Monica Rizzo

Background: Targeted perioperative prophylaxis (T-PAP) has been proposed to mitigate the impact of carbapenem-resistant Enterobacterales (CRE) infections in patients colonized with CRE who are undergoing liver transplantation (LT). This study aims to investigate the impact of T-PAP versus standard perioperative prophylaxis (S-PAP) in preventing CRE infections. Methods: Observational, multinational cohort study of adults with CRE colonization at LT. The endpoints were CRE infection within 15 and 30 days after LT. Exposure was T-PAP defined as the use of agents with in vitro activity against the colonizing strain. T-PAP was differentiated into T-PAP with old drugs (T-PAPold) and T-PAP with novel drugs (T-PAPnew) according to the regimens used. T-PAPnew included patients exposed to new betalactam/betalactamse inhibitors (BL/BLIs) or cefiderocol. Treatment-effect models with augmented inverse probability weighting were employed to assess the average treatment effect (ATE) of T-PAPold and T-PAPnew versus S-PAP on CRE infection. Results: A total of 408 CRE pre-transplant carriers were included. T-PAPold was administered to 112 patients (27.5%), and T-PAPnew was administered to 28 patients (6.9%). Post-transplant CRE infection at 15 and 30 days occurred in 87 (21.4%) and 106 (26.0%) patients, respectively. The ATE of T-PAPnew at 15 and 30 days post-transplant was −0.146 (P = .002) and −0.056 (P = .320), respectively. The ATE of TPAPold at 15 and 30 days post-transplant was 0.003 (P = .941) and −0.005 (P = .897) respectively. Conclusions: The protective effect of T-PAPnew in preventing CRE infections is significant within the first 15 days, but its effectiveness decreases within the first month.

Burn injuries among migrants crossing the Mediterranean increasingly represent a serious health issue, particularly in southern Europe. We retrospectively reviewed 91 migrant patients admitted to the Burn Center of ARNAS Civico Hospital in Palermo between 2015 and 2025: 65 (71.4%) had chemical burns from seawater–fuel mixtures, 25 (27.5%) had flame burns due to vessel explosions or torture, and 1 (1.1%) had a burn injury of other etiology. Mean age was 25 ± 9.84 years, and mean TBSA was 16.09% ± 11.06%. Chemical burns healed faster than flame burns (P = .0043). Split-thickness grafting was required in 40.0% of flame burns versus 3.07% of chemical burns (P = .000026). Inhalation pneumonia occurred in 20% of flame burns versus 3.07% of chemical burns (P = .0164), and sepsis developed in 28.0% of flame burns versus 0% of chemical burns (P = .000064). Among the 7 septic patients, mean burn surface area was 32.14% ± 16.54% TBSA, and 2 patients (28.57%) died. Predominant isolates included Acinetobacter baumannii and Klebsiella pneumoniae. These findings highlight the elevated risk of surgical, pulmonary, and infectious complications following flame burns in resource-limited maritime settings. Optimized burn care protocols, rapid microbiological diagnostics, and improved postrescue coordination are critical to reducing morbidity and mortality in this high-risk group.

Background: Brain disorders can occur in the context of peripheral organ diseases as well as solid organ transplants. The aim of this study was to explore the involvement of neurologists in the evaluation and management of solid organ transplant candidates and recipients when a nervous system impairment co‐exists.Methods: We invited all European Academy of Neurology members to answer a web‐based survey. Descriptive statistics were used to summarize the results.Results: In total, 176 respondents completed the survey; neurologists are more involved in the evaluation of neurological complications after (31.8%) than before an organ transplant (21%), when they see a small volume of patients, and mainly for neurological comorbidities. A minority (9%) of neurologists received a specific training on the topic of neurological manifestations of extracranial conditions as well as only 6.2% of them are involved in research activities in the brain–body interactions field.Conclusion: This survey highlights a mismatch between the impressive statistics on brain dysfunction in peripheral organ diseases as well as transplant and the small volume of solid organ transplant candidates/recipients seen by neurologists. According to recent recommendations every organ‐eligible candidates should undergo a cognitive screening, however, it is not common that neurologists are involved in the multidisciplinary committee to determine the transplant eligibility. Delirium is the most frequent reason for a neurological consultation after a transplant, but also other critical brain conditions. Educational programs in the field of neurology of systemic diseases are worth being implemented as well as including neurologists in research programs on brain–body interactions.

Metastatic colorectal cancer (mCRC) is a severe condition with high rates of illness and death. Current treatments are limited and not always effective because the cancer responds differently to drugs in different patients. This research aims to use artificial intelligence (AI) to improve treatment by predicting which therapies will work best for individual patients. By analyzing large sets of patient data and using machine learning, we hope to create a model that can identify which patients will respond to chemotherapy, either alone or combined with other targeted treatments. The study will involve dividing patients into training and validation sets to develop and test the models, avoiding overfitting. Various machine learning algorithms, like random survival forest and neural networks, will be integrated to develop a highly accurate and stable predictive model. The model’s performance will be evaluated using statistical measures such as sensitivity, specificity, and the area under the curve (AUC). The aim is to personalize treatments, improve patient outcomes, reduce healthcare costs, and make the treatment process more efficient. If successful, this research could significantly impact the medical community by providing a new tool for better managing and treating mCRC, leading to more personalized and effective cancer care. In addition, we examine the applicability of learning methods to biomarker discovery and therapy prediction by considering recent narrative publications.

Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, while bleeding complications continue to pose major challenges. To describe anticoagulation modalities and bleeding events in adults receiving VV ECMO. International prospective observational study in 41 centers, from December 2018 to February 2021. Anticoagulation was recorded daily in terms of type, dosage, and monitoring strategy. Bleeding events were reported according to site, severity, and impact on mortality. The study cohort included 652 patients, and 8471 days on ECMO were analyzed. Unfractionated heparin (UFH) was the initial anticoagulant in 77% of patients, and the most used anticoagulant during the ECMO course (6221 days, 73%). Activated partial thromboplastin time (aPTT) was the most common test for monitoring coagulation (86% of days): the median value was 52 seconds (39-61), but dropped by 5.3 seconds after the first bleeding event (95% CI -7.4 to -3.2, p< 0.01). Bleeding occurred on 1202 days (16.5 %). Overall, 342 patients (52.5 %) experienced at least one bleeding event (one episode every 215 hours on ECMO), of which 10 (1.6%) were fatal. In a multiple penalized Cox proportional hazard model, higher aPTT was a potentially modifiable risk factor for the first episode of bleeding (for 20 seconds increase, hazard ratio 1.07). Anticoagulation during VV ECMO was a dynamic process, with frequent stopping in cases of bleeding, and restart according to the clinical picture. Future studies might explore lower aPTT targets to reduce the risk of bleeding.

Background: The impact of the new “borderline” hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21–24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear. Objectives: The aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients. Method: Survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP <21 mm Hg or 21–24 mm Hg and PVR <3 WU), BLPH (mPAP 21–24 mm Hg and PVR ≥3 WU), mild-moderate PH (MPH; mPAP 25–35 mm Hg and cardiac index [CI] ≥2 L/min/m2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI <2 L/min/m2). Results: BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057–3.748, p < 0.001) and notably less in COPD patients (HR: 1.015, 95% CI: 1.003–1.027, p = 0.0146). Conclusions: In ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome.

Endoscopes are medical instruments that are used routinely in health structures. Due to their invasive nature and contact with many patients, they may cause hospital-acquired infections if not disinfected correctly. To ensure a high-level disinfection procedure or reprocessing, since the methods currently adopted in our institute are adequate, we evaluated retrospectively the presence of microorganisms in our endoscopes after reprocessing. Microbiological surveillance was performed from January 2016 to December 2019 in the instruments in use in our endoscopic room after reprocessing. In total, 35 endoscopes (3 duodenoscopes, 3 echoendoscopes, 12 bronchoscopes, 5 colonoscopes, and 12 gastroscopes) were evaluated for the presence of microorganisms, including multidrug-resistant pathogens and indicator microorganisms (IMOs). Our procedures were in agreement with an internal protocol based on Italian, international, and the Center for Disease Control and Prevention (CDC) recommendations. Of a total of 811 samples, 799 (98.5%) complied with the regulatory guidelines, while 9 (1.1%) were positive for IMOs, and 3 (0.4%) displayed more than 10 colony-forming units (CFU) of environmental and commensal pathogens. Our results show that the internal reprocessing protocol is very efficient, leading to a very low number of observed contaminations, and it could be easily implemented by other health facilities that face a huge number of hospital-acquired infections due to incorrectly disinfected endoscopes.

Case Report from JAMA Surgery — Image of the Month—Quiz Case