Introduction: Urinary tract infections (UTIs) caused by carbapenem-resistant pathogens are increasingly common and pose serious treatment challenges due to limited antibiotic options and high complication rates. Identifying patients at risk is essential for guiding empirical therapy and improving outcomes. The primary objective of this study was to identify risk factors associated with carbapenem-resistant (CR) UTIs by comparing them with carbapenem-susceptible (CS) UTIs. Secondary objectives included analyzing the types of microorganisms involved in both groups, their antibiotic susceptibility profiles, and the presence of carbapenemase enzymes among CR UTI cases. Method: We conducted a retrospective case-control study involving 127 hospitalized patients with UTIs caused by CR microorganisms and 91 patients with UTIs caused by multidrug-resistant (MDR) strains that retain susceptibility to carbapenems, admitted between 1 October 2023, and 31 March 2025. Results: In univariate analysis, CR UTI patients had significantly higher rates of neoplasia, neurological disorders, urosepsis at admission, septic shock, the presence of urinary catheters at diagnosis, permanent nephrostomy catheters, hospitalizations within the past 180 days, previous antibiotic exposure including carbapenems, and recent urological procedures. Multivariate analysis revealed four independent risk factors for CR UTIs: neoplasia (OR = 2.152; 95% CI: 1.044–4.436; p = 0.038), neurological disorders (OR = 7.427; 95% CI: 2.804–19.674; p < 0.0001), antibiotic use in the previous 180 days (OR = 2.792; 95% CI: 1.487–5.396; p = 0.001), and prior carbapenem treatment OR = 10.313; 95% CI: 1.277–83.248; p = 0.029). Most of the isolated organisms belonged to the Enterobacterales genus, with Klebsiella spp. and Pseudomonas aeruginosa being the most common pathogens in CR UTIs, accounting for over 90% of cases. Among patients tested for carbapenemase production, all but one tested positive for at least one carbapenemase. Conclusions: Neoplasia, neurological disorders, recent antibiotic therapy, and prior carbapenem use were significantly associated with increased risk of developing CR UTIs. Klebsiella spp. and Pseudomonas aeruginosa were the predominant causative organisms, with New Delhi metallo-β-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) being the most frequently identified resistance mechanisms.

1) Background- Coronary artery bypass grafting (CABG) is a common surgical intervention for patients with severe coronary artery disease. The Model for End-Stage Liver Disease (MELD) score has been widely used to predict mortality risk in patients with end-stage liver disease, but its utility in predicting postoperative outcomes in cardiac surgery patients is less well-established. 2) Methods-This retrospective study aims to investigate the association between preoperative MELD score and post-operative complications, length of hospital stay, and mortality in patients under-going coronary artery bypass grafting. This is a single-center, retrospective cohort study conducted at a tertiary care academic medical center. The study includes all adult patients who underwent elective coronary artery bypass grafting between January 2011 and December 2020. Preoperative MELD scores were calculated for each patient, and postoperative outcomes including major ad-verse cardiac events, length of hospital stay, and 30-day mortality was assessed. To ensure a homogeneous study cohort, we excluded patients who underwent emergent cardiac procedures or had incomplete data necessary for the calculation of MELD scores and assessment of postoperative outcomes. Data was extracted from the electronic medical records, including patient de-mographics, comorbidities, preoperative laboratory values, operative details, and postoperative outcomes. The study protocol was approved by the Institutional Review Board, and the require-ment for informed consent was waived due to the retrospective nature of the study.3) Results- This study reveals a statistical association between the MELD score calculated at admission and the length of hospital stay, duration in the ICU, patient age, and the duration of aortic clamping and extracorporeal circulation. Specifically, there is an exponential increase in the MELD score corre-lating with the rise in these factors, both collectively and individually, highlighting a significant relationship between the duration of extracorporeal circulation and aortic clamping time. 4) Conclusion-Patients with a high MELD score had an increased risk of postoperative complications and mortality compared to those with a low MELD score. Careful preoperative patient selection and optimization of the patient's clinical condition may improve outcomes in patients with advanced liver disease undergoing cardiac surgery.

Background: Zenker’s diverticulum arises from the posterior hypopharyngeal wall through Killian’s dehiscence and predominantly affects older adults. Surgical and endoscopic treatments may be complicated by adverse events, including recurrent laryngeal nerve injury, cervical emphysema, mediastinitis, and pharyngoesophageal fistula formation. Methods: We report the case of a 69-year-old male who underwent open surgical treatment for Zenker’s diverticulum and subsequently developed an upper esophageal fistula complicated by a retroesophageal abscess. Results: The patient was treated using an externally adapted endoluminal vacuum-assisted closure system (EndoVAC), which enabled continuous drainage, local lavage, and progressive closure of the esophageal defect. Conclusions: Endo-VAC therapy represents a safe and minimally invasive therapeutic option for the management of postoperative esophageal fistulas following Zenker’s diverticulum surgery and may reduce the need for extensive esophageal reconstruction.

Background: Upper esophageal perforations are life-threatening conditions associated with a high risk of mediastinitis, sepsis, and multiorgan failure. Standard management often requires extensive surgical intervention, which carries substantial morbidity. Methods: We report the case of a 56-year-old male with an iatrogenic cervical esophageal perforation complicated by cervicomediastinal abscess formation. Due to anatomical constraints preventing standard endoluminal approaches, a hybrid organ-preserving strategy was employed, consisting of surgical drainage combined with an externally adapted vacuum-assisted closure (VAC) system applied adjacent to the esophageal defect. Results: The patient demonstrated progressive clinical improvement without the need for esophageal diversion or major reconstructive surgery. Inflammatory markers were monitored serially and showed a downward trend, serving as adjunctive indicators of treatment response. The esophageal defect healed successfully, was confirmed radiologically, and no treatment-related complications were observed. Conclusions: This case suggests that externally adapted VAC therapy may represent a potential organ-preserving option in selected patients with complex cervical esophageal perforations when conventional techniques are not feasible. Further studies are required to validate this approach.

Background/Objectives: Chronic mesh-associated inflammatory remodeling may complicate abdominal wall repair through persistent foreign body response, fibrosis, and extracellular matrix disorganization. This exploratory study compared pathological and well-integrated mesh–tissue interfaces using histology and atomic force microscopy (AFM). Methods: Fourteen mesh–tissue complexes were analyzed: seven pathological explants and seven well-integrated reference specimens. Hematoxylin–eosin and Van Gieson staining assessed inflammation, foreign body reaction, fibrosis, and collagen organization. Contact-mode AFM evaluated surface topography, fibrillar-like organization, directionality, and ISO 25178-2 areal surface parameters. Values from 64 scans per specimen were averaged to obtain one specimen-level value, and groups were compared using the two-sided Mann–Whitney U test. Results: Pathological explants showed greater fibro-inflammatory heterogeneity, reduced collagen continuity, increased surface heterogeneity, discontinuous fibrillar-like features, and reduced structural organization. Sa, Sq, Sku, Sp, Sv, and Sz were higher, whereas Ssk was lower, in the pathological group (U = 0; exact two-sided p = 0.000583 for all parameters). Representative directional analysis suggested broader orientation distribution and reduced preferential alignment. Conclusions: Histology and AFM provided complementary morphological information on mesh–tissue remodeling. Larger standardized studies are required before AFM-derived parameters can be assigned diagnostic or prognostic significance.

Background/Objectives: Diclofenac (DCF) and other nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation management; however, their clinical significance is limited by poor aqueous solubility, short biological half-life, and dose-dependent gastrointestinal, renal, and cardiovascular adverse effects. Nanocarrier-based delivery systems have been extensively explored because they can enhance the apparent solubility of poorly water-soluble NSAIDs, provide controlled and sustained drug release, prolong systemic circulation, and improve drug localization at the site of action. By reducing peak plasma concentrations and off-target exposure, these systems may decrease dose-dependent gastrointestinal and systemic adverse effects while maintaining therapeutic efficacy. Most studies focus on optimizing formulation composition, while the manufacturing process is often treated as a secondary parameter. The research critically evaluates conventional and emerging fabrication methods for NSAID nanocarriers, using DCF as the principal reference compound, with emphasis on their impact on physicochemical characteristics, reproducibility, scalability, and translational potential. Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science (2015–2026, with emphasis on 2022–2026) for DCF and NSAID-loaded submicron delivery systems reporting quantitative formulation data and clearly defined fabrication methods, resulting in a narrative review of approximately 375–395 eligible studies, comprising 75 DCF-specific studies and approximately 300–320 studies involving other NSAIDs that were included as representative surrogate systems when DCF-specific evidence was unavailable for particular fabrication approaches. The review followed Scale for the Assessment of Narrative Review Articles (SANRA) recommendations. Studies were analyzed using a standardized seven-parameter framework including encapsulation efficiency, release profile, particle size control, polydispersity, scalability, reproducibility, and process complexity. Results: Batch-based techniques, such as thin-film hydration for chitosan-coated liposomal systems, consistently provide high encapsulation efficiency, sustained drug release, and good biocompatibility. However, these methods are often associated with batch-to-batch variability, operator dependence, and limited scalability. In contrast, continuous manufacturing approaches, including microfluidic mixing, nanostructured lipid carriers, and Quality-by-Design (QbD)–guided processes, demonstrate improved control over particle size distribution and polydispersity, enhanced reproducibility, and better scalability potential. Conclusions: Manufacturing methodology is an important determinant of DCF and NSAID nanocarrier performance alongside formulation composition. Continuous manufacturing approaches offer promising improvements in reproducibility, process control, and scalability, but current evidence remains uneven across different nanocarrier classes. Further standardized comparative studies are needed to support their broader translation into clinical applications.