = 1.155), but confidence in clinical teaching roles was moderate to high (Mean = 3.90, SD = 0.670). Most of the respondents (71%) identified primarily as engaging educators. Confidence increased with years of experience, with a majority (54.8%) gaining confidence within 3-5 years. Lower confidence was reported in curriculum development, technology-enhanced learning, and academic leadership domains. Emergency physicians in Singapore are confident clinical educators but less familiar with broader educational roles. Faculty development initiatives should address gaps in curriculum planning, educational leadership, and technology integration. Recommendations such as structured pathways, longitudinal mentorship, and protected time for more educator responsibilities are critical to supporting professional growth and enhancing educational excellence.
Candidemia is a major cause of hospital-acquired bloodstream infections and is associated with high mortality. This study evaluated clinical characteristics, pathogen distribution, antifungal susceptibility, and factors associated with 28-day outcome in patients with candidemia. We retrospectively analyzed 169 patients with confirmed candidemia at Guangdong Provincial People's Hospital from January 2021 to December 2023. Patients were classified as survivors (n = 81) or non-survivors (n = 88) according to 28-day outcome. Species distribution, time to positivity (TTP), antifungal susceptibility, clinical features, and prognostic factors were compared. Variables significant in univariate analysis were entered into a multivariable logistic regression model. Most patients were admitted to the intensive care unit (70.41%), and the 28-day mortality rate was 52.07%. The main causative species were Candida albicans (38.46%), Candida parapsilosis (27.22%), Candida glabrata (15.98%), and Candida tropicalis (15.98%). TTP differed significantly among species; C. tropicalis showed the shortest median TTP (18.73 h), whereas C. parapsilosis and C. glabrata showed longer TTPs (38.34 h and 37.15 h, respectively; P < 0.0001). C. tropicalis showed high resistance rates to fluconazole and voriconazole, at 33.33% and 37.04%, respectively. Univariate analysis showed that age, coronary heart disease, respiratory disease, concomitant bacterial bloodstream infections, septic shock, APACHE II score, catheter insertion, mechanical ventilation, glucocorticoid use, antifungal treatment within 48 h, and antifungal therapy duration ≥14 days were associated with 28-day mortality. Multivariate logistic regression further demonstrated that only antifungal therapy lasting ≥14 days emerged as an independent risk factor for 28-day mortality. Candidemia entails severe infection and poor prognosis, with C. albicans predominating. Clinicians should maintain vigilant monitoring and interventions targeting identified risks while tracking evolving resistance patterns.
Of the extradiaphragmatic muscles, the parasternal intercostal muscles are major muscles that aid in breathing when the diaphragmatic muscles are fatigued. This study was conducted to determine the activity of the parasternal intercostal muscle activity during weaning and its association with weaning-induced pulmonary edema (WIPO). The objectives were to determine the parasternal muscle thickening fraction (PTF%) in patients undergoing spontaneous breathing trials (SBTs), its association with WIPO, and to assess the risk factors associated with increased PTF%. A prospective observational study was conducted on critically ill patients admitted to a tertiary care hospital and ready to undergo weaning from mechanical ventilation (MV). The ultrasound examination for evaluation of WIPO was done along with echocardiography before and after 30 min of SBT, and the parasternal and diaphragmatic muscle evaluation was performed after 30 min of SBT. The primary outcome was weaning failure, and secondary outcomes were the presence of WIPO. One hundred and thirty patients underwent a weaning trial, and 90 (69%) patients had weaning success, and 40 (31%) patients had failure. (PTF%) >10% had good discriminating capacity to predict weaning failure (area under the curve = 0.798, 95% confidence interval [CI] [0.715-0.881], P < 0.001, sensitivity 60%, and specificity 84%). PTF% ≥10%, diaphragm thickening fraction (DTF%) <21%, and diastolic dysfunction were independent predictors of WIPO (P < 0.001). The risk factors associated with increased PTF% >10% are MV days ≥5 days before SBT and DTF% <27%. The PTF% is simple and accessible during ultrasound examination and has good predictive capacity to determine weaning failure and presence of WIPO in patients receiving MV.